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NATIONAL LIBRARY OF MEDICINE
             Washington
Founded 1836
U. S. Department of Health, Education, and Welfare
Public Health Service 
 
 
         TREATISE
             *f ON THE
      STRUCTURE,  ECONOMY,
                           i ' ■
                 AND
      _w    D I S E A^SE S
                OF THE

          LIVER;
             TOGETHER WITH
  AN INQUIRY. INTO THE PROPERTIES
                 AND
         COMPONENT PARTS
                OF THE
  BILE and BILIARY CONCRETIONS.*;
                —-A^nifr
                 BY  '-. '  /
,  WILLIAM SAUNDERS, M.D. F.R.S.
     FELLOW OF THE COLLEGE OF PHYSICIANS,
      AND SENIOR PHYSICIAN TO GUY's HOSPITAL.
FIRST AMERICA*, FROM SECOND LONDON EDITION,  }
     WITH CONSIDERABLE ADDITIONS.
        .BOSTON :
PRINTED FOR W. PELHAM N°, 59 CORNHILL.
   1797.
[Price One Dollar,] 
 
PREFACE.
 X h e  former edition of the follow-
ing fheets has met with a fale which far
exceeded'  the   Author's  expectations.
The refpeclful notice  which has been
taken of the work,  by  Gentlemen of
the firft rank  in  the  profefTion,  and
whofe approbation and efteem he mud
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 ftil.
 • c. -           a i             . . 
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 hte
practical obfervations, and  to  obferve
the variety of fymptoms which  occur
in the different ftages of thofe difeafes
in which the liver is  the organ chiefly
affeded.
   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 effect on |
various other organs.  Probably many
complaints, which the patient is ready
to refer to  the organs  of refpiration, to
the  flomach, or other parts of the ali-
mentary canal,  may  have their fource
in a,morbid ftate of this organ.         > 
                  PREFACE.             v
     The  accumulation  of bile  in the
   liver and gall-bladder, producing a tur-
   gefcerit  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 bed cured by
  purgatives, and fuch other  means as
  promote  the  evacuation of bile.   It is
  probable  likewife,  that the good effects
  perceived from the operation  of  active
  purgatives in  the early  ftages  of acute
-  difeafes,  and  the advantages  arifing
  from  fpontaneous  or  even   artificial
  diarrhoea  in the  more advanced ft .o-cs
  of them,  chiefly depend  on the hepatic
  fy fem being kept pervious, fo frequent-
 ly the feat of  dangerous  feven.  Some
 affj.tions of the mind, it is alio pr>ba-
 b.V,  may  be intimately connected with
 fuch a ftate of the liver.
                   a 3 
VI
PREFACE.
  Not  only by  his own obfervation,
but alfo by the  correfpondence which
he has had with  Gentlemen of the pro-
feflion,  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 mud ftill>
therefore,  confider  the  antiphlogiftic
practice, there  fpecified,  as the molt
likely to fuccecd ; 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 effects.
   That he  poffeffes no  prejudices
a^ainft this important article  of the  -
Materia  Medka, will appear clearly: 
                PREFACE.            vil
 when the reader difcovers the attention
 he has paid to the different modes of ex-
 hibiting it in fome difeafes ariiing from
 an affection of this  organ.   Jn a ftate
 of the liver, approaching to fchirrus,
 he confiders  it as the  only medicine
 to be depended upon -,  and more than
 this,  in other difeafes, 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
%o fome morbid ftate of the liver. The
Author has, therefore,  improved this
edition by giving  fome explanation  on 
viii
PREFACE.
the general pathology of dropfy,  more
efpecially, however, as depending  on
the refiftance to  the tranfmiftion 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, Letfufer on
Phyfiology  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. 
IX
CONTENTS
                 C H A P.  I.

     ANATOMICAL  DESCRIPTION OF
                 THE LIVER.


THE Bile fecreted by the liver, page i.   Figure of
  the Tver not eflential to its funftion, but deternv'ned
  by that of  the animal, 2.   Its figure defcribed
  ibid.  The proportion of its lobes different in  the
  foetus, 3.   Cuufe of this difference is the umbili-
  cal vein, 4.   Its fituation defcribed, ibid.  Differ-
  ent in females, and in the foetis, 5.   Its connexion
  to the "diaphragm by ligaments explained, 6.   Its
  fituation with refe>e6f. to the ftomach, 8.   The gall-
  bladder, its fituation defcribed,  ibid.

                 C H A P.   II.

        Vejfels of the  Liver,  pige 11.
Secretory organs plentifully furnifhed with blood
  —The fame veflel generally carries blood both  for
  fecretion  and nutrition—Hence  the  proportion
  devoted to each  purpofc  uncertain, 12.  In  the 
X
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, 15.   Origin of this vein, 16.  Its fuppofed
  ftructure, 17.  GlifTon's opinion  on this  f'ubjecl,
  ibid.  Its ramification and termination,  19.  Pori
  biliarii and hepatic duft,  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  injected
  contrary to the courfe of their contents, 24. Nerves
  —their  origin, ibid.


                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 paffage  through  the
  fpleen,  31.   Experimental  inveftigdtion ui this
  fubjeft—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,  and the  Office of  the
       Blood which it contains, page 41.

Different opinions on this fubjeft, 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,  4^.  The communication of
  veffels fuppofed to be favourable to this doftrine,
  46.  In what refpe£l  the artery may  be faid to
  communicate with  the duel;, 47.   No conclufion
  to be drawn from thefe fa£ls, ibid.   The capacity
  of the hepatic artery compared  with the bulk of 
Xll            9     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-
   rished, but  require different proportions of blood
   tor their actions, 50.  The a£Hon of a fecreting
   organ  fuppofes  great vital  energy, ibid.—hence
   much  blood, ibid.   An extraordinary  lufus jna-
   turae, 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 mo ft
   minute veffels, 54.  How far fecretion depends on
   any  peculiar arrangements  of parts,  55.    The
   opinions of Malpighi and Ruyfch ftated, ibid.  Ap-
   pearances like cryptse in the liver, 56.   Alfo in
   the kidney, 57.

                CHAP.   VI.

          Courfe of the Bile,  page 59.

From the pori biliarii  to  the truek of the hepatk
   duct, ibid.   Its properties changed by the  abfot-
   bents," 60.  Its paffage into the duodenum iubjel 
CONTENTS.               X1J1
    to  interruption, ibid.   Effecl 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-cyftic duels  in the
    human fubjeel,  difproved, 65.  Further confider-
    ations on the ceconomy of the gall bladder, ibid. Is
    it a paflive receptacle ? 67.   The affirmative argu-
    ed  for from analogy, ibid.   It is not vifibly mufcu-
    lar, 68.  Nor irritable on the application of ftimu-
    li; therefore a paflive receptacle, ib.   Regurgita-
    tion of bile from the inteftine by the duel; how pre-
    vented, 69.  The caufes impeding the flow of bile
    into the inteftine, 70.   Permanent  ftru&ure, ibid.
    Spafin doubtful, except at  the  termination  of the
t   duel, 71.  Preffure from fchirrous ftate of the pan-
    creas, 72.   Schirrous impacled liver, ibid.  Jaun-
    dice not always connecled with obftruclion in the
    biliary duels, proved by the yellow fever, 73.  Mor-
    gagni and  Boerhaave's opinion of jaundice, arifing
    from  obftrucled fecretion,  confidered, ibid.  By
    what channels the  bile paffes into  the  blood, 75,
    Haller's opinion by regurgitation, j6.   Abforp-
    tion confidered, yj.  Is jaundice produced both by
    regurgitation  and  abforption ?  78.  That the ab-
    forbents 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.
                C  FI A  P.   VII.

                 Bile, page 83.

Its colour, varies by dilution, ibid.   Confillence, 84.
  Vifcidity, perhaps not effential,  ibid.  A fapona-
  ceous fluid, ibid.   Has a bitter tafte and faint nau-
  feous fmell,  85.   Conjectures  on  its  constituent
  parts drawn from  its fcnfible properties,  ib.  The
  ancient mode of inveftigation.by heat alone, inade-
  quate,  86.   The mod  natural examination,  by
  chymical attractions, 87.  -Gentle evaporation difli-
  pates the odorous  principle  along with the water—
  the refiduum folid and  brittle,  88.  Its vifcidity
  depends on an animal mucilage, 90.  The effecls
  of mineral  acids, ibid.   More ftrongly marked
  when affifted by  heat, 91.  They  effecl; 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 refinous principle, 95.  Proofs,
  96.  Recapitulation, ibid.   Its antifeptic proper-
  ties confidered, 97.


               CHAP.  VIII.

          On Bilia7y Calculi} page 99,

Extern al characters, and  fenfible  properties are
  various, ibid.   Therefore not mere infpiflations of 
contents.
XV
bile, ioo.  Different fpecimens fliould 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 refinous
matter,  105.  Inquiry into  the  prefcnce  of an
alkali,  ibid.  The mineraj  and volatile alkali de-
tected,  106.
                 CHAP.   IX.

