University of California Berkeley 
 
THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 OF CALIFORNIA 
 
 PRESENTED BY 
 
 PROF. CHARLES A. KOFOID AND 
 MRS. PRUDENCE W. KOFOID 
 
 W' %$& 
 
 1797 Ko^okf 
 
 JW36921 5 
 
A 
 
 TREATISE 
 
 ON THE 
 
 STRUCTURE, ECONOMY, 
 
 AND 
 
 DISEASES 
 
 OF THE 
 
 LIVER; 
 
 TOGETHER WITH 
 
 AN INQUIRY INTO THE PROPERTIES 
 
 COMPONENT PARTS 
 
 OF THE 
 
 BILE AND BILIARY CONCRETIONS. 
 
 B y 
 WILLIAM SAUNDERS, M.D. F.R.S. 
 
 FELLOW-OF THE COLLEGE OF PHYSICIANS, 
 
 FIRST AMERICAN, FROM SECOND LONDON EDITION, 
 WITH CONSIDERABLE ADDITIONS. 
 
 BOSTON : 
 
 PRINTED FOR W. PELHAM N 59 CORNHILL, 
 
 \Price One Dollar,] 
 
PREFACE. 
 
 JL H E former edition of the follow- 
 ing fheets has met with a fale which far 
 exceeded the Author's expectations. 
 The refpecTful notice which has been 
 taken of the w r ork, by Gentlemen of 
 the firft rank in the profeffion, anJ 
 whofe approbation and efteem he muft 
 ever be proud to acknowledge, toge- 
 ther with the favourable manner in 
 which it has been received in the vari- 
 ous critical periodical publications, have 
 induced him to extend his inquiries 
 and obfervations upon the fubjeft ftii 
 a 2 
 
IV PREFACE. 
 
 farther, and to prepare a fecond edition 
 for the prefs. 
 
 THE attention which his book has 
 excited, has been the occafion of his 
 being frequently confulted, and of 
 bringing many cafes under his review, 
 which have enabled him to extend his 
 practical obfervations, and to obferve 
 the variety of fymptoms which occur 
 in the different ftages of thole difeafes 
 in which the liver is the organ chiefly 
 
 INDEED, fo general is the influence 
 of the different functions of this vifcus, 
 that any derangement of them may be 
 expected to have a confiderable efFe6l on 
 various other organs. Probably many 
 'complaints, which the patient is ready 
 to refer to the organs of refpiration, to 
 the ftomach, or other parts of the ali- 
 mentary canal, may have their fource 
 in a morbid ftate of this organ* 
 
PREFACE. 
 
 THE accumulation of bile in the 
 liver and gall-bladder, producing a tur- 
 gefcent ftate of that organ, and per- 
 haps occafioning a congeftion in the 
 large blood veffels of the abdomen, 
 may be the frequent caufe of that fpe- 
 cies of apoplexy which is beft cured by 
 purgatives, and fuch other means as 
 promote the evacuation of bile. It is 
 probable likewife, that the good effeds 
 perceived from the operation of aflive 
 purgatives in the early ftages of acute 
 difeafes, and the advantages ariflng 
 from fpontaneous or even artificial 
 diarrhoea in the more advanced ftages 
 of them, chiefly depend on the hepatic 
 fyftem being kept pervious, fo frequent- 
 ly the feat of dangerous fevers. Some 
 arTedtions of the mind, it is alfo proba- 
 ble, may be intimately connected with 
 fuch a ftate of the liver. 
 
VI PREFACE. 
 
 NOT only by his own obfervation, 
 bat alfo by the correfpondence which 
 he has had with Gentlemen of the pro- 
 feilion, who have feen the hepatitis in 
 the Eaft Indies, he is more fully con- 
 firmed in the propriety of the treat- 
 ment he has recommended in the firft 
 ftage of that difeafe. He muft ftill, 
 therefore, conllder the antiphlogiftic 
 practice, there fpecified, as the moft 
 likely to fucceed ; and with all his par- 
 tiality for the ufe of mercury, in the 
 more advanced ftages of the difeafe, 
 and even before the inflammatory 
 fymptoms have fubfided, he thinks that 
 too early an application of it has been 
 attended with difagreeable effefts. 
 
 THAT he poffefles no prejudices 
 againft this important article of the 
 Materia Medica, will appear clearly, 
 
PREFACE. VII 
 
 when the reader difcovers the attention 
 he has paid to the different modes of ex- 
 hibiting it in fome difeafes arifingfrom 
 an affedion of this organ. In a Hate 
 of the liver, approaching to fchirrus, 
 he confiders it as the only medicine 
 to be depended upon ; and more than 
 this, in other difeafe^, fuch as diarrhoea 
 and dyfentery, which he confiders 
 as having frequently a reference to 
 fuch a ftate of the organ., he has experi- 
 enced confiderable advantage from the 
 ufeof it. 
 
 BEING confulted by many patients 
 labouring under afcites, and other fpe- 
 cies of dropfy, he has frequently been 
 able to trace the fource of thefe difeafes 
 to fome morbid ftate of the liver. The 
 Author has, therefore, improved this 
 edition by giving fome explanation on 
 
Vlll PREFACE. 
 
 the general pathology of dropfy, more 
 efpecially, however, as depending on 
 the refiftance to the tranfmiffion of 
 blood through the venous fyftem of the 
 liver ; he has likewife extended his in- 
 quiries on the fubjed of diet, and the 
 probable influence of the hepatic fyf- 
 tem on the procefs of digeftion. 
 
 HE cannot conclude this Preface 
 without acknowledging the obligations 
 he has to Dr. Haighton, Lefturer on 
 Phyliology and Midwifery at Guy's 
 Hofpital, for the ingenuity and accura- 
 cy with which he has planned and ex- 
 ecuted the various' experiments made 
 on brute animals for the purpofes of 
 explaining and corroborating the doc- 
 trines advanced in this treatife. 
 
CONTENTS, 
 
 CHAP. I. 
 
 ANATOMICAL DESCRIPTION Or 
 THE LIVER. 
 
 THE Bile fecreted by the liver, page I. Figure of 
 the liver not effential to its function, but determined 
 by that of the animal, 2. Its figure defcribed, 
 ibid. The proportion of its lobes different in the 
 foetus, 3. Caufe of this difference is the umbili- 
 cal vein, 4. Its fituation defcribed, ibid. Differ-' 
 ent in females, and in the foetus, 5. Its connexion 
 to the diaphragm by ligaments explained, 6. Its 
 fituation with refpeft to the ftomach, 8. The gall 
 bladder, its fituation defcribed, ibid* 
 
 CHAP. II. 
 
 yeffels of the Liver, page 1 1 . 
 
 SECRETORY organs plentifully furniflied with blood 
 
 The fame veffel generally carries blood both for 
 
 fecretion and nutrition Hence the proportion 
 
 devoted to each purpofe uncertain, 12. In the 
 
CONTENTS. 
 
 liver this difficulty is removed, ibid. How arterial 
 blood only is fit for nutrition, ibid. Origin and 
 branches of the hepatic artery, 13. Its ramifica- 
 tion through the liver, and termination, 14. Bile 
 fecreted by venous blood carried by the vena por- 
 tarum, i^. Origin of this vein, 16. Its fuppofed 
 ftrufture, 17. GlifTon's opinion on this fubjecT:, 
 ibid. Its ramification and termination,* 19. Pori 
 biliarii and hepatic duel;, 20. Its mufcularity con- 
 fidered, ibid. Abforbents fuperficial and deep 
 feated, 22. Their origin and termination Their 
 communications, ibid. Their valves lefs complete 
 here than in other parts, 23. May be injefted 
 contrary to the cour/e of their contents, 24. Nerves 
 -their origin, ilid. 
 
 CHAP. III. 
 
 The Nature of the Blood circulating through 
 the Vena Portarum confidercd> page 27. 
 
 VENOUS blood more favourable for the fecretion of 
 bile than arterial but in what refpeft the blood of 
 the vena portarum differs from other venous blood 
 is a defideratum, 28. The fubferviency of the 
 fpleen to the ceconomy of the liver confidered, 29. 
 The arguments by which it is fupported are exa- 
 mined, firft, the fplenic blood is poured into the 
 vena portarum, 30. Second, the changes it is fup- 
 
CONTENTS. XI 
 
 pofed to receive, during its paflage through the 
 fpleen, 31. Experimental inveftigation of this 
 fubjecl: Blood from the fplenic vein not more fluid 
 than other blood, nor more putrefcent, 32. Bile, 
 fecreted after the fpleen is taken out, compared 
 with other bile, 36. No fenfible difference, 37. 
 Hence the liver is independent on the fpleen, ibid. 
 A reflexion drawn from experimental inquiry, 37. 
 Animadverfions on venous blood as being better 
 adapted to the biliary fecretion then arterial, 38. 
 Arguments favouring this opinion drawn from the 
 foetus, 39. 
 
 CHAP. IV. 
 
 Of the Hepatic Artery y and the Office of the 
 Blood which it contains, page 41. 
 
 DIFFERENT opinions on this fubjecl:, ibid. Whe- 
 ther an auxiliary to the vena portarum, 41. The 
 grounds of this opinion as founded on a fuppofed 
 analogy between the liver and lungs, 42. The 
 analogy difproved, 45. The communication of 
 veflels fuppofed to be favourable to this do6brine, 
 46. In what refpecl the artery may be faid to 
 communicate with the duel:, 47. No conclufion 
 to be drawn from thefe fals, ibid. The capacity 
 f the hepatic arteiy compared with the bulk of 
 
Xll CONTENTS. 
 
 the liver confidered, 48. The proportion between 
 mufcles and the arteries that fupply them, ibid. 
 Tendons compared with their arteries, 49. The 
 brain with its arteries, ib. All thefe parts are nou- 
 rifhed, but require different proportions of blood 
 for their actions, ,50. The action of a fecreting 
 organ fuppofes great vital energy, ibid. hence 
 much blood, ibid. An extraordinary lufus na- 
 turas, note, ibid. 
 
 CHAP. V. 
 
 Interior Structure of the Liver, page 53. 
 
 IN what part of the liver is fecretion performed 
 Terminations of the vena portarum, ibid. Reafons 
 for thinking the fecretion is performed in the mofl 
 minute veflels, 54, How far fecretion depends on 
 any peculiar arrangements of parts, 55. The 
 opinions of Malpighi and Ruyfch ftated, ibid. Ap- 
 pearances like cryptae in the liver, 56. Alfo in 
 the kidney, 57. 
 
 CHAP. VI. 
 
 Courfe of the Bile, page 59. 
 
 FROM the pori biliarii to the trunk of the hepatic 
 duel, ibid. Its properties changed by the abfor- 
 bents, 60. Its paffage into the duodenum fubjecl: 
 
CONTENTS. X11I 
 
 to interruption, ibid. EfFecT: of this on the gall- 
 bladder, 61. Gall bladder, its contents and ufe, 
 
 62. The common opinion doubted by Albinus, 
 
 63. The exiftence of hepatico-cyflic duels in the 
 human fubjecl:, difproved, 65. Further confider- 
 ations on the ceconomy of the gall bladder, ibid. Is 
 itapafTive receptacle ? 67. The affirmative argu- 
 ed for from analogy, ibid. It is not vifibly mufcu- 
 lar, 68. Nor irritable on the application of ilimu- 
 li ; therefore a paflive receptacle, ib. Regurgita- 
 tion of bile from the intefline by the duel how pre- 
 vented, 69. The caufcs impeding the flow of bile 
 into the inteftine, 70. Permanent ilruclurc, ibid. 
 Spafm doubtful, except at the termination of the 
 duel:, 71. Preffure from fchirrous ftate of the pan- 
 creas, 72. Sc.hirrous impacted liver, ibid. Jaun- 
 dice not always conne6ted with obftruclion in the 
 biliary duels, proved by the yellow fever, 73. Mor- 
 gagni and Boerhaave's opinion of jaundice, arifing 
 from obftrufted fecretion, confidered, ibid. By 
 what channels the bile paries into the blood, 7^. 
 Haller's opinion by regurgitation, 76. Abforp- 
 tion confidered, 77. Is jaundice produced both by 
 regurgitation and abforption ? .78. That the ab- 
 ibrbents take up the bile is proved by experiment, 
 ibid. But does not regurgitation likewife concur ? 
 79. The affirmative proved by experiment, ibid. 
 Inference, 80. 
 
 * 
 
XIV CONTENTS. 
 
 CHAP. VII. 
 Bile, page 83. 
 
 ITS colour, varies by dilution, ibid. Confidence, 84* 
 Vifcidity, perhaps not eflential, ibid. A fapona- 
 ceous fluid, ibid. Has a bitter tafte and faint nau- 
 feous fmell, 85. Conjectures on its conflituent 
 parts drawn from its fenfible properties, ib. The 
 ancient mode of investigation by heat alone, inade- 
 .quate, ,86. The moil natural examination, by 
 chymical attractions, 87. ^Gentle evaporation diffi*- 
 pates the odorous principle along with the water 
 -the refiduum folid and brittle, 88. Its vifcidity 
 depends on an animal mucilage, 90. The effels 
 of mineral acids, ibid. More itrongly marked 
 when afTifled by heat, 91. They effect the de- 
 compofition by engaging the alkaline principle, 92. 
 Proofs of this, 93. No common fait pre-exifts in 
 the bile, but only its alkaline bafis, ibid. Its colour 
 and tafte re fide in a refmous principle, 95. Proofs, 
 96. Recapitulation, ibid. Its antifeptic proper- 
 ties confidered, 97. ' 
 
 CHAP. VIII. 
 
 On Biliary Calculi, page 99. 
 
 EXTERNAL characters, and fenfible properties are 
 various, ibid. Therefore not mere infpiffations of 
 
CONTENTS. XV 
 
 bile, 100. Different fpecimens mould be examin- 
 ed, 101. An inquiry into the conftituent parts of 
 a calculus, ibid. Its fenfible properties, 102. 
 Relative folubility in ol. terebinth and alcohol 
 leaves an earthy refiduum, 104. Much refmous 
 matter, 105. Inquiry into the preferice of an 
 alkali, ibid. The mineral and volatile alkali de- 
 tected, 106* 
 
 CHAP. IX. 
 Of the Ufe of tbe Bile, page 109. 
 
 THE probability of a connexion between red blood 
 and the bile, ibid. The fubferviency of bile to 
 chylification, confidered, no. The refult of ex- 
 periment not favourable to that opinion, in. Nor 
 its probability ftrengthened by the fymptoms of 
 jaundice, ibid. Its principal ufe is that of a ftimu- 
 lus to the inteftines, 112. May correct acidity in 
 the primae vise from its alkaline principle, 113. 
 And re fi ft a tendency to fermentation, ibid. This 
 corroborated from hypochondriafis and chlorofis, 
 114. When defeftrve may be fupplied by arti- 
 ficial means, ibid. Its defecl: more productive of 
 difeafe than its excefs, 115. Is antifeptic from its 
 bitternefs, ibid. 
 
XVI 
 
 CONTENTS. 
 
 OF THE DISEASES OF THE LIVER, 
 
 DEPENDING ON ITS FUNCTION 
 
 AS AN ORGAN OF SECRETION. 
 
 CHAP. I. 
 Of the increased Secretion of Bile, page 117. 
 
 EXCESSIVE fecretion of bile the endemia of warm 
 climates Its effecls and fymptoms, ibid. A 
 change of climate advantageous, 118. Lefs'dif- 
 treffing to natives than foreigners, 119. Bile more 
 antif .y ic in warm climates than in cold, . 120. Ob- 
 ftinate difeafes conne6 : ted more frequently with a 
 defect of bile, than its excefs, 121. Diluents advan- 
 tageous, 123. Internal ufe of warm water confider- 
 e&,ibid. Bath, Briftol, and Buxton waters pro- 
 bably act on this principle, 124. In profufe biliary 
 fecretions, emetics are improper, 125. Chelten- 
 ham water, obfervations on its ufe, 126. Regimen 
 for bilious habits, 128. Cholera morbus, a def- 
 
CONTENTS. XV11 
 
 cfiption of, ibid. The bile appears to be imperfect, 
 129. Cure 131. 
 
 CHAP. II. 
 
 Of the dimini/hed Secretion of Bile, 
 page 135. 
 
 THIS fometimes depends on chronic inflammation of 
 the liver, 136. Its fymptoms, ibid. Connected 
 with the ftomach, 137. Proper regimen in fuch 
 cafes, 138. The temporary lofs of bile, how 
 fupplied, 143. The tendency of bile to correct 
 acidity in the primae vise, (Note). The ufe of mer- 
 cury confidered, 144. Other modes of treat- 
 ment, 147. 
 
 CHAP. III. 
 
 Of Obftruftion to the free Paflage of Bile into the 
 Duodenum, page 151. 
 
 JAUNDICE, 152. Definition, ibid. Hiftory, ibid. 
 Decline, 1,53. Appearances on difie&ion, 155. 
 Diftinguimed from chlorofis, 156. And the en- 
 demic fever of the Weft Indies, 137. Influence of 
 
XV111 CONTENTS. 
 
 thepaflions on the biliary fecretion, 158. Bile is 
 imperfect when the fecretion is hurried, ibid. A 
 fedentary life difpofes to jaundice, &c. 159. Alfo 
 the abufe of fpirituous liquors, 161. Obfervations 
 on the biliary dufts, 162. And on calculi as pafs- 
 ing through them, 164. PrefTure on the duels, a 
 caufe of jaundice, 166. Prognofis, 168. Cure, 
 169. By folvents impracticable, ibid. Emetics, 
 their ufe, 170. Purgative medicines, bitters, &c. 
 ibid. Exercife, 171. Mr. Dick's treatment of 
 jaundice by calomel, (a Note). His obfervations 
 on the ufe of mercury in hepatitis, 172. 
 
 CHAP. IV. 
 
 Of the Difeafes to which the Liver is Jubjeft in 
 common with other Organs of a glandular 
 Structure, page 175. 
 
 LIVER fubjeft to acute and chronic inflammation, 
 ibid. Hepatitis, fymptoms of, 176. Symptoms 
 vary from the part of the liver attached, 177. 
 Diftinguifhed from other complaints, ibid* Sto- 
 mach affefted fympathetically, ibid. Hepatitis, 
 its termination in fuppuration, 178. Thefe ab- 
 fcefles not always vifible externally, but difcharge 
 themfelves internally, 179. In what fenfe the bili- 
 ary duls can convey the matter into the duodenum r 
 
CONTENTS. XIX 
 
 ibid. Immediate communication with inteftiries 
 more frequent, 180. The precife part varies with 
 the particular feat of the abfcefs, 181. Hepatitis 
 fometimes confounded with peripneumony, 183. 
 Alfo with inflammation of the itomach, ibid. Fa- 
 vourable termination of, 184. Has corroded large 
 blood vefTels, 185. Sometimes terminates by me- 
 taftaiis, ibid. Suppurativefyinptomsof, not always 
 .evident, ib. Sometimes ends in gangrene, 186.. 
 Often terminates in a fchirrous, ib. Schirrous liver 
 fometimes miftaken for dyfpepfia, how diftinguifh- 
 ed, 187. Schirrous liver, fymptoms of, appear- 
 ances on diffetlion, 190. Explained, 191. Proxi- 
 mate caufe of hepatitis inveftigated by analogy, 192. 
 The veflels may be in two oppofite ftates, (viz.) one 
 aUve, the other pafiive, 193. Application of this, 
 198. How an active inflammation may degenerate 
 into an indolent one, 199. The operation of re- 
 mote caufes, 200. Some curative indications de- 
 duced, 201. Dropfy, its caufes and connexion 
 with difeafes of the liver confidered, 203 (a Note). 
 Tubercular ftate of the liver, 204. Their forma- 
 tion explained, 205. The particular feat of aftive 
 and indolent inflammations confidered, 212. Cure 
 of the aHve inflammation in its firfl ftage, 213. 
 Blood-letting, 214. Blifters, 215. Laxative medi- 
 cines, 216. Antimonials and diluents, ibid. Ne- 
 ceflity for the antiphlogiftic plan particularly urgent 
 in warm climates, 217. When fuppuration fol- 
 lows^ the matter efcapes by different outlets, 218, 
 
XX CONTENTS. 
 
 Duodenum, colon, lungs, integuments, 219. This 
 conformable to a law of nature, ibid. Thefe out- 
 lets not equally favourable to the patient, 220. 
 Lungs lefs fo than inteftines, or the integuments, 
 ibid. The pus feldom efifufes into the abdomen, 
 221. May be difcharged by lancet, ibid. Slow, 
 but progreflive return of health, 222. Explanatory 
 remarks, ibid. Confiderations on the ufe of mer- 
 cury, 'ibid. Its exhibition, how regulated in the 
 Eaft Indies, 225. Its aftion in fchirrous liver 
 further confidered, 226. Its application to the 
 vicinity of the liver not particularly advantageous, 
 
 227. No direl communication between the ab- 
 forbents of the (kin and liver, ibid. Abforption 
 more rapid from ulcerated and veficated furfaces, 
 
 228. Mercury not detectable in the fecretions by 
 chymical tells, ib. The connexion between fchir- 
 rous liver and dyfentery, 229. Conclufion, 230, 
 
CHAP. I. 
 
 ANATOMICAL DESCRIPTION 
 
 OF THE 
 
 LIVER. 
 
 SECT. I. 
 
 JL o the fecretion of the bile Nature has 
 deftined an organ of confiderable fize,. call- 
 the Liver -, its magnitude is greater than 
 that of any gland in the body, fo that 
 it occupies a very coniiderable part of 
 the abdominal cavity. 
 
 2. ITS figure is fomewhat irregular, 
 confequently it does not readily admit, of 
 
[ 2 3 
 
 companion with any mathematical figure ; 
 it is unlike any body with which we are 
 acquainted. This circumflance of the liver 
 is perhaps lefs eflential than many others, 
 as figure does not appear to throw any 
 light on its ceconomy. At leaic we na- 
 turally incline to this opinion, from tak- 
 ing a view of this vifcns in different 
 animals, when it appears that the external 
 figure cf the liver ,is determined by the 
 figure of the animal itfelf, or that parti- 
 cular cavity in which it is contained. In 
 the human fiibjecl: it is fomewhat flattifh 
 and convex on irs anterior furface, irregular 
 on its pofcerior, having feveral depre/Tions ; 
 at its inferior edge there is a fiflure ex- 
 tending fome way up, particularly on its 
 pofterior furface, which forms a divifion 
 into two lobes of unequal fizcs. Thefe, 
 from their fituation in the. abdominal ca- 
 vity, are diftinguifhed by the names of 
 right and left, of which the right is the 
 lanjer. Befides thefe, there is a fmailer 
 
[ 3 ] 
 
 'obe, fituated at the fuperior and pofterior 
 -jart, called Lobulus Spigelii. 
 
 3. THOUGH in adult fubjects the right 
 obe is larger than the left, in the fcetus 
 
 the left is as large as the right. This varie- 
 ty depends on the difpofition of the umbili- 
 cal vein in the fcetus with refpect to this 
 organ - 3 for on its arrival at that gland, it 
 fends off feveral branches, fome of which, 
 penetrating the left lobe, are of coniider- 
 able fize ; but after birth, when the circu- 
 lation takes a new courfe, the whole liver, 
 but more efpecially the left lobe, dirmniOie* 
 in bulk. 
 
 4. BESIDES this variety in the proportion 
 of its lobes, the whole foetal liver muft 
 necefTarily exceed that of the adult in pro- 
 portion i for, in addition to the veflels pro- 
 per to the liver, and neceflary to its cecono- 
 my, there is one peculiar to the fcetus, viz. 
 the umbilical vein. This vefTel, which has 
 
 - its origin in the placenta, accompanies th 
 other veflels of the cord, and perforates the 
 
[ 4 ] 
 
 navel ; thence, having reached the inferior 
 edge of the liver, it pafies along the fiffure 
 which feparates the lobes, and, having en- 
 tered its fubflance, fends off feveral branches; 
 thole going to the left lobe are larger and 
 more in number than thofe to the right. 
 After which the umbilical vein divides into 
 two branches, one taking the courfe of the 
 vena cava, called canalis venofus ; the 
 other, uniting with the branch of the vena 
 portarum, pours its blood into that fyftem ; 
 fo that by much the largeft proportion of 
 the blood circulating between the foetus 
 and the placenta pafles through the liver, 
 and this fufrkiently explains why the fcetal 
 liver exceeds in proportion that of the adult. 
 5. THIS organ is fituated in the fuperior 
 part of abdomen, principally on the right 
 fide, occupies the epigaftric and the right 
 hypochondric regions, and fometimes ex- 
 tends into the left hypochondre. Its pre- 
 cife fituatton cannot be eafily determined, 
 as the inferior part of the cheft admits of 
 
[ 5 ] 
 
 confiderable variety both in its figure and 
 capacity. In males, where there is a greater 
 capacity of cheft, the hypochondres arc 
 more capacious, hence the epigaftric and the 
 right hypochondric regions are large enough 
 to contain this vifcus. 
 
 6. IM females^ who have naturally a 
 final ler cheft, which is flill more contracted 
 by tight lacing, the epigaHric and the right 
 hypochondric regions are infuHicient to con- 
 tain the liver, it therefore extends far into 
 the left hypochondre ; befides, which, it 
 fometimes, in theie cafes, occupies no in- 
 confiderable part of the umbilical region. 
 Its fituation, then, with refpect to the gene- 
 ral cavity of the abdomen, admits of forne 
 variety. In the fetus, it occupies the whole 
 epigaflric region, and both the hypochon- 
 dres y not lo much from any peculiarity in 
 the figure of the upper part of the abdo- 
 men, as from a difference in the proportion 
 of the right and left lobe, wnicii has already 
 been noticed. 
 
 B 3 
 
[ 6 ] 
 
 7- THOUGH the fituation and extent 
 of the liver, in the general cavity of the 
 abdomen, admit of fome variety, yet its 
 pofition with refpect to the diaphragm is 
 rather precife, being connected to it by 
 doublings of the peritonaeum, called liga- 
 ments. 
 
 8. THIS vifcus, in common with the 
 others of this cavity, receives a cover; ng 
 from the peritonaeum, which, doubling 
 upon itfelf, and quitting the liver, is 
 attached to the diaphragm. This connec- 
 tion obtaining in certain parts, forms 
 the ligaments. The moll confpicuous of 
 
 *t 
 
 which, is that fituated on its anterior part, 
 in a line correfponding to the fiffure, 
 forming the diftinclion between the right 
 and left lobe, which, extending from 
 the fuperior to the inferior edge, is call- 
 ed by fome, from its refemblance to a 
 fcythe, the FALCIFORM ligament -, by 
 others, from its function, the SUSPENSORY 
 ligament. 
 
[ 7 1 
 
 o,. THE lateral portions of the liver are 
 connected in like manner to the corref- 
 ponding parts of the diaphragm, taking 
 the name of lateral ligaments. Befidcs 
 which, fome anatomifts reckon the por- 
 tion of peritonaeum furrounding the veflels, 
 which pafs from this vifcus through the 
 diaphragm, as a fourtli ligament, and call 
 it the coronary ligament. 
 
 By , thefe different reflexions of the 
 peritonaeum, the liver is fupported in its 
 fituation. 
 
 10. BUT there is yet another part, 
 ufually numbered with the ligaments, 
 which, however, performs no ligamento- 
 ry function, viz. the the ligamentum rotun-' 
 dum.* This pafles from the concave part 
 
 * The ligamentum- rotundum has already been 
 noticed under the name of umbilical vein, of 
 which it is to be confidered as the collapfed re- 
 mains : for after the circulation through it has 
 ceafed, which neceiFarily happens at birth, its 
 cavity diminishes, and in time becomes nearly 
 obliterated. 
 
C 8 ] 
 
 of the liver along its longitudinal fuTure, 
 and is continued to the umbilicus. 
 
 IT. HENCE in the living fubjecl the 
 fituation of the liver mull vary with refbcc~fc 
 to the general cavity, according as the dia- 
 phragm defcends or afcends, in the acts of 
 infpi ration or expiration. 
 
 12. THE fituation of the Pcomach with 
 refpect to this organ is fuch, that the right 
 portion of the former is frequently covered 
 by the left lobe of the latter, and, from the 
 bilious tinge frequently found oh the ex- 
 ternal furface of the duodenum near the 
 pylorus, it appears that the gall-bladder 
 ufually reds on this part. 
 
 13. THE gall-bladder is a bag fome- 
 what :;ynfcTm in its fhnpe, its neck or 
 fmall extremity being iituated fuperiorly, 
 
 its fundus, or large extremity, infe- 
 
 riorlv. It is lodged in a depreflion on the 
 
 we furface of the right lobe of the 
 
 liver, to which it is p.ttachvci. by a cor-tinu- 
 
 ation of the peritoneal coat of thdu v.icus 
 
[ 9 ] 
 
 over its furface. It varies fomewhat in fize 
 according to the degree of diftention which 
 it fuffers, but, in moft inflances, the fun- 
 dus projects a fmall diftance below the infe- 
 rior edge of the liver. Deflined by Na- 
 ture to contain bile, it has a duel which 
 both receives and difcharges it, thececono- 
 mv of which will be confidered hereafter. 
 
[ II ] 
 
 CHAP. II. 
 
 VESSELS OF THE LIVER. 
 
 SECT. I. 
 
 JL_JVERY organ deftined by Nature to 
 fecrete a fluid, is very plentifully fnrniihed 
 with blood. The riceefTity of this is evi- 
 dent 5 for it requires, not: only a fupply of 
 that fluid for thepurpofe of its nourifnment, 
 but an additional quantity alfo to enable it 
 to perform its Decretory functions; as it is 
 from the blood that all the fecretions are 
 derived. 
 
 SUCH is the ceconomy of Nature in 
 glandular bodies "in general, that the fame 
 
[ 12 ] 
 
 fluid which is fit for the nourifhment of the 
 gland, is adapted ajfo to its fecretory office, 
 and is conveyed to the organ by the fame 
 verTel. But the phyfiologift is unable to- 
 afcertain, with any degree of precifion, how 
 much blood is allotted to nutrition,, and 
 how much to fecretion. 
 
 2. OUR knowledge of the ceconomy of 
 Nature in this refpect, receives fome light 
 from a peculiarity which obtains in the li- 
 ver, and which diftinguiflies it in a very 
 finking manner from all the other glands in 
 the body. For, while the functions of nu- 
 trition and fecretion are in them combined 
 in the fame veflel, in this, thefe offices are 
 kept apart, and performed by different vef- 
 fels. Therefore, by a judicious comparifon 
 of the area of the nutrient with that of the 
 fecreting velTel, we may readily allot to each 
 its due proportion. But this idea will be 
 farther purfued hereafter. 
 
 3. BLOOD of every defcription is not 
 equally fit for nutrition : that only, which 
 
C <3 
 
 has received the change from respiration, 
 and which circulates through the arteries, 
 is well adapted to this purpofe, therefore 
 the liver receives its nutrimental blood from 
 an artery. 
 
 4. THE rule which feems to guide the 
 conduct of Nature in the origin of veflels 
 fupplying other organs, obtains equally in 
 this, as the hepatic artery arifes from the 
 nearefl confklerable trunk. The following 
 is the mode of its origin : 
 
 5. THE Aorta, while it is paffing be- 
 tween the crura of the diaphragm, fends off, 
 from its anterior part, three confiderable 
 azygous trunks : the firft takes the name of 
 cceliac artery ; the fecond, which is almoft 
 immediately under the former, is called the 
 fuperior mefenteric ; and the third, going 
 off from the aorta at fome diftance from the 
 laft veflel, is named the inferior mefenteric 
 artery : the two laft fupply the inteftinal 
 
 canal. 
 
 c 
 
[ H ] 
 
 6. THE cceliac trunk foon divides into 
 three branches the firft, being diftributed 
 to the lefTer curvature of the ftomach, is the 
 coronary artery; the fecond, pafling to the 
 left, is called the fplenic artery -, and the 
 third, or largeft, whofe office we are now to 
 confider, takes the name of the hepatic artery. 
 
 7. THE hepatic artery, at its origin, is a 
 veflel of confiderable fize, but before it ar- 
 rives at the liver is fenfibly fmaller; the 
 caufe of which is, that in its progrefs it 
 fupplies adjacent parts with blood, viz. the 
 right portion of the flomach by means of 
 the gaftrica dextra and pylorica, and the 
 gall bladder by the arteria cyftica ; therefore 
 in forming a true eftimate of the quantity 
 of blood fent to the liver for its nourifh- 
 ment, we are to confider the area of the hepa- 
 tic artery, after the three preceding branches 
 are fent off. 
 
 8. THIS veflel, agreeably to the general 
 law of diftribution, divides into branches 
 before it enters the fubftance of the liver; 
 
L 15 1 
 
 its ramifications then multiply and extend 
 with great minutenefs through the whole 
 mafs ; fo that in every part of its fubflance 
 there is circulating blood pofTefied of pro- 
 perties fit for nutrition. But as this blood 
 is in a (late of conftant motion, and is con- 
 tinually changing by fuccefiive fupplies, a 
 redundancy is prevented here, as well as in 
 other parts of the body, by returning veins. 
 The ultimate branches then of the hepatic 
 artery terminate in the hepatic veins, and 
 thefe return the blood into the vena cava 
 inferior, by three or four venous trunks. 
 Such is the circulation through the liver as 
 connected with its nourifhment. We are 
 next to confider it as an organ of fecretion. 
 
 9. THIS organ differs from every other 
 gland of the body with regard to the na- 
 ture of the blood from which fecretion is 
 performed. While other fluids are fecreted 
 from florid arterial blood, which has lately 
 received changes from the air by the inter- 
 vention of the lungs, the bile is formed from 
 c 2 
 
[ '6 ] 
 
 blood of a dark colour, poflefling the com- 
 mon characters of venous blood, and is con- 
 veyed to the liver by a vein. 
 
 10. THE -vena partarum, which conveys 
 this Jslood, takes its name from the part of 
 the liver at which it enters ; there being two 
 eminences, one on each fide of the fiffure, 
 called the port^, t where this veflel- begins 
 to penetrate. To nnderftand the origin of 
 the vena portarum, and the properties of the 
 bloocl which it conveys, it will be neceflary 
 to explain the circulation through the chy- 
 lopoietic organs. The branches of the cceliac 
 and mefenteric arteries, as we have before 
 obferved, di (tribute their contents to the 
 ftomach, inteftines, pancreas, and fpleen, 
 "belkles the hepatic artery which fnpplies the 
 liver. The blood circulating through all 
 thefe vifcera, except the lad, being returned 
 by their refpec"Hve veins, is poured into 
 their common trunk, the vena portarum : 
 thus the origin of the vena portarum ap- 
 pears to confiil in the concurrence of all the 
 
[ '7 1 
 
 veins of the peritoneal vifcera except the 
 liver. 
 
 11. As the function cf this vein differs 
 from that of other organs, it has been fup- 
 pofed to pofTefs forne peculiarities of flruc- 
 ture. Some have thought it more mufcular 
 than other veins, and that its charafters 
 approach nearer to thofe of an artery. It 
 certainly does not pofTefe the grand difcri- 
 minating mark of an artery, or the power 
 of preferving its orifice circular when di- 
 vided tranfverfely. If it differs from veins 
 in general, it is in having thicker tunics 
 in proportion to the capacity of its canal ; 
 but with refpect to the arrangement and 
 difpofition of its mufcular fibres, this part of 
 its ftructure does not appear fu fHci en tly defin- 
 ed to authorize us to fpeak with precifion. 
 
 12. GLISSON, whofe opinion ..on this fub- 
 ject is not always quoted with approbation, 
 conceived its grand character! Hie to confift 
 in a continuation of that duplicature of the 
 
 c 3 
 
[ is- ] 
 
 peritoneum furrounding the vellels going 
 to the liver, in the manner of a capfula, 
 and to which it is ufual to annex his name. 
 He conceived, likewife, that it not only 
 envelopes the trunk of tjiis vein, but ac- 
 companies it in all its ramifications through 
 the liver 5 fo that if a feclion were made 
 into this organ, the branches of the vena 
 porcarum would be diflinguilhed from thofe 
 of other vefiels by the prefence of this 
 adventitious tunic. 
 
 13. FOR this membrane, which the ima- 
 gination had formed, fancy foon fuggefted 
 a ufe Miftaken obfervation had led him 
 to believe that it pofTe fifed mufcular pro- 
 perties, and that it propelled with force the 
 blood, whofe motion would orherwife have 
 been languid. The invefligations of other 
 anatomifts have not confirmed this opinion. 
 They have difproved the continuation of 
 this peritoneal capfula beyond the trunk of 
 the vena portarnm, and have demonftrated 
 that it does not envelop the vena portarum 
 
[ 19 I 
 
 in a particular manner., but only inverts it 
 in common \vith other veffels, and as foori 
 as it has arrived at the liver it quits them 
 altogether, and, by expanding itfelf over 
 the fubflance of this gland, forms its tunic. 
 
 14. THE vena portarum having reached 
 the liver at that part called the great fifTure, 
 forms one large trunk called the finus of the 
 vena portarum, from which three principal 
 branches ulually take their origin > thefe, by 
 forming fubordinate ramifications in a reori- 
 
 o o 
 
 lar feries, at _ length arrive at their termina- 
 tions. 
 
 15. The extremities of thefe vefiels end 
 in two ways : one with refpect to the cir- 
 culation of the blood -, the other, as.con- 
 nected with their ceconomy, as fecreting 
 veflels. In the firft point of view they in- 
 ofculate with branches of hepatic veins, and 
 through that channel return to the inferior 
 cava all that blood which is not employed 
 in the bufmefs of fecretion. So that the 
 hepatic veins are the common recipients of 
 
[ 20 ] 
 
 the contents of the hepatic arteiy, and like- 
 \vife thofe of the vena portarum. 
 
 1 6. THE fecreting termination of this 
 vein is in the beginnings of the hepatic 
 ducts, called pori biliarii; which in their 
 origin muft neceiTarily be very minute, inaf- 
 much as they preclude admiffion of the red 
 particles of the blood : from thefe minute 
 beginnings they gradually enlarge by an 
 linionof branches, until at length they pafs 
 out from the liver at its fiiTure, by two or 
 three trunks, which foon after join together, 
 and form the trunk of the hepatic duel. 
 
 17. THE ftructure of this veiTel is appa- 
 rently membranous, having no fibres which 
 can be conud?red as mufcular, at leafl as far 
 as we can decide by ocular demon ftration. 
 But, as the eye, even when aided by glafTes, 
 is not always competent to detect mvifculari- 
 ty, we are compelled to- have recourie to 
 another and lefs fallacious ted, which is the 
 power of contraction on the application of a 
 ftimulus, Mechanical and chymical ftimuli 
 
[ 21 ] 
 
 have been applied to this du6l in a living 
 animal, without producing any contraction 
 which can be referred to mufcularity. Some 
 chymical ftimuli, it is true, will corrugate 
 this canal ; but they are luch as produce 
 effects only by corrofion, and which they do 
 as readily on inanimate as on living matter. 
 
 1 8. A MOTHER argument againft their muf- 
 cularity is, that canals obvioufly mufcular, 
 readily adapt their capacity to their contents. 
 This lav/ is very evident in the vafcular fyf- 
 tem. But when a biliary duel: has. been di- 
 lated by the pafiage of a gall ilone, it does 
 not very foon return to its primitive dimen- 
 fions. And, perhaps, thofe painful affecti- 
 ons of thefe parts, which have been very 
 commonly confide red fpafmodic, may find 
 a more adequate explanation in the pafiage 
 of a calculus. 
 
 19. IF the internal furface of this fyftem 
 of veffels be examined, in will be found mo- 
 derately vafcular, as there is an appearance 
 of follicles in many parts -, hence it is proba- 
 ble, that it fecretes a mucous kind of fluid. 
 
[ 22 ] 
 
 20. BESIDES the veflels already defcribed, 
 the liver is very plentifully ftipplied with 
 abforbents, which take their origin from 
 every part of itsfubftance, but more efpeci- 
 allyfrom the branches of the hepatic duel". 
 The proof of this origin will be referved 
 until we treat of the ceconomy of this organ. 
 From the interior part, the abforbents pur- 
 fue the direction of the furface, fpme rami- 
 fying on the anterior and fome on the pof- 
 terior furface : their difpolkion while on 
 thefe parts is arborefcent. Thofe on the con- 
 vex^ furface incline towards the direction of 
 the falciform ligament upon which they pafs, 
 and extending their courfe in the direction 
 of the diaphragm, terminate in the thoracic 
 duct near to that part. Thofe which ramify 
 on the concave furface, form, by a feries of 
 junctions, a common trunk, which, pafs- 
 ing from the liver in the direction of the 
 hepatic artery, and with it and the other 
 vefTels being inclofed in Gliflbn's capfula, 
 terminate in the thoracic duct near the 
 receptaculum chyli. 
 
21. THESE two fets of abforbents, 
 while ramifying within the liver, have a 
 free communication with each other, as 
 may be proved by injection with mercury. 
 From a fuperficial abforbent on the convex 
 furface, mercury will fometimes penetrate 
 the fubftance, and thence pervade thofe on 
 the concave fide, from which the thoracic 
 duel may be filled. 
 
 22. THESE veffels poflefs the fame cha- 
 racter while in this organ as they do in 
 other parts of the body ; that is to fay, 
 they are valvular. But notwithftanding 
 this, they may be injected 'in a direction 
 contrary to that in which their contents 
 move. This, though apparently a para- 
 dox, is ftrictly confonant to reafon and 
 fact; for the function of the valves here 
 is lefs complete than in fome other parts 
 of this fyftem, fo that bypreffure, mercury 
 may take a retrograde courfe in the fame 
 
 vefTel. Another reafon is, that as the 
 
 lateral .communicating veflels exceed the 
 
[ 24 ] 
 
 valves in number, aclufter of abforbents may 
 be injecled by a conrfe in part retro- 
 grade, and in part circuitous. It is in this 
 way an injection may be made to pafs 
 through the branches of the fpermatic vein, 
 in a direction contrary to the natural circu- 
 lation -, yet thofe vetfels are plentifully fur- 
 niflied with valves. 
 
 23. BESIDES vefifels, the liver is furniflied 
 with nerves, though not very plentifully. 
 The par vagumand intercoftal nerves, while 
 in the cavity of the thorax, communicate by 
 branches with each other. Near to this 
 part of junction feveral branches are fent 
 off, fomeof which are diftributed to parts 
 contiguous, others to more diftant organs. 
 But there is detached from each fide a branch 
 more confpicuous than the others, viz. the 
 fplanchnic nerves, both of which, having 
 pierced the diaphragm, unite. 
 
 24. AT the part of union there is formed 
 a ganglion, which, from its crefcent-like 
 
Figure, is called femilunar. From this gan- 
 glion a multiplicity of nervous filaments are 
 parting off in various directions, which, in- 
 termixing and obferving a radiated courfe, 
 form the folar plexus. From this, feveral 
 fubordinate plexufes are detached, which re- 
 ceive names from the parts they fupply; 
 hence the names of ftomachic plexus, fplenic 
 plexus, &c. But from its right portion, 
 Feveral fmall nervous filaments pafs, which, 
 furrounding the hepatic artery, accompa- 
 ny it to the liver, and take the name of 
 hepatic plexus. 
 
valves in number, aclufter of abforbents may 
 be injected by a courfe in part retro- 
 grade, and in part circuitous. It is in this 
 way an injection may be made to pafs 
 through the branches of the fpermatic vein, 
 in a direction contrary to the natural circu- 
 lation j yet thofe vetfels are plentifully fur- 
 niilied with valves. 
 
 23. BESIDES veiTels, the liver is furnifhed 
 with nerves, though not very plentifully. 
 The par vagumand intercoftal aerves, while 
 in the cavity of the thorax, communicate by 
 branches with each other. Near to this 
 part of junction feveral branches are fent 
 off, fomeof which are diftributed to parts 
 contiguous, others to more diflant organs. 
 But there is detached from each fide a branch 
 more confpicuous than the others, viz. the 
 fplatichnic nerves, both of which, having 
 pierced the diaphragm, unite. 
 
 24. AT the part of union there is formed 
 a ganglion, which, from its crefcent-like 
 
figure, is called femilunar. From this gan- 
 glkm a multiplicity of nervous filaments are 
 pafling off in various directions, "which, in- 
 termixing and obferving a radiated courfe, 
 form the folar plexus. From this, feveral 
 fubordinate plexufes are detached, which re- 
 ceive names from the parts they fupply; 
 hence the names of ftomachic plexus, fplenic 
 plexus, &c. But from its right portion, 
 feveral fmall nervous filaments pafs, which, 
 furrounding the hepatic artery, accompa- 
 ny it to the liver, and take the name of 
 hepatic plexus. 
 
CHAP. III. 
 
 THE NATURE OF THE BLOOD 
 
 CIRCULATING THROUGH THE VENA 
 
 PORTARUM CONSIDERED. 
 
 SECT. I. 
 
 G given a general defcription of 
 the veflels fupplying the liver, we are led to 
 examine into the nature of their contents. 
 And here we may remark, that it is very de- 
 firable, but at the fame time extremely dif- 
 ficult, to afcertain the peculiar chara6ters 
 of the blood, after circulating through 
 each of the chylopoietic vifcera, previoufly 
 D 2 
 
I 28 ] 
 
 to its paflage into the liver, by the vena 
 portarum j and to determine why it feems 
 better adapted to the fccretion of bile than 
 common arterial blood, from which other 
 fecretions are fupplkd. 
 
 2. THAT venous blood is more favorable 
 to tliis fecretion than arterial, is very evi- 
 ' dent ; this exception of the liver to Nature's 
 law, in the ceconomy of other glands, may 
 be admitted as a proof. But the peculiar 
 changes induced in the blood, after circu- 
 lating through the arteries of the flomach> 
 and yielding the gaftric fluid j after penetra- 
 ting the pancreas, and there affording pan- 
 creatic juice ; after pervading the inteilines> 
 where it not only gives out the inteftinal 
 mucus, but from its vicinity to feculent 
 matter may receive putrefcent properties, 
 are at prefent, and may perhaps continue 
 long to afford, an ample field of fpeculation 
 and conjecture. 
 
 3. THE power of thefpleen in thisrefpecl: 
 has been particularly acknowledged and in- 
 
[ 29 ] 
 
 ' Med upon 5 infomuch that modern phyfiolo- 
 ^ifls have confid^red this as its only function. 
 That the fpleen, in common with the other 
 vifcera, may contribute fomevvhat to change 
 the properties of the circulating blood, 
 ought not to be denied; but whether this be 
 the principal and only end of its function, I 
 think, cannot be too carefully invefligated. 
 
 4. THE number and rank of thofe phy- 
 fiologifts, who have confidered the fpleen 
 as an auxiliary organ to the liver, are too re~ 
 fpectable to be oppofed on any ground, ex- 
 cept that of experiment and induction. 
 
 When opinion is oppofed to opinion, and 
 no reafons adduced on either fide in fupport 
 of each, whatever difference there may hap- 
 pen to be in the credit or authority of their 
 refpective promulgators, the opinions thern- 
 felves ftand on equal ground. It is the rea- 
 fons then which ftamp the true vak-e of any 
 opinion, and to them only we (hall clirecl 
 our inveftigation. 
 
[ 32 ] 
 
 iment by way of refutation. But waving 
 that controveriy, let us inquire how far the 
 fpleen afting on its blood as a diluting or- 
 gan, can be fupported by facts. 
 
 EXPERIMENT. 
 
 10. THE abdomen of a living dog being 
 opened, and the fpleen with its veiTels being 
 drawn gently out, blood was taken both 
 from the artery and the vein, and received 
 into cups of fimilar fhape and equal fize. 
 On weighing each, there was found to be 
 420 grains of arterial, and 468 of venous 
 blood. Both coagulated in lefs than two 
 minutes, and in about the ufual time they 
 feparated into Jerum and craffamentum. In 
 twenty-four hours the Jerum of both was 
 accurately weighed : the 420 grains of 
 blood from the fplenic artery feparated 191 
 
C 33 3 - 
 
 grams of ferum ; the 468 grains from the 
 vein, feparated 213 grains. 
 
 ii. BUT our conceptions of this matter 
 will be much aflifted by inftituting a com- 
 parifon with one common ftandard, ftill 
 preferving the ratio. 
 
 Therefore we fay, 1000 parts of blood 
 from the fplenic artery feparated 454, while 
 the fame quantity from the vein yielded 455 : 
 a difference fo inconfiderable as this, furely 
 can never be laid hold of as a proof that the 
 fpleen is fubfervient to the liver, on the 
 principle of a diluting organ. 
 
 But to purfue the inquiry ftill further, I 
 thought it of importance to examine the 
 fluidity of ihe/erum. 
 
 EXPERIMENT. 
 
 12. EQUAL portions of each Jerum 
 were expofed nearly to the fame degree of 
 
[ 34 ] 
 
 heat, until coagulation had taken place. 
 Upon prefling the furface of each, there 
 exuded at different points fmall particles of 
 a watery fluid, which Senac calls the ferofity 
 of the blood; and, upon examining the 
 proportions of each, I could not difcover 
 any difference. Therefore, if we admit that 
 the liver receives any affiftance from the 
 fpleen, it does not appear to owe any thing 
 to that organ on the principle of dilution. 
 
 13. THE other change fuppofed to bfe 
 induced in the blood by its circulation 
 through the fpleen, is a putrefcent tenden- 
 cy : this has been conjectured in part from 
 its contiguity to the colon, and in part from 
 the languid (late of the circulation through 
 that vijcus. 
 
 Without instituting any ferious inquiries 
 into the probable weight of thefe reafons, 
 and their fufficiency to fupport the propofi- 
 tion, let us inquire into the facl: itfelf. 
 
[ 35 1 
 
 EXPERIMENT. 
 
 14. Two portions of blood, one taken 
 from the fplenic artery, the other from the 
 vein, were expofed for four hours to a heat 
 upwards of 90 degrees -, but neither of 
 them betrayed the fmalleft marks of putref- 
 cency. 
 
 This opinion appears to have originated 
 in an erroneous idea concerning the proper- 
 ties of the bile, which fome have confidered 
 as the mod putrefcent fluid of the body ; 
 but with extreme impropriety, as experi- 
 ments have fully evinced. 
 
 15. THUS far our inquiries have favour- 
 ed very little the connection between the 
 fpleen and the liver. But in order that the 
 refutation may be more complete, it is ne- 
 cefTary that a comparifon be made between 
 bile taken from an animal whofe fpleen has 
 been previouffy removed, and one in which 
 
 is ilill remaining. 
 
EXPERIMENT. 
 
 16. THE fpleen of a dog was removed, 
 and the wound healed up in a few days. He 
 was kept feveral weeks afterwards, during 
 which time he ran about the houfe like any 
 other dog. Another dog in perfect health 
 being procured, both were flrangled, and 
 the bile contained in the ^all bladder of 
 each collected in feparate veflels for the pur- 
 pofe of comparifon. 
 
 17. THE colour of both, which was 
 that of a bottle-green, correfponded very 
 exadry. 
 
 There was no difference in tenacity : in 
 both it was juft fufficient to prevent its fall- 
 ing from a phial in drops. 
 
 The tafte of each was intenftly bitter, 
 and (lightly pungent. 
 
 No perceivable difference in frnelL 
 
 Portions of each being mixed with litmus. 
 
*[ 37 j 
 
 lurmerick, and fyrup of violets, betrayed 
 no difference of colour. 
 
 Equal portions of each of thefe fpecimens 
 of bile, being mixed with equal portions of 
 concentrated vitriolic acid, a brown colour 
 was produced ; and with a very diluted vi- 
 triolic acid, a draw colour. 
 
 With concentrated nitrous acid, both ef- 
 fervefced, and exhibited a brown colour. 
 
 With alkohol there was a flocculent ap- 
 pearance. Evaporation to a thick extract 
 left a refiduum, which was highly inflammable. 
 
 1 8. THE refult of thefe experiments 
 makes it highly probable, that the bile fe- 
 creted after the lofs of the fpleen, differs in 
 no refpect from other bile ; and that the li- 
 ver in theexercife of its function is perfectly 
 independent on that vifcus. 
 
 19. TH us we fee that an opinidn, which 
 has received a degree of currency from the 
 fandion of .men of eminence, lofes its im- 
 portance, when examined by the teft of ex- 
 
[ 38 ]. 
 
 periment j and a patient inveftigation of 
 "Nature's .operation, on this plan, mufl ever 
 prevail over authority or prejudice. 
 
 20. IT has been proved above, that 
 /venous blood is the proper fource of the 
 biliary fecretion. Some. afTert, that fome 
 additional properties are imparted to it 
 during its circulation through the peritonaea! 
 <vijcera : but neither experiment nor obferva- 
 tion has contributed any thing conclufive 
 in favour of fuch opinion. 
 
 ai. THE peculiar ceconomy of the bi- 
 liary organ in the/^to, is particularly de- 
 fervingour confideration, as the blood from 
 which the fecreted fluid is made, cannot be 
 jconfidered as ftrictly venous, but as partak- 
 ing, in fome meafure, of the arterial cha- 
 racter ; and this intermediate condition of 
 blood appears to produce a correfpondent 
 ftate of the bile : for it is matter of noto- 
 riety that foetal bile is lefs active and con- 
 centrated, and abounds more in the watery 
 principle, than that of the adult. This 
 
[ 39 ] 
 
 being granted, it neceflarily follows, that 
 whatever changes are induced in the blood 
 in paffing from the arterial to the venous 
 condition, thofe changes furnifh the prin- 
 ciples which adapt the blood more com- 
 pletely to this purpofe. But as phyfiologills 
 are not agreed refpe&ing the efTential dif- 
 ference between arterial and venous blood, 
 whatever properties the one poflefTes of* 
 which the other is cleft itute, any reafoning 
 founded on fuch an uncertain bafis mufl 
 necefiarily be unmeaning and inconclufive. 
 
 22* BUT to revert to the ceconomy of the 
 liver in thefatius'i it may be obferved, that 
 befides the blood which is lent to it by the 
 hepatic artery and vena por/arum, it receives 
 a large portion by the umbilical vein. 
 
 23. To understand this, we fhould advert- 
 to fome of the peculiarities of thefatus in 
 utero. It is very generally admitted, that 
 the placenta is to thefatus, what the lungs 
 are after birth -, that by both a change is 
 
 induced in the blood, by which it lofes 
 E 2 
 
C 40 ] 
 
 the venous character, and afTumes the arte- 
 rial one, in fuch proportion as the exigen- 
 cies of each may require. As foon as the 
 change is wrought in the blood of the pla- 
 centa, it is conveyed by the umbilical vein 
 to the liver of thefatus ; part of this blood 
 mixes with the common blood of the vena 
 portarum, and with it concurs in.furnifhing 
 the fecretion of the bile ; the remainder is 
 carried into the vena cava inferior by the 
 canalis venofus. 
 
 24. Ixthef&tuS) then, it feems that the 
 blood in the vena port arum has more of 
 the arterial condition than that of the 
 adult, and feems to produce a bile of lefs 
 activity. 
 
CHAP. IV. 
 
 ON THE HEPATIC ARTERY, 
 
 AND THE OFFICE OF THE BLOOD 
 
 WHICH IT CONTAINS. 
 
 SECT. I. 
 
 JDy far the greater number of phyfioio- 
 gifts have agreed, that the hepatic artery 
 carries blood to the liver for its nourifh- 
 ment, and that this is its only deflination. 
 There are a few, however, who incline to 
 a different opinion -, and contend that, in 
 addition to this function, it concurs with 
 the vena fortarum in the fecretion of the 
 bile. 
 
[ 42 ] 
 
 2. THE reafons on which this latter opi- 
 nion is founded, have at lead fpecioufriefs 
 to recommend them ; and in our inquiry 
 into this queflion, the merits of both opi- 
 nions will be carefully inveftigated : and at 
 the fame time that we efteem it our duty to 
 detect and expofe fallacy wherever it ap- 
 pears, it is no lefs congenial to our inclina- 
 tion to afcribe to each argument its due and 
 proper force. 
 
 3. THE firft pofition advanced in favour of 
 this opinion is, "That it is probable that 
 cc the office of the hepatic artery is not con- 
 cf fined to|jhe nourifhment of the liver, from 
 <c the difproportion of its veflels to the bron- 
 <c chial arteries, which nourifh the lungs." 
 