      Of the Ifeof the Bile,  page 109.

The probability of a connexion between red  blcod
  and the bile,  ibid.   The fubferviency of bile to
  chylification, confidered, 110.  The refult of ex-
  periment not favourable to that opinion, 111.   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  viae  from its alkaline  principle,  113.
  And refift  a tendency to fermentation, ibid.  This
  corroborated from  hypochondriasis and chlorofis,
  114.   When  defective may be fupplied by  arti-
  ficial means, ibid.  Its  defect 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 increafed Secretion of Bile, page 117.

Excessive fecretion of bile the endemia of warm
  chm:ttes — Its  effeCts  and fymptoms,   ibid.   A
  change of climate advantageous,  n8.   Lefs  dif-
  treffing to natives than foreigners, 119.   Bile more
  antifeptic in warm climates than in cold,  120.  Ob-
  ftinate difeafes  connected more  frequently  with a
 defeaofbile, than its excefs, 121. Diluents  advan-
 tageous, 123. Internal ufe of warm water confider-
 ed, ibid.   Bath, Briftol, and Buxton waters pro-
 bably acl 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.                xvii

   cription of, ibid.  The bile appears to be imperfeCt,
   129.  Cure 131.



                  CHAP. II.

      Of the dimimjked Secretion ef Bile,

                  Page  135-

 Th is fometimes depends pn chronic inflammation of
   the liver,  136.   Its  fympioms,  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 viae,  (Note).   The ufe of mer-
   cury  confidered, 144.  Other modes of treat-
   ment,  147.



                CHAP. III.

 Of Obflruclion to  the free Pajage of Bile into the
            Duodenum, page  151.

Jaundice,  152.  Definition, ibid.  Hiftory,  ibid.
  Decline,  153.   Appearances on diffeCtion,  1,5,5.
  Diftinguifhed from chlorofis, 156.  And the en-
  demic fever of the Weft Indies, 157.  Influence of 
xviii
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 duCts, 162.   And on calculi as pafs-
 ing through them,  164.   Preffure on the ducts, a
 caufe of jaundice, 166.  Prognofis, 168.   Cure,
 169.   By  folvents impracticable,  ibid.  Emetics,
 their ufe,  170.   Purgative medicines,  bitters, &c.
 'bid.   Excrcife,  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  ths  Liver is fubjecl in
   common with  other Organs  of a  glandular
   Structure, page  175.

Liver fubjea 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 affeaed  fympathetically, ibid.  Hepatitis,
  its  termination in fuppuration,  178.  Thefe  ab-
  fceffes not always vifible externally, but  difcharge
  themfelves internally, 179.   In what fenfe the bili-
  ary duas can convey the matter into the duodenum, 
contents.
xix
ibid.   Immediate  communication  with  inteftines
more frequent, 180.   The pivcife part varies with
the particular feat of the  abfcefs,  181.   Hepatitis
fometimes  confounded with peripneumony, 183.
Alfo with inflammation of the ftomach, ibid,  fa-
vourable termination  of, 184.  Has corroded large
blood veffels, 185.   Sometimes  terminates by me-
taftafis, ibid.   Suppurative fymptomsof, not always
evident, ib.  Sometimes ends in  gangrene, 186.
Often terminates in a fchirrous, ib.  Schirrous liver
fometimes mi {taken for dyfpepfia, how diftinguifh-
ed, 187.   Schirrous  liver, fymptoms of, appear-
ances on diffeClion, 190.  Explained,  191.  Proxi-
mate caufe of hepatitis inveftigated by analogy, 192.
The veffels may be in two oppofite ftates, (viz.) one
aaive, the other paflive, 193.  Application of this,
198. How an aaive  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 aaive
and indolent  inflammations confidered, 212. Cure
of  the aaive inflammation  in  its firft 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,
ibzd.   The pus feldom effufes into the  abdomen,
221.  May be discharged by lancet, ibid.   Slow,
but progreffive 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 aaion  in fchirrous liver
further  confidered, 226.  Its  application  to  the
vicinity of the liver not particularly advantageous,
227.  No direa communication between  the  ab-
forbents of the fkin and  liver,  ibid.  Abforption
more rapid from ulcerated and veficated furfaces,
228.  Mercury not deteaable 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.

  1 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 confiderable  part  of
the abdominal cavity.
   2.   Its  figure  is  fomewhat  irregular,
conlequently  it does not readily admit  of
                    B 
                [   2  ]
comparifon with any mathematical figure;
if is unlike any body with  which we are
acquainted.   This circumftance of the liver
is perhaps lefs  effential than many  others,
as  figure  does not  appear to  throw  any
light  on its ceconomy.   At lealt we na-
turally incline to  this  opinion,  from tak-
ing  a  view  of  this vifcus  in different
  to
animals,   -when it  appears  that the external
figure of the liver  is determined . by the
figure of the animal itfelf,  or that parti-
cular cavity in which it is contained.  In
the human  fubje£t  it is  fomewhat flattifh
and convex on its  anterior furface, irregular
on  its pofterior, having feveral depreflions j
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 fizes.  Thefe,
from their  fituation in the  abdominal ca-
vity,   are  diftinguifhed by the names  of
right and  left, of which  the  right is the
larger.   Befides thefe,  there  is a  fmaller 
                  [  3   ]
 lobe,  fituated at the fuperior and pofterior
 part, called Lobulus Spigelii.
   3. Though  in adult fubjedts  the right
 lobe 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; for on  its  arrival  at that gland, it
 fends off feveral branches, fome of which,
 penetrating  the  left lobe,  are  of confider-
 able fize j  but after birth,  when the circu-
 lation takes a jiew courfe,  the whole liver,
 but more efpecially the left lobe, diminifhes
 in bulk.
  4.  Besides this variety in the proportion
 of its lobes, the  whole foetal  liver  mull
 neceffarily exceed that of  the adult in pro-
portion i for, in  addition to the  vefiels pro-
per to the liver, and neceffary 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 the
other veiTels of the cord, and perforates the 
                [   4  ]
navel ;  thence, having  reached the inferior
edge  of the liver,  it paffes along the fiffure
which feparates the lobes,  and, having en-
tered its fubftance, fends off feveralbranches;
thofe 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 j 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 fcetus
and  the placenta paffes through  the  liver,
and  this fufficiently explains  why the foetal
liver exceeds in proportion that of the adult.
   5.  This organ  is fituated in the fupenor
part of abdomen, principally  on  the  rignt
fide, occupies the epigaftric  and the right
hypochondric regions, and fometimes ex-
tends into  the left hypochondre.  Its pre-
cife   fituation cannot be eafily determined,
as the inferior  part of the cheft admits of 
                C   5   ]
confiderable  variety  both  in its figure and
capacity.   In males, where there is a greater
capacity  of  cheft,"*"the  hypochondres  are
more capacious,, hence the epigaftric and the
right hypochondric regions  are large enough
to contain this vifcus.
  6.  In  females,  who  have  naturally  a
fmaller cheft, which is ftill more contracted
by tight lacing,  the epigaftric and the r!K"t
hypochondric regions are infufficient to con-
tain  the liver, it therefore extends  far into
the  left  hypochondre j  befides  which, it
fometimes,  in thefe cafes, occupies no in-
confiderable part of the umbilical region.
Its fituation, then, with < ipeel to the gene-
ral cavity of the a'od:men, admits  of fome'
variety.  In the  fcetus, it occupies the wLoie
epigaftric  region,  and  both  the hypochon-
dres  ; not fo much from any peculiarity in
the figure of the upper  pan of the  abdo-
men, as from a  difference in  the proportion,.
of the right and left lobe, which has already
been noticed. 
                [   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 covering
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 moft confpicuous of
which, is that fituated  on its anterior part,
in a  line  correfponding  to  the  fiffure,
forming the diftincTion 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
Jigament. 
[  7   ]
   9.  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.   Befides
which,   fome  anatomifts  reckon the por-
tion of peritonaeum furrounding the veflels,
which pafs  from this  vifcus through  the
diaphragm, as a  fourth ligament, and call
it the coronary ligament.
   By  thefe  different   reflections  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  paffes 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 neceflarily happens  at birth,   its
cavity diminifhes,  and in  time  becomes nearly
obliterated. 
                ['  8  ]
of the liver along its  longitudinal fifiure,
and is continued to the umbilicus.
   ii. Hence  in  the  living  fubject  the
fituation of the liver muft vary with refped
to the general cavity, according as the dia-
phragm defcends or afcends,  in the ads of
infpiration or  expiration.
   12. The fituation of the  ftomach  with
refped 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  on the ex-
ternal furface of the  duodenum  near the
pylorus, it appears that  the  gall-bladder
ufually  refts on  this part.
   13.  The  gall-bladder is a "bag  fome-
what pyriform  in  its fhape,  its  neck or
fmall extremity being fituated fuperiorly,
and  its  fundus, or large extremity,  infe-
riorly.   It is  lodged in a depreffion on the
concave furface  of the right  lobe of the
liver, to which it is attached by a continu-
ation of  the peritonasal  coat of that vifcus 
                [  9   3
over its furface.  It varies fomewhat in fize
according to the degree of diftention which
it  fuffers, but, in moft inftances, the fun-
dus prqjeds a fmall diftance below the infe-
rior edge of  the  liver.   Deftined  by Na-
ture to contain bile, it has a dud  which
both receives and difcharges it,  theoscono-
my of which will be confidered hereafter. 
 