 4. IN examining this argument, we find 
 it is of an analogical nature ; and confe- 
 quently, if well founded, cannot extend its 
 force beyond preemption or probability. 
 But we muft always keep in view the differ- 
 ence between an analogy which is clofe, and 
 where the points of coincidence are ftrik- 
 
[ 43 1 
 
 ing and well marked ; and one where they 
 are but few, and thofe not very evident. 
 Even the former will always fall fhort of 
 proof, while the latter can fcarcely warrant 
 ib much as a conjecture. 
 
 Therefore the object which is held out 
 
 as the analogy cannot be "too feverely fcru- 
 
 
 tinized. 
 
 5. THIS argument, then, refts on a pre- 
 fumption, that the lungs, which are at leaft 
 as marly as the liver, are nourifhed by the 
 bronchial arteries, which are much lefs ca- 
 pacious than the hepatic artery ; therefore 
 it has been faid, if the bronchial arteries are 
 fufficient to nourifh the lungs, the hepatic 
 artery ought to do fomething more than 
 nourifh the liver ; or, in other words, it 
 ought to contribute fomewhat to the fecre- 
 tion of bile. 
 
 6. THE inference would be natural and 
 fair, provided it were firft eftablifhed, that 
 the bronchial arteries alone nourifhed the 
 lungs. 
 
[ 44 ] 
 
 7- BEFORE the days of Ruyfch, phyfiolo- 
 gifts imagined that the lungs were nourifhed 
 by the pulmonary artery ; they were the 
 more perfuaded of this, becaufe the exift- 
 ence of any other veflel going to the lungs 
 had not been fufpected. But Ruyfch, by 
 by his art of injecting, difcovered the 
 bronchial arteries, and thefe he confidered 
 as their true nourifhing veflels ; and what 
 feemed to give flrength and confirmation to 
 this opinion was, that the blood, while cir- 
 culating through the pulmonary arteries, 
 porTefTes the venous character, and of courfe 
 is unfit for nutrition ; while that fent by the 
 arteries of Ruyfch is in every refpect adapted 
 to this end. 
 
 But the following arguments may he ad- 
 duced, not only from fpeculation, but from 
 experiment, to prove that the fubftance of 
 the lungs is nourifhed by the blood in the 
 extreme branches of the pulmonary artery 5 
 and that the bronchial arteries of Ruyfch are. 
 confined to the nourifhment of the branches- 
 of the bronchi* alone* 
 
As the blood in the fmaller branches of 
 the pulmonary artery is expofed to the in- 
 fluence of the air, it mud necefTarily receive 
 a change, and afTume the arterial character ; 
 in which ftate it is as fit for nutrition as the 
 blood circulating in other arteries. 
 
 We learn from obfervation and experi- 
 ment, that when inflammation has occafion- 
 ed the furfaces of the pleura and lungs to 
 adhere, fuch adhefions become vafcular, and 
 may be injected by the pulmonary artery : 
 and, as the blood diftributed to thefe adhefi- 
 ons is for the purpofe of their nourifhment, 
 their communication with the ultimate 
 branches of the pulmonary artery proves 
 inconteftably, that fuch blood is fit and 
 proper for the nourifhment of the lungs. 
 
 Hence it appears, that there is not the 
 lead analogy between the hepatic artery and 
 the liver on the one hand, and the lungs 
 and the bronchial artery on the other. Con- 
 fequendy the argument, which refted on 
 this analogy, is not entitled to notice. 
 
[ 46 ] 
 
 " A iecond argument in favour of the 
 
 :c hepatic artery aflifting in the fecretion of 
 
 '' bile, is founded on an apparent commu- 
 
 cc nication between the ultimate branches 
 
 cc of thofe veflels and the beginnings of the 
 
 ;c biliary duels ; for, fay the advocates for 
 
 f this dodrine, afubtile fluid may be inject- 
 
 c ed with eafe from one fet of veflels to the 
 
 <c other." 
 
 That the biliary duels may be -filled by 
 fubtile fluid injected into the artery, we 
 fhali not deny ; but this fact does by no 
 means prove a direct communication be- 
 tween one fet of veflels and the other, as 
 will very foon appear. 
 
 When we reflect on the circulation 
 through the liver, it mud be evident to us, 
 that, as the hepatic veins return blood both 
 from the hepatic artery and the vena porta- 
 rum ; the hepatic artery has communication 
 with the latter by the intervention of the 
 hepatic veins, and that a fluid injection 
 thrown in by the artery will pafs very readi- 
 ly into the veins 3 where, if its exit be pre- 
 
[ 47 1 
 
 vented by tying them up, it may regurgitate 
 into the terminations of the vena port arum, 
 and thence efcape into the port biliarii* 
 
 But left this explanation fhould be ob- 
 jedted to as being too circuitous, another 
 offers itfelf much more direct, and which 
 admits of proof from injection. 
 
 Water inje&ed by the hepatic duel pafles 
 with freedom into the hepatic veins; and 
 again, a firnilar fluid pafles eafily from the 
 veins into the duel: : hence a fluid, injedted 
 by the artery, pafles firft into the veins, 
 and afterwards into the port liliani ; fo that 
 the arguments founded on the phenomena 
 refulting from injections cannot be admitted 
 as proofs, that the hepatic artery exercifes 
 a fecretory function. 
 
 The capacity of the hepatic artery with 
 relation to the bulk of the liver, has been 
 the ground on which its fubferviency to the 
 fecretion of the bile has very much refted, 
 from an idea that it carried to the liver more 
 blood than the mere purpofes of nutrition 
 
r 48 ] 
 
 i 
 
 required; hence it was imagined, that it 
 either co-operated with the vena fort arum 
 in the immediate act of fecretion, or that 
 it feparated from the blood, circulating 
 through its extreme branches, a fluid which 
 formed one of the conftituent parts of the 
 bile. 
 
 But the capacity of the hepatic artery 
 does not neceflarily fuppofe either one or 
 the other of thefe offices; for it is well 
 known, that parts of the body, which, are 
 not fecreting organs, are furnifhed with a 
 larger proportion of arterial blood than the 
 liver: of this kind are the mufcles, the 
 brachial artery being larger with refpect to 
 the arm, than the hepatic artery is with 
 refpecl: to the liver. 
 
 Now mufcles, we know, are organs 
 which occafionally perform ftrong and 
 repeated actions, which, like other actions 
 when long continued, tend to debilitate and 
 exhauft the machine; but, when their 
 exertions are moderate, they become invi- 
 
I 49 ] 
 
 gorated and enlarged, and the increafe of 
 bulk which they acquire in this way, is prin- 
 cipally owing to an increafe in the capacity 
 of their blood vefiels, as appears, not only 
 from the more florid colour of thofe mufcles, 
 but likewife, from comparing the capacities 
 of the trunks of the vefTels with the mufcles 
 themfelves. 
 
 Tendons, on the contrary, though parts 
 equally alive, yet, from their more paflive 
 condition, require a fupply of blood fuf- 
 ficient only for their nourilhment. 
 
 The brain is an organ which, with rela- 
 tion to its bulk, receives a larger quantity 
 of blood than any other part of the body, 
 yet its function as a fecreting organ is not 
 obvious. 
 
 The inference intended to be drawn from 
 thefe facts is, that parts, though not fecre- 
 tory, require a fupply of blood in propor- 
 portion to the actions they perform. 
 
 Now furely we cannot hefitate to admit 
 that the exertion of a fecreting organ necef- 
 
farily implies a confiderable fupply of vital 
 energy, as it confifls in changing the blood 
 into a fluid different in all its properties from 
 the blood itfelf, fo that it may affume a new 
 mode of exiitence. In other glands arterial 
 blood ferves the double pur-pole of being 
 the fabulum of the fecretions, and of fupply- 
 ing the organ with vital energy fufficient to 
 effect itspurpofe; but in the liver, where 
 the fecretion is performed from venous 
 blood, which is unfit for furnifhing it with, 
 vital energy, the neceftlty for a copious quan- 
 tity of arterial blood feems very evident. * 
 
 * An extraordinary cafe of Lufus Nature has 
 lately occurred to Mr. Abernethy, Teacher of 
 Anatomy 5 in which the vena portarum had a 
 fingle termination. Inftead of conveying its 
 blood into the fubftance of the liver, prior to its 
 termination in the inferior vena cava by the in- 
 tervention of the hepatic veins, the blood return- 
 ed by the veins of the different chylopoietic organs, 
 was conveyed by the vena portarum immediately 
 into the vena cava inferior near to the origin of 
 the emulgent veins. The hepatic artery, which 
 appeared to be fomewhat enlarged, was the only 
 veflel carrying blood to the liver, and in thisindi. 
 
f s. ] - . 
 
 Admitting the vena portarum alone to be 
 the fecreting vefiel, and that the hepatic 
 artery furnifhes blood only for imparting a 
 due degree of energy, it ftill remains a quef- 
 tion, of what nature the communication 
 between thefe twoveflels is. Perhaps here 
 it may be more confonant to the true fpirit 
 of phyfiology to content ourfelves with the 
 the fact, and to trace its application to the 
 ceconomy of this organ, than to indulge 
 ourfelves in framing vifionary hypothefes, 
 which exiil only in the efflorefcence of fancy. 
 
 vidual inftance it appeared to perform the double 
 function of nutrition and fecretion. That bile 
 was fecreted in this place, appears evident from 
 the prefence of it both in the inteftines, and gall 
 bladder. The latter, though of its ufual fize, 
 contained only a fmali portion of this fluid, the 
 properties of which were very fimilar to thofe of 
 the bile in other young fubjecls. The fubject of 
 the prefent cafe was a child apparently about one 
 year old, in every refpect well nourished. 
 
[ 53 3 
 
 CHAP. V. 
 
 INTERIOR STRUCTURE OF THE 
 LIVER. 
 
 SECT. I. 
 
 i 
 
 T is from the blood circulating through 
 the branches of the vena portarum y that 
 bile is fecreted ; but in what particular part 
 of this fyftem the change commences, and 
 what is theprecifeftructureof the parts adapt- 
 ed to this end, are fit fubjects for inquiry. 
 
 a. IT has been already obferved, that the 
 ultimate branches of the vena portarum have 
 a double termination ; one of which is, with 
 
[ 54 ] 
 
 refpe6t to the circulation of red blood, by 
 the beginnings of the hepatic veins ; the 
 other, with refpect to the immediate fecret- 
 ing vefTr Is, by thepori biliariL 
 
 3. DOES the change commence in the 
 fmall branches of the vena -port arum before 
 they terminate in the hepatic veins ? 
 
 4. THIS is fcarcely probable ; for any 
 bilious properties, which the blood may- 
 have acquired at this part, would be loft 
 with refpecl: to the hepatic duel, as it finds 
 a more ready courfe through the hepatic 
 veins : befides which, the conftitution 
 would be in a continual ftate of jaundice. 
 
 5. THE probability is, that there is no 
 fenfible alteration induced on the blood of 
 the vena for tar urn before it terminates in red 
 veins. And as arteries terminate in veins 
 by capillary veflels, fo, from the analogy 
 which obtains between the vena portarum 
 and an artery, we prdume that the fame 
 termination does not take place until the 
 branches have become capillary. 
 
C 55 1 
 
 6. IT follows from this, that the true fe- 
 creting veflels are the very ultimate branches 
 which communicate with the port biliarii. 
 
 7. THE next qu eft ion is, how far the fe- 
 cretion of bile is connected with any pecu- 
 liar arrangement or ftrudhire of thefe parts : 
 or, in other words, whether the fecreting 
 veflel communicates with the beginnings of 
 the excretory duel by a cylindrical continu- 
 ation of canal, or by the interpofition of a 
 cell or follicle. 
 
 8. ON this point, the opinions of Mai- 
 pighi and Ruyfch divide anatomifts : Malpigbi 
 having examined into the (truclure of glan- 
 dular bodies, obferved bundles of circum- 
 fcribed knotted appearances afTuming a glo- 
 bular form, to which he gave the name of 
 corpora globcja \ and, by further examinati- 
 on, by means of injection, he found them 
 ftill more confpicuous in confequence of 
 diftention : hence he inferred that they were 
 hollow, and that each of them confifted of 
 a cell or follicle. 
 
[ 56 ] 
 
 9. RUYSCH, it Teems, in the earlieft part 
 of life, embraced this opinion ; but from 
 employing himfelf, frequently, in exploring 
 the flructure of glandular bodies by injec- 
 tion, lie was led to relinquifh the doctrine 
 of Malpigbi, and to inttitute another which 
 feemed to him' more cohfonant to nature. 
 
 10. FROM his injections he was induced to 
 believe, that the appearances defcribed by 
 Malp'ghi were fallacious; and that they 
 were not mere crypt*, or cells, as "they had 
 been reprefented, but confided of aferies of 
 veflcls coiled up in a circumfcribed form, 
 and, that the ultimate branches of the fe- 
 creting veffel communicated, both with the 
 returning vein and excretory duel by a con- 
 tinuation of canal. 
 
 11. WITHOUT examining the merits of 
 thefe doctrines, as applied to different glan- 
 dular bodies, we may obferve, that in the 
 liver there are fome appearances favourable 
 to the Malpighian opinion. If a fubtile in- 
 jeftion be thrown in by the vena portarum* 
 
[ 57 ] . 
 
 and the liver be afterwards cut into thin 
 dices, there will be found knotted appear- 
 ances, that bear a ftrong refemblance to 
 cells, and which, from their equality of bulk, 
 and uniformity of fhape, cannot be confi- 
 dered as the produce of extravafation. 
 
 12. THE kidney likewife, when injected 
 by the emulgent artery, rather minutely ex- 
 hibits, in its cortical part, knotted appear- 
 ances equally regular with thofe in the liver. 
 
 13. BUT here again the queftion returns 
 upon us- Do tbey, or do thsy not* confifl of of- 
 
 Jemblages ofveJftJs > or are they mere cavities ? 
 Feeling my incapacity of folving this pro- 
 blem to the fatisfadion of my readers, I muft 
 beg leave to withdraw myfelf from the con- 
 ted in the beautiful language of the Roman 
 poet : 
 " Non noftrum inter vos tantas componere litest 
 
CHAR VI, 
 
 COURSE OF THE BILE 
 
 SECT. I. 
 
 V^ONFESSING, then, our inability to deter- 
 mine the precife ftrudture and mechanifm 
 of the parts, which form the immediate feat 
 offecretion, it remains to trace the courfe 
 of the bile from the interior part of the liver 
 to the place deftined for its reception. 
 
 2. THE bile being formed, is convey- 
 ed from the feat of fecretion, by the 
 branches of the hepatic dycTr, which, at their 
 origin, are very minute, and are there called 
 fort biliarii. From thefe its pafTes into larg- 
 
[ 60 ] 
 
 cr branches, and thence gradually into the 
 trunk of the hepatic duct. 
 
 3. IT is probable that the bile is not mere- 
 ly conveyed through thefe pafTages, but that 
 it undergoes, during this courfe, a change 
 from dilution to concentration ; for the nu- 
 merous abforbents with which the liver is 
 fupplied, and which originate from its inte- 
 rior parts, make it highly probable that the 
 more aqueous particles are removed by that 
 fyftem, and carried into the circulation, 
 leaving the remaining fluid in a more con- 
 centrated ftate. 
 
 4. THE bile, having arrived at the trunk 
 of the hepatic duct, naturally pafles forwards 
 into the duodenum. But we are not to con- 
 fider its motion as uniformly progreffive, and 
 without interruption; for it is probable, 
 from the oblique manner in which the biliary 
 duel perforates the fubftance of the intefline, 
 that the perifcaltic motion of that gut, con- 
 fiding in part of the contraction of its circu- 
 
[ 6i ] 
 
 lar, and in part of that of its longitudinal 
 fibres, will, by comprefling the duct at its 
 termination, occafion frequent, but momen- 
 tary, interruptions. 
 
 5. DURING thefe periods the duct mud 
 necefTarily fuffer a degree of diftention, but 
 which is foon relieved by means of a canal 
 of communication with the gall bladder, viz. 
 the cyftic duel. So that it appears, that 
 the motion of the bile is not conftantly in 
 the fame direction, but fometimes paffing 
 from the liver to the inteftine, at others, 
 from the inteftine to the gall bladder. 
 
 6. IN moft fubjects that we examine, 
 this receptacle contains aconfiderable quan- 
 tity of bile ; on an average, an ounce may 
 be about the quantity. 
 
 7. IF this bile be compared with that of 
 the hepatic duct, it will be found thicker in 
 its confidence, of a darker colour, and more 
 pungently bitter: for here alfo, as well as in 
 the liver, there are numerous abforbents, 
 which remove the watery parts. But, it is 
 
 G 
 
[ 62 ] 
 
 probable, that the increafed vifcidity de- 
 pends in part on the mucus fecreted by the 
 gall bladder itfelf, fo that cyflic bile may be 
 confidered as a compound fluid. 
 
 8. THE gall bladder then, appears to be an 
 occafional receptacle for the bile, whenever 
 there is an impediment to its pafTage by 
 the common duel: into the inteftine; and 
 this, as a diverticulum, prevents a furcharge, 
 which would probably take place in the 
 hepatic du6t. 
 
 9. THAT this purpofe is anfwere'd, is 
 probable from what takes place, when, from 
 any caufe, the cyftic dud is obftru&ed, for, 
 in this cafe, the bile, finding no pafTage 
 into that receptacle when its courfe into 
 the duodenum is obftructed, neceflarily ac- 
 cumulates in the duftus choledochus communis 
 and^ hepaticus, and, confequently, enlarges 
 the capacity of thofe canals. 
 
 10. FOP. a proof that this is a law of Na- 
 ture, we appeal to the difiection of morbid 
 bodies where this complaint exifted ; and 
 
there is a cafe in point, related by Dr. 
 Ludwig, of Leipfic, in which the duftus 
 
 choledochus communis was dilated to more 
 
 
 
 than an inch in diameter. 
 
 11. THIS explanation of the courfe of 
 the bile to and from the gall bladder appears 
 the moft fatisfactory, and is that moft 
 ufually received ; but the eflablifhment of it 
 has met with oppoficion upon two grounds. 
 
 Firft, That the gall bladder fecretes its' 
 own bile j and, 
 
 Secondly, That the branches of the 
 hepatic duel:, while in the fubftance of the 
 liver, detach fmall canals leading imme- 
 diately into the cyft; and from which they 
 have received the compound name of hepa- 
 tico-cyftic ducts. 
 
 12. THE principal fupporter of the for- 
 mer of thefe propofitions is Allinus. He 
 was led to this from the vafcularity of the 
 gall bladder ; from its internal furface hav- 
 ing an appearance like follicles ; and from 
 
 the gall bladder having been found diftended 
 G ^ 
 
[ 64 ] 
 
 with bile, when the cyftic duel was com- 
 pletely obftruc~led by a gall (lone. 
 
 The two firft arguments are barelypre- 
 fumptive ; it will therefore be unnecefTary 
 to refute them in form. 
 
 The laft, being more fpecious, may de- 
 ferve fome confideration : we will begin 
 with admitting the faft. 
 
 13. Now it is well known that the gall 
 bladder frequently contains biliary calculi, 
 at the fame time that it is diftended with 
 bile. Suppofing, then, that one of thefe 
 concretions happens to make, its way into 
 the cyftic duel, and that the patient, being 
 of an irritable habit, dies from this, or 
 from any other caufe, and the body be ex- 
 amined under thefe circumflances - 3 in fuch a 
 cafe the gall bladder will be found diftend- 
 ed with bile, when its retrograde courfe by 
 the cyftic duel is obftrucled : but diftention 
 is from the bile previoufly contained in that 
 receptacle. 
 
 Here then is a fource of fallacy. 
 
14. BUT if it be true that the gall blad- 
 der is fometimes diftended with bile, when 
 the cyftic duct is obftructed, it is no lefs fo, 
 that it is fometimes found empty, and fome- 
 times containing a fluid, compofed princi- 
 pally of its mucus, tinged with a fmall quan- 
 tity of bile. 
 
 15. THE propofition relative to the ex- 
 iftence of the hepatico-cyftic duels needs 
 further fupport : they have been frequently 
 fought for, in vain, in man and in other 
 animals. In the ox fome have contended 
 for their exiftence. In the ferpent tribe 
 they certainly do not exift; for in thefe 
 animals, the gall bladder is detached from 
 the liver, fo that there is no poffibility of 
 communication except by the intervention 
 of the cyftic duct. In the human fubjedt 
 their exiftence may be eafily diiproved by 
 experiment. 
 
 16. IF the gall bladder be emptied of its 
 contents, and either air or water be injeft-? 
 
 c 3 
 
[ 66 ] 
 
 ed into the liver by the hepatic du6V, ^'ei- 
 ther of them will penetrate into the gall 
 bladder. Now as fluids of fo fubtile a na- 
 ture as thefe, would readily pervade thofe 
 duds if they exifted, we necefTkrily conclude 
 that the gall bladder receives its bile by the 
 cyftic duel. 
 
 17. BUT the caufes which determine the 
 retrograde courfe of the bile from the duffus 
 communis into th.e gall bladder by the duftus 
 cyfticusy are not conftant and uniform in their 
 operation ; they admit of intervals, during 
 which this motion of the bile is either en- 
 tirely fufpended, or changed for one directly 
 oppofite. Were it not fo, the gall bladder 
 would be in a conftant ftate of furcharge, 
 and of courfe become diftended to an enor- 
 mous fize, fo that a rupture of it would be 
 endangered. . 
 
 18. To guard againft this evil, a part of 
 its contents is occafionally difcharged, from 
 the preflure, which the furrounding parts 
 
are conftantly making on it. Thus, this 
 prefTure will vary fomewhat in its force from 
 the relative degrees of dtftention of the fto- 
 mach from food : and when the ftomach is 
 diftended, there is the moft copious flow of 
 bile into the duodenum. 
 
 19. By this mode of difcharging the con- 
 tents, the gall bladder is confidered as apaf- 
 five receptacle. But, this idea has been 
 controverted; at leaft it has not always been 
 admitted in the extent here flated. Argu- 
 ments, founded on analogy, have been ad- 
 duced to prove that it pofiefTes fome active 
 power on its own contents ; and that though 
 affifted by the prefTure of adjacent parts, as 
 acted upon by the diaphragm and abdominal 
 mufcles, yet that there is inherent in it a pow- 
 er, by which it co-operates with thofe agents^ 
 and relieves itfelf from any accumulation. 
 
 2t>. THE analogy here alluded to, is the 
 urinary bladder, which, by its own mufcu- 
 lar power, is able to evacuate its contents. 
 
 21. DILIGENT fearch has been made by 
 
[ 68 ] 
 
 anatomifts to difcover mufcular fibres in the 
 gall bladder, and fuch a ftrudture has been 
 defcribed, but their precife dire&ion is not 
 yet agreed upon. This difference of opinion, 
 though it does not difprove their exiftence, 
 yet it weakens the probability of it ; for, an 
 appearance fo equivocally and indiftinctly 
 marked, as to admit of a diverfity of defcrip- 
 tion, divides the mind too much to admit 
 of its receiving any of them. 
 
 22. THIS difficulty has induced anato- 
 mifts to adopt another criterion of mufcula- 
 rity, viz. irritability; and, with a view, 
 either to eftablifh or to difprove its prefence, 
 experiments have been inftituted. Various 
 Simulating powers, both chymical and me- 
 chanical, have been applied to the gall blad- 
 der, without producing any evident con- 
 traction. Mechanical Stimuli, indeed, pro- 
 duce no effect; and, when any contraction 
 has followed the ufe of chymical application, 
 it has been confined to fuch as afted by a 
 
[ 69 ] 
 
 corroding quality, and where the apparent 
 contraction has been nothing more than the 
 corrugation which may be induced on in- 
 animate animal matter. Upon this fubject 
 the experiments of Baron Haller appear to 
 be fufficient and decifive. 
 
 23. HAVING explained the powers by 
 which the bile is conveyed from the liver 
 and the gall bladder into the duodenum, we 
 are naturally led to contemplate the means 
 by which its return from the duodenum is 
 prevented. 
 
 24. THE contrivance is fimple and effec- 
 tual. It confitls of nothing more than the 
 oblique manner, in which the common bili- 
 ary duct pafTes through the coats of the intef- 
 tine, from the external to the internal fur- 
 face, and by which the office of a valve is 
 performed -, fo that while the bile has a free 
 paflage from without inward, the orifice of 
 the duct collapfes when a contrary direction 
 is attempted. 
 
25- THE caufes which impede the flow 
 of bile into the duodenum are generally very 
 tranfient in their operation, under which 
 flate, there is only a moderate furcharge of 
 the duels, and no material inconvenience en- 
 fues. But it happens, not unfrequently, 
 that the obftrudlion is of a permanent nature, 
 in which cafe the bile is necefTarily detained 
 in thefe parts for a time, after which, it finds 
 its way into the mafs of blood, where, by 
 being circulated through every part of the 
 body, it gives yellownefs to the fkin, and 
 producesjaundice. 
 
 26. THE caufes which occafion this ob- 
 flruction are various. A very common one 
 is the prefence of a gall ftone either in the 
 hepatic or common dud ; perhaps the lat- 
 ter is more general, as biliary calculi form 
 more frequently in the gall bladder, where 
 the bile is in a ftate of quiefcence, than in 
 the branches of the hepatic duel, where it is 
 in motion, 
 
[ 7' ] 
 
 27 SOMETIMES a flriftureof the common 
 duct is an obilrudling caufe ; fuch as have 
 been difcovered after death, are ufually of 
 that permanent kind connefted with a dif- 
 eafed condition of that part, a. removal of 
 which can fcarcely be hoped for. 
 
 28. BUT a caufe of jaundice has been re- 
 ferred to a fpafmodic flrifture of this duel, 
 and which, as not being connected with a 
 change of organization, may attack by par- 
 oxyfms, returning at indeterminate periods. 
 
 29. WITHOUT examining into the fymp- 
 toms which have been fuppofed to character- 
 ife this caufe ; it may poflibly be thought 
 a fufficient refutation to prove, that the 
 biliary duels of a living animal poflefs no 
 marks of irritability when afted upon by 
 ftimuli ; the contrary of which we fhould 
 
 expect were they furnifhed with mufcular 
 fibres. 
 
 The only part of the common duct liable 
 to fpafmodic affection is that which pafles 
 
[ 72 ] 
 
 through the coats of the duodenum, which 
 may be acled upon by the mufcular fibres 
 of that inteftine ; and here we fhonld dif- 
 tinguifti between the contraction of the in- 
 teftine in which the biliary duel is pailive, 
 and a contraclion of the duel itfelf. 
 
 30. ANOTHER caufe of obftrucled bile 
 confids in a prefiure of the duel by the 
 head of the pancreas, which is fometimes 
 found in a fchirrous (late, and which, from 
 its connection, may eafily produce fuch an 
 -effecl : for the biliary duel, a little before 
 it terminates in the intefline, penetrates 
 fome way into the fubftance of the pan- 
 creas, and receives the excretory duel of 
 that gland. Therefore the orifice which 
 appears on the inner furface of the duode- 
 num tranfmits, in common, the bile and 
 pancreatic fluid. 
 
 31. To thecaufes of obftruclion already 
 enumerated, there is another fometimes 
 annexed ; viz. a fchirrous impacled ftate of 
 the liver, which from a very extenfive depo- 
 
E 73 3 
 
 fit of folid matter throughout its fubftance, 
 in an interftitial form, diminifhes the capa- 
 cities of the for i biliarii y fo that they are 
 unable to carry off the bile as fad as fe- 
 creted, and an accumulation of it within 
 the fubftanceof the liver muft therefore ne- 
 ceflarily enfue. 
 
 32. HITHERTO the caufe of jaundice has 
 been referred to obftru&ion in fome part or 
 other of the biliary duels. But there are 
 fome cafes which incline us to believe that 
 jaundice may exift, though the biliary ca- 
 nals are pervious and free. The yellow fe- 
 ver of the Weft Indies furnifhes an inftance 
 in point. The charadters of this complaint 
 are a diffufion of bile through the mafs of 
 blood, producing jaundice, with an exceflive 
 quantity of it in the alimentary canal, fo 
 that- it is difcharged by vomiting and purg- 
 ing. In this cafe jaundice feems to depend 
 upon a redundant fecretion. 
 
 33. BUT Boerhaave and Morgagni have 
 
 H 
 
[ 74 ] 
 
 favoured an opinion the direct reverfe of 
 this. They confider jaundice, fometimes, 
 as the effect of a fufpended fecretion, and 
 fuppofe that the blood, in confequence of 
 this, retains a bilious character, thereby 
 giving ayellownefs to the Ikin. 
 
 34. THIS opinion is founded on a miftak- 
 cn notion, that all the iecreted fluids pre- 
 exift in the mafs of blood ; and that the 
 province of the different glands is confined 
 to the more mechanical feparation of thofe 
 fluids. 
 
 35. As there are few, if any, phyfio- 
 logifts, of the prefent day, who entertain 
 fuch an opinion of glandular fecretion, to 
 offer any thing of an argumentative nature, 
 by way of refutation, would be altogether 
 fuperfluous. It is now generally underflood 
 and believed, that the blood is the fabulum 
 or fource of all the fecretions, and that the 
 glands through which it circulates, change 
 its properties, every one according to its 
 
[ 75 ] 
 
 peculiar mode of action j fo that the fecre- 
 tions may be confidered as new fluids formed 
 by their refpective glands. 
 
 36. IF this idea of fecretion be true, it 
 muft necelTarily follow, that, if the aftion 
 of the whole fecreting fyftem of the liver 
 be arrefted, no bile can be formed, and 
 confequently none can be conveyed into 
 the mafs of blood. To argue otherwifc 
 would be to oppofe every principle of rea- 
 foning ; it would be imputing effects to a 
 caufe which has no exiftence. 
 
 37. IN every cafe of jaundice bile muft 
 be fecreted and carried into the blood vef- 
 fels ; but the channel by which it is convey- 
 ed has given rife to controverfy. 
 
 38. THERE are on this fubject two opini- 
 ons which divide phyfiologifts ; fome of 
 whom affert, that the bile after fecretion is 
 carried to the blood veiTels by regurgitation > 
 whilft others attribute this effect to ab- 
 forption. 
 
 H 2 
 
[ 76 ] 
 
 The firfl opinion has moft generally pre- 
 vailed. 
 
 39. BARON HALLER, who introduced 
 this to our notice, refts his opinion on the 
 free communication of veiTels in the inte- 
 rior part of the liver; but more efpecially 
 on a communication between the hepatic 
 veins and biliary duels. The proof of this 
 communication is fair and decifive. 
 
 40. HE obferves that a fubtile injection 
 thrown in by the hepatic duel will efcape 
 readily by the hepatic veins. This is a fact > 
 and I know from experiment that water in- 
 jected in the fame direction will return by 
 the veins in a full ftream, though very little 
 force is ufed. From the facility with which 
 water takes this retrograde courfe, a proba- 
 bility arifes, that, if from any caufe the na- 
 tural direction of the bile be obftructed, it 
 will naturally obey the fame direction. 
 
 This explanation of jaundice feemed ful- 
 ly fufficient tofatisfy the mind of Baron Hatter. 
 
f 77 ] 
 
 41. BUT a more extend ve acquaintance 
 with the ceconomy of the abforbent fyftem 
 has given a new turn to this fpeculation, 
 and has induced a phyfiologift of the pre- 
 fent day, to folve the caufe of jaundice on 
 the principle of abforption only. This 
 opinion reits on an experiment where the 
 hepatic duct of a living animal was tied, and 
 afterwards the abforbents of the liver were 
 very much loaded with bile. 
 
 42. THIS fact certainly proves that the 
 abforbents have the power of taking up 
 bile; a circumftance which I apprehend 
 would be generally admitted, though it had* 
 not received the confirmation of experiment. 
 But it does not invalidate the probability of 
 a part paffing into the blood veflfels by the 
 hepatic veins 3 the circumftances 'and facts 
 upon which that opinion refts, retain all 
 their original force, and ftand unaffected by 
 this experiment. 
 
 43. THE queftion then feems to be, \vhe- 
 
 H3 
 
[ 78 3 
 
 therm cafes of jaundice the bilepafies into 
 the blood veflels by regurgitation, by ab- 
 forption, or by both channels ? 
 
 44. THAT the abforbents take up the bile 
 from the interior part of the liver, and 
 convey it by the thoracic duel into the mafs 
 of blood, the following experiment will 
 evince. 
 
 EXPERIMENT. 
 
 45. AN incifion was made into the abdo- 
 men of a living dog, large enough to allow 
 a ligature to be made on, the hepatic dut; 
 this being done, the parietes of the abdomen 
 were brought together by futures. Two 
 hours after, the dog was Strangled, and 
 the parts carefully examined. On infpeftion 
 it appeared that the abforbents had been 
 very active, for they were very much diften- 
 
[ 79 1 
 
 ded with a fluid of a bilious colour, and 
 their courfe, which was very confpicuous, 
 could be traced with the greateft eafe to the 
 thoracic duel, the contents of which feemed 
 only moderately bilious. The bilious co- 
 lour was in a great meafure concealed by 
 the red particles of blood, which had been 
 extravafated by the injury, taken up by the 
 abforbents, and conveyed into that canal. 
 It is probable, however, that the bile was 
 only juft entering the blood veflels, as on 
 a very careful infpection of the eye, the tu- 
 nica conjunctiva did not betray the flighted 
 appearance of jaundice, 
 
 4^. IT feems then that during the ipacc 
 of two hours, the fccretion of the liver 
 had been fufiicient in quantity to diftend 
 its ducts ; to flimulate the abforbents to 
 relieve that diftention ; and to allow of a 
 final 1 portion of their contents to be con- 
 veyed into the blood veflels. 
 
 47, BUT it Hill remains to determine, 
 
[ 8o ] 
 
 whether or not a fmall quantity of bile wa* 
 not regurgitating by the hepatic veins dur- 
 ing the procefs. 
 
 48. To afcertain this, a fecond dog was 
 procured, and a ligature made on the he- 
 patic duel as in the preceding experi- 
 ment. Two hours after, blood was taken 
 from the jugular vein, and fet to reft, in 
 oider that it might feparate into its/erum and 
 crajjamentum. The liver was then drawn 
 down a little from the diaphragm, and blood 
 taken from one of the hepatic veins. This 
 blood, as well as the former, was allowed 
 to feparate into parts : and on immerfmg 
 pieces of white paper into the ferum of 
 each, that taken from the hepatic veins 
 gave the deepefl tinge, the other produced 
 only a very (light degree of difcoloration. 
 
 49. IN this experiment the period of ex- 
 amination was the fame as the la ft, viz. 
 two hours; a fpace of time jufl fufficient 
 for the bile to begin to make its way into 
 
the circulation without having poured In 
 fuch a quantity as to tinge in any fenfible 
 degree the general mafs of blood. Hence 
 we fee evidently why the blood which was 
 returning from the liver by the hepatic 
 veins, contained a larger proportion of bile 
 than that taken from the general circulation. 
 50. As the firft of thefe experiments 
 proves, that the abforbents of the liver are 
 concerned in the production of jaundice, fo 
 the laft demonftrates with equal force, that 
 when from the operation of any obftrucling 
 caufe the bile is accumulated in its duels, 
 fo as to diftend them in a confiderable degree, 
 Nature relieves herfelf, in part, by allowing 
 a portion of it to take a retrograde courfe by 
 the hepatic veins. 
 
83 
 
 CHAP. VII. 
 
 BILE. 
 
 SECT. I. 
 
 JL K i s fluid, upon bare infpection, is ap- 
 parently homogeneous ; of a green colour, 
 in which a yellow fhade is very confpicuous 
 when the bile is diluted with a watery fluid ; 
 but if examined in its moreconcentrated (late, 
 is of a deep green. Hence it is that the 
 dilution of this fluid by the more watery 
 parts of the blood gives the yellownefs of 
 jaundice. 
 
[ 84 ] 
 
 2. THE confidence of bile is ufually 
 vifcid, and its tenacity is fometimes fuch, 
 that it cannot be poured from a phial in 
 drops, but is drawn out into threads like 
 the albumen. It is obferved to be more 
 vifcid in the human fubject than in brute 
 animals. 
 
 3. BUT a queftion may here arife, how 
 far this tenacity is eflential to the bile, or 
 whether it may not be explained on the prin- 
 ciple of its being a compound fluid, con- 
 fitting in part of genuine bile, with a por- 
 tion of that mucus which is fecreted by the 
 gall bladder > for it is the bile contained in 
 this receptacle, which is ufually the fubject 
 of chymical experiment. 
 
 4. WHEN bile is agitated in a phial, it 
 forms a lather in the form of foap and wa- 
 ter ; and that it really pofTefles faponaceous 
 properties is rendered highly probable from 
 the ufe to which it is applied by fcourers ot 
 
cloth ; it being known to afiifl very power- 
 fully in the removal of greafy fpots. 
 
 5. To thefe fenfible properties we may 
 add its tafte and fmell ; the firft being in- 
 tenfely bitter, with a degree of pungency 5 
 the laft of a faint and naufeous nature. 
 
 6. FROM this ailemblage of properties, we 
 naturally prefume, that bileisafaponaceous 
 fluid combined with a mucilaginous fub- 
 Itance, from which it receives its tenacity; 
 and to thefe are fuperadded the green colour- 
 ing matter and the principle of bitternefs. 
 
 7. IT is* therefore the province of chy- 
 miftry to determine, by careful and accurate 
 inveftigation, in what degree thefe conjec- 
 tures concerning the nature of that fluid^can 
 be confirmed by experiment. 
 
 8. IN the firft dawnings of chymicai 
 knowledge, when our acquaintance with 
 the agents of chymiftry, and their effects 
 on matter, was narrow and confined, the 
 means ufually employed to afcertain the 
 
[ 86 ] 
 
 component parts of bodies, were feldom any 
 other than thofe of fubjecting them to dif- 
 dilation by different degrees of heat, from 
 the lefs violent to the more intenfe. Hav- 
 ing exerted the whole power of the furnace 
 in this way, the inquirers thought themfelves 
 in pofieflion of a very perfect analyfis of 
 every body, which they thus fubmitted to 
 invefligation. 
 
 BUT reflection and an extended ftate of 
 knowledge foon convinced them how re- 
 mote they were from a thorough acquaint- 
 ance with the conftituent parts of bodies ; 
 and their unfuccefsful attempts to reproduce 
 the original fubftance, by a recombination 
 of fuch of its elements, as they, in this way, 
 were able to collect, foon convinced them, 
 that another, and lefs fallible, mode of pro- 
 fecuting thefe inquiries was very much to 
 be wifhed. 
 
 10. BESIDES, they were not acquainted 
 with the nature of the agent they employed, 
 
dther abftractedly, or in a flate of combi- 
 nation with matter ; therefore the changes 
 thus induced could be but imperfectly un- 
 derftood. 
 
 11. To guard againft this difficulty, ano- 
 ther, and more natural, mode of inveftigat- 
 ing bodies was introduced, viz. the forming 
 of different compounds by the addition of 
 certain chymical re-agents -, and in this way 
 it was found that a more correct analyfis 
 could be obtained. Thus the torturing of 
 bodies by the application of beat neceflarily 
 yielded to the more natural examination by 
 chymical attractions. 
 
 12. IT is by no means intended here to 
 profcribe altogether the agency of beat, it 
 being often found eflentially ufeful, as an 
 auxiliary, to the chymical bodies employed, 
 enabling them the better to effect their dif- 
 ferent decompofitions and combinations. 
 
 13. AQJJANTITY of recent ox bile being 
 procured, feveral experiments were inftitut- 
 
[ 88 ] 
 
 ed, with a view to afcertain its component 
 parts. 
 
 EXPERIMENT I. 
 
 14. A PORTION of it, being received into 
 a (hallow earthen veflel, was evaporated cau- 
 tioufly by a moderate heat. On examining 
 the vapour, it appeared to be principally 
 water pofTefTing neither acid nor alkaline 
 properties, but ftrongly impregnated with 
 that principle, in which the peculiar odour 
 of bile chiefly refides. The refiduum gradu- 
 ally infpiffates and affumes the form of an 
 extract > which, if the evaporation be carried 
 fufficiently far, will become as brittle as 
 refin, and may be pulverized with equal 
 eafe. 
 
 15. FROM this experiment we learn that 
 the fluidity of bile depends chiefly on aqueous 
 
matter, and that in the exhalation of it, even 
 by the more moderate degrees of heat, it is 
 accompanied by the odorous principle, 
 which, it feems, is of a very volatile nature. 
 1 6. As bile poflefles a confiderable degree 
 of tenacity, and as the tenacity of animal 
 fluids depends chiefly on a mucilaginous 
 principle, it was determined next to afcer- 
 tain whether that principle gives vifcidity to 
 the bile. 
 
 EXPERIMENT II, 
 
 17. ON a portion of bile was poured a 
 quantity of alcohol ; a coagulum was imme- 
 diately formed, which -floated in a green 
 liquor. On filtering this compound the 
 green fluid readily pafled, while a mucila- 
 ginous fubftance of confiderable tenacity was 
 detained by the paper. This mucilage was 
 1 3 
 
[ 90 ] 
 
 of a whitifh colour, and pofTefled only a 
 flight degree of bitternefs, while the filtrat- 
 ed liquor preferved both the bilious co- 
 lour and tafte. It is fcarcely necefTary to 
 add, that it was free from vifcidixy. The 
 GLUTINOUS principle of the bile appears 
 then to refide in an animal mucilage. 
 
 1 8. THE fluidity, odour, and vifcidity of 
 bile being thus accounted for, we are next 
 led to the inveftigation of the principles on 
 which its bitternefs, colour, and fapona- 
 ceous quality, depend. 
 
 EXPERIMENT III. 
 
 19. To a quantity of recent bile was add- 
 ed a diluted marine acid; a coagulation was 
 produced. The fluid feparated by the filter 
 was of a green colour, but much lighter 
 than that of bile; and, notwithitanding the 
 
predominance of the acid, the bitter taflc 
 was very diftinguifhable. 
 
 20. THE more folid matter detained by 
 the filter was very glutinous, of a green 
 colour, and intenfely bitter. 
 
 
 EXPERIMENT IV. 
 
 21. Two other portions of bile were put 
 into proper veflels ; to one was added a di- 
 luted vitriolic, to the other a diluted nitrous 
 acid. Both exhibited phenomena fimilar to 
 thofe in the laft experiment. The filtrat- 
 ed liquors were green, and bitterifh j the 
 coagula intenfely fo, and glutinous. 
 
 22. As, in thefe experiments, the de- 
 compofition appeared to be incomplete, it 
 was thought eligible to try, whether or not 
 a more perfect feparation might be obtained 
 by the aflutance of heat, 
 
C 9* 1 
 
 EXPERIMENT V. 
 
 23. A QUANTITY of bile and diluted 
 marine acid were put into a flafk, and pla- 
 ced in a fand bach until they had acquired 
 the boiling heat. On infpedtion, the fepa- 
 ration into parts was very evident -, and on 
 committing it to the filter, it feparated a 
 colourlefs fluid deftitute of every bilious 
 property. The refiduum confided of a very 
 dark green mafs, intenfely bitter, and ex- 
 tremely glutinous. When examined, it ap- 
 peared to be compofed of an animal muci- 
 lage, in combination with a refinous fub- 
 ftance. 
 
 24. BUT to afcertain in what way the 
 acid had effefted the decompofidon, it be- 
 came necefTary to examine the filtrated li- 
 quor. It was therefore iiibjecled to a cau- 
 
[ 93 ] 
 
 tious evaporation, and, at a proper period, 
 was fuffcred to cool. 
 
 25. UNDER cooling, cryftals were form- 
 ed of a cubic figure, which decrepitated 
 by heat, and pofiefTed all the characters of 
 common fait. 
 
 Therefore the decbmpbfition was here 
 occafioned by the marine acid engaging the 
 mineral alkali, which it feparated from the 
 other element of the faponaceous body, 
 and, by uniting with that bafis> formed com- 
 mon fait. 
 
 26. BUT, notwithflanding we are able 
 to account for the production of common 
 fait in this way, it does not exclude the 
 poflibility of a- fmall quantity of it pre- 
 exifting in the bile, independent on this ar- 
 tificial coaibination of its elements. . 
 
 27. To fatisfy my doubts on this point, 
 the following experiment was made. 
 
[ 94 ] 
 
 EXPERIMENT VI. 
 
 28. To a portion of bile was added 
 alcohol, in quantity fufHcient to fetloofe all 
 its mucilaginous matter. The fluid part, 
 being feparated by a* filter, was examined 
 by nitrated filver, but no luna cornea was 
 
 produced : therefore the marine acid (the 
 
 ^ 
 
 acid principle of common fait) does not 
 appear to have any exiftence in the bile. 
 
 19. FROM this experiment we learn, that 
 the faline bafis of the faponaceous matter 
 of the bile is the mineral alkalis but the 
 other element isflill a queftion. 
 
 EXPERIMENT VII. 
 
 30. To determine this point a quantity 
 of bile was decompofed by a diluted marine 
 
I 95 I 
 
 acid, aflifted by heat (as in Experiment V.) 
 The coagulum detained by the filter was ex- 
 amined. It appeared to poflefs moft of the 
 charadters of bile in a folid concentrated 
 flate. It had a pungent bitter tafte, dark 
 green colour, and was extremely glutinous. 
 When perfectly dry, it was very inflamma- 
 ble, and burned with as much rapidity as 
 any bituminous fubftance would do. 
 
 31. THIS appearance led to a fufpicion of 
 the prefence of a refin, but as a higher de- 
 gree of certainty was ftill wilhed for, further 
 experiment was necefTary. 
 
 
 EXPERIMENT VIII. 
 
 32. I THEREFORE diffufed a portion of 
 this refiduum through rectified fpirit of wine : 
 a large proportion of it was diflblved, 
 
C 96 ] 
 
 which imparted to the fpirit both the 
 colour and tafle of bile; the infoluble 
 part being chiefly of a mucilaginous na- 
 ture. 
 
 33. FROM the facility with which alcohol 
 difTolves the green and bitter part, it is 
 fcarcely probable, that it partook of the 
 nature of an un&uous oil ; but that it was 
 either a refinous body, or a kind of efTential 
 oil. 
 
 34. THIS point was eafily determined : 
 for, "on the addition of water to the folu- 
 tion, a precipitation took place. The 
 filtered liquor was colourlefs and free from 
 bitternefs. The refiduum was nothing more 
 than a refinous fubftance, in which refided 
 both the colouring principle and bitter tafle. 
 
 35. ON taking a retrofpec~l of the above 
 experiments, the bile appears to be refolv- 
 able into the following elements, viz. 
 
 Firft, Water, impregnated with the 
 
 odorous principle. 
 
C 97 1 
 
 Secondly, A mucilaginous fubflancc 
 
 refembling the albumen. 
 
 Thirdly, -A refinous fubftance contain- 
 ing the colouring principle and bitter tafte. 
 And 
 
 Fourthly, The mild mineral alkali. 
 
 36. WITH refpect to their combination-, 
 it feems that the faponaceous matter confifts 
 of the bitter refin in union with the alkali : 
 this admits of a ready union with a mucilage,, 
 and with this again the aqueous matter very 
 cafily combines, fo that the whole forms a 
 mafs apparently homogeneous. 
 
 37. THE following experiments were in- 
 ftituted with a view of examining fome 
 doctrines, founded on the bile having a 
 greater power of refilling putrefaction than 
 the blood. 
 
 
EXPERIMENTS IX &f X. 
 
 38. E(*yAL quantities of blood and bile 
 of the fame ox were each put into a dif- 
 ferent veiTel of the fame fize, and expofed 
 to the fame degree of heat. On the third 
 day. the blood began to give out by its 
 odour, marks of putrefaction ; the bile 
 remained in its natural ftate. On the fourth 
 day the bile had a pungent odour by no 
 means ungrateful, while the blood was 
 extremely putrid. On the fixth day the 
 bile became putrid, and had a very offen- 
 live fmell. 
 
[ 99 j 
 
 CHAP. VIII. 
 
 ON BILIARY CALCULI. 
 
 SECT. I. 
 
 favoured by Dr. Baillie with an 
 opportunity of examining the ftructure, and 
 general appearance of biliary calculi^ in his 
 collection I found that they are very gene- 
 rally either of a lamellated or radiated ftruc- 
 ture : on the outer furface chiefly of the 
 former ; on the inner of the latter. The 
 colour is extremely various : in fome they 
 are of a light colour, approaching to a 
 
 K 2 
 
.0 ] 
 
 white ; in others as black as jet ; in many 
 of a brown or ochry appearance : thefe laft 
 have generally a very bitter tafte ; the radi- 
 ated part is frequently white, and without 
 tafte. 
 
 2. THEY are, very generally, inflamma- 
 ble, and fufible in the fire -, and, for the 
 moil part, they are foluble in fpirit of wine, 
 and oil of turpentine. There are fome, 
 however, which are not foluble in either of 
 thefe fluids. Many of them have the con-* 
 fiftence of phosphorus, and cut like wax. 
 
 3. IN the radiated calculi there is a fub- 
 ftance, in every refped, like Spermaceti. 
 Some calculi^ inflead of burning with a 
 flame, only become red, and confume to an 
 afh, like a cinder. 
 
 4. THIS variety in the appearance of 
 calculi clearly evinces that they are not 
 mere infpifTations of bile, but that there 
 is a difference either in the component 
 
parts themfelves, or in the proportion of 
 thofe parrs. 
 
 5. THEREFORE, in chymical inveftigati- 
 on, itfeems neccffary that experiments ftiould 
 be made on different fpecimens, as it is 
 probable, even a priori, that the refult of 
 experiments made on one fpecimen, will 
 not apply, very ftri&ly, to a feries of inqui- 
 ries made on another. 
 
 6. As we prefume, from bare infpeclion, 
 that thefe calculi are not mere infpiffations 
 of bile, but that they contain principles 
 which are not to be found in that fluid, it 
 affords a fubject of rational inquiry, to de- 
 termine what are thofe elements, and of 
 what nature is their combination. 
 
 7. To afcertain this, feveral experiments 
 were inftituted on a calculus of the follow- 
 ing characters. 
 
 The external furface was of a chocolate 
 colour j when rubbed off, it had a lighter 
 coloured layer underneath. 
 * 3 
 
On making a fection through its centre^ 
 it appeared to be compofed of lamellae. 
 
 It was rubbed to powder very eafily. 
 
 Its tafte was moderately bitter. 
 
 It was fufible by heat, and when inflamed^ 
 burned like a refinous fubftance. 
 
 Ol. terebinth, unaided by heat, diflblved 
 a very large portion ; but alcohol, under 
 the fame circumftances, diflblved only a 
 fmall part. 
 
 8. To determine how far the agency of 
 heat could affift the folvent power of alco- 
 hol, an experiment was made. 
 
 EXPERIMENT. 
 
 TWENTY grains of this calculus were 
 infilled in an ounce of alcohol, and, after 
 previous agitation, the phial was placed in 
 a fand bath. Before the fluid had arrived 
 
[ I0 3 I 
 
 at the boiling point, it diflblved nearly the 
 whole of the fubftance. The clear liquor, 
 being poured from the refiduum, was 
 fuffered to cool. Under cooling, the whole 
 afTumed the appearance of a foiid chryftal- 
 lized mafs. 
 
 EXPERIMENT. 
 
 9. A SMALL quantity of alcohol being 
 poured on this refiduum, and aflifted by 
 heat as before, exhibited very little folvent 
 power. Thefe experiments fhow that there 
 is a fmall proportion of this biliary calculus 
 which refills the folvent power of alcohol. 
 What is its nature ? 
 
 EXPERIMENT. 
 
 10. To this refiduum was added a quan- 
 tity of diluted marine acid, A fufficient 
 
104 
 
 time having elapfed, the fluid was commit- 
 ed to the filter. To the clear liquor was 
 added a portion of the aq. kali, and a white 
 precipitation, apparently of an earthy na- 
 ture, immediately took place.* 
 
 Hence one point in which a biliary cal- 
 culus differs from fluid bile is, in contain- 
 ing a quantity of earthy matter. 
 
 ii. THE cryflallized mafs formed by the 
 alcohol was next fubjected to examination. 
 Some of the phenomena already related 
 having led to a fufpicion, that a refinous 
 matter forms one of the conftituent parts of 
 biliary calculi, the proof of it was referved 
 for the following experiment. 
 
 EXPERIMENT. 
 
 12. THE thryftallized mafs, being made 
 
 * I fufpeft it to be of an earthy nature, not 
 only from its folubility in an acid> but from its 
 pofTeiling no inflammability. 
 
[ < 5 I 
 
 fluid by heat, was poured into a pint of wa- 
 ter -, a white flocculated precipitate was im- 
 mediately formed, leaving an opaque fuper- 
 natant liquor. The whole was committed 
 to the filter, and the folid part being col- 
 ledled and dried, was found to be of* a refi- 
 nous nature. 
 
 EXPERIMENT. 
 
 13. To the clear filtered liquor was added 
 a fmall quantity of diluted marine acid, 
 from a fufpicion that an alkaline principle 
 might form one of the conftituent parts of a 
 gall (lone, as well as of the bile, and by that 
 means a fmall portion of the refinous fub- 
 ftance might ftill be held in folution ; but 
 no precipitation followed. This experiment 
 makes the prefence of an alkali fomewhat 
 equivocal ; but the following proved its ex- 
 iftence very fatisfactorily. 
 
[ 106 ] 
 
 EXPERIMENT. 
 
 14. THE fluid mixture of the laft experi- 
 ment was carefully evaporated almoft to 
 drynefs. On cooling, two kinds of cryf- 
 tals formed ; one fpiculated, the other cubic. 
 The cubes, poflefling the characters of com- 
 mon fait, proved the prefence of the mineral 
 alkali : and the fpiculated cryftals, which 
 were the common crude fal ammoniac, af- 
 forded prefumptive evidence in favour of 
 the volatile alkali. But what placed the 
 matter beyond doubt was the following ex- 
 periment. 
 
 EXPERIMENT. 
 
 15. A DROP or two of aq. kali was added 
 to thefe cryftals, and the volatile alkali be- 
 came immediately fenfible. 
 
E 107 ] 
 
 1 6. FROM thefe experiments we infer, 
 that this fpecimen of biliary calculus con- 
 fided chiefly of a refmous matter, with a 
 fmall proportion of earth, apparently calca- 
 reous, combined with the mineral and vola- 
 tile alkali. 
 
I 109 ] 
 
 C HAP. IX. 
 
 OF THE USE OF THE BILE. 
 
 SECT. I. 
 
 G 
 
 E E N and bitter bile being in common 
 to all animals with red blood, and found 
 only in fuch, makes it probable that there is 
 forne relative connexion between this fluid 
 and the colouring matter of the blood, by 
 the red particles contributing more efpec: al- 
 ly to its formation. An opinion very gene- 
 rally prevails, that the bile affifts in the pro- 
 cefs of chylification, by mixing with the 
 L 
 
[ 110 ] 
 
 digefted food contained in. the duodenum: 
 for it is demonftrably true, that the digefted 
 matter does not aflume a chylous form un- 
 til it has patied below that part of the in- 
 teftine where the biliary and pancreatic 
 duels make their entrance. And upon the 
 ground of this fact, it has been prefumed, 
 rather than demonftrated, that either all, 
 or fome of the conftituent parts of the bile 
 contribute to chylification. What founda- 
 tion exiils for fuch an opinion, the following 
 experiment will tend to fhow. 
 
 EXPERIMENT. 
 
 2. A DOG was fed with animal food, and 
 in three hours the abdomen was opened. A 
 portion of the duodenum, and jejunum of 
 confiderable length, was cut open, fo that 
 
[ III ] 
 
 the contents might be obferved. Portions 
 of food, reduced to a pultaceous mafs, were 
 feen oozing through the pylorus ; the bile 
 was likewife obferved to pafs (lowly out of 
 its dud, which, when carefully attended 
 to, appeared to flow over the furface of the 
 digefted matter adhering to the interline. 
 Upon removing the bile from the furface of 
 this digefted matter, it did not appear to have 
 mixed with it in any fenfible degree. 
 
 3. HENCE it feems fomewhat doubtful, 
 whether the bile really forms one of the 
 conftituent parts of the chyle, as has been 
 imagined, or not. If, however, all, or 
 any of the elements of bile do contribute to 
 chylification, no traces of their prefencc 
 can be difcovered from the fenftble proper- 
 ties of the chyle. 
 