C   »   ]
CHAP.   II.
VESSELS OF THE LIVER.
              SECT..I.

 XLvery  organ  deftined by  Nature to
fecrete a fluid, is very plentifully furnifhed
with blood.  The -neceffity of this  is evi-
dent ;,  for it requires, not only a fupply of
that fluid for thepurpofe of its  nourifhment,
but an  additional quantity alfo to enable it
to perform  its fecretory  fundions;  as it is
from  the  blood that  all the fecretions  are
derived.
  Such is the  ©economy of Nature  in
glandular bodies in acne,al, that the fame 
                 [   12   ]
  fluid which is fit for the nourifhment of the
  o-land,  is adapted alfo to its fecretory office,
  and  is conveyed to the organ by the fame
  veffel.  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 oeconomy of
 Nature in this refped, receives fome light
 from  a peculiarity  which obtains in the li-
 ver,  and which diftinguifh.es it  in  a  very
 ftriking manner from all the other glands in
 the body.   For, while the fundions of nu-
 trition  and  fecretion are in them combined
 in the fame  veffel,  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 veffel, 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 
                [   '3  ]
has received the change from  refpiration,
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
oondud of Nature in the  origin of veffels
fupplying other organs, obtains equally in
this,  as the hepatic  artery  arifes from the
neareft confiderable 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 diftancc from the
1 aft veffel,  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 leffer curvature of the ftomach, is the
coronary artery;  the  fecond, paffing 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
veffel 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 ftomach 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  nourifti-
ment, we are to confider the area of the hepa-
tic  artery, after the three preceding branches
are fent off.
   8. This  veffel, agreeably to the general
law of diftribution,  divides into  branches
before it enters the fubftance of the liver j 
                [   '5   ]
its  ramifications then multiply and extend
with  great minutenefs  through the  whole
mafs ; fo that  in every part of its fubfhnce
there is  circulating blood pofleffed of pro-
perties fit for nutrition.   But as this blood
is in  a ftate  of conftant motion, and is con-
tinually  changing  by fucceffive 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
conneded  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 
                [  16  ]
blood of a dark colour, poffeffing the com-
mon charaders of venous blood, and is con-
veyed to the liver by a  vein.
   10. The vena portarum,  which  conveys
this  blood,  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 portee,  where this  veffel begins
to penetrate.  To underftand  the  origin of
the vena portarum, and the properties of the
blood which it conveys, it will be neceifary
to explain the circulation through  the chy-
lopoietic organs.  The branches of the cceliac
and  mefenteric arteries,  as  we  have  before
obferved,   diftribute their contents to the
ftomach,  inteftines, pancreas,  and fpleen,
befides  the hepatic  artery which fupplies the
liver.   The  blood circulating  through all
thefe vifcera, except the laft, being returned
by  their  refpedive veins, is  poured  into
their common trunk,  the  vena portarum :
thus the  origin of the vena portarum ap-
pears to confift in the concurrence of all the 
                [   i7   J
veins of the peritonaeal  vifcera except  the
liver.
   11.  As the fundion of this  vein  differs
from thit of other organs,  it has been fup-
pofed to poffefs fome peculiarities of ftruc-
ture.—Some have thought it more mufcular
than other  veins,  and  that  its  charaders
approach nearer to thofe  of an  artery.  It
certainly does not poffefi the grand  difcri-
minating mark of an arteiy,  or the power
of preferving i:s  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 refped  to  the  arrangement and
difpofition of its mufcular fibres, this part of
its ftrudure  does not appear fef-'icientlydefin-
ed to.authorize us to fpeak with precifion.
   12.  Glisson, whofe opinion  on this fub-
jed  is not always quoted  with  approbation,
conceived its grand charadere'lie  to  confift
in a  continuation of t'^tt duplicative of the
                    c 3 
                [   is   ]
peritonaeum furrounding the  velfels 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 this vein,  but  ac-
companies it in all  its  ramifications through
the liver ;  fo that  if a fedion were  made
into this organ, the branches of  the vena
portarum would be diftinguifhcd from thofe
of  other veiTels by  the prefence of this
adventitious tunic.
   13. For this membrane, which the ima-
gination  had formed,  {.incy foon fuggefted
a ufe—Miftaken obfervation  had  led him
to  believe that it poffeffed mufcular pro-
perties,  and that it propelled with force  the
blood, whofe motion  would otherwife have
been languid.   The inveftigations of  other
anatomifts have not confirmed this opinion.
They  have difproved  the  continuation of
this peritonaeal capfula beyond the trunk of
the vena  portarum, ajid  have demonftrated
that it does not  envelop the vena portarum 
                 [   19  J
 in a particular manner,  but only invefts it
 in common  with other veffels, and as foon
 as it has arrived  at the  liver  it quits them
 altogether,  and,  by  expanding itfelf over
 the fubftance of this gland, forms its tunic.
   14.  The vena portarum having  reached
 the liver at that part called the great fiffure,
 forms one  large trunk called the firms of the
 vena  portarum,  from which three principal
 branches ufually take their origin ;  thefe, by
 forming fubordinate ramifications in a regu-
 lar feries,  at length arrive at their  termina-
 tions.
   15.  The extremities of thefe veffels  end
 in two ways: one with  refped  to  the  cir-
 culation of  the blood; the other,  as con-
 neded  with  their  oeconomy,  as fecretino-
 veffels.   In the firft point of view they  in-
 ofculate with branches of hepatic veins, and
 through that channel return to the 1:erior
 cava all that  blood which  is not emp.oved
in the  bufinefs of feuetion.   So that the
hepatic  veins are  the common recipients of 
                [.  20   ]
the contents of the hepatic  artery, and like-
wife thofe of the vena portarum.
   16.  The fecreting  termination  of  this
vein is  in  the beginnings  of the  hepatic
duds,  called pori  biliarii;' which in their
origin muft neceffarily 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
union of branches,  until at length they pafs
out from  the liver at its fiffure,  by two or
three trunks, which foon after join together,
and form the .trunk of the hepatic duct.
   17.  TrtEftrudureof this vcfi'l.l is appa-
rently membranous,  having no fibres wh'eh
can be Configured as mufcular, at leaft as far
as wre  can decide  by ocular demonftration.
But, as the eye, even when aided by glaffes,
is  not always competent to deted mufculari-
ty, we are compelled  to have recourfe to
another and lefs  fallacious teft, which is-the
power of contradion^n the npplicarion of a
ftimulus.   Mechanical  andchymical  ftimuli 
                [   21   ]