 4. ANOTHER difficulty in admitting this 
 as one ufe of the bile, is from the circum- 
 flances of jaundice. In *this complaint, 
 the pafifage of that fluid into the inteftine 
 
 I 2 
 
[ 112 ] 
 
 is cither completely obflructed, or very 
 much impeded -, but there are no fymptoms 
 which clearly manifeft a defect of chylifi- 
 cation. 
 
 5. ONE important ufe of the bile is, un- 
 queftionably, that of ftimulating the intef- 
 tine, and performing the office of a purga- 
 tive -, for when the excretion is impeded, as 
 in the jaundice, the inteftines, being de- 
 prived of their natural ftimulus, become 
 torpid, and coftivenefs enfues. This torpor 
 is diffufed by fympathy over every part of 
 the fyftem, and languor and laffitude pre- 
 vail. 
 
 6. IT is probable, therefore, that even 
 admitting the bile to contribute fomewhat 
 to the digeftion and affimilation of our 
 food -, its principal office is that of a natu- 
 ral and habitual ftimiilus to the inteftines, 
 keeping up their energy and periftaltic mo- 
 tion, which may be affected either by an 
 
[ "3 1 
 
 increafe of its quantity, or a change in its 
 quality, produced by difeafe. 
 
 When we take, however, a view of the 
 conflituent parts of bile, as clearly afcer- 
 tained by the foregoing chymical experi- 
 ments, it feems very probable, that from 
 its refmous bitter, it may counteract any 
 active and fpontaneous changes to which 
 animal and vegetable matter would other- 
 wife be fubjectj and that as the propenfity 
 to acidity in our vegetable aliment is ex- 
 tremely obvious, the alkaline matter of 
 bile tends to correct it. Bilelikewife, from 
 its faponaceous and foluble quality, lefTens 
 the adhefive nature of our foeces, and, by 
 fmoothing their furface, promotes their eva- 
 cuation. In cafes of defective fecretion 
 the fceces are hard, knotty, and irregularly 
 fixed. One important part of digeftion is 
 ultimately perfected in the upper end of 
 the duodenum $ and as perfect digeilion is 
 always oppofed to fermentable changes, 
 "i 3 
 
[ "4 ] 
 
 the bile is well calculated to finifh that pro- 
 cefs. We probably may err in confining 
 the ufe of bile, therefore, to any fingle 
 operation, while from its nature it feems 
 fo well qualified to anfwer a variety of ufe- 
 ful purpofes in the animal ceconomy. We 
 fhall afterwards obferve, that where it is de- 
 fective it may be imitated by artificial 
 means with advantage ; and in no inftance 
 has the application of chymiftry to the cure 
 of difeafes appeared more fuccefsful than in 
 fuggefling the ufe of proper remedies in 
 cafes of difeafed and defective bile. 
 
 It frequently occurs that bile is fecreted 
 in too fmall a quantity, as in hypochon- 
 driacal complaints, and chlorofis -, in which 
 difeafes an unufual degree of torpor takes 
 place, exprefled in the one cafe by dejection 
 and defpair ; in the other by inactivity and 
 languor ; the ftools are generally of a light 
 clay colour, and the body is coflive. 
 Bile therefore affords & ftimulus by which 
 
[ "5 ]- 
 
 tone and energy are communicated from the 
 inteftines to the whole body, the defect of 
 which on the primse vias is more productive 
 of difeafe than its excefs. In the latter 
 cafe/ if it be healthy in its nature, it only 
 proves a falutary purgative, but if in a dif- 
 eafed ftate, it deranges the animal oecono- 
 my like any other foreign flimulus which 
 may be applied to the inteftines. It like- 
 wife, from its bitternefs, poffefles antifeptic 
 powers, which are peculiarly ufeful in the 
 inteftinal canal, 
 
[ "7 3 
 
 OF THE DISEASES OF THE LIVER 
 DEPENDING ON ITS FUNCTIONS AS 
 AN ORGAN OF SECRETION. 
 
 CHAP. L 
 
 ON THE INCREASED SECRETION 
 OF BILE. 
 
 SECT. I. 
 
 Jl H E Inhabitants of warm climates are 
 extremely fubjecl to difeafes arifing from 
 the increafed fecretion of bile, and the 
 excefs' of its quantity in the primas via?, 
 which, either by regurgitating into the fto- 
 mach, produces a general languor of the 
 body, together with naufea> foul tongue^ 
 
[ "8 ] 
 
 lofs of appetite, and indigeftion j or, by 
 being directed to the inteftines, excites a 
 painful diarrhoea, ultimately tending to 
 weaken their tone, and diflurb theif regular 
 perifbaltic motion. It generally happens 
 that, during the excefs and prevalence of 
 bile in the firft pafiages, fome abforption 
 of it takes place in the habit, fo that the fkin 
 becomes yellow, and the urine is fenfibly im- 
 pregnated with it. The pulfe is quicker 
 than natural, and there is a confiderable de- 
 gree of third, with an increafe of heat, the 
 ufual fymptoms of fever. The body be- 
 comes emaciated, and the general afpect 
 of the patient is extremely unhealthy. 
 
 2. Under fuch circumftances, a change 
 of climate becomes neceflary, by which the 
 fecretion of bile is gradually diminifhed, 
 its powers, perhaps, rendered lefs active, 
 and the healthy functions of the flomach 
 and bowels are again reftored. A fea 
 yoyage from a warm to a colder clim ate 
 
[ "9 1 
 
 generally efFeds this purpofe, fuppofmg, as 
 is frequently the cafe, that the liver and 
 and other abdominal vifcera are in a found 
 ftate. ^ 
 
 3. SUCH fymptoms as I have now enu- 
 merated are the fpontaneous effects of a 
 warm climate on healthy conftitutions, inde- 
 pendent of any intemperance, and cannot 
 always be prevented by the moft careful 
 attention to diet, or by avoiding fuch irre- 
 gularities as, in all fituations, contribute to 
 produce difeafe. 
 
 4. THE natives of warm climates are lefs 
 fubjecl to the inconveniences arifing from 
 the increafed fecretion of bile than Euro- 
 peans who inhabit thofe countries, and 
 whofe conftitution, by former habits, is ill 
 prepared to admit fuch increafed excitement 
 of the liver, or fuch additional irritation on 
 the primse vise, without much derangement 
 of the * animal reconomy. The bile in 
 warm Slimates is, perhaps, more bitter and 
 
[ 120 ] 
 
 more faturated with its component part* 
 than in colder countries ; it is therefore a 
 more adttve emetic or purgative -, and, al- 
 though it was not fecreted in a larger quan- 
 tity, its effects on the firft pafTages would be 
 more feverely felt. 
 
 5. WE have had occafion, in treating of 
 the nature and properties of bile, to correct 
 a common and prevailing opinion of its be- 
 ing extremely putrefcent -, experiments, ex- 
 ecuted with great accuracy and fidelity, 
 fufEciently prove that it is lefs difpofed to 
 putrify than any other animal fluid ; -and 
 that it even preferves, in a fweet flate, ani- 
 mal fubflances, which, when expofed to 
 limilar circumftances of fluidity and heat, 
 without the admixture of bile, would in "a 
 Ihorter time have aflumed the character of 
 putrefaction. It feems, therefore, to be a 
 wife law of the animal ceconomy, that in 
 warm climates a larger quantity of this 
 fluid fhould be prepared by the conuitution 
 
[ 121 ] 
 
 than in colder countries - 9 and by its being 
 more bitter and more active, it pofiefTes a 
 greater antifeptic power than the milder and 
 more diluted fluid of a colder climate ; 
 hence it is better fitted to correct and re- 
 flrain the propenfities to fpontaneous and 
 putrid fermentations, fo extremely preva- 
 lent in warm climates. 
 
 6. I DO not, however, mean to deny, that 
 many and great inconveniences are found to 
 arife from the prevalence of bile in the 
 primse vise ; but I am firmly perfuaded, 
 that a diminution of its natural quantity 
 would produce difeafes of a more permanent 
 and alarming nature. It is more difficult to 
 fupply the defect in the quantity of this fluid, 
 than to carry off its excefs ; it is even more 
 eafy. to diminifti its acrimony than to in- 
 creafe its power, and thereby render it more 
 active, and better fuited to anfwer the vari- 
 ous and ufeful purpofes intended by it to the 
 animal ceconomy. 
 
 M 
 
7. I HAVE been frequently confulted by 
 perfons whofe appetite and digeftion have 
 been much diflurbed by a long refidence in 
 tropical climates ; and who, although they 
 have generally received much benefit by a 
 fea voyage, and a gradual return to Europe, 
 yet require the afliflance of medicine, with 
 a view to deftroy the tendency to exceflive 
 fecretion, and finally to reftore ftrength and 
 vigorous -action. 
 
 8. AFTEP. obtaining all the information 
 which I fuppofe neceftary refpecling the con- 
 flitution and habits of the patient, the ori- 
 ginal and progreffive ftate of fymptoms, 
 and the effects of fuch remedies as have been 
 employed, I proceed to afcertain how far 
 any local or organic affection of any of the 
 vifcera has taken place. If, upon inveftiga- 
 tion, I find that the conftitution has only 
 iuffered by the prevalence or the excefs of 
 bile, and that the difpofition to that morbid 
 incrcafe of fecretion flill remains, difturb^ 
 
[ 3 3 
 
 ing the functions of the ftomach, and irri- 
 tating the bowels, I recommend it to my 
 patient, every morning before breakfaft, to 
 dilute the contents of the flomach, by 
 drinking from half a pint to a pint of water, 
 of a temperature from 90 to 1 14 degrees of 
 Farrenheit's thermometer, likewife to 'take 
 a moderate degree of exercife before break- 
 fad. This may be done either in London or 
 at Bath, though I am perfuaded, that the be- 
 nefit derived is by dilution, and that tepid 
 
 <?? 
 
 water dilutes better than cold water, and 
 that pure water dilutes better than water 
 impregnated with faline, earthy, or metallic 
 matter. I do not, however, mean to dif- 
 courage invalids from going to places of 
 public refort, which may contribute, by 
 their amufements, to reftore a conftitution 
 enfeebled by a warm climate, or intenfe ap- 
 plication to bufinefs. 
 
 9. THE chymical analyfis of mineral 
 waters has been of confiderable advantage, 
 M 2 
 
fince, befides the difcoveries which it has 
 made with refpedt to the folid contents of 
 many of them, it has alfo proved, with re- 
 fped toothers, which contain but little folid 
 matter, that it is the quantity of water, and 
 not the impregnating fubftance, which does 
 good. 
 
 I believe the experiment of drinking good 
 pump water at home, of the temperature of 
 Bath, Buxton, or Briftol water, has feldom 
 been tried. I have frequently, with much 
 fuccefs, recommended the ufe of warm wa- 
 ter in dyfpeptic cafes f* and in anomalous 
 gout, it feems to allay the irritation of the 
 flomacfc, to promote and difFufe a generous 
 warmth in the extreme parts, and, if taken 
 at night, will generally produce fleep. Per- 
 haps it acts upon the principle of tepid 
 bathing ; with- . this difference, that any 
 action on- the ftomach has a more extenfive 
 influence on the fyilem, than the fame action 
 would have on the furface of the body. 
 
to. WATER heated to a certain degree, 
 when taken into the llomach will produce 
 giddinefs of the head, while the fame water, 
 of a lower temperature, will produce no 
 fuch effect : this is the reafon why patients 
 at Bath are dire&ed to drink the water of 
 different fprings, though not differently im- 
 pregnated, and it gives rife to a refinement 
 in practice which has for its foundation only 
 the different effects of temperature. It is 
 not improbable, but that more benefit will 
 arife when the temperature is carried to that 
 degree which produces fome fenfible effect 
 upon the head ; it is impoffible to lay down 
 any general rule on this fubject j it is trial 
 alone on the individual that can determine 
 the point of action. 
 
 ii. I CONSIDER* the waters of Bach, Brif- 
 tol, and Buxton, as not having any powers 
 fuperior to common pump water, heated to 
 the fame temperature. The fteadinefs and 
 uniformity, however, of their feveral tem- 
 M 3 
 
L 126 ] 
 
 peratnres entitle them to fome preference, 
 and render them proper to be drunk by per- 
 fons whofe ftomachs are irritable, and im- 
 patient of their contents, and perhaps weak- 
 ened in their digeftive powers by long habits 
 of ingurgitation and gluttony, or from in- 
 tenfe application to ftudy, accompanied with 
 a fedentary life. 
 
 12. IN fick headachs, which generally 
 arife from bile in the flomach, half a pint 
 of warm water taken at bed time has a good 
 effect. In all cafes where bile is fecreted in 
 too large a quantity, the ufe of emetics is 
 improper ; they increafe the irritable condi- 
 tion of the hepatic fyftem, and divert the 
 bile from the inteflines. In almoft all cafes 
 where vomits are given, bile, during their 
 action, is forced from the duodenum into the 
 flomach, which would otherwife have been 
 carried off by the inteflines ; indeed, the 
 actions of naufea and vomiting increafe its 
 fecretion. In general, bile is a purgative 
 
t 127 ] 
 
 
 
 fufliciently ftimiilating for its own evacuati- 
 on, only requiring the afliftance of warm 
 water for facilitating its difcharge : if, how- 
 ever, in fome cafes, it irritates without 
 purging, I would recommend the ufe of 
 fmall dofes of the neutral falts, fuch as folu- 
 ble tartar, fal catharticus amarus, and the 
 like ; and in all cafes they do mofb good un- 
 der dilution. 
 
 13. THIS fuggefts the propriety of re- 
 commending the ufe of Cheltenham water 
 to perfons returning from warm climates* 
 It may be drank either with or .without its 
 chalybeate part, but at all events its dofe 
 fhould be fuch as to produce a purgative 
 "effect. Perhaps it would be more advan- 
 tageous to take it every other morning than 
 to ufe it daily : it may be fuccefsfuily and 
 well imitated by artificial means, fo as to 
 be drunk at a diftance from the fpring near- 
 ly with equal effect as at Cheltenham. 
 
 14.. THE flomach., in its energy and pow- 
 
r 128 
 
 
 
 er, is greatly aflifted by warm clothing, ef* 
 pccially on the lower extremities of the bo- 
 dy. The diet of a patient, whofe ftomach 
 and bowels are extremely irritable by the 
 excefs and prevalence of bile, Ihould be 
 moderate in quantity, and of eafy digeftion. 
 This will necelTarily exclude melted butter, 
 every thing fried, every fpecies of paftry, 
 together with cold, and raw or unboiled ve- 
 getables. Ripe fruits may be admitted, in 
 moderate quantities, rather before than af- 
 ter dinner. Water, or wine and water, 
 may be drank for common ufe. Spirituous 
 liquors of all kinds fhould be avoided, as 
 having a tendency, more diredly, to pro- 
 duce difeafes of the liver, and to weaken 
 the tone of the ftomach. 
 
 15. THE CHOLERA MORBUS may very 
 properly be confidered under the head of 
 thofe difeafes which depend on the increafed 
 fecretion of bile. It takes place, with dif- 
 ferent degrees of violence, in different ha- 
 
bits : in fome it is fo acute as to prove fatal 
 in a few hours, while in others it is expreffed 
 only by a flight purgative and emetic ope- 
 ration. In general the fymptoms are as 
 follow. 
 
 1 6. THE patient is feized with a violent 
 difcharge of a dark coloured fluid, in large 
 quantity, and fome what of a bitter tafte, 
 both from the ftomach and inteftines, with 
 much pain and anxiety about the prxcordia, 
 
 I together with cramps or fpafms, particular- 
 ly of the lower extremities ; there is a con- 
 fiderable degree of thirft, the pulfe is ex- 
 tremely quick and weak* When the difeafe 
 proves fatal, the pulfe intermits and becomes 
 more feeble, the extremities become cold, 
 the patient is feized with hiccup, and dies 
 in the fame manner as perfons do from in- 
 flammation of the bowels. 
 
 17. THIS difeafe is extremely prevalent 
 in this country, in the months of Augufl: 
 and September, fo as to be confidcred as 
 
f 
 
 an autumnal epidemic. It frequently takes 
 place fpontaneoufly, and independently of 
 any fenfible occafional caufe being applied ; 
 at other times it is evidently connecled with 
 a fudden change of temperature in thofe 
 months. 
 
 1 8 IT may likewife arife from the in- 
 temperate ufe of food of difficult digeftion, 
 and unripe fruits. In the autumn, the he- 
 patic fyftem is more irritable in this country, 
 than at any other feafon : and the difeafes, 
 which prevail in the months of Augufl and 
 September, are obvioufly connecled with 
 the flate of the biliary fecretion, and ap- 
 proach in their nature to fuch as prevail in 
 warm climates. 
 
 19. THE fluid difcharged in the Cholera 
 Morlus is evidently bilious, but it is bile in 
 a very difeafed flate, by no means correfpond- 
 iiig with the character of the natural or 
 healthy flate of that fluid. 
 
 20. IT feems probable, that from the 
 

 C '3t 1 
 
 quantity fecreted, and the rapid manner in 
 which it is poured into the duodenum, 
 there is not time fufficient for a perfect fe- 
 cretion, that the fluid therefore is fome- 
 what of an intermediate nature between 
 blood and bile. Perhaps, from a hurried 
 circulation, a confiderable quantity of red 
 globules efcape, unchanged, from the ca- 
 pillary vefTels into the. port biliarii, and unit- 
 ing with a portion of bile, are carried by the 
 hepatic duels into the duodenum. 
 
 21. THE varied and increafed action of a 
 gland has much influence in determining 
 the nature of the fluid fecreted. In fome 
 cafes bile is difcharged, of a green colour, 
 and extremely acrid, not pofTefllng the qua- 
 lities of healthy bile. 
 
 22. THE cure of Cholera, Morbus is bed 
 effected, by firft diluting the contents of the 
 ftomach and inteftines, by the plentiful ufe 
 of warm water, water gruel, chicken broth, 
 and the like, and afterwards by allaying 
 
C '32 ] 
 
 irritation by opiates. In the advanced ftage 
 of the difeafe, with a weak pulfe and cold 
 extremities, I have feen great advantage 
 from the ufe of opium with aromatics, as in 
 the confettio opiata, and of mufk in large 
 dofes. Every thing which has a tendency 
 to vomit or purge actively Ihould be avoid- 
 ed, but emollient glyfters may be frequently 
 employed. If, in the firit flage of the dif- 
 eafe, fymptoms of fever and inflammation 
 fhould occur, the patient may lofe a confi- 
 derable quantity of blood, and a large blifter 
 .fhould be applied to the abdomen. In fome 
 cafes the warm bath may be employed with 
 advantage ; it is, however, chiefly to diluents 
 and opiates that we truft for a cure. 
 
 23. THE fecretion of bile is frequently 
 increafed and hurried by caufes ading on 
 the ftomach, fuch as fea ficknefs, and eme- 
 tics 5 the difcharge of bile by vomiting is, 
 therefore, no proof of its having exifted in 
 the ftomach before the exhibition of the vo- 
 
[ 133 ] 
 
 mit, or of its having been the primary caufe 
 of naufea and indigeftion : it is only the 
 effect of direct a6tion on that organ. 
 
 24. IN the bilious fever of the Weft 
 Indies, the naufea and vomiting, which 
 arife from fome flight degree of inflammati- 
 on near the pylorus and upper furface of the 
 duodenum, invite bile into the ftomach, 
 which has no tendency to produce the 
 fever; it is only an effect, and not the caufe 
 of the difeafe. 
 
 25. IN warm climates, contagious and 
 febrile poiibns have a great tendency to act 
 on the hepatic fyftem, and hurry much the 
 fecretion of bile ; indeed, hemorrhages from 
 the liver, accompanying the increafed fecre- 
 tion of bile, frequently take place, and dif- 
 fection generally Ihows congeftion and a 
 turgefcent ftate of that organ ; this naturally 
 fuggefts the ufe of active purgatives in thofe 
 fevers, fuch as calomel, jalap, and the neu- 
 tral falts j indeed, fo fpecifkally has the 
 
C 134 ] 
 
 liver been fuppofed affe&ed in thefe cafes, 
 that fome late writers on the fubject of the 
 contagious yellow fever now raging in the 
 Weft Indies, have recommended the ufe of 
 mercury, in order to produce a falivation 5 
 under which, we are allured, all the fymp~ 
 toms of malignancy have fubfided. 
 
[ 135 3 
 
 CHAP. II. 
 
 OF THE DIMINISHED SECRETION 
 OF BILE. 
 
 S E C T. I. 
 
 JLR o M what has been already obferved 
 on the ufe of bile and its application to the, 
 purpofes of the animal cecoaomy, it is ob- 
 vious, that a confiderable diminution of the 
 quantity fccreted will be followed by difeafe. 
 The liver may be rendered incapable of 
 fecreting the ufual quantity of bile by any 
 defedt in its ftrudure ; and that this is, fre- 
 
 N 2 
 
C/36 ] 
 
 quently, the impeding caufe, appears from 
 direction. 
 
 2. IT is an organ very fufceptible of 
 chronic inflammation, which, without 
 alarming in the firfl inftance, by painful or 
 active fymptorns, gradually induces obftruc- 
 tion - 9 firft, with an increafe, and frequently 
 afterwards a diminution of its bulk, perhaps 
 ultimately obliterating the capillary fyftem 
 and pori biliarii, the more immediate feat 
 of fecretion. In fuch cafes, the patient will 
 be fubject to occafional pain in the right 
 hypochondrium, extending to the fcapulse, a 
 quick pulfe, an increafe of heat, alternating 
 with chilly fenfations, difficult breathing on 
 quick motion, fome difficulty on lying on 
 the left fide, flatulency, indigeftion, acidity, 
 coftivenefs, and, together with a gradual 
 diminution of ftrength and fleih, the patient 
 has a pale or fallow complexion. Such 
 fymptoms are accompanied with a defecl: 
 in the fecretion of bile, and a torpid ftate 
 of the inteitines. 
 
[ 137 ] 
 
 3. IT is probable, that under thefe cir- 
 cumftances, the original mifchief is in the 
 ftomach and duodenum, and that the fym- 
 pathetic action on the liver is lefs, on which 
 perhaps healthy fecretion may depend ; 
 hence dyfpepti'c complaints generally pre- 
 cede affections of the liver, and arife from 
 intemperance either in eating or drinking, 
 but are more particularly induced by the 
 abufe of fpiricuous liquors, even though 
 diluted with water. The flomach, by long 
 failing, has its digeftive powers much weak- 
 ened, by which the fecretion of bile is dimi- 
 nifhed, and a difeafed ftru6ture of the organ 
 ultimately induced. Grief and anxiety of 
 mind firft weaken the powers of the ftomach, 
 and ultimately thofe of the liver, and there- 
 by diminilh fecretion : a fedentary life will 
 do the fame. 
 
 4. HYPOCHONDRIACAL complaints are al- 
 ways attended with fymptoms of dyfpepfia 
 and diminifhed fecretion, and great torpor of 
 
the alimentary canal. In the chlorofis of 
 women we have likewife a diminution in the 
 quantity and adlivity of bile. 
 
 5. WHEN. the diminifhed fecretion is 
 preceded by affe&ions of the (lomach, fuch 
 as lofs of appetite, indigeftion, and flatu- 
 lent eru&ations, the diet of the patient 
 fhould be attentively regulated $ and the 
 art of cookery fhould be rendered merely 
 fubfervient to digeftion, and the prepara- 
 tion of healthy chyle. The quantity of food 
 taken at any one time fhould be moderate, 
 and water fhould be the only liquid drunk 
 with our meals, as more effectually pro- 
 moting digeftion than fermented liquors of 
 any kind. All raw or unboiled vegetables 
 fhould be avoided ; ripe fruits may be mo- 
 derately taken ; almoft all boiled vegetables 
 may be admitted. Animal food fhould be 
 well boiled, or moderately roafted, and 
 taken with its own gravy. Pye-cruft, and 
 every thing fried, fhould be excluded 3 but- 
 
[ '39 ] 
 
 ter, rendered rancid by being melted, 
 ihould be likewife forbid. The patient 
 fhould ufe moderate exercife, and drink 
 fome natural chalybeate water of a tepid 
 heat, before breakfaft, and perhaps in the 
 evening. By thus giving vigour and energy 
 to the ftomach and duodenum, the healthy 
 action of the liver will be reflored. 
 
 6. I am perfuaded that the ftomach digefts' 
 folid aliment more eafily than liquid and 
 bulky food ; and that foups and broths are 
 more quickly difpofed to run into active 
 fermentation, and require the exertion of 
 more vitality to reftrain fuch morbid and 
 fpontaneous changes, than animal food in 
 a folid form. During the period of our 
 being awake, the ftomach fhould have a 
 fupply of food, at leaft every fix hours ; 
 the quantity, in that cafe, would be more 
 moderate at any one time, and would be pro- 
 portioned to the demand of the fyftem : 
 the fupply Ihould be regular. Nor is there 
 
t HO ] 
 
 1* 
 
 any good foundation for diverfifying our 
 meals j fo that breakfaft and dinner ihould 
 be made up of different kinds of food. 
 The fecretion of bile would be thereby more 
 regular, and the quality better prefervcd 
 under fuch a regimen. A ftomach, vitiat- 
 ed by bad habits, is widi difficulty reformed, 
 but may ultimately be reconciled to fnnple 
 and healthy aliment. There are fome flo- 
 machs which reject milk when it has been 
 medicinally recommended ; but they arc 
 fuch to which milk has been a perfect ftran- 
 ger j and in that, as in fimilar cafes, fmall 
 repeated quantities of it, taken without 
 the mixture of any other kind of food, 
 have reconciled the flomach to any larger 
 quantity, which may be thought. necefTary. 
 The condition of the gaftric fluid, and the 
 action of the ftomach, accommodate them- 
 felves to that regimen, to which the ilornach 
 has been accuflomed. 
 
 7. THRE are fome ilomachs which are 
 
quick and powerful in finifhing the procefs 
 of digeftion, and may require a greater and 
 more frequent fupply of aliment than 
 others, whofe powers are more limited ; 
 but in all cafes the ftomach fhould never be 
 perfectly empty. A fenfe of uneafinefs and 
 acute pain has proceeded from mere empti- 
 nefs, under which, perhaps, the ftomach 
 may be faid to feed upon itfelf : this occurs 
 very frequently in delicate females j who, 
 ^either from caprice or fafhion, take in very 
 fmall quantities of food at any one time, 
 and yet whofe meals are not more frequent 
 than others of a more vigorous conftitution. 
 In fuch cafes a meat breakfaft, and a lunche- 
 on at noon, will prove the beft remedies. 
 I believe that chlorofis, atrophy, tubercle, 
 and other glandular affections, would be 
 beft obviated by fuch a regimen, and females 
 acquire more vigorous and active health by 
 fuch a plan as is now recommended. With 
 refpect to the quality of our different meals, 
 
] 
 
 we feem to depart more from the cuftom 
 of our hardy anceilors, with regard to break- 
 fall, than any other meaL* 
 
 A very leading fymptom of a '-weak flo- 
 mach, and an enervated conftitution, is the 
 loathing of food at breakfaft ; while a vigor- 
 ous ftomach difcovers more energy in the 
 morning than at any other time of the day. 
 Digeflion is beft promoted by a flate of reft 
 after eating, and the exercife of the body is 
 beft adapted to reftpfirig energy, and pro- 
 moting the necefTary fecretions.f 
 
 * A Maid of Honor, at the Court of Queen 
 Elizabeth, breakfafted upon beef, and drank ale 
 after it ; while the Sportfman, and even the Day- 
 labourer, now frequently breakfaft upon tea. 
 
 f Dr. Harwood, the Profeflbr of Anatomy at 
 Cambridge, took two pointers equally hungry, 
 and equally well fed ; the one he fuffered to lie 
 quiet after his meal, and the other he'kept for 
 above two hours in conftant exercife. On re- 
 turning home, he had them both killed. In the 
 ftomach of the dog that was quiet, and afleep, all 
 the food was digefted : but ia the ftomach of the 
 other dog that piocefs was fcarcely begun. 
 
. [ 143 ] 
 
 6. The temporary lofs of bile may be 
 fupplied by various bitters, occafionally 
 united with rhubarb, aloes, and the like. 
 The excefs of acidity may be corrected by 
 alkaline remedies and lime water. In in- 
 fants the bile is frequently not fufEciently 
 active, and generally fecreted in too fmall a 
 quantity, which in them induces difeafes of 
 prevailing acidity.* 
 
 r We may obferve farther, that the ftomach, 
 in its office of digeftion, may derive affiftance from 
 the liver, by the latter counteracting fome of thofe 
 effects which arife from the difeafed action of the 
 former/ 
 
 We know that when the powers of the ftomach 
 have been weakened, and when the digeftive pro- 
 cefs confequently proceeds but flowly and weakly, 
 there is often a confiderable tendency to acefcency 
 in the different parts of the primse vise. Differ- 
 ent portions of the aliment, taken in, have a ten- 
 dency to run into the acetous fermentation, when 
 affifted by heat and moifture. 
 
 Thus we find many of the vegetables which we 
 take into our ftomachs, are digefted with difficulty, 
 and are very apt, in bad ftomachs, to occafiou 
 fymptoms of acidity. Flatulence and diftention 
 frequently fucceed the taking of thefe fubftances 
 
[ 144 ] 
 
 7. IN cafes of difeafed ftrudlure of the 
 liver, producing a diminution of fecretion, 
 and particularly when fuch change of flruc- 
 
 into the ftomach, and the gaffes fent out from the 
 mouth ferve as an indication of what is going for- 
 ward within. Cabbages, cauliflowers, peas, beans, 
 and the different farinaceous vegetables, are apt to 
 produce this effect ; whilft thole fubftances which 
 have no direct tendency to acefcency, may yet 
 prove an indirect caufe of it, by weakening the 
 tone of the ftomach, and thus difturbing the di- 
 geftive and afilmilating functions. 
 
 But there feems to be a power in a healthy fto- 
 mach of counteracting thofe fpontaneous changes 
 ^vhich would take place out of the ftomach, or in 
 a difeafed ftomach. It is not, perhaps, too much 
 to expect, from a vigorous ftomach, that it fhould 
 convert into good nutriment, every thing which 
 contains materials capable of forming a healthy 
 chyle. Its powers may probably extend much 
 farther than any trial yet made has difcovered ; 
 and many fubftances, which cuftom has not yet 
 introduced as articles of diet, may be very well 
 managed by this organ. We find that it is capa- 
 ble of affimilating fome fubftances which are vari- 
 ous and heterogeneous, and, therefore, it is fa/r 
 to conclude, that it is equally capable of acting 
 upon fome which are more fimple. 
 
t 145 ] 
 
 ture has arifen from inflammation, mercury 
 has been found ufeful, even carried to the 
 
 degree of producing a flight falivation, 
 
 
 If, then, the ftomach poiTeiTes a power, when 
 
 in a healthy ftate, of counteracting the fpontane- 
 ous changes which would take place in fome fub- 
 .ftances out of the body, and will even prevent 
 acefcency in thofe which are difpofed to produce 
 it, if acefcency does prevail, we muft conclude, 
 that it is owing to fome diminution of the powers 
 of the flomach. The queftion then to be anfvver- 
 ed is, " Can the liver contribute any thing to- 
 ** wards the prevp .* of fuch an effect as this ?" 
 
 It has bee / proved, in the courfe of 
 
 thofe expt. ,. - v.-hich have been before related, 
 that there is L* Ji.e a refinous fubftance, in which 
 refide the colouring principle and bitter tafte. 
 This bitter, refembling the vegetable bitter, has 
 probably properties in common with that, and is 
 capable of refitting the fermentation going on in 
 the ftomach, and alimentary canal, when any of 
 its contents are difpofed to run into this ftate. 
 When it cames into contact with thefe fubRances, 
 it may act as a chymical agent, and produce fuch 
 a change upon them as fhall prevent that procefs 
 to which they are difpofeJ. 
 
 That this is the effect of the vegetable bitter on 
 other occasions, conitant experience evinces, in 
 o 
 
moderating the violence, however, of its 
 operation by plentiful dilution with gum 
 
 arabic, and other vegetable demulcents. 
 
 
 
 the ufe of hops, by which beer is prevented from 
 proceeding fo rapidly to the acetous fermentation. 
 
 The alkali, which is discovered as a conftituent 
 part of the bile, may ferve to neutralize the acef- 
 cent matter when it prevails in too high a degree, 
 and thus prevent any mifchievous effects, which 
 might arife from its continuance in that ftate, 
 during its paUage through other parts of the fyf- 
 tem. We are to remember, that if this change 
 does not take place till after it has pafTed from 
 the ftomach into the duodenum, it may ftill, in a 
 fecondary way, operate upon the ftomach, upon 
 that principle of fympathy which we have before 
 referred to, as fubfifting between different parts of 
 the alimentary canal, or between the ftomach and 
 duodenum, or other fmall inteftines. 
 
 Let us pbferve farther, that the mineral alkali 
 which conftitutes a part of healthy bile, may ferve 
 to neutralize the acefcent matter when it prevails 
 in too high a degree, and fo prevent any mifchiev- 
 ous effects which might arife from its continuance 
 in that ftate, whilft it is pafBng through other 
 parts of the fyftem. 
 
 But not only to this acefcent ftate of the con- 
 tents of the primae vise, but alfo to that of putref- 
 
[ 147 ] 
 
 In many cafes where the liver and other 
 abdominal vifcera have been difeafed, and 
 in cafes of glandular and mefenteric affec- 
 tion, attended with pain and tenfion, and 
 even fymptoms of hectic fever, I have 
 feen advantages from tepid bathing, th<: 
 temperature of the water being 90 degrees 
 of Farenhek's thermometer. The practice 
 of tepid bathing may accompany the uie 
 of mercury, and may moderate the dan- 
 
 cency> the bile offers a proper corrective. The 
 foregoing experiments ferve to prove the greater 
 power which bile has of refitting putrefaction than 
 the blood. Without referring, at prefent, to the 
 relative difpofition to putrefcency betwixt the two 
 fluids, we may real ark, that if the bitter property 
 of bile have this tendency, this is a circumllance 
 which at once explains the effect referred to. But 
 when we confider that to preferve the general tone 
 and vigour of thefyftem is the heft mode of obvi- 
 ating putrefcency, we may attribute this effect to 
 the bile, which, by its immediate influence on the 
 inteftine, and its more remote influence on the ge- 
 neral fyftem, through the medium of the ftomach, 
 may produce it. 
 
 O 2 
 
gerous exhalement which may fometimes 
 iirife from it. 
 
 8. SEA ficknefs, and a fea voyage, con- 
 tribute very much to reftore the fecretion 
 of healthy bile, fo neceffary to the welfare 
 of the animal ceconomy ; and fymptoms 
 of dyfpepfia and diminifhed fecretion, which 
 are now rendered more confpicuous among 
 females from their fedentary life, are moil 
 effectually removed by the means already 
 fuggefted. 
 
 9. IN fome cafes, the refiftance to the 
 fecretion of bile may arife from the vifci- 
 dity of the fluid obftruding the extremi- 
 ties of the common duct as it enters 
 the duodenum : this will be removed moft 
 effectually by calomel, fcammony, or jalap, 
 which fbem in their operation to ftimulate 
 and evacuate the duodenum, while many 
 other purgatives act moil forcibly on the 
 large inteftines. 
 
 10. IN the infantile fever of children, 
 
[ H9 1 
 
 fo well defcribed by Dr. Butter, a bilious 
 diarrhoea comes on, which proves falutary 
 and critical, and fhould be encouraged by 
 a folution of fal. polychreft. in water, and 
 fometimes by the occafional life of calomel 
 and fcammony, eipecially in the early ftage 
 of the difeafe. 
 
 ii. THERE feems much fympathy be- 
 tween the brain and the liver; and in 
 maniacal perfons, in whom there is gene- 
 rally a defect in the fecretion of bile; 
 this evil is beft removed by the means, al- 
 ready recommended. 
 
CHAP. III. 
 
 OF OBSTRUCTION TO THE FREE 
 
 PASSAGE OF BILE INTO THE 
 
 DUODENUM. 
 
 SECT. I. 
 
 A F, after bile is fecreted, its free admifiiOH 
 into the duodenum be impeded, fo that an 
 accumulation of it takes place in the excre- 
 tory duels of the liver; it either regurgi- 
 tates into the habit by the hepatic veins-, 
 or is abforbed by the lymphatic fyftem; 
 in either cafe it produces the difeafe called 
 
C 152 ]' 
 
 JAUNDICE ; the hiftory and cure of which 
 I fhali now endeavour to explain. 
 
 2. JAUNDICE may be defined a yellow 
 colour of the fkin, and tunica conjunctiva 
 of the eye, with urine of an obfcure red, 
 tinging line.n with a yellow hue, and with 
 the fasces generally of a light and clay-like 
 appearance in confiftence and colour. 
 
 3. THIS is a difeafe to which women 
 are more fubject than men, and adults 
 than children; though it takes place occa- 
 fionally in perfons of all ages and of both 
 fexes. It is attended with a fenfe of lafli- 
 tude and languor, a fenfe of pain and ten- 
 fion, or weight and oppreffion about the 
 prascordia ; there is frequently much anxie- 
 ty, and fome degree of difficulty in breath- 
 ing. The eyes and roots of the nails firft 
 become yellow, afterwards the whole body, 
 which is alfo fometimes attended with an 
 itching of the fkin. The difeafe is often ac- 
 companied with naufea, vomiting, flatulen- 
 
[ '53 1 
 
 cy, acidity, and indigeftion j and the fae- 
 ces, which are commonly of a white colour, 
 have not the ufual feculent fmell. Solid 
 food generally taftes bitter in the mouth in 
 fome, and in the moft unfavourable ftate 
 of the difeafe there occurs hiccup, and oc- 
 cafional paroxyfms of rigor., or chillinefs. 
 The pain is fornetimes extremely acute in the 
 right hypochondrium, or in the epigaftri- 
 um. The flate of the pulfe varies -, in ge- 
 neral it is quicker than natural, though in 
 fome cafes, efpecially during the pafTage of 
 a gall ftone, it is flower. It very feldom 
 or never happens, that objects appear to the 
 patient of a yellow colour. 
 
 4. THIS difeafe is frequent during preg- 
 nancy, and in early infancy ; in both, how- 
 ever, it is of a very fhort duration. 
 
 5. ITS decline is marked by a gradual di- 
 minution of the fenfe of weight, opprefli- 
 on, or uneafmefs about the prascordia; a 
 return of appetite anddigeftion -, the colour 
 
[ 154 ] 
 
 of the urine becomes more diluted ; it is 
 fecreted in a larger quantity ; the flools ac- 
 quire a yellow colour, are more copious, 
 and more eafily procured -, fometimes hard 
 and concrete matter is found in the fasces. 
 
 6. IT is a difeafe into which, a patient is 
 very liable to relapfe. It is very unfavour- 
 able, if the pain be violent, and attended 
 with a quick pulfe, lofs both of flrength 
 and flefh, with occafional chillinefs, watch- 
 fulnefs, and melancholy; under thofe cir- 
 cumftances, he becomes fubject either to 
 profufefweating or hcEmorrhagy. Whenthefe 
 fymptoms attend it, the difeafe frequently 
 terminates in a confirmed afcites. 
 
 7. UNDER fuch circumftances we may 
 conclude, that though fome bile mufl be 
 fecreted, and that its regurgitation, or 
 abforption, is the confequence of fome 
 refiftance to its free ingrefs into the duode- 
 num ; yet that apart of the liver is, in its 
 ftrufture, or organization, materially dif- 
 
[ '55 1 
 
 eafed, a circumflance which, though fre- 
 quently attendant on jaundice, is by no 
 means neceflary to coniiitute the difeafe. 
 
 8. ON diflection, various appearances 
 prefent themfelves to our notice. The 
 brain, the bones, and even the cartilages, 
 are found deeply tinged of a yellow colour. 
 The pori biliarii, and forrie of the larger 
 branches of the hepatic duels, are found 
 fometimes obliterated by difeafed ftruc- 
 ture. Gall flones are often found in the 
 duftus communis, but more frequently in 
 the gall bladder and cyftic duct. In fome 
 a thickening and difeafed flrudture of the 
 ductus communis has taken place, not 
 unlike what has been obferved in the cefo- 
 phagus or urethra. In many cafes there 
 have been appearances of mechanical pref- 
 fure from the diftention and tumour of fur- 
 rounding and neighbouring parts, as of the 
 pancreas, duodenum, and colon, either of 
 a temporary or permanent nature j hence a 
 
[ '56 ] 
 
 jaundice may arife from prefTure during 
 pregnancy. The bile has been found of a 
 very vifcid, and pitchy confidence, efpeci- 
 ally in the gall bladder, paffing from the 
 cyflic to the common duel, and thereby 
 perhaps refilling the paffage of the more 
 fluid hepatic bile, which would otherwife 
 flow freely into the duodenum. 
 
 9. THE Morofis, to which young women 
 are extremely fubjccl:, to a fuperficial ob- 
 ferver, puts on the appearance of jaun- 
 dice. In the chlorofis, the tunica conjunc- 
 tiva is not more difcoloure.d than any other 
 part of the body, and the urine is not of a 
 deep colour, but rather pale and limpid. I 
 am perfuaded, however, that in chlorotic 
 habits the bile is more infipid, is fecreted in 
 lefs quantity, and of a more pale colour 
 than in health. This imperfect flate is, 
 perhaps, in common to all the other fecreti- 
 ons of chlorotic fubjeds, and may poflibly 
 arife from the watery flate of the blood, 
 
[ '57 1 
 
 the paucity of red particles, and the .defec- 
 tive energy of the whole fyftem. 
 
 10. IN the endemic fever of the Weft 
 Indies, in which the fkin is obvioufly 
 tinged with bile, there feems rather a re- 
 dundancy of it in the primas vise, than a 
 deficiency. Perhaps the quantity of bile 
 which is fecreted is fo very confiderable, that 
 though the greateft part of it efcapes into 
 the primas vise, the whole may not readily 
 find a pafTage ; and the furcharge thus occa- 
 fioned may give rife to regurgitation and 
 abforption. The reafon for this may proba- 
 bly be, that the diameter of the common 
 duel, or of the larger branches of the pori 
 biliarii, though fully adequate to tranfmit 
 the whole of the bile fecreted in the healthy 
 flate of the liver, yet may be infurHcient to 
 convey the excefs produced under an hurried 
 and imperfect action of that organ -, and 
 therefore with every appearance of a large 
 
[ 158 ] 
 
 fupplyof bile in the primse vias, a jaundice 
 may take place. 
 
 11. THE fymptoms of pyrexia, and other 
 phenomena of febrile miafmata acting on the 
 body under this difeafe, the delirium, the 
 quick proftration of ftrength, /after early 
 fymptoms of local inflammation, either in 
 the duodenum, or region of the biliary 
 duels, diilinguifh it very readily from jaun- 
 dice. 
 
 12. THE fecretory ceconomy of the 
 liver, in common with that of mod other 
 organs in the body, is very much under the 
 dominion of the paffions. Anger, it is 
 well known, produces ftrongly marked 
 effects ; it not only augments the quantity 
 of bile fecreted very confiderably, butlike- 
 wife vitiates it :. hence it is, that by being 
 carried into the duodenum in large quanti- 
 ties, and thence regurgitated into the flo- 
 mach, it produces effects like thofe of an 
 emetic. 
 
13- IF the ductus communis docs not 
 tranfmit it as faft as it is fecreted, and the 
 gall-bladder is fo full that it cannot receive 
 the excefs; then it will be forcibly returned 
 upon the hepatic fyftem, and by entering 
 the blood veflels produce jaundice. 
 
 14. IT feldom happens, when' a fecreti- 
 on is hurried by the exc'cfs of action, that 
 the fluid fecreted pofiefTes its^ natural and 
 healthy properties; hence arifes the varia- 
 tion in appearance of bile, which, in fome 
 acute cafes, as in cholera rnorbus, I have 
 feen of a colour as black as foot, fo as to re- 
 femble more the red particles of the blood, 
 in a broken or difeafed flate, than the bile.' 
 Such a fluid may be confidered as fomething 
 between blood and bile, and carried off fo 
 
 41 
 
 quickly, that the procefs of making bile 
 had only juft begun, though the change in 
 the condition of the blood with a view to 
 that procefs had taken place. This could 
 not have depended on any difeafed ftructure, 
 p 2 
 
[ 160 ] 
 
 for it is inftantly removed by opiates and 
 other means which may reflrain immoderate 
 action. 
 
 15. ME:; engaged in literary purfuits, 
 and women, from leading fedentary lives, 
 are very much difpofed to jaundice and other 
 difeafes of the abdominal vifcera -, for the 
 excretory powers of the liver depend but 
 little upon any action which the biliary ducts 
 can perform, as they pofTefs a very fmall de- 
 gree of irritability; but are aflifted prin- 
 cipally from the agency of the diaphragm, 
 abdominal mufcles, and periftaltic motion 
 of the inteitines -, and more efpecially from 
 the agitation which the ^hepatic fyflem fuf- 
 fers duringbodily exercife. Thewant there- 
 fore of a degree of exercife fufficient to aflift 
 the biliary duels in their excretory function, 
 muft neceffarily lay an ample foundation for 
 morbid affections. And the neceflity of this 
 external aid to the perfect action of the li- 
 ver, feemsmore obvious from the circum- 
 
ftances of its venous circulation, which is 
 always more languid than in thofe fecretory 
 organs where the fluids are kept in a flate of 
 more rapid motion by arterial impulfe, 
 Horfe exercife feems. peculiarfy well calcu* 
 lated to affift the action of the abdominal 
 vifcera, in cafes of defective excitement in 
 the hepatic fyftem.- 
 
 16. THE bile, during its flay in the gall 
 bladder, acquires a vifcid confidence, per- 
 haps, in fome meafure, from the abforption 
 of its more aqueous parts, and likewife from 
 a propenfity to fpontaneous feparation, by 
 which its coagulable part may detach itfelf. 
 Though this circumftance is lefs obvious in 
 bile than in blood, and though it may re- 
 quire more time to be effected, yet I think 
 it probable, from analogy, that fuch a fe- 
 paration of its parts may take place. 
 
 17. IN many cafes we find the abufe of 
 fpirituous liquors difpofes to 'jaundice, 
 evidently of the moil unfavourable kind 3 
 
 p 3 
 
becaufe generally accompanied with dil- 
 eafed ftruclure. They may ad by firft al- 
 tering the ftructure of the ftomach and duo- 
 denum, and afterwards, by fympathy of 
 contiguity, affect ihe biliary duels of the 
 liver. In the direction of thofe who have 
 been intemperate dram-drinkers, the difeaf- 
 ed ftructure may be traced from the ftomach 
 along the courfe of the ductus communis, 
 and I have frequently feen thefe ducts fo 
 contracted and thickened, that they could 
 not tranfmit bile.* 
 
 * I was informed by the late Mr. Hunter, that 
 the ftomachs of dram-drinkers are generally found 
 in a flabby and inelaftic ftate, capable of fecreting 
 only difeafed fluid: ,his lofs of tone in the fto- 
 mach is followed by frequent vomiting, tremulous 
 motions of the mufcles, propenfity to palfy, and 
 lofs of memory In many cafes, as has been al- 
 ready obferved, the liver is fo far difeafed that it 
 does not even fecrete bile, and a pallid and un- 
 healthy afpect takes place. 
 
 The urine is fecreted in a fmall quantity, of a 
 deep colour, though not tinging linen of a yellow 
 
C 163 ] 
 
 1 8: HOWEVER remotely fitnated fome 
 parts of the body may be from others; yet 
 a difeafed action is quickly propagated to a 
 diftance, without affecting intermediate 
 parts : and it frequently happens, that an 
 attempt to cure the difeafe of a part, is 
 followed only by its removal to fome other 
 organ of the body ; hence the fupprefllon 
 of iffues, cutaneous eruptions, and hasmor- 
 rhoids, are followed, in fome cafes, by mor- 
 bid affections of the lungs, in others of the 
 hepatic fyftem, and thefe do not always 
 fubfide on reftoring the difeafed action to 
 the organ firft affected. In confirmation of 
 this opinion, I have feen a jaundice with a 
 fenfe of .pain and opprefiion on the right hy- 
 pochondrium, correfpond and alternate with 
 
 hue. This is frequently a more dangerous (late 
 of difeafe than jaundice, which indicates only a 
 refiftance to the pafTageof bile into the duodenum, 
 and may take place in the moft healthy ftate of 
 the liver. 
 
t 164 ]^ 
 
 piles, and habitual difcharges of pus in the 
 lower extremities. 
 
 19. IT is generally admitted, and I think 
 fufficiently proved by fome experiments al- 
 ready mentioned, that the biliary ducts are 
 very paffive, that they fubmit very eafily to 
 mechanical diflenfion from calculi, without 
 contracting afterwards like fenfible or irri- 
 table parts ; therefore when jaundice has 
 arifen from very acrid emetics, or griping 
 purgatives, or colic, or hyfteria, the refifl- 
 ance to the free paflage of bile is either at 
 the very extremity of the ductus communisj 
 or during its oblique courfe through the 
 fubftance of the duodenum, at which part 
 it is liable to comprefllon from the mufcular 
 action of that inteftine. And perhaps, like- 
 wife, the increafe of the quantity of bile in 
 the inteftine may depend on an action com- 
 municated to the ductus cbmmunis. In 
 the one cafe the duct may be clofed, in the 
 other it may be acted upon by fuccefTive 
 
3 
 
 motions, by which it emulges more quickly 
 
 its contents. 
 
 i 
 
 20. WHEN we were treating of the natu- 
 ral and chymical hiftory of the bile, we an- 
 nexed fome obfervations on the appearances 
 and component parts of biliary calculi, which 
 will fuperfede the necefiity of a repetition 
 of them in this place. It will be proper 
 here, however, to remark, that fuch concre- 
 tions do not occur in every part of the bilia- 
 ry fyftem with equal frequency ; from dif- 
 
 fection it appears that they very rarely exifl 
 
 
 in the hepatic duels, fometimes met with in 
 
 the ductus communis, more frequently in 
 the ductus cyflicus, and are moft common 
 in the gall bladder. The bile accompany- 
 ing them is more vifcid than ufual, and 
 appears to contain a larger portion of the 
 colouring and bitter principles. 
 
 21. THE number and fize of thefe cal- 
 culi vary much : fometimes the gall blad- 
 der is filled with them, at others there are 
 
[ 166 ] 
 
 not more than one or two ; fometimes they 
 are fmall and angular, at others large, and 
 have a more regular furface. I have feen a 
 gall ftone nearly the fize and figure of the 
 gall bladder itfelf, fo as nearly to fill the 
 whole cavity. Thefe large calculi are iefs 
 frequently the caufe of jaundice than fmaller 
 ones : for, from their bulk, there is but 
 little probability of their entering the ductus' 
 cyflicus, and afterwards of obfiructing the 
 ductus communis. It is from calculi of 
 fmaller dimenfions that fuch obstructions 
 are occafloned. However the rule is not 
 without exceptions, and from diflection it 
 appears, that calculi of confiderable bulk 
 muft have patted, for the ductus communis 
 has been enlarged to an inch in diameter, 
 an inftance of which has been met with by 
 Dr. Heberden. 
 
 9.2. BUT calculi have pafTed, during life, 
 of fuch a bulk as to occafion a doubt whe- 
 ther they efcaped into the intefunes by the 
 
I '67 1 
 
 natural canals, or made their way thither 
 by a preternatural pafTage. Dr. Cheflon, 
 fome years ago, met with a cafe where a 
 gall flone of an unufual magnitude pafTed 
 during life, and the patient got well. 
 Some years after fhe died of another 
 complaint, and on examination it appeared 
 that this large gall flone had made a pre- 
 ternatural pafiage through the gall bladder 
 into the inteftine. Mr. Cline, in his excel- 
 lent collection of anatomical preparations 
 . at St. Thomas's Hofpital, has an inftance 
 of a cafe of this kind. 
 
 23. A PERMANENT jaundice has fre- 
 quently arifen from furrounding tumours 
 comprefling the hepatic du&s : a fchirrous 
 enlargement of the pancreas, has fome- 
 times produced this effeft. ExcefTive vo- 
 miting, and violent exercife, perhaps by 
 forcing ftones from the gall bladder 'into 
 the cyftic duel:, and from thence into the 
 common du6l, have produced the difeafe. 
 
[ 168 ] 
 
 There is an inftance where jaundice arofe 
 from the feeds of goofeberries being found 
 in the extremity of the ductus communis 
 as it enters the duodenum. In fhort, what- 
 ever can obftrucl or impede the pafTage of 
 the bile into the duodenum, muft be confi- 
 dered as a caufe fufficient to produce jaun- 
 dice : but in what way the bile pafTes from 
 the biliary veflels into the general circula- 
 tion, has already been explained in thephy- 
 fiological part of this work. 
 
 24. THE jaundice, when arifing from 
 a difeafed ftate of the ftructure of the liver, 
 or from the tumour of ftirrounding parts, 
 and more efpecially if accompanied with fe- 
 ver and gradual diminution of ilrength and 
 fleih, is feldom cured, and generally ter- 
 minates in afcites. 
 
 25. IF, on the other hand, it has arifen 
 fuddenly in young and vigorous habits 
 (though accompanied even with much pain), 
 unattended with fever and the other unfa- 
 
[ i6 9 3 
 
 vourable circumflances above remarked, 
 it is feldom of long duration, and by a ju- 
 dicious treatment may be effectually re- 
 moved. 
 
 26. THE cure of jaundice con (Ids in the 
 removal of exciting caufes, and in allevi- 
 ating urgent fymptoms. Calculi are the 
 mofl frequent exciting caufes, 
 
 27. Ir appears from experiments that 
 fome calculi are foluble in an alkali, in 
 fpirit of wine, and oil of turpentine ; but 
 it is altogether impracticable to make a 
 direct application of thofe fubftances to 
 calculi in the biliary duels, as we have no 
 facts to prove, that by the courfe of cir- 
 culation, they can be carried into the gall 
 bladder fo little changed as to preferve any 
 fenfible degree of pow-er. , It remains yet 
 to be proved, that the proportion of al- 
 kali in the bile is increafed by alkaline 
 remedies. 
 
 28. MANY faline remedies pafs into the 
 
[ * 7 1 
 
 urine unchanged, and may act on calculi 
 in the bladder -, but we cannot detect the 
 prefence of alkaline or other folvents in the 
 bile. The analogy, therefore, between the 
 action of folvents in biliary and urinary cal- 
 culi will not obtain. 
 
 29. THE paffage of gall ftones may be 
 promoted by gentle vomits, and for this 
 purpofe ipecacuanha may be given ; but its 
 action will be affifted if it be exhibited in 
 fmall and divided dofes, fo as to occafion, 
 for a time, a degree of naufea, but ultimate- 
 ly to produce the full effect of an emetic. 
 And, perhaps, it is on this principle that 
 fea-ficknefs, in thofe cafes, has been fo very 
 efficacious. 
 
 30. THE duodenum may be ilimulated 
 by calomel combined with fcammony or 
 rhubarb, and in cafes of a defect of bile in 
 the inteftinal canal, the deficiency may be 
 fupplied with a purgative bitter, by an infu- 
 
fion of camomile flowers, with tincl. aloes, 
 or colomba, with rhubarb and foap, or kali 
 vitriol, with infuf. rhei. In cafes of violent 
 pain, with a flow pulfe, opiates and tepid 
 bathing may be recommended. In cafes of 
 pyrexia, with local pain and dyfpncea, venas 
 fec>io and the antiphlogiftic regimen may 
 be ufed with advantage. 
 
 31. GENTLE exercife on horfeback is par- 
 ticularly ufeful in promoting the paflage of 
 calculi, and preventing the ftagnation of 
 bile in the gall-bladder, which probably 
 renders it vifcid, and liable to obftruct the 
 free paflfage into the duodenum. 
 
 32. IN jaundice from tumour or prefTure 
 >of furrounding parts, fmall dofes of calo- 
 mel, or fome other mercurial preparation, 
 may be ufeful, unlefs fymptomatic fever 
 ihould take place, in which cafe mercury is 
 hurtful. Chalybeate waters may be ufed to 
 advantage with a view of giving tone and 
 
 0.2 
 
[ 172 I 
 
 energy to the fyftem, fo very defective in 
 cafes of jaundice.* 
 
 * Mr. Dick, a gentleman high in the profeffi- 
 onal line, in Bengal, and of much practice in Cal- 
 cutta, in a letter to me, fays, " I have been for 
 
 " the laft feven years in the habit of giving calo- 
 " me! in the jaundice, in dofes from two to five 
 tc grains every night, till the mouth was affected, 
 " and in every cafe the jaundice went off as foon 
 " as the mouth became fore. I now fcarcely ufe 
 " any other medicine, except merely to prevent 
 " coftivenefs. I cured upwards of forty patients 
 " in that way, and all in lefs than a month> gene- 
 " rally in ten days, or a fortnight." The fame 
 gentleman, in a fubfequent letter to a friend, after 
 paying many compliments to my Treatife on the 
 
 Liver, fays,- " I think, however, that Dr. S. 
 