 haveifcbeen applied  to this  dud ima living
 animal, without producing  any contradion
 which can be referred to mufcularity.  Some,
 chymical  ftimuli,  it is.true,  will  corrugate
 this canal;  but  .'hey  are fuch as produce
 effeds only by corrofion,  and which they do
 as readily on inanimate as on living matter.
   13. Another argument againft their muf-
 cularity  is,  that canals obvioufly  mufcular,
 readily adapt their capacity to their contents.
 This law  is very evident in the vafcular fyf-
 tem.  But when  a biliary dud has been di-
 lated by the paffage of a gall  ftone,  it does
 not very foon return to its primitive dimen-
 fions.  And, perhaps, thofe painful affedi-
 ons  of thefe  parts,  which have  been very
 commonly confidered fpafmodic,  may find
 a more adequate explanation in the paffage
 of a calculus.
   19.  If  the internal  furface of this fyftem
 of veffels  be examined, it 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   ]
   10.  Besides the veffels already defcribed,
the liver  is very plentifully  fupplied with
abforbents,  which  take  their  origin  from
every part of its fubftance,  but more efpeci-
allyfrom the branches of  the  hepatic dud.
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 diredion of  the furface, fome rami-
fying on the anterior and fome on the pof-
terior  furface:  their difpofition while  on
thefe parts is arborefcent.  Thofe on the con-
vex furface incline towards the diredion of
the falciform ligament upon which they pafs,
and extending  their courfe in the diredion
of the  diaphragm, terminate in the thoracic
dud near to that part.  Thofe which ramify
on the concave furface,  form,  by a feries of
jundions, a common  trunk,  which,  pafs*
ing from the liver in the diredion of  the
hepatic artery,  and with  it and the  other
veffels being  inclofed in  Gliffon's capfula,
terminate in   the  thoracic  dud near  the
receptaculum  chyli. 
[  23  ]
   2IV These  two  fets of  abforbents,
 while ramifying within  the liver,  have a
 free  communication with each  other,  as
 may be  proved by injedion 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
 dud may be filled.
    22. These veffels poffefs the fame cha-
rrader while  in  this organ as  they  do in
c other parts of the body;  that  is to fay,
ttjiey  are valvular.    But  notwithftandino-
t this,  they  may  be injeded in a  diredion
c contrary to  that  in  which their contents
i move.   This,  though apparently a  para-
c dox,  is  ftridly  confonant to reafon and
f fad; for the fundion of the valves  here
i is lefs complete  than in fome  other parts
( of this fyftem, fo that by preffure, mercury
l may take a retrograde courfe  in the fame
i veffel.--"■'-Another  reafon  is,  that  as  the
1 lateral communicating veffels exceed  the 
                  E   24   ]
 valves in number, aclufter of abforbents may
 be injeded  by a courfe  in  part  retro-
 grade,  and in part circuitous.   It is in this
 way an  injedion  may  be made to  pafs
 through the branches of the fpermatic  vein,
 in a diredion contrary to  the natural  circu-
 lation;  yet thofe veffels are plentifully fur-
 nifhed  with valves.
   23. Besides veffels, the liver is furnifhed
 with nerves,  though not very plentifully. 1
 The par vagum and intercoftal nerves, while I
 in the cavity of the thorax, communicate by
 branches with  each  other.  Near  to  this
 part of jundion feveral  branches are fent 1
 off, fome of which are diftributed to parts I
 contiguous, others to more diftant organs. ]
 But there is detached from  each fide a branch I
more confpicuous than the others, viz.  the J
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 
                [   25   ]
figure, is called femilunar.  From this gan-
glion a multiplicity of nervous filaments are
paffing off in various diredions,  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.
» 
 
[  *7   ]
CHAP.   III.
   THE NATURE OF THE BLOOD
CIRCULATING THROUGH THE VENA
      PORTARUM CONSIDERED.
              SECT. I.

 JTIaving given a general defcription of
the veffels fupplying the liver, we are led to
examine  into the nature of their contents.
And here we may remark, that it is very de-
finable, but at the fame time extremely dif-
ficult, to afcertain  the peculiar charaders
of the blood,  after circulating  through
each of  the chylopoietic vifcera, previoufly
                   D 2 
                [   28   ]
to its paflage  into  the liver, by the vena
portarum;  and to determine why it  feems
better adapttd to the fecretion of bile than
common arterial blood, from which  other
fecretions are fupplied.
   2.  That venous blood is more favorable
to this fecretion than  arterial,  is very evi-
dent; this exception of the liver to Nature's
law, in the  ceconomy ofother glands, may
be admitted as a proof.  But the peculiar
changes induced in  the blood,  after circu-
lating through the arteries of the ftomach,
and yielding the gaftric fluid ;  after penetra-
tingthe pancreas, »and there affording pan-
creaticjuice;  after pervading the inteftines,
where it not  only gives out the inteflinal
mucus,  but  from  its  vicinity  to fasculent
matter may  receive  putrefcent  properties,
are  at  prefent, and may perhaps continue
long to afford, an ample field of fpeculation
and conjedure.
   3. The power of thefpleenin  this refped
has been particularly acknowledged and  in- 
                r   29  ]
 fifted upon; infomuch that modern phyfiolo-
 gifls have confidered this as its onlyfundion.
 1 hat the fpleen, in common with the other
 vifcera, may contribute fomewhat to change
 the  properties  of the  circulating  blood,
 ought not to be denied;  but whether this be
 the principal and only end of its fqndion, I
 think, cannot be too carefully inveftigated.
   4.  The number and  rank of thofe phy-
 fiologifts, who have confidered the  fpleen
 as an auxiliary  organ to the liver, are too re-
 fpedable to be  oppofed on any ground, ex-
 cept that of experiment and indudion.
   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
 refpedive promulgators,  the opinions them-
 felves ftand on equal ground.   It is the rea-
fons then which ftamp the true value  of any
opinion, and to them only we  fhall  dired
our invefiigation. 
                  [   3°   ]
     5. First,  " The blood which  has  circu-
   lated through the fpleen, and which is returned
  from that  vifcus hy the fplenic vein, is poured
   into the vena portarum."
     6.  The pofition is unqueftionably true,
   and ✓ merits confideration ;   yet its  proper
   influence on the mind,  when confidered  as
   proof,  ought to be duly weighed : for when
   we recoiled  that this circumftance  in  the
-  fpleen is not a peculiarity in that organ  but
   one which obtains in every peritoneal vifcus,
   except the liver, it muft be evident, that,
   as far as this argument alone has force,  the
   pofition falls infinitely fhort of proof,   and
   that the fpleen adminifters to the office of
   the liver only in the  fame proportion as the
   contiguous vifcera.—This idea then  appears
   to owe its birth more to  our ignorance of
   the real ufe of  that organ, than to any force
   in the caufe juft affigned.
     7.   Secondly,  " The  blood in  its courfe
   through the fpleen,  receives   changes which 
                 [   3'   ]
 enable it the better to concur with the liver in the
fecretion of bile."
   The  changes  afcribed are, a greater  de-
 gree of  fluidity,, and  a  putrefcent  ten-
 dency.
   8.  Baron  Hauler   was  of  opinion,
 that the blood returned  by the epiploic and
 mefenteric veins contained  a large portion
 of adipofe matter, which  it received by the
 abforbent power of-thofe veins,  and which
 imparted to it fo great a degree of  vifcidity,
 that without the diluting power of the fple-
 nic blood, which mixes with it when enter-
 ing the  vena portarum,  it would be liable to
 concrete.
   9.  There  is little  probability in  this
 opinion,  whether we confider the power of
 the  epiploic veins  to abforb fat from  the
 omentum,  or the fundion  of the fpleen to
 dilute the blood of the vena portarum.
   Abforption by red veins has fo few  advo-
 cates in the prefent day,  that it were fuper-
 fluous to adduce either argument or experi- 
                [   32   ]
ment by  way of refutation.   But waving
that controverfy, let us inquire how far the
fpleen ading on its blood as a diluting  or-
gan,  can be fupported by fads.
            EXPERIMENT.

   10.   The abdomen of  a. living dog being
opened,  and the fpleen with its veffels 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 lei's than two
minutes, and in  about the ufual time  they
feparated into ferum and creffanientu-m.  In
twenty-four hours  the ferum  of both was
accurately  weighed:  the   420 grains of
blood from the fplenic artery fcparaced 191 
[  33  3
grains of ferum;  the 468  grains from the
vein,  feparated 213 grains.
  11.  But our conceptions of this matter
will be  much afllfted 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 the ferum.
            EXPERIMENT.