 " has not fo high an opinion of the good effects 
 t( of mercury, in liver complaints, as it deferves. 
 (( I have been confirmed more and more by late 
 " practice, in my opinion, of its effects in the jaun- 
 " dice, though I do not attempt to reafon upon it. 
 
 ts In recent attacks of liver complaints, after 
 <c early bleeding, bliftering, and the free ufe of 
 " laxatives, I never faw a cafe where fuppuration 
 " came on, if mercury was freely ufed, and conti- 
 " nued till the mouth was fore j and, if I be not 
 " much miftaken, it is in fuch cafes that it has the 
 4C beft effects.- In chronic cafes, where there is 
 
c< no. fever, but only an obtufe pain in the fide and 
 " fhoulder, with a fullnefs in the iide, and about 
 (t the pit of the ftomach, keeping up a conftant 
 " uneafinefs, mercury feems to me to have but 
 " little good effects : when ufed freely it removes 
 " the fymptoms at the time, but they generally re- 
 " turn as foon as the mercury is left off. Having 
 been repeatedly baffled in this way, and obferv- 
 " ing very often that fuch liver attacks fucceeded 
 " long courfes of mercury, undergone for the 
 " cure of venereal complaints, I have for feveral 
 " years paft trufted to a feton or iflue made in the 
 " fide, and with fuccefs far beyond my expeda- 
 <c tions." 
 
 Thefe being the remarks of a gentleman of 
 much practice and obfervation, I have given them 
 in his own words, being convinced that they de- 
 ferve the particular attention of thole who prac- 
 tice in India. 
 
C 175 I 
 
 CHAP. IV. 
 
 OF THE DISEASES TO WHICH'THE 
 
 LIVER IS SUBJECT IN COMMON 
 
 WITH OTHER ORGANS OF A 
 
 GLANDULAR STRUCTURE. 
 
 SECT. I. 
 
 JL H E liver is fufceptible both of acute 
 and chronic inflammation ; perhaps of the 
 former, as being more immediately con- 
 nedted with its arterial or nutrient, the latter 
 .with its venous or fecretory fyftem. When 
 
the liver is feized with acute inflammation 
 the difeafe is called Hepatitis. 
 
 2. IT is generally preceded by fome 
 degree of horripulatio and rigor, which in 
 fome cafes, however, are fo flight as to 
 evade the attention or recollection of the 
 patient; to thefe fucceed an increafe of heat 
 and quicknefs of pulfe. The pain in the 
 right bypochondrium, or region of the liver, 
 is very acute, attended with difficult and 
 painful refpiration, great watchfulnefs, and 
 occafional delirium. The patient lies with 
 more eafe on the right fide. The urine is 
 fecreted in fmall quantity, is high coloured, 
 and frequently tinged with bile. The tongue 
 is generally covered with a white cruft, and, 
 together with the mouth and fauces, is ex- 
 tremely dry. Thefe are the leading fymp- 
 toms of Hepatitis. 
 
 3. THE fymptoms are fomewhat varied, 
 according to the particular part of the liver 
 which may happen to be the feat of the 
 
3 
 
 
 
 difeafe. If the inflammation attack the 
 convex furface of the liver, fo that the pe- 
 ritoneum becomes affected, the pain is much 
 increafed by external preffure, and fome de- 
 gree of tumour may be obferved. If that 
 part of the organ be difeafed which is more 
 immediately contiguous to the diaphragm, 
 it gives rife to difficult and painful refpirati- 
 on,, dry and frequent cough, acute fhooting 
 pains in the thorax, extending to the hume- 
 rus, clavicle, and fcapula. 
 
 . 4. THESE fymptoms, from the refem- 
 blance they bear to thofe of pleurify, peri- 
 pneumony, and other inflammatory affec- 
 tions of the chefr, are apt to miflead an un- 
 wary practitioner ; but are to bediftinguifh- 
 ed from them by an attention to the hiftory 
 and progrefs of the complaint. 
 
 5. IN fome cafes of Hepatitis the ilo- 
 mach is fo extremely irritable, that violent 
 retching or vomiting occur, fymptoms in- 
 fluenced, perhaps, by the inflammation 
 
being in the vicinity of that organ. In mod 
 cafes the fecretion of bile is increafed under 
 active inflammation, though its paffage into 
 the duodenum is frequently impeded, fo that 
 jaundice is no uncommon fymptom of this 
 difeafe. 
 
 6. IF the fymptoms of fever and local 
 pain continue to increafe rapidly for a few 
 days, a fuppu ration takes place, a large 
 quantity of pus is formed, the external 
 tumor becomes more prominent, a fluctuati- 
 on may be perceived, fo as fuccefsfully to 
 direct the operation of the furgeon to an 
 artificial opening by the cauflic or the lancet. 
 During the formation of pus frequent rigors 
 are felt, and a fenfe of weight and opprefllon 
 fucceeds that of acute pain, 
 
 7. IT frequently happens that pus is 
 formed either in the vicinity of the dufts y 
 or in the concave part of the liver; fo that 
 no external tumor can be perceived. The 
 ufual fymptoms of fuppuration, however, 
 
C 179 ] 
 
 may be obferved in all cafes where matter 
 is produced j and if the outlet to it be free 
 and open by the inteftines, the patient fre- 
 quently recovers, even after being much 
 emaciated, and under appearances extreme- 
 ly unpromifing. If again, on the other 
 hand, the pu$ is difcharged either through 
 the diaphragm into the cavity of the 
 thorax, or more direclly into that of 
 the abdomen, the difeafe generally proves 
 fatal. 
 
 8. WITH refpedlto the manner in which 
 the difcharge is effefted in thofe cafes where 
 it pafTes off by the inteflines, it muft be 
 clear that fome of the branches of the he- 
 patic duel are involved in the fuppuration, 
 and confequently deftroyed by the ulcerative 
 procefs. 
 
 9. WE fhould then naturally fufpect that 
 the pus would infmuate itfelf into thofe ori- 
 fices of the hepatic duels, which ulceration 
 
 "had formed, and by thofe channels make its 
 
way into the duodenum. But this explana- 
 tion is not unattended with difficulty : for 
 it muft be recollected, that wherever fuppu- 
 ration and ulceration are going forward, 
 there adhefion is an attendant. 
 
 10. IT would be departing from the 
 main object of this work to branch off 
 into a digrefllve inquiry on the advantages 
 refultirig to the machine from this connexi- 
 on of inflammatory flages, as thofe advan- 
 tages are as much diverfified as the parts 
 which are the feat of inflammation. It js 
 in place here, however, to obferve, that an 
 abfcefs of the liver, in common with other 
 parts, has its boundaries circumfcribed by 
 the effufion of coagulable lymph fo changed 
 by pafTing through inflamed veflels, that 
 the parietes of that abfcefs become fold ered 
 into a folid compact mafs. Thus an abfcefs 
 which, under contrary circumilances, would 
 have diffufed itfelf to an indefinite extent, 
 now becomes determined and circumfcribed. 
 
ii. THESE conilderations prepare us fora 
 change, which mufl neceffarily be induced 
 on the ulcerated branches of the ,bepatic 
 du<5l; the coagulable lymph, which is eve- 
 ry where poured out upon the internal fur- 
 face of the abfcefs, will, in all probability, 
 fo obflruct the ulcerated orifices of the bili- 
 ary duels, that no pus can make its way by 
 them into the inteflines. 
 
 12. NOTWITHSTANDING^ this, I think it 
 very probable that an -abfcefs may point on 
 the concave furface of the liver, and fo far 
 involve the hepatic duel:, that it may ulce- 
 rate through its coats, and allow the matter 
 to pafs into the duodenum. Whether we 
 may be able to diftingnifh fuch a cafe in the 
 living fubject is rather doubtful; but I 
 fhould fufpecl: that the difcharge of pus by 
 the inteftines will be very gradual, as the 
 opening of communication is rather fmall. 
 
 13. PERHAPS the molt ufeful evacuation 
 of hepatic abfcelTes by the inteftinal canal 
 
 R 
 
is that where an adhefion takes place between 
 the fuppurating part and the inteftines, 
 an ulceration enfues, and the contents of 
 the abfcefs have a ready pafTage into the in- 
 teftines. This may happen in different parts 
 of the inteftinal canal, according to the 
 Htuation of the abfcefs. When it is feated 
 at the concave part, the duodenum may be 
 favourable for thatpurpofe; but when the 
 lower edge of the liver is the part concern- 
 ed, the great arch of the colon is the ufual 
 outlet ; and in thefe cafes it is highly pro- 
 bable, from the fcale of the parts concerned, 
 that the opening of communication will be 
 more extenfive, and the difcharge of the 
 matter more free.* 
 
 * This view of the complaint accords general- 
 ly with that of my friend Dr. Cheflon, who fa- 
 voured the world with his thoughts on this fubjcft 
 many years ago, in his publication called Patho- 
 logical Inquiries and Obfervations, a work not 
 lefs diftinguifhed for accuracy of obfervation than 
 valuable for the judicious remarks it contains. 
 
E 
 
 14. THE difeafes which are miftaken for 
 hepatitis are peripneumony, inflamma- 
 tion of the flomach, and rheumatic affec- 
 tions of the mufcles in the neighbouring 
 parts.- 
 
 15. THE hepatitis is lefs eafily diftin- 
 guifhed from peripneumony when that 
 part of the liver is affected which is feated 
 within the falfe ribs, and where it enlarges 
 itfelf in fuch a direction as to make aprefTure 
 
 on the diaphragm fufficient to diminifh the 
 cavity of the cheft : and it is probable, like- 
 
 wife, that from the extenfion of the inflam- 
 mation into the fubflance of that organ, its 
 operation as an inflrument of refpiration may- 
 be much impeded. Under thefe circum- 
 ftances a troublefome cough, with difficulty 
 of breathing, comes on ; fo that the dif- 
 eafe afiumes the appearance of thoracic in- 
 flammation. 
 
 1 6. IT is more eafily diftinguifhed from 
 the inflamed condition of the flomach, by 
 
 R 2 
 
.[ '84 ] 
 
 its not being accompanied with that extreme 
 fenfe of heat and pain with which that or- 
 gan is affected, efpecially after taking any 
 thing into it; nor is the debility of the 
 fyftem fo great in the inflammation of the 
 liver as in -that of the ftomach, 
 
 17. IN the cafe of mnfcular pain there is 
 little or no fever ; the pain is more diffufed, 
 is frequently removing from place to place, 
 and is more influenced by varying the pof- 
 ture of the body : it generally alternates' 
 with rheumatic pain in one or more joints 
 of the body. 
 
 18. WHEN the hepatitis terminates fpon- 
 taneoufiy and favourably there is fome eva- 
 cuation by hcemorrhagy, diarrhoea, per- 
 fpiration, or a copious fediment in the 
 urine. In fome cafes I have feen a great in- 
 creafe of bronchial fecretion accompanying 
 the refolution of this difeafe ; and it is not 
 improbable but that a fuperficial difchargc 
 of coagulable lymph may promote this re- 
 
folution, though afterwards productive of 
 adhefive inflammation. 
 
 19. IT has frequently happened that a 
 large abfcefs has very quickly formed, 
 which, either by corroding the large blood 
 veflels, or by efFufing pus into the ge- 
 neral cavity of the abdomen, has proved 
 fatal. 
 
 20. SYMPTOMS, indicating the formation 
 of matter in the fubftance of the liver have 
 fometimes fuddenly ceafed -, fo that either 
 a tranilation of the difeafe to fome other 
 organ has taken place, or pus has either 
 been quickly abforbed, and been difcharg- 
 ed by urine. 
 
 21. THE period of fuppuration vanes ac- 
 cording to the degree of inflammation, tem- 
 perament of the patient, nature of the cli- 
 mate, feafon of the year, or the means of 
 cure whicR have been adopted. 
 
 22. THE fymptoms of fuppuration are not 
 always, however, very obvious , the mod- 
 
 
[ 186 ] 
 
 finking of them are, a diminution of pain, 
 a fenfe of pulfation, and of weight in the 
 right hypochondrium, efpecially when lying 
 on the left fide, frequently returning ri- 
 gors, an acceffion of fever towards the 
 evening, with flufhings of the countenance, a 
 propenfity to profufe fweating, and other 
 fymptoms of hectic fever. In many cafes 
 the fluctuation is very apparent. I have 
 feen fome cafes where the pain and inflam- 
 mation have fubfided very fuddenly, and 
 have been fucceeded by a low, fluttering 
 pulfe, cold extremities, deiiquium, and 
 death : fo that there has been reafon to fuf- 
 pect that this organ may on forne occafions, 
 though much lefs frequently than others, 
 become gangrenous. 
 
 23. THE hepatitis frequently terminates 
 in the enlarged and fchirrous ftate of the 
 organ; and we may obferve, ongthe infpec- 
 tion of dead bodies, fuch a variety in the 
 appearances, as to fuggeft the idea of dif- 
 
E 187 
 
 ferent kinds of fchirrous afFedlion, which 
 will be beft explained by attending to the 
 progrefs of chronic inflammation in the 
 liver, to which fpecies it is more fubjecV 
 than to the acute. It is indeed fufficiently 
 evident from direction, that the liver is 
 fubjecl: to inflammation, which did not ob- 
 vioufly appear from any prevailing fymp- 
 tom before death : though perhaps a more 
 accurate attention to circumftances might 
 have afcertained the difeafe.* 
 
 24. FROM repeated obfervation I am in- 
 duced to believe that the chronic inflamma- 
 tion of the liver is frequently miftaken for 
 a dyfpeptic ftate of the ftomach. And I 
 have feen many cafes of this kind, which 
 have been fuppofed to arife from indigef- 
 tion. The patient generally complains 
 
 * For a more particular account of the difeafed 
 ftrufture of the liver, the reader may confult the 
 Morbid Anatomy of the Human Body, by Dr. 
 Baillie ; a moft excellent and ufeful book. 
 
f pain, which he falfely attributes to the 
 flomach j and its continuance is fo fhort, 
 and the degree of it frequently fo incon- 
 fiderable, that no alarm refpecting the fu- 
 ture health of the patient is produced. The 
 relief obtained by eructation and difchargc 
 of air tendsto confirm the opinion that the 
 feat of the difeafe is in the ftomach ; but this 
 relief may be explained on the principle 
 of removing the diflention of the ftomach, 
 and fo taking off the preffure of this organ 
 from that which we believe to be the feat of 
 the difeafe. I believe from experience, that 
 an attention to the following circumftances 
 will enable us with fome certainty to dif- 
 tinguifli the difeafe. 
 
 25. IN thofe cafes where the liver is 
 affected, confiderable pain is felt in the 
 parts near the fcrobiculus cordis and epi- 
 gaflric region, upon any degree of pref- 
 fure; and as the difeafe advances, an in- 
 creafe of heat, a quicknefs of pulfe, and 
 
other fymptoms of fever, are obferved, 
 efpecially towards night. The patient will 
 fometimes derive relief from bleeding at 
 the arm, and the blood, when drawn, will 
 put on thofe appearances which are com- 
 mon to febrile complaints and diforders of 
 an inflammatory nature. 
 
 26. THE acute inflammation of the liver 
 is an endemic difeafe in warm climates, 
 more particularly in the Eaft Indies, and 
 very generally terminates in fuppuration. 
 When the fymptoms of active inflammation, 
 however, have been checked, though not 
 effectually removed, by the antiphlogiftic 
 practice, the difeafe frequently becomes 
 chronic, and terminates in a fchirrous in- 
 duration of the organ. 
 
 27. ON this fubject much information 
 may be obtained by obferving the coun- 
 tenance of the, patient, which, though not 
 wearing the appearance of jaundice, 
 
[ 1 90 ] 
 
 has a peculiar fallownefs, expreflivc of a 
 morbid condition of the liver. 
 
 28. THE two complaints are not more 
 distinguished by their fymptoms than they 
 are by the different flates of the liver 
 which produce them. 
 
 29. IN chronic inflammation a condi- 
 tion obtains in fome degree the reverfe of 
 the former. Inftead of appearances which 
 accompany and characterife acute and active 
 inflammation, there are manifeft figns of in- 
 dolence and want of action in the circulating 
 fyftem. The colour natural to this organ 
 in the healthy ftate, and which appears to be 
 imparted to it from the bile, is loft 5 it: 
 afTumes an afh or clay-coloured hue, evident- 
 ly connected with a diminifhed fecretion. 
 
 30. THIS kind of liver is obvioufly 
 fmaller, it undergoes a change in lhape; 
 the lower edge, which is naturally thin, 
 efpecially of the left lobe, becomes rounded 
 and gibbous. 
 
31. IF we cut into its fubftance, we find 
 uniformly a folid compact appearance, in- 
 terfperfed with foramina, evidently the 
 orifices of divided vefTels -, but if we com- 
 pare the cut furface of a difeafed liver with 
 that of a healthy one, we obferve a very 
 fenfible difference, the latter being much 
 more porous than the former. This mor- 
 bid and compact ftate, together with the 
 diminifhed bulk of this organ, lead us at 
 firft view to a fufpicion that the diminifhed 
 fize may be explained on the principle of 
 confolidation of its fubftance; or, in other 
 words, that it has gained in compactnefs 
 what it has loft in external bulk. 
 
 32. IF this explanation were juft and 
 adequate, we fhould find the liver of its na- 
 tural weight; but obfervation has evinced 
 that, together with a diminution of bulk, 
 there is fome degree of lofs in its weight, 
 evidently proving that a portion of its folid 
 fubftance has been removed, and carried 
 
I 9 2 
 
 into the general mafs of fluids, agreeably 
 to a law of the abforbent fyftem. 
 
 33. BUT I ftrongly fufpect that this 
 diminution of fubftance obtains in dif- 
 ferent degrees, according to the period or 
 duration of the complaint. In the more 
 early ftages of fchirrofity the liver is not 
 fenfibly diminifhed in its bulk: nay, I am 
 perfuaded that there is at this period an 
 increafe both of bulk and weight, but that 
 afterwards there is a gradual diminution of 
 both ; and this is nothing more than may- 
 be expected, when we confider the caufes 
 that occafion this difeafe. 
 
 34. THESE caufes are of a nature which 
 tend to produce a hurried, and confequently 
 an imperfect iecretion of bile, viz. long refi- 
 dence in a warm climate, and the immo- 
 derate ufe of ardent fpirits. 
 
 35. BUT, whatever be the remote or 
 occafional caufes, it mud be evident that 
 the immediate caufes can admit but of 
 
I 193 ] 
 
 little variety. To produce an increafed 
 fecretion of bile, it muft be evident that 
 there muft be an increafed action of the 
 branches of the vena portaruuj, and an 
 accelerated circulation of fluids through 
 thofe branches : hence a condition of vef- 
 fels is induce^, approaching in fome refpects 
 to that of inflammation, with this differ- 
 ence, that it is an inflammation in which 
 the vein, or fecreting veffel, is more con- 
 cerned than the artery or nutrient yeffel. 
 
 36. THE effect of this action, efpecially 
 when protracted to a confiderable extent, 
 muft neceflarily be that of inducing an 
 alteration in the ftructure of the part an 
 alteration fimilar to what obtains in other 
 organs labouring under indolent and chro- 
 nic inflammation. 
 
 37. THIS change of ftructure, from its 
 folidity and compactnefs, feems to depend 
 en the cffufion of the coagulable lymph 
 into the parenchymatous fubftance of the 
 
C 194 1 
 
 liver, with this peculiarity, that while it 
 is, in a&ive inflammations, depofited by 
 arteries, it is, in the chronic kind, effufed 
 by the veins. 
 
 38. THUS we are in poflefTion of a 
 caufe <which appears to offer an explana- 
 tion of that diminiihed fecretion of bile 
 ufually met with in fuch cafes, where a 
 hurried or exceffive fecretion was wont to 
 prevail : but to proceed any further in this 
 train of reafoning would be to anticipate 
 what we have to propofe on the fubjecl: of 
 the pa>ximate caufe. 
 
 39. IF the pofition juft flated be true, it 
 muft be admitted as a confequence, that 
 fuch livers are not performing their full 
 {hare of that office in the machine to which 
 they were deftined by nature. 
 
 40. Now we know, that by a law of the 
 abforbent fyftem, fuch parts as ceafe to 
 perform the office nature intended they 
 fhould do, are confidered as ufelefs bodies, 
 
[ '95 J 
 
 and are fit fubjefts for the action of thefe 
 veflels : hence it is that there is a greater 
 diminution of fubftance in thofe fchir- 
 rofities which are of long (landing, than in 
 fuch as are of more recent date. 
 
 41. To inquire in what confifts the 
 proximate caufe of inflammation of t he- 
 liver, is to inveftigate what is the proxi- 
 mate caufe of inflammation in general.- 
 The limits prefcribed to this work do 
 not allow us to enter extenfively into this 
 queftion, as it would involve an examin- 
 ation of the prevailing theories on this 
 fubjecl:. 
 
 42. FROM obfervation we are taught 
 the means that are ufed with advantage to 
 palliate and even to remove inflammation ; 
 and from obfervation likewife we learn, 
 that the fame means winch are ferviceable 
 in one inflammation are injurious in ano- 
 ther : now, admitting the axiom, " that 
 cc flmilar caufes produce fimilar effects un- 
 
 S 2 
 
 
" der fimilar circumftances," and finding 
 likewife that fome inflammations are aggra- 
 vated by the very means which cure others * 
 we infer as a confequence, that the condi- 
 tion of inflamed veflels, or x in other words, 
 the proximate caufe of thofe fymptoms 
 N 'denominated inflammation, is not always 
 . ;he fame. Hence arifes a confiderable ihare 
 pf the difficulty attending the inveftigation 
 of proximate caufes in general. 
 
 43. THE phenomena of inflammation 
 evidently Ihow, that in every inflamed part 
 there is a congeftion of blood, in a greater 
 or lefs degree. This is very confpicuous in 
 thofe parts of the body where, from their 
 fituation, we are enabled to fee the change 
 of colour, as in the fkin -, but more efpeci- 
 ally the tunica conjunctiva of the eye, 
 where, from its trafifparency, and the white 
 fubjacent tunica albuginea, we have an op- 
 portunity of feeing clearly the commence-* 
 ment and progrefs of inflammation* 
 
[ 197 ] 
 
 44 THE firfl appearance is a diftention 
 of fome of its veffels in fuch a degree, as 
 to allow red blood to pafs where ferum only 
 was wont to circulate. In the progrefs of 
 inflammation more veiTels become diftend- 
 ed, until at length the whole eye aflumes 
 almoft one uniform red appearance. 
 
 45. Now, on what peculiar ftate of vef- 
 fels does this diftention depend ? Are the 
 powers that aft in propelling the blood 
 from the larger veflels to the fmaller ones 
 increafed, while the refifting powers of the 
 ultimate branches remain the fame as in 
 health ? Or have the ultimate branches un- 
 dergone a change of fuch a nature as to yield 
 to the ordinary force or natural vis a tergo 
 of the larger veflels ? 
 
 46. THERE are good reafons for believ- 
 ing that each of thefe conditions exifts in its 
 turn : at lead the methods employed with 
 fuccefs to remove inflammations of this part 
 lead to that opinion. FO'L it is a fad well 
 
[ i 9 8 1 
 
 eftablifhed in the treatment of thefe coin- 
 plaints, that the fame means which are em- 
 ployed in the cure of one opthalmia tend 
 only to aggravate another. The means 
 generally employed in thefe cafes are fuch 
 as either diminifh action or increafe tone -, 
 and each plan of treatment is fuccefsful in. its 
 proper cafe. 
 
 47. Now what has been faid of opthal- 
 mia will apply to hepatitis and other inflam- 
 mations. 
 
 Thelivermay be inflamed in confequence 
 of external injury. In fuch cafes it is pro- 
 bable that a violent and ilrong action will 
 take place, analogous to what would happen 
 in the eye from the prefence of an extraneous 
 body -, and that a plan of treatment evi- 
 dently fedative or antiphlogiftic is moil 
 likely to be efficacious in both. 
 
 48. ON the other hand, the fame organs 
 rriay be in a ftate of inflammation without 
 die application of' any obvious Simulating: 
 
E 199 I 
 
 cauie. In the eye, experience has evinced 
 that this kind of opthalmia is mod fuccefs- 
 fully treated by bark, and fuch external 
 applications as tend to ftimulate and give 
 tone ; evidently fhowing that the efTential 
 character of that inflammation is debility. 
 And further, it is now well underftood that 
 an inflammation of the eye, which was of 
 the active kind at its commencement, 
 changes in its progrefs to a ftate of debility, 
 and yields only to thofe means that give 
 tone and ftrength to the part. 
 
 49. IT is of importance to ourfubject ta 
 inveftigate in what way an active inflamma- 
 tion degenerates into an indolent one. 
 
 We have faid, in every inflammation, 
 there is fome degree of congeftion of blood, 
 and confequently diftention of veffels : if 
 this congeftion be relieved at its commence- 
 ment, by lefTening the diflending caufe, the 
 vefTels, ftill preferving their tone, readily 
 return to their original dimenfions ; but if,. 
 
[ 200 ] 
 
 on the other hand, the congeftion is allow- 
 ed to remain, and of courfe the diftention 
 of the veflels, their tonic power neceflarily 
 becomes diminifhed, and fuch means only 
 can avail, as tend to lefien the column of 
 the blood, and increafe the contractile power 
 of its veflels. 
 
 Thefe reafonings may ferve to give 
 fome idea of the two ftates of the veflels 
 as conne&ed with active and indolent in- 
 flammation. 
 
 50. As the principles laid down apply to 
 inflammations of any organ, we ihall en- 
 deavour to fhow, by canfidering the na- 
 ture of remote caufes, in what way they 
 may produce this flate of veflels in he- 
 patitis. 
 
 51. MANY remote caufes of hepatitis 
 may be enumerated, fuch as affections of 
 the mind, particularly anger, long protract- 
 ed fumrner heat, the intemperate ufe of 
 fpirituous liquors, &c, But to produce 
 
[ 201 ] 
 
 the fame difeafe it is natural to expect that 
 there is one principle of action in common 
 to them all. This principle appears to con- 
 fift in inducing a ftate of excitement in the 
 circulation of the liver : the accelerated, 
 though imperfect, fecretion of bile, toge- 
 ther with the fenfe of fuln-efs in the region 
 of the liver antecedent to inflammation, 
 tend to perfuade us that hepatitis is gene- 
 rally ulhered in by fymptoms of exifting 
 congeflion. 
 
 52. IF proper methods be taken to re- 
 lieve this congeflion on its firft attack, fuch 
 as diminifliing the column of blood, or 
 inducing a determination of it to conti- 
 guous .parts, the tone of the vefTels will be 
 preferved, and evident inflammation pre- 
 vented. Or even if an obvious inflamma- 
 tion has commenced, the fame means will 
 be equally ferviceable by allowing the dif- 
 tended vefTels to recover that tone which 
 they were beginning to lofe. But if the 
 
[ 202 ] 
 
 congeftion has been of fome duration, and 
 the tonic ftate of the veflels confiderably 
 impaired, if the moft aftive means are not 
 employed, the confequenee will be either 
 a fuppuration, if the inflammation be vio- 
 lent, or a degeneracy into fchirrus, if the 
 inflammation has been moderate : and it is 
 in this way, I conceive, that an inflamma- 
 tion of the liver, which was of the aclive 
 kind at its commencement, changes in its 
 progrefs into a ftate of fchirrofity. 
 
 53. OR, a ftate of fchirrus may be gra- 
 dually induced on the liver, without any 
 pre-exifting active inflammation, as hap- 
 pens after a long refidence in a warm cli- 
 mate, where, from frequent accelerated 
 fecretion of bile, the hepatic veflels, j but 
 more efpecially the branches of the vena 
 portarum, become fo relaxed, that they 
 effufe into the parenchymatous fubftance 
 of the liver that folid matter, which appears 
 to be nothing more than the coagulable 
 
I 203 ] 
 
 lymph of the blood changed in a peculiar 
 way.* This is the morbid ftrufture of the 
 liver, which generally terminates in afcites. 
 54. BUT there is an appearance fome- 
 times met with on difieftion that is per- 
 
 * DROPSY is a very general confequence of a 
 difeafed liver ; which, from previous inflammati- 
 on, may have fuffered in its ftruclure in fuch a 
 way as to produce a confidcrable impediment to 
 the tranfmiflion of blood by the vena portarum. 
 