  12.  Equal  portions  of  each ferum
were expofed. nearly to the fame  degree of 
                [   3+  -]
 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 ar.y thing
 to that organ on the principle of  dilution.
   13.   The other change fuppofed to be
 induced  in the  blood by  its  circulation
 through  the fpleen, is a putrefcent tenden-
 cy : this has  been conjedured in part  from
 its contiguity to the colon,  and  in part from
 the languid ftate of the circulation through
 that vifcus.
  Without inftituting any ferious inquiries
into the  probable weight  of thefe reafons,
 and their fufficiency to fupport the propofi-  J
tion, let us inquire into the fad itfelf. 
[  35   ]
             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 moft 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 connedion  between the
 fpleen and the liver.   But in order that the
 refutation may be more complete, it is ne-
 ceffary that a comparifon be made  between
 bile taken from an animal whofe fpleen has
 been previoufy removed, and one in which
that vifcus is ftill remaining. 
E  36  ]
            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  ftrangled,  and
the bile  contained  in  the gall bladder of
each colleded in feparate veffels for the pur-
pofe of comparifon.
   17.  The   colour of both, which was
that of a  bottle-green, correfponded very J
exadly.                                  t
   There was  no difference in tenacity:  in '
both it was juft fuffkient to prevent, its falUJ
ing from a phial in drops.                  "
   The tafte  of each was intenfely  bitter,,:
and fiightly pungent.
   No perceivable difference in fmell.
   Portions of each being  mixed with litmus, ^ 
                 [   37   ]
 turmerick, 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 ftraw 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
 lefta refiduum, which was highly inflammable.
   18.  The  refult of  thefe  experiments
 makes it highly probable,  that the  bile fe-
 creted after the lofs  of the fpleen, differs in
 no refped from other bile; and that the li-
 ver in theexercife of its fundion isperfedly
 independent on that vifcus.
   19. Thus  we fee that an opinion, 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-
                    E 
                [  38  ]
periment;  and a  patient  inveftigation of
Nature's operation, on this  plan, muft  ever
prevail over authority or prejudice.
   20. It  has been  proved  above,   that
venous blood is  the  proper fource of  the
biliary fecretion.  Some affert, that fome
additional  properties  are  imparted  to it
during its circulation through the peritoneal
vifcera :  but neither experiment nor obferva-
tion  has contributed any  thing conclufive
in favour of fuch opinion.
   21. The  peculiar oeconomy of the bi-
liary organ in the fcetus,  is  particularly de-
fervingour confideration, as the blood from
which the fecreted  fluid is made, cannot be
confidered as ftridly venous, but as partak-
ing,  in fome  meafure,  of the  arterial cha-  1
rader ; and this  intermediate  condition  of ' ,
blood appears to produce  a correfpondent
ftate  of  the bile:  for it is  matter of noto- j
riety that foetal bile is lefs  adive and con-
centrated,  and abounds more in the watery
principle,  than  that  of the adult.   This 
                 [   39   ]
 being granted,  it neceffarily 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 phyliologilh
 are not  agreed refpeding the effential dif-
 ference between arterial and venous blood,
 whatever  properties  the one poffeffes  of
 which the other is deftitute, any reafoning
 founded on  fuch an uncertain  bafis muft
 neceffarily be unmeaning and inconclufive.
  22.  But to revert to the ceconomy of the
 liver  in the fcetus, it may be obferved,  that
 befides the blood which is fent to it by the
 hepatic artery and vena portarum, it receives
 a large portion by the umbilical vein.
  23.  To underftand this, we fhould advert
 to fome of the peculiarities of the fcetus in
utero.    It  is very generally admitted,  that
the  placenta is to the fcetus,  what the lungs
are  after  birth ;  that by both a change is
induced  in the blood,  by which it lofes
                    e 2 
                [   4°  ]
the venous charader,  and affumes 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 the fcetus ;  part  of this blood
mixes with the common blood of the  vena
portarum,  and  with it concurs in furnilhing
the fecretion of the bile;  the remainder is
carried  into the vena  cava inferior  by the
canalis venofus.
   24. In the fcetus, then, it feems  that the
 blood  in  the  vena portarum  has  more  of
 the arterial condition  than  that of the
 adult,  and feems to produce a bile of lefs
 adivity. 
[  4i   ]
CHAP.   IV.
   ON THE HEPATIC ARTERY,
AND THE OFFICE OF THE BLOOD
      WHICH IT CONTAINS.
             SECT.   I.

 JDy far the greater number of phyfiolo-
gifts have agreed,  that the hepatic  artery
carries blood to the liver for its nourifh-
ment, and that this is its  only deftination.
There are a few, however, who incline to
a different opinion ; and contend that,  in
addition  to this  fundion, it  concurs with
the vena portarum in the  fecretion of the
bile.                     '       '
                  E3 
                 [   42   ]
   2. The reafons on which this latter  opi-
 nion is founded, have at leaft fpecioufnefs
 to recommend them ; and in our  inquiry
 into this queftion,  the merits of both  opi-
 nions will be carefully inveftigated :  and at
 the fame time that we efteem it our duty to
 deted  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
 ;f the office of the hepatic artery is not con-
 cf fined  to the nourifhment of the liver, from
 " thedifproportion of its veffels to the brori-
 " 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  prefumption  or probability.
But we  muft always keep in  view the differ-
ence between an analogy which is clofe,  and
wl^ere the points of coincidence  are  ftrik- 
                 [.43   ]   '
 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
 fo  much as a conjedure.
   Therefore the objed 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 maffy 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
kings. 
                [   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 veffel going to the lungs
had  not  been fufpeded.   But Ruyfch, by
by  his art  of  injeding,  difcovered  the
bronchial arteries, and thefe he confidered
as their  true  nourilhing veffels ; and what *
feemed to give ftrength and confirmation to
this opinion was, that  the blood, while cir-
culating  through  the  pulmonary arteries,
poffeffes  the venous charader, and of courfe
is unfit for nutrition ; while that fent by the
arteries of Ruyfch is in  every- refped 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;
and that  the bronchial  arteries of  Ruyfch are
confined to the nourifhment of the branches
of the bronchia alone. 
                [   45   ]
  As the blood  in the fmaller branches of
the pulmonary  artery is expofed to the in-
fluence of the air, it muft neceffarily receive
a change, and affume the arterial charader ;
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  injeded 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
leaft analogy between the hepatic artery and
the liver on the one  hand, and the lungs
and the bronchial artery on the other.   Con-
fequently the argument, which refted on
this analogy, is not entitled to notice. 
                [   46   ]
   " A fecond  argument in favour of  the
 " hepatic artery affifting  in the fecretion of
 ff bile, is founded on an  apparent  commu-
 "nication  between the  ultimate  branches
 " of thofe veffels and the beginnings of the
 ff biliary duds; for, fay the advocates for
 ff this dodrine, afubtile fluid may be inject-
 " ed with eafe from one fet of veffels to the
 " other."
   That the biliary duds may  be  filled by
 fubtile fluid injeded  into  the artery,  we
 fhall  not deny ;  but this fad  does by no
 means prove  a dired  communication be-
 tween one fet  of veffels  and the other, as
 will very foon  appear.
   When  we   refled  on   the  circulation
 through the liver,  it muft be evident to us,
 that,  as the hepatic  veins  return blood both  4i
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  injedion  *
thrown in by the artery  will pafs very readi-  %
ly into the veins j where, if its exit be pre- 
[  47  ]
vented by tying them up, it may regurgitate
into the terminations of the vena portarum,
and thence efcape into the pori biliarii.
  But left this  explanation fhould  be ob-
jeded to  as being  too circuitous,  another
offers itfelf much more dired, and which
admits of proof from  injedion.
  Water  injeded by the hepatic dud paffes
With freedom  into  the hepatic veins;  and
again, a  fimilar fluid paffes eafily from the
veins into the dud:  hence a fluid, injeded
by  the  artery,  paffes  firft into the veins,
and  afterwards into the fori biliarii;  fo that
the arguments founded  on the phenomena
refulting from injedions cannot be admitted
as proofs, that the hepatic artery exercifes
a fecretory fundion.
  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 
             .   [  48  ]
required;  hence it was imagined,  that  it
either  co-operated  with the vena portarum
in the immediate ad  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 neceffarily 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 refped to
the arm,  than the hepatic  artery  is with
refped to the liver.
  Now mufcles,  we  know,  are  organs <
which  occasionally  perform  ftrong   and
repeated actions,  which, like other  adions
when long continued, tend to debilitate and
exhauft the  machine;  but,  when  their
exertions are moderate,  they become  invi- 
[  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 veffels,  as appears, not only
from the more florid colour of thofe mufcles,
but likewife, from comparing the capacities
of the trunks of the veffels with the mufcles
themfelves.
   Tendons, on the contrary, though  parts
equally alive, yet, from their more paflive
condition, require a fupply of  blood Suf-
ficient only for their nourifhment.
   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 fundion as a fecreting organ is not
 obvious.
   The inference intended to be drawn from
 thefe fads is, that parts, though not fecre-
 tory,  require  a fupply of blood in propor-
 portion to the adions they perform.
   Now furely we cannot hefitate to admit
 that the exertion of a fecreting organ necef-
                        F 
                 [   S«   ]
farily implies a confiderable fupply of vital
energy,  as it confifts 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 exiftence.   In other glands arterial
blood  ferves the double purpofe of  being
the pabulum of the fecretions, and of fupply-
ing the organ with vital  energy fufHcient to
effed its purpofe; but in the liver,  where
the fecretion  is  performed  from  venous
blood,  which is unfit  for furnilhing  it with
vital energy, the neceffity for a copious quan-
tity of arterial blood feems very evident. *

  * An extraordinary cafe of Lufus  Natura has
lately  occurred  to  Mr.  Abernethy,  Teacher of
Anatomy •, in which the  vena portarum  had  a
iingie  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
■yefle! carrying blood to the liver, and in this indi- 
[   5'   ]
   Admitting the vena portarum alone to be
 the fecreting  veffel, 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 two veffels is.   Perhaps here
 it may  be more confonant to the true fpirit
 of phyfiology to content ourfelves with the
 the fad, and to trace  its application to the
 oeconomy  of this  organ,  than  to indulge
 ourfelves in framing vifionary hypothefes,
 which exift only in the efflorefcence of fancy.

 vidual inftance it  appeared to  perform the coub'e
 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  fmall portion of this  fluid, the
properties of which were  very fimilar to thofe of
the bile in other young fubjeds.  The  fubjed of
the prefent cafe was a child apparently  about one
year old, in every refped  well nourifhed.
p 2 
 
r  53   i
CHAP.  V.
INTERIOR STRUCTURE OF THE
              LIVER.
             SECT.   I.

 Xt is from the blood circulating through
the branches of the vena portarum,  that
bile is fecreted ; but in what particular part
of this fyftem the change  commences, and
what is theprecifeftrudureof the parts adapt-
ed to this end, are fit fubjeds for inquiry.
  2. It has been already obferved, .that the
ultimate branches of the vena portarum have
a double termination ; one of which  is, with
                * 3 
                [   54   ]
refped to the circulation of red blood,  by
the beginnings of the  hepatic  veins ;  the
other,  with refped to the immediate fecret-
ing veffels,  by thepori biliarii.
   3. Does the change  commence in the
fmall branches of  the vena portarum  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 refped to the hepatic dud,  as it finds
 a more  ready courfe  through the hepatic
 veins:   besides  which,   the  constitution
 would be  in  a  continual ftate of jaundice.
    5.  The probability is, that there is no
  fenfible  alteration  induced on the blood of
  the venaportarum before it terminates in red
  veins.   And  as arteries terminate in veins
  by  capillary  veffels,  fo, from the  analogy
  which obtains between the  vena portarum
  and  an  artery, we prefume  that  the fame
   termination  does not  take  place  until  the
   branches huve become capillary. 
               [   55   ]
  6. Ir follows from this,  that the true  fe-
creting veffels are the very ultimate branches
which communicate with the peri biliarii.
  7. T h e  next queftion is, how far the fe-
cretion of bile is conneded with any pecu-
liar arrangement or ftrudure of thefe parts :
or,  in  other words, whether  the fecreting
veffel communicates with the beginnings of
the excretory dud by a cylindrical continu-
ation of canal,- or by the interposition of  a
cell or follicle.
   8. On this  point, the opinions  of Mal-
pighi and Ruyfch divide anatomifts :  Malpighi
having examined into the ftrudure  of glan-
dular bodies, obferved bundles of  circum-
fcribed knotted appearances affuming a glo-
bular form, to which  he gave the  name of
corpora globofa;  and, by further  examinati-
on, by means of injedion, 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 feems, in the earliest part
 of life, embraced this  opinion ;  but  from
 employing himfelf, frequently, in exploring
 the ftrudure of glandular bodies by  injec-
 tion, he  was led to relinquifh the dodrine
 of Malpighi,  and to  institute another which
 feemed to him  more confonant'to nature.
   10.  From his injedions he was induced to
 believe, that the appearances defcribed by
 Malp'ghi  were fallacious;  and  that  they
 were not mere crypia, or cells, as  they had
 been reprefented, but confifted of a feries of
 veffels coiled up in a circumfcribed form,
 and, that the ultimate  branches of the fe-
 creting veffel Communicated, both with the
 returning vein and excretory dud by a con-
 tinuation of canal.
   ii.  Without examining the  merits  of
 thefe dodrine?, 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-
jedion be thrown in by the  vena  portarum, 
                [   57   J
and the  liver; be afterwards cut into thin
flices,  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 like wife, when injeded
by the emulgent artery,  rather minutely ex-
hibits, in its  cortical part,  knotted  appear-
ances equally regular with thofe in the liver.
   i<?.  But  hereagainthe  question returns
upon us—Do they, or do they noty confift of af-
femblages of veffels;  or are they mere cavities ?
Feeling my incapacity of folving this  pro-
blem to  the fatisfadion of my readers, I muft
be<* leave to withdraw myfelf from the  con-
test in the'beautiful language of the Roman
 poet:
  " Non noftrum inter vos tantas componere litest 
 
[  59  ]
CHAP.   VI.
COURSE OF THE BILE,
               SECT.  I.