 Such dropfles fometimes firft manifeft them- 
 felves by water in the abdomen, at others by a fluid 
 in the cellular membrane. Now, as both of 
 thefe originate from the fame caufe, it may de- 
 ferve inquiry, to what circumftances we ihould 
 impute this apparent want of uniformity in na- 
 ture. 
 
 This explanation muft be fought for in the laws 
 of the circulation. Whatever {hare a diminifhed 
 action of the abforbent fyftem may have in pro- 
 ducing an accumulation of watery fluids, it muft 
 be evident that a confiderable degree of effufioii 
 from the exhalant fyftem is eflentially neceffary, 
 and which excefs of effufion can arife only from 
 an excefs of vafcular acYion. 
 
 Admitting this pofition, it muft follow as a con- 
 fequence, that when the action of the whole ex- 
 halant fyftem of the body is increafed, the effu- 
 
[ 204 ] 
 
 haps a little difficult to explain on this 
 fyftem of reafoning this is a tubercular 
 flate of the fubftance of this organ, con- 
 filling of a feries of circumfcribed inflam- 
 mations, interfperfed through the apparent 
 
 HOD, which is the effect of it, muft be as exten-. 
 five as the caufe : and on the contrary, when the 
 accelerated action is confined to a part, the effufi- 
 on muft likewife be equally limited. Now are 
 there any caufes to which we can refer this exten- 
 five or limited action ? As all accelerated action is 
 to be referred to ftimuli of fome defcription, we 
 naturally inquire how that condition of vefiels 
 can be produced fometimes in "the whole exhalant 
 fyftern, fometimes in a part. 
 
 From eftablifhed laws in the vafcular fyftem, 
 it is clear, that whatever can impede the free paf- 
 fage of the blood from the venous fyftem to the 
 right fide of the heart, or from the right fide of 
 the heart to the left, will operate as a ftimulating 
 caufe, and produce effects on the exhalant fyftem, 
 either limited or extenfive. 
 
 To fatisfy ourfelves reflecting this point, we 
 need only comprefs a principal vein either of the 
 upper or lower extremity, at the fame time allow- 
 ing the artery to remain free. The effect of this 
 experiment will be, that the veins below the preff- 
 ed part immediately become diftended, the lirnb 
 
healthy fubftance of it. Now it may feem 
 a little difficult to underftand how an ac- 
 celerated circulation through the whole 
 fubftance of the liver can produce effects 
 fo partial and circumfcribed. But the dif- 
 
 fcmetime after becomes enlarged, and if prefled 
 upon with the finger, is proved to be evidently in 
 a ftate of oedema. 
 
 Let us inquire what operations have taken place 
 to which we can refer thele effects. It is evident,, 
 that the return of venous blood was firft impeded 
 by preffure, and that a refiftance was formed to 
 the action of the arteries, the ordinary efforts of 
 which are now become infufficient to propel the 
 blood with its wonted velocity; hence a neceffity 
 for greater exertion of the arterial fyftem to fur- 
 mount the difficulty : but as the exhalants form a 
 part of this fyftem, and partake of the general 
 effect, an effuiion of their watery contents fol- 
 lows as a confequence ; hence the oedema, or in 
 other words, a local dropfy. 
 
 The production of the effect juft ftated does not 
 argue or fuppofe any previous difeafe either in the 
 exhalants or abforbents, but arifes from the con- 
 
 >curring operation of two caufes, (viz.) an impe- 
 diment to the return of venous blood, and the 
 confequent accelerated action of the capillary and 
 
 %xhalant fyftems. And it ought further to be re- 
 T 
 
[ 206 ] 
 
 ficulty is no greater in this cafe than in 
 any other of local inflammation. Do we 
 not continually fee inftances of circtim- 
 fcribed inflammations and abfcefles where 
 
 the ftate of the circumjacent parts is natu- 
 
 
 
 marked, that as the remote caufe was limited to 
 a particular part of the body, fo was the effect 
 produced by it. 
 
 Let us n9\v transfer this reafoning to the liver, 
 and fee how far an impediment to the free paf- 
 fage of blood, through that organ, may operate 
 towards the production of afcites. 
 
 That ftate of the liver, which more particularly 
 difpofes to this difeafe, is the fchirrous or indurat- 
 ed one: that, which when examined by making 
 ilices of it, manifefts a folid and clofe compacted 
 mafs, as if there had been deposited interftitially 
 within its fubftance, folid matter fufficient to def- 
 troy its parenchymatous character. Indeed the 
 fact feems very evident, that its veffels are lefs 
 pervious, and confequently that the blood cannot 
 be tranfmitted by them fo freely as in a ftate of 
 health. 
 
 Now in a former part of this work we endea- 
 voured to make it probable, that the indurated 
 or fchirrous condition of the liver depended more 
 on a difeafed action of the vena portarum than of 
 the arterial fyftem of this gland j and that when 
 
[ 207 ] 
 
 ral and healthy ? Such phenomena do not 
 tend to difprove the principles we wifh to 
 eftablifb, but fhow that the difeafed condi- 
 tion of veflels we have before pointed at, 
 may exift in a number of fmall parts of 
 
 an inflammation arofe in this way, it was to be re- 
 garded rather as of the paffive than of the active 
 kind ; or a fpecies but little difpofed to terminate 
 in fuppuration. Its effects are rather thofe that 
 characterize indolent^ parts, fuch as induration, 
 fchirrofity, &c. But this confequence neceffaii- 
 ly enfues, that though venous inflammation has 
 not activity enough to produce pus, it has power 
 to effufe the coagulable lymph of the blood into 
 the interftitial parts of the liver, and thereby di- 
 minifli the capacities of the blood veflels, more ef- 
 pecially of the vena portarum : and thus an im- 
 pediment .to the free paffage of blood through 
 that fyftem is formed. 
 
 Having thus fhown the probability of an ob- 
 ftruction exifting to the paflage of the blood 
 through the liver, in what manner does this bear 
 a refemblance to the effects of a ligature on the 
 principaf vein of an extremity ? 
 
 Before we can anfwer this queftion, we muft 
 recall to the attention of our readers wiiat has 
 been faid in a former part of this work on the 
 fubjeft, relative to the circulation of blood through 
 
 rn O 
 
[ ao8 ] 
 
 any organ, while the greater part of its 
 bulk ihall be in a natural ftate ; or that 
 there may exift a confiderable number of 
 itimulating caufes in the fubftance of the 
 liver, each having its own fphere of action, 
 and each limited in its extent.. 
 
 the chylopoietic organs. There it was remarked, 
 that the blood which had circulated through the 
 ftomach and inteftines, omentum, fpleen, and 
 pancreas, and we may likewife add, the perito- 
 neal covering of thefe vifcera, was returned to 
 the heart by the intervention of the vena porta- 
 rum of the liver : therefore it follows, that the 
 circulation of blood through this vifcus ftands in 
 the fame relation to the peritoneal vifcera as the 
 returning blood in the principal vein of an extre- 
 mity does to that particular limb ; and likewife 
 it muft follow of neceility, that whenever the 
 liver is affected with any confiderable degree of 
 fchirrofity, the circulation through the vena por- 
 tarum will receive fome interruption. That in- 
 terruption, in whatever degree it may exift, muft 
 excite the capillary veiTcls and exhalantsin the pe- 
 ritoneal vifcera to greater actions; and the effufi- 
 on of lymph from thofe parts follows as a con- 
 fequence. Such appears to me to be a rational 
 
55 THE explanation juft given is not 
 offered as the mere fuggeflion of theory, 
 but admits of a degree of probability ap- 
 proaching to demonftration. This laft 
 opinion feems flrongly fupported by the 
 refult of an experiment that was made for 
 the purpofe of inveftigating a point in 
 phyfiology, not connected with the prefent 
 queftion. 
 
 EXPERIMENT. 
 
 56. Two drachms of crude mercury 
 were injected by means of a proper s appa- 
 
 explanation of afcites, as founded on a fchirrous 
 affection of the liver. 
 
 On the fame principle may be explained the 
 hydrothorax, as originating in the excitement of 
 inflammation in the cavity of the cheft ; or ia 
 any mechanical obftacle to the free paflage of 
 Wood ficm rnefide of the heart to the other, or 
 fi m the pr ell 11 re on the diaphragm ariiing from 
 an enlarged liver, or an ?Tcitic dropfy. 
 T J 
 
[ 210 ] 
 
 ratus into the crural vein of a dog. It 
 produced no efFe6ts that were obvious for 
 at leaft a whole day ; but afterwards there 
 were evident marks of increafed action in 
 the vafcular fyftem, attended with a quick 
 and hard pulir. After he had continued 
 in this ftate two or three days,, a dyfpncea 
 fupervened -, this was foon followed by a 
 cough, and fymptoms evidently denoting 
 an affection of the lungs, which daily in- 
 creafed until he died. His lungs, on ex- 
 amination, were found in a tubercular (late ; 
 many of thefe tubercles had fuppurated and 
 formed vomicas. 
 
 57. THE que'flion here is, whether thefe 
 tubercles and vomicse arofe from the intro- 
 duction of the mercury ? 
 
 The anfwer is very clear. The animal 
 was in perfect health before. This is only 
 a preemptive evidence. But a minute ex- 
 amination of the tubercles put the matter 
 out of doubt ; for on making feet ions into 
 
the fubfiance of them, each contained & 
 globule of mercury, forming a kind of 
 nucleus to the circumfcribed inflammation 
 or tubercle. Whether thefe mercurial glo- 
 bules afted on the principle of fimple 
 flimuli, or in a fpecific way, is not a fubject 
 for our prefent investigation : but the in- 
 ference intended to be drawn is, that fymp- 
 toms of general excitement may exift in the 
 whole body, and that only a particular 
 organ may fhow marks of difeafe - y and 
 further, that the circulation may be accele- 
 rated through the whole vafcular fyftem 
 of a particular organ, while only particular 
 parts of that organ fuffer a vifible alteration 
 in their ftructure. 
 
 58. Now it is natural to refer thefe ap- 
 pearances to fome local caufe, but which is 
 not always fo evident as in the experiment 
 juft recited. This caufe may confiil iiv 
 local alterations in the tone of the veflels 
 in particular parts of an organ ; and that y 
 
C 212 ] 
 
 in confequenceof an accelerated circulation 
 through its whole fubftance, thefe debilitat- 
 ed parts may readily fall into a ftate of 
 chronic inflammation. 
 
 59. IN confidering the active and indo- 
 lent inflammations of the liver, we have 
 referred the former to the hepatic artery 
 or nutrient vefTel ; while the latter has 
 been confidered as an affection of its fecre- 
 tory vefTel. As this opinion is not taken 
 up on the ground of mere conjecture, it 
 will not be out of place to affign a reafon 
 for having adopted it. 
 
 60. WHEN we ftate that chronic inflam- 
 mations of the liver appear to be con- 
 nected with its fecretory office, we do not 
 mean to reft the explanation on any thing 
 fpecific in its fecretory energy, but on its 
 peculiarity of having the fecretion effected 
 from venous blood inftead of arterial. 
 
 61. IT is a faft well eftablifhed in phy-" 
 ilology, ,that the living power or energy 
 
of any organ is, casteris paribus, in pro- 
 portion to the quantity of arterial blood 
 that circulates through it. There is fome- 
 thing then in the condition of arterial blood 
 that fits an organ for active and vigorous 
 purpofes ; the proofs of this pofition arc 
 fo numerous, that they mult occur to every 
 one. Now when we recollect that by far 
 the greater portion of blood that pafTes 
 'through the liver is of the venous kind, 
 and when it is remembered likewife that 
 this blood is lefs fitted to aflive purpofes 
 than arterial, there will appear fufficient 
 grounds for believing that chronic inflam- 
 mations of the liver are to be referred to the 
 vena portarum ; while thofe of the active 
 kind are imputable to the hepatic artery. 
 
 62. IN the active and acute inflamma- 
 tion of the liver, as well as that of other 
 organs, the antiphlogiilic practice fliould 
 be adopted j and as the attention of the 
 practitioner ihould be directed to the pre- 
 
vention of fuppu ration, he muft be guided 
 by the circumftances of each individual 
 cafe in forming bis judgment to what ex- 
 tent that practice may be purfued. Here 
 much depends on his difcernment, as well 
 refpecting the extent of the antiphlogiilic 
 practice, as in determining the preciie pe- 
 riod when it is likely to be mod ufeful : 
 for it mud be obvious, that if any confi- 
 derable advantage is to be _ expected from 
 this practice, it mud be locked for in an 
 early itage of the difeafe,- when the inflam- 
 mation has not advanced beyond the proba- 
 bility of refolution. 
 
 63. THE more prominent part of the 
 antiphlogiftic treatment is blood-letting : 
 the quantity of blood to be taken away, 
 together with the propriety of repeating 
 that operation, can be judged of only by 
 the violence of fymptoms, by the effecl: 
 upon the pulfe, and by the circumftances 
 of each individual cafe. 
 
64. BLISTERS, applied to the region of 
 the ' liver, co-operate very flrongly with 
 the views of blood-letting, and therefore, 
 in attempting refolution, recourfe fhould 
 be had to them very early $ and here again 
 the fame difcrimination is necefTary with 
 refpect to their duration and repetition, as 
 was required in the cafe of blood-letting. 
 It has been advanced by fome, and experi- 
 ment appears to have juftifled the pofition, 
 that a quick fucceffion of blifters to the 
 vicinity of an inflamed organ prevails more 
 over the activity of inflammation, than the 
 long protra&ed difcharges from a fingle 
 vefication. My own experience having 
 abundantly confirmed the truth of this doc- 
 trine, I cannot recommend it to the practi- 
 tioner in too ftrong terms. 
 
 65, As fubfervient to the intention of 
 refolution, medicines promoting alvine 
 evacuations 'are highly expedient ; for this 
 purpofe, thofe which are of a faline nature 
 
[ 216 ] 
 
 appear to me to claim a preference, and 
 perhaps it is adding not a little to their 
 efficacy to exhibit them in a diluted form, 
 in which ftate they not only feem to be 
 more ftrictly antiphlogiftic, but are lefs 
 
 liable to occafion naufea and other dif- 
 
 <iy 
 
 agreeable fenfations in the ftomach. 
 
 66, IN blood-letting, blifters, and lax- 
 ative medicines appear to confiit the more 
 eflcntial parts of antiphlogiftic practice ; 
 but there are other refources of which we 
 can avail ourfelves, and which, though 
 fubordinate in point of activity, are found 
 from practice to be very efficacious as 
 auxiliaries. Under this head we may rank 
 antimonials exhibited in fuch dofes as may 
 tend to produce and continue a degree of 
 foftnefs and moiiture upon the fkin 5 and 
 this operation of antimonials is much 
 aided by a free and plentiful ufe of dilut- 
 ing liquors, of which there is an endlefs 
 variety. 
 
7. BY the means above recited, the 
 practitioner, if called in at the commence- 
 ment of the difeafe, will generally be able 
 to check every tendency to the fuppurative 
 procefs. 
 
 68. IN warm climates, more efpecially 
 in the Eaft Indies, where hepatitis may be 
 regarded as the endemia of the country, 
 the tendency to run on into the fuppura- 
 tory procefs is fo great as fcarcely to be 
 refilled even by the moft active practice -, 
 therefore, if an early and vigorous purfuit 
 of the antiphlogiftic plan of treatment be 
 neceflary in this country, where the courfe 
 of the difeafe is comparatively moderate ; 
 the extenfion of fuch treatment to the 
 utmoft limits of prudence, becomes expe- 
 dient, if we would oppofe with fuccefs the 
 rapidity of its progrefs. 
 
 69. IF, either from an unufual violence 
 of the difeafe, the too late application 
 for medicinal afliftance, or the unavailing 
 
[ 218 ] 
 
 efforts of the antiphlogiftic plan of treat- 
 ment, the inflammation fhall have pro- 
 ceeded to the fuppurative flage, different 
 phenomena occur, according to the partu 
 cular part of the liver in which the fup- 
 puration is feated. Thefe phenomena are 
 fuch as arife out of the laws which regulate 
 the opening of abfceffes : for the operation 
 of nature in this refpect, as well as in moft 
 others, is regular and uniform. 
 
 70. FROM obfervatioh we learn, that 
 hepatic abfcefles fometimes open fpontane- 
 ouily into the inteftinal canal in the manner 
 explained, at fome length, in a former part 
 of this work j at others, they make their 
 way through the diaphragm into the air 
 cells of the lungs, from whence the 
 matter is difcharged by expectoration -, or 
 an adhefion takes plac? between the ante- 
 rior furface of the liver and the parietes 
 of the abdomen, allowing the pus to 
 make its efcape by the common integu- 
 ments. 
 
?i. EACH of thefe channels of difcharge 
 is determined very much by the particular 
 feat of the abfcefs. When the pofterior or 
 concave furface is concerned, the matter 
 ufually paffes off by fome part of the in- 
 teftinal canal, frequently the duodenum ; 
 but when it is feated towards the inferior 
 edge, the colon offers a ready outlet. When 
 the fuperior pordon iuppurates, the air 
 cells of the lungs favour the efcape ; and 
 fuc'i abfceffes as form towards the anterior 
 furface, ufually extend thcmfelves to the 
 integuments, through which they cither 
 difcharge their contents fpontaneoufly, or 
 by the aid of chirurgical means. 
 
 72. THE intention of nature in relieving 
 herfelf by thefe different channels is the 
 fame, as fhe is guided by one common 
 principle in each of them, viz. that of 
 availing herfelf of the neareft outlet. But 
 experience has evinced that thefe are 
 not all equally favourable to her ultimate 
 
 u 3 
 
[ 220 } 
 
 views; and fome hepatic abfcefTes, which 
 have been difcharged by the lungs, appear 
 to have produced their fatal effects more 
 from an extenfion of fuch abfceffes into 
 the fubftance of thefe organs, than from 
 any derangement the con-ftitution .had fuf- 
 tained from the affection of the liver. I 
 feel- myfeif warranted the more in main- 
 taining this idea, not only from having 
 repeatedly feen the fymptoms of hepatitis, 
 in its latter ilage, evidently transformed 
 into the characters of peripneumony ; but 
 from having afcertained, by examination 
 after death, that a fuppurating furface, 
 which originated in the liver, extended 
 itfelf into the fubftance of the lungs in 
 fuch degree, as clearly to explain the caufe 
 of the peripneumonic fymptoms. 
 
 73. THE difcharge of hepatic abfcefTes, 
 either by the inteftines or the abdominal 
 furfaee, is much preferable, as in the for- 
 mer, the organ, though important and even 
 vital, is affected only to a fmall extent.; 
 
[ 221 ] 
 
 and in the latter, very little danger can 
 arife from an opening of a moderate fize. 
 What occafions our furprife is, that they 
 fo feldom effufe their contents into the ca- 
 vity of the abdomen. The law itfelf is 
 wonderful, though the means by which na- 
 ture carries her intentions into effect are very 
 obvio.us j for in all thefe cafes the opening 
 is furrounded by adhefions fo effectually, 
 that there is little danger of the general ca- 
 vity being expofed. 
 
 74. IF, however, the difeafe is well 
 marked, and the abfcefs has pointed to a 
 determined part of the integuments, we 
 need not wait for a fpontaneous opening, 
 but by means of a lancet may difcharge 
 the matter. Such abfcelfes are feldom in 
 hafte to heal, nor is it defirable, until the 
 cavity of the abfcefs (hall have been filled 
 up by healthy granulations. During this 
 procefs, which is fometimes tedious, the 
 health gradually returns 3 and I have had 
 v -3 
 
[ 222 ] 
 
 experience of cafes where the difcharge ac- 
 companying this granulating operation was 
 continued for years, during which time the 
 health was in a progrefTive Hate of amend- 
 ment, and at length was perfectly eftab- 
 lifhed. 
 
 75. Sucn infbances, though furprifing, 
 are not myfterious, for a part only of the 
 liver has been concerned in the abfcefs. 
 During the period of active inflammation, 
 the conftitution partook of the effects, per- 
 haps more from a principle of fympathy 
 with the inflamed organ, than from any 
 derangement in its economy as a gland;, 
 and therefore it is natural to expect, that, 
 as the inflammatory fymptoms fubfide, the 
 figns of health fhould return. 
 
 76. AN opinion has for fome time pre- 
 vailed, that mercury is a fpecific in every 
 difeafe of the liver; and that even in active 
 phlegmonous inflammations it will obviate 
 fuppuration. This opiniop appears to, have 
 
f 223 3 
 
 been founded on an idea, that there is foine-* 
 thing very peculiar in the inflam; nation of 
 the liver that is not met with in any other 
 
 organ. 
 
 77. IT is true, that in confidering its 
 glandular office, it affords an exception to 
 the law of glands, in having its fecretion 
 performed from venous blood ; and this 
 we have already confidered as having a con- 
 nexion with chronic inflammation, which 
 experience has fhown to be relievable by 
 mercury. The fuccefs in thefe cafes has per- 
 haps led to an empirical practice, and due 
 difcrimination may not always have been 
 made between inflammations of a more 
 indolent, and 'fuch as are of a more active 
 nature. 
 
 78. To exhibit a remedy without due 
 difcrimination is to abufe it, and at length 
 to bring it into neglect; and in this way 
 the world has been deprived, for a time, 
 of the benefit of fome of the mod valuable 
 
[ 224 ] 
 
 articles of the materia medica, which, how- 
 ever, have been reftored to them afterwards, 
 on the recommendation of men of candour 
 and ability, after having determined their 
 true value by repeated and judicious exhi- 
 bition. 
 
 79. PERHAPS the fame fate may await the 
 ufe of mercury in complaints of the liver, 
 if, by a blind empirical adrniniftration of it, 
 it be incautioufly employed in the active 
 periods of inflammation, when, from its 
 ftitnulant properties, it appears better cal- 
 culated to accelerate than to retard the fup- 
 purative procefs. 
 
 80. IT is very probable, that the attach- 
 ment of the practitioners in warm climates 
 to the early ufe of mercury, may havearifen 
 in part from the great debility confequcnt 
 on the previous excitement of the fyftem, 
 which debility is fuppofed to prevail the 
 moil-, where there had been much evacuati- 
 on $ and this prejudice has perhaps been car- - 
 
[ 225 I 
 
 ried to a dangerous extreme. But there are 
 not wanting fome, who are perfectly aware 
 of the neceflityof proper diftinctions, and 
 who pay due regard to them in their prac- 
 tice. 
 
 8 1. IN theEaft Indies, where this com- 
 plaint is endemic, I am informed, on the 
 bed authority, that many judicious and fuc- 
 cefsful practitioners feldom adminifter mer- 
 cury until the violence of the inflammato- 
 ry action has been moderated by bleeding, 
 active purging, and the antiphlogiflic plan 
 of treatment. Then it is, that mercury 
 is employed to the greateft advantage. But 
 it appears, on attentive obfervation, that 
 the tranfition of active inflammation into a 
 Hate of refolution, is not immediately fol- 
 lowed by a healthy condition of the part, 
 but it remains for a time debilitated and 
 diipofed to lapfe into a chronic Hate. This 
 will probably be found the proper period for 
 the exhibition of mercury, which acts as a 
 
I 226 ] 
 
 fpur on the vafcular fyftem of this organ, 
 and by its moderately Simulating effects, 
 occafions a degree of action, which, when 
 protracted to a proper length, terminates in 
 health. 
 
 Si. BUT the difpofition of hepatitis to 
 terminate in a fchirrons and difeafed ftruc- 
 ture, either of the whole, or of a part of 
 the liver, is fo ftrong in fome cafes, as not to 
 be refitted by a moderate mercurial action. 
 Here we are to take the advantage of its 
 more active operations ; and, inftead of in- 
 ducing a flight change upon the pulfe, with 
 only a tendernels of the mouth, we ought 
 to extend its effects to the production of a 
 gentle falivation, which, when continued 
 for a length of time, generally effects a 
 cure. 
 
 83. IN the exhibition of mercury for 
 this purpofe, a preference has been given 
 to friction ; and the part on which the 
 mercurial ointment has been rubbed, is 
 
[ 2*7 ] . 
 
 the right hypochondrium, from a notion 
 of .its efficacy being greater when applied 
 to the vicinity of the difeafed organ, than 
 to a diftant part. But my opinion is, that 
 there is no material advantage derived 
 from this ; and it is of little importance, 
 what part is made choice of, provided the 
 effects produced on the general fyflem arc 
 equally ftrong. 
 
 84. THE knowledge we derive from ana- 
 tomy of the ftructure, origin, and directi- 
 on of the lymphatic veflels, fufficiently 
 proves, that neither by the internal ufe of 
 mercury, nor by its external application, 
 can any of it be made to pafs through the 
 liver in its way into the conftitution > it 
 cannot, therefore, act on the liver but by 
 being firft introduced into the blood veflels. 
 It is fome.times difficult in cafes of difeafed 
 liver, efpecially if attended with dropfy, 
 to introduce mercury into the constitution ; 
 under fuch circumftances, the beft abforb~ 
 
[ 228 ] 
 
 ing furface fliould be employed for the 
 purpofe of fri&ion : fuch parts of the body 
 as have the fined cuticle, as between the 
 fingers, in the axilla, or groin, abforb mod 
 readily, and if the cuticle be removed by 
 bliders, from any part of the body, fuch 
 a furface will be found bed adapted to the 
 purpofe of abforption. Ulcers frequently 
 abforb better than entire furfaces, and in 
 many cafes fuch artificial means of pro- 
 moting abforption may be admitted. It 
 is likewife a fubjed worth confidering, 
 whether dill greater advantage can be 
 derived from the introduction of active 
 and chymical preparations of mercury by 
 abforption than by the ufe of the common 
 
 mercurial ointment. Ulcerated furfaces 
 
 will abforb the faline preparations of mer- 
 cury, while a furface, covered with a cu- 
 ticle, would, with difficulty, admit them. 
 The quantity of mercury, at any one time, 
 in a date of adion in the body, is fo fmall 
 
3 
 
 as to elude all the powers of chymical 
 inquiry. By various and accurate tefts, I 
 have not difcovered .in the fecretions any 
 mercury in perfons under a falivation, 
 either from the internal or external ufe of it. 
 85. THE fchirrofity, which we have 
 been confidering as the remains of hepa- 
 titis, is often very intimately connected 
 with other difeafes ; and is thought by 
 men of obfervation and experience, to 
 fland in relation to them, as a caufe. 
 Thus in India, the fever and dyfentery, 
 which are confidered as the endemias of 
 the country, have been found, on direction, 
 to be accompanied with difeafes of the 
 liver. In fome inftances, the whole fub- 
 ftance has been in a fchirrous ftate j in 
 others, abfcefles and the ufual appearances 
 of hepatitis have been met with : the fa<5t 
 is certain, though the relation in which 
 they are placed to each other may be matter 
 
 of opinion. 
 
 x - 
 
[ 230 
 
 86. IF it be true, and there can be but 
 little room for doubt, that every difeafe of 
 a gland mud affect, in fome degree or 
 other, its fecretory powers, we may admit, 
 that the biliary fecretion may become 
 extremely vitiated, may acquire acrid pro- 
 perties, and may morbidly affecl: the in- 
 teftinal canal by its paflage through it j 
 hence may follow ulcerations of the inter- 
 nal furface, giving rife to the common 
 fymptoms of dyfentery. But if it be an 
 eilabliflied fact, as has been aflerted by 
 high authority, that the dyfentery is 
 always contagious ; there would feem to 
 be a nece/Iity for calling in fome other 
 principle of action, in addition to the 
 acrimony of the bile. But waving this 
 controverfy, which cannot be protracted 
 to a greater length* without evidently 
 digrefling from the main purpofe of this 
 chapter, it is in place here to obferve, that 
 
thefe dyfcnteries are fo far congenial to the 
 hepatic affe&ions with which they are com- 
 bined, that they are generally relieved by 
 mercury administered under the cautions 
 we have already laid clown. 
 
 > I N I S,