  v-^onfessing, then, our inability to deter-
 mine  the  precife ftrudure and mechanifm
 of the parts, which form theimmediate feat
 of fecretion, it remains to  trace the courfe
 of the bile from the interior part of the liver
 to the place destined for its reception.
   2.  The  bile  being formed, is convey-
 ed  from  the feat  of fecretion,   by   the
 branches of the hepatic dud, which, at their
 origin, are very minute, and are there called
port bxliarii.  From thefe its paffes into larg- 
                [  60  ]
er 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 paffages,  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 dud, naturally paffes  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
dud perforates the fubftance of the  inteftine,
that the periftaltic motion of that gut, con*-
fisting in part of the contradion of  its circu- 
                [  61   ]
 lar,  and  in part of that of its longitudinal
 fibres, will, by  compreffing the dud at its
 termination, occasion frequent,  but momen-
 tary, interruptions.
   5. During thefe periods  the dud muft
 neceffarily fuffer a degree of diftention, but
 which is foon relieved by means of  a canal
 of communication with the gall bladder, viz.
 the cyftic dud.   So that it appears,  that
 the motion  of the bile is not constantly in
 the  fame diredion, but fometimes paffing
 from the  liver to the inteftine,  at others,
 from the inteftine to the gall bladder.
   6.  In   moft fubjeds  that we  examine,
 this receptacle contains a confiderable 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 dud,  it will  be found thicker in
 its confiftence, 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
                   o 
                [   62   ]
probable, that the increafed  vifcidity de-
pends in part on the mucus fecreted by the
gall bladder itfelf,  fo that cyftic 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 paffage by
the common dud into the inteftine;  and
this, as a diverticulum, prevents a furcharge,
which  would probably  take  place in the
hepatic dud.
  9. That  this  purpofe is  anfwered,  is
probable from what takes place, wjien, from
any caufe, the cyftic dud is obftruded, for,
in this  cafe,  the  bile,  finding no paffage
into that receptacle when  its courfe  into
the duodenum is obftruded,  neceflarily ac-
cumulates in the duel us choledochus  communis
and  hepaticus, and, confequently,  enlarges
the capacity of thofe  canals.
   10.  For a proof that this is a law of Na-
ture,  we appeal to the diffedion of morbid
bodies where  this  complaint  existed ;  and 
[  63  ]
 there  is  a  cafe  in  point,   related by  Dr.
 Ludwig, of  Leipfic,  in which the duclus
 choledochus  communis  was dilated  to  more
 than an inch in diameter.
   n.  This  explanation of the courfe  of
 the bile to and from the gall bladder appears
 the  moft  fatisfadory,  and  is  that  moft
 ufually received ; but the eftablifhment of it
 has met with oppofition  upon two grounds.
   Firft,  That the gall bladder fecretes  it*
 own bile; and.
   Secondly,  That  the  branches   of  the
 hepatic dud,  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 duds.   "
   12.  The  principal fupporter of  the for-
 mer of thefe  propofitions is Albinus.   He
 was led to this from the vafcularity of the
gallbladder; from its  internal  furface hav-
 ing an  appearance like follicles;' and from
 the gall bladder having been found distended
                 G 2 
                [  64  ]
with bile, when the cyftic dud was com-
pletely obftruded by a gall stone.
  The two firft  arguments are barely pre-
Uimptive;  it  will  therefore be unneceffary
to refute them in form.
  The last,  being more fpecious,  may de-
ferve  fome  consideration:  we  will  begin
with admitting the.fad.
   13. Now it is well  known  that  the gall
bladder frequently  contains biliary  calculi,
at the fame  time that  it is distended with
bile.   Supposing, then, that  one of thefe
concretions  happens to make its way into
the cyftic dud, 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 circumstances;  in fuch a
cafe the  gall bladder will be found distend-
ed with bile, when  its retrograde courfe  by
the cyftic dud is  obftruded :  but diftention
is from the bile previoufly contained  in that
receptacle.
  Here then is a fource of fallacy. 
                [  65   ]
  14. But if it be true that  the gall  blad-
der is fometimes distended with bile,  when
the cyftic dud is obftruded,  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 proposition  relative to the ex-
istence of the hepatico-cyftic duds   needs
further fupport u 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 exist;  for in  thefe
animals,  the  gall  bladder is detached from
the liver, fo  that  there  is no pofllbility of
communication except by the  intervention
of the cyftic  dud.  In  the  human fubjed
their exiftence  may be eaiily difproved by
experiment.
  16. If the  gall bladder be emptied  cfits
contents,  and either air  or water be inject- 
                [  66  ]
ed into the liver by the hepatic dud, nei-
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 existed, we neceffarily conclude
that the gall bladder receives its bile by the
cyftic dud.
   17.  But the caufes which determine the
retrograde courfe of the bile from the duclus
communis into the gall  bladder by the duclus
cyfticus, are not constant 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 diredly
oppofite.   Were it not fo, the gall bladder
would  be in a constant 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  against this evil, a part of
its contents is occasionally difcharged, from
the preffure, which  the furrounding parts 
                [   67  ]
are constantly  making on  it.   Thus, this
preffure will vary fomewhat in its force fro.n
the relative degrees of diftention 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 a paf-
five receptacle.   But, this idea  has been
controverted; at least it has not always been
admitted in the extent here ftated.   Argu-
ments, founded on analogy, have been ad-
duced to prove that it poffeffes fome adive
power on its own contents;  and that though
affifted by the preffure of adjacent parts,  as
aded 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.
  20. 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   ]
anatomists to difcover mufcular fibres in the
gall bladder, and fuch a ftrudure  has been
defcribed, but their precife  diredion 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 indiftindly
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-
mists to adopt another criterion of mufcula-
rity,  viz. irritability,  and, with  a view,
either to eftablifh or to difprove its  prefence,
experiments have been inftitutecL   Various
stimulating powers, both chymical  and me-
chanical, have been  applied to the gall blad-
der,  without producing  any  evident con-
tradion.  Mechanical Stimuli, indeed,  pro-
duce no effed;  and, when  any contradion
has followed the ufe of chymical application,
it has been confined to  fuch  as aded by a 
               [  6g  ]
corroding quality,  and where the apparent
contradion has been nothing more than  the
corrugation which  may be induced on in-
animate animal matter.  Upon this fubjed
the experiments of  Baron Haller appear to
be fufficient and decisive.
   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 simple and effec-
tual.   It confifts of nothing more than  the
oblique manner, in which the common bili-
ary dud paffes 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
paffage from without inward,  the orifice of
the dud collapfes when a contrary diredion
is attempted. 
               [   7°   ]
  25. The caufes  which impede the  flow
of bile into the duodenum  are generally  very
tranfient  in  their  operation, under  which
ftate, there is only a moderate furcharge of
the  duds, and no material inconvenience en-
fues.  But it happens,  not unfrequently,
that the obftrudion is of a permanent nature,
in which  cafe the bile is neceffarily detained
in thefe parts for a  time, after which, it  finds
its way into  the mass of blood,  where,  by
being  circulated through every  part of the
body,  it gives  yellownefs to the fkin,  and
produces jaundice.
  26.  The  caufes which occafion  this ob-
ftrudion 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 dud, where it is
in motion. 
               [  7i   ]
  ^7« Sometimes a ftridureof the common
dud is an obltruding caufe; fuch  as have
been difcovered after death,  are  ufually of
that permanent kind  conneded 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 ftridure of this dud,
and which,  as not being  conneded with  a
change  of organization,  may attack by par-
oxysms, returning at  indeterminate  periods.
  29.  Without examining into the fymp-
toms which have been fuppofed to charader-
ife  this caufe ; it may poffibly  be thought
a fufficient  refutation  to  prove,  that  the
biliary  duds of a living  animal  poffefs no
marks of irritability when aded  upon by
ftimuli; the  contrary of which we fhould
 exped were  they furnifhed with mufcular
 fibres.
   The only part of the common dud liable
 to  fpafmodic affedion is  that which paffes 
                [   72  ]
 through the  coats of the duodenum, which
 may be aded upon by the  mufcular fibres
 of that inteftine;   and here we fhould dif-
 tinguifh between the contradion of the in-
 teftine in which the biliary  dud is paflive,
 and a contradion of the dud itfelf.
   30. Another caufe of  obftruded bile
 confifts in a  preffure  of the  dud by the
 head of the pancreas, which  is fometimes
 found in a fchirrous ftate, and which, from
 its connedion, may easily produce fuch an
 eflfed :  for the biliary dud,  a little before
 it terminates   in the  inteftine, penetrates
 fome way into  the  fubftance of  the pan-
 creas, and receives the excretory  dud 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 the  caufes of obftrudion already
enumerated,  there  is  another fometimes
annexed ;  viz. a fchirrous impaded ftate of
the liver, which from a very extensive depo- 
                [   73   ]
 fit of  folid matter throughout its fubftance,
 in an interstitial form, diminifhes the capa-
 cities  of the pori biliarii, fo  that they are
 unable to  carry  off the  bile as faft as fe-
 creted, and an  accumulation of it within
 the fubftance of the liver muft therefore ne-
 ceffarily enfue,
  32.  Hitherto the caufe of jaundice has
 been referred to obftrudion in fome part or
 other of the biliary  duds.  But there are
 fome cafes which incline  us to believe that
jaundice  may exist, though the  biliary ca-
 nals are pervious and free.—The yellow fe-
 ver of the Weft Indies furnifhes an  inftance
 in point.  The charaders of this complaint
are  a diffufion of bile through the mafs  of
 blood, producing jaundice, with an excessive
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.
  22- But  Boerhaave and Morgagni have
                    h 
                [  74  ]
favoured  an  opinion the dired reverfe of
this.  They confider jaundice,  fometimes,
as the effed  of a fufpended  fecretion,  and
fuppofe that  the  blood,  in  confequence of
this,  retains  a bilious  charader, thereby
giving ayellownefs to  the fkin.
  34. This opinion is founded on a mistak-
en notion, that all the fecreted fluids pre-
exist in the mafs of blood;  and that the
province of the different glands is confined
to the more mechanical feparation of thofe
fluids.
  3$. As  there are few,  if any, physio-
logists,  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 understood
and believed, that the blood is the pabulum
or fource of all the fecretions,  and that the
glands through which it  circulates,  change
its  properties, every one  according to  its
                                         c 
                [  75  1
peculiar mode of adion;  fo that the fecre-
tions may be confidered as new fluids formed
by their refpedive glands.
  26.  If this idea of  fecretion be true,  it
muft neceffarily follow, that, if the  adion
of the whole fecreting fyftem  of  the liver
be arretted,  no bile  can be  formed,  and
confequently< none  can  be conveyed into
the  mafs  of blood.   To argue otherwife
would  be to oppofe every principle of rea-
foning; it would be  imputing effeds 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 fubjed two  opini-
ons  which divide physiologists ;  fome of
whom  affert,  that the  bile after fecretion  is
carried to the blood veffels by regurgitation,.
whilst  others attribute this  effed to ab-
forption.
                   h  2 
                 [   76   ]
    The firft Opinion has moft generally pre-
  vailed.
    20. Baron  Haller,  who   introduced
  this to our notice,  refts his opinion on the
  free communication of veffels in the inte-
  rior part of the liver; but more efpecially
  on a communication  between  the hepatic
  veins  and biliary duds.   The proof of this
  communication is fair and decisive.
    49.  He obferves that  a fubtile injedion
  throwTn in by the hepatic dud will efcape
  readily by the hepatic veins.  This is a fad;
  and I  know from experiment that  water in-
  jeded in the  fame diredion will  return by
  the veins in a full stream,  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-
k  tural  diredion  of the bile be obftruded, it
  will naturally obey the fame diredion.
    This explanation of jaundice feemed ful-
  lyfufhcient tofatisfy the mind of Baron Haller, 
               [   77   J
  41. But a more extenfive acquaintance
with the ceconomy of the abforbent fyftem
has given  a  new  turn to this fpeculation,
and has  induced a physiologist of  the pre-
fent day,  to folve the caufe of jaundice on
the principle of  abforption only.   This
opinion rests on an experiment  where the
hepatic dud of a living animal was tied, and
afterwards the abforbents of the liver  were
very much loaded with bile.
  42. This fad 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 veffels by the
hepatic veins;  the circumstances and facts
upon  which that opinion rests,  retain  all
their original force,  and ftand unaffeded by
this experiment.
  43. The queftion then feems to  be, whe-
                   " 3 
               [   7«  ]
ther in cafes of jaundice the  bile paffes into
the blood veffels 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 dud  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 duct;
this being done,  the parietes of the abdomen
were brought  together  by futures.   Two
hours after,  the  dog  was ftrangled,  and
the parts carefullyexamined.  On infpedion
it appeared  that the abforbents had  been
very adive, for they were very much diften- 
                 t   79   ]
 ded with a fluid of  a bilious- colour, and
 their courfe,  which was  very  confpicuous,
 could be traced with the greatest eafe to the
 thoracic dud, 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 veffels, as on
 a very  careful infpedion of  the eye,  the tu-
 nica conjundiva did not  betray the flighted
 appearance of jaundices
   46.  It  feems then that during the fpace
 of two hours,  the fecretion  of the liver
 had  been fufficient in quantity to  diftend
 its duds;  to  ftimulate  the abforbents to
 relieve that diftention ;  and to allow of a
fmall portion of  their contents  to be con-
veyed into  the blood veffels.
  47. But  it ftill  remains to  determine, 
                [   8o   ]
whether or not a fmall quantity of bile  was
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  dud  as in  the   preceding  experi-
ment.  Two hours after,  blood was taken
from the jugular vein,   and  fet to reft, in
order that it might feparate into its ferum and
craffamentum.   The  liver was then diawn
down a little from thediaphragm, and blood
taken from one of the hepatic veins.  This
blood, as well as  the former, was  allowed
to feparate into  parts :   and  on immerfing
pieces  of  white  paper  into  the ferum of
each, that taken  from the  hepatic veins
gave the deepest tinge*  the other produced
only a very flight degree  of difcoloration.
  49. In this experiment the period of  ex-
amination  was the fame as  the  last, viz.
two hours;  a fpace of time just fufficient
for  the  bile to begin to make its way into 
[  Si   ]
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 produdion of jaundice, fo
the laft demonftrates with equal force, that
when from the operation of any obftruding
caufe the bile is accumulated  in its duds,
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. 
 
I  S3   ]
CHAP.  VU.
BILE.
               SECT.  I.

 T
  A  h 1 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 ftate,
 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  confiftence  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 question  may here arife, how
far this tenacity is  effential to the  bile, or
whether it may not  be explained on the prin-
ciple  of its being a compound  fluid,  con-
futing in part  of genuine bile, with a por-
tion of that mucus which is fecreted by the
sail 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 poffeffes faponaceous
properties is rendered highly probable  from
the ufe to which it is applied by fcourers of 
                 I   85   ]
  cloth; it being known to aflift very  powcr-
,_ fully in the removal of  greafy Spots.
    5. To thefe fenfible  properties we may
  add its tafte and fmell;  the firft being in-
  tenfely bitter, with a degree of pungency;
  the laft of a faint and naufeous nature.
    6. From this affemblage of properties, we
  naturally prefume,  that bile is a faponaceous
  fluid combined with a mucilaginous fub-
  ftance, from which it receives its tenacity;
  and to thefe are fuperadded the green colour-
  ing matter and the principle o&j^tternefs.
    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  chymical
  knowledge, when our  acquaintance  with
  the agents of chymiftry,  and their  effeds
  on  matter,  was   narrow and confined, the
  means  ufually employed  to afcertain the
                     1 
                [   86   ]
component parts of bodies, were feldom any
other than  thofe of fubjecting them to dif-
tillation by different degrees of heat, from
the less violent to the more intenfe.   Hav-
ing exerted the whole power of the furnace
in this way, the inquirers thought themfelves
in poffeffion  of a  very perfect analyfis of
every body, which  they thus  fubmitted to
inveftigation.
  But  reflection and an extended ftate of
knowledge foon convinced them how  re-
mote they w^re  from a thorough acquaint-
ance with tne 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
bewifhed.
  10.  Besides,  they  were not  acquainted
with the nature of the agent they employed, 
                  [  87  ]
  either abftradedly,  or  in a ftate of combi-
  nation with matter;  therefore the changes
  thus induced could be  but imperfedly  un-
  derstood.
     n. To guard  againft this difficulty, ano-
  ther, and more natural, mode of investigat-
  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 corred analysis
  could be obtained.   Thus the torturing of
  bodies by the application  of hmt neceffarily
  yielded to the more natural examination by
  chymical attractions.
     12. It is  by no means  intended here to
  profcribe altogether the agency of heat,i\i
  being often found  eflentially ufeful, as an
  auxiliary, to the chymical bodies employed,
  enabling them the better to effect their  dif-
  ferent decompositions and combinations.
     13. A qju a n t 1 t y  of recent ox bile being
  procured, feveral experiments were inftitut-
                   .   1  2 
                [   88   ]
ed, with a view to afcertain its component
parts.
           EXPERIMENT  I.

   14.  A portion of it, being received into
a fhallow earthen veffel, was evaporated cau-
tioufly by a moderate heat.  On examining
the vapour,  it  appeared  to be principally
water poft^Png neither acid  nor alkaline
properties, but  strongly impregnated with
that principle, in which the peculiar odour
of bile chiefly resides.  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 
                [  89  ]
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.
   16.  As bile poffeffes 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 paffed,  while a  mucila-
ginous fubftance of confiderable tenacity was
detained by the paper.  This mucilage was
                   13 
                [  9°  ]
of a  whitifh  colour, and  poffeffed  only a
flight degree of bitternefs,  while the filtrat-
ed liquor preferved both  the  bilious, co-
lour  and tafte.   It  is fcarcely  neceflfary to
add, that it was  free from  vifcidity.  The
glutinous principle t>f  the  bile appears
then to reside in an animal mucilage.
   18.  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, notwithstanding the 
                [   9i   ]
predominance of the  acid,  the bitter tafte
was very distinguishable.
   20.  The more  folid matter detained  by
the filter was very  glutinous, of  a  green
colour, and intenfely  bitter.




           EXPERIMENT  IV.

   fit.  Two other portions of bile were put
into proper veffels ; to one was added  a di-
luted vitriolic, to the other a diluted nitrous
acid.   Both exhibited phenomena similar to
thofe  in the laft  experiment.  The filtrat-
ed liquors were green, and  bitterifh; 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 perfed feparation might be obtained
by the affiftance of heat. 
[  92  ]
          EXPERIMENT V.


    23.  A quantity  of bile  and  diluted
marine acid  were put  into a-flafk,  and pla-
ced in a fand bath  until they  had  acquired
the boiling heat.   On infpedion,  the fepa-i
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 confifted 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  refihous fub-
ftance.
  24. But to afcertain in what way the
acid had effeded the decomposition, it be-
came neceflfary to  examine the filtrated  li-
quor.   It was therefore fubjeded to a cau- 
                [   93   ]
tious evaporation,  and, at a proper period,
was suffered to cool.
  25. Under cooling, crystals were form-
ed of a  cubic figure, which decrepitated
by heat,  and poflfeffed all the charaders of
common fait.
  Therefore  the decomposition  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 bafts, formed com-
mon fait.
  26. But,  notwithstanding  we are able
to account for the  produdion of common
fait in  this  way, it does not exclude the
pofllbility of  a  fmall quantity of  it pre-
existing in the bile,  independent on  this ar-
tificial  combination of its elements.
  27. To fatisfy my doubts on this  point,
the following experiment  was made. 
                V  94   ]


          EXPERIMENT VI.

  28. To a  portion  of bile   was  added
alcohol,  in quantity fufficient to fet loofe all
its mucilaginous matter.   The fluid  part,
being feparated by a filter,  was examined
by nitrated silver, 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.
  29. From  this experiment we learn,  that
the faline bafts of the faponaceous matter
of the bile  is the mineral  alkali;  but the
other element is ftill  a queftion.
          EXPERIMENT VII.

  30. To determine this point a quantity
of bile was decompofed by a diluted marine 
                [95  ]
 acid, affifted by heat (as in Experiment V.)
 The coagulum detained by the filter was  ex-
 amined.  It appeared to poffefs moft of the
 charaders of bile in a  folid  concentrated
 ftate.   It had a pungent bitter tafte,  dark
.green colour, and was extremely glutinous.
 When perfedly 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 wifhed for, further
 experiment was neceflfary.
         EXPERIMENT VIII.
  32. I  therefore diffufed  a portion of
this rejiduum through redified fpirit of wine:
a large proportion  of  it  was  diffolved, 
                [  96  ]
which   imparted  to  the  fpirit  both  the
colour  and tafte  of  bile;   the  infoluble
part being  chiefly of a mucilaginous na-
ture.
  33.  From the facility with which alcohol
diffolves the green and bitter  part,  it is'
fcarcely  probable, that  it partook of the
nature of an unduous oil;  but that it was
either a refinous body, or a kind of eifential
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 rejiduum was nothing more
than a refinous  fubftance,  in which resided
both the colouring principle and bitter tafte.
  2$.  On taking  a retrofped of the above
experiments, the  bile appears to be refolv-
able into the following elements, viz.
  Firft,——Water,   impregnated with  the
odorous principle. 
               [   97  ]
  Secondly,----A mucilaginous  fubftance
refembling the albumen.^
  Thirdly,—A refinous fubftance contain-
ing the colouring principle and bitter tafte.
And
  Fourthly,—The  mild mineral alkali.
  36. With refped 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
easily combines, fo that the whole forms a
mafs apparently homogeneous.
  37. The following experiments were  in-
ftituted with yi view  of  examining fome
dodrines,  founded on the bile  having a
greater  power of  refifting putrefadion than
the blood. 
f  9*   ]
       EXPERIMENTS IX fcf X.

  38. Eqjjal quantities of  blood and bile
of  the fame ox were each  put into a dif-
ferent  veffel 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 putrefadion;  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-
five fmell. 
[  99  ]
CHAP.   VIII.
ON BILIARY CALCULI.
             SECT.  I.

 XDeing favoured by Dr. Baillie with  an
opportunity of examining the ftrudure, and
general appearance of biliary calculi* in his
colledion I found that they are very gene-
rally either of a lamellated or radiated struc-
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 
                [   ioo  ] .
 white; in others as black as  jet;  in many
 ©f 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 fusible in the  fire ; and, for the
 moft 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 phofphorus,  and cut like wax.
   3. In the radiated calculi there is  a fub-
 ftance,  in   every refped, like ffermaceti.
 Some  calculi,  inftead  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- infpiffations of bile,  but that there
 is  a  difference  either  in the  component 
                [   ioi   ]
 parts themfelves,  or in  the proportion of
 thofe parts.
   5.  Therefore,  in chymical  inveftigati-
 on, it feems neceflfary that experiments fhould
 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  ftridly, to a feries of inqui-
 ries made on another.
   6.  As we prefume, from bare infpedion,
 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 fubjed  of rational  inquiry, to de-
 termine what are thofe elements,  and of
 what nature is their combination.
   7.  To afcertain this, feveral experiments
 were instituted on a calculus of  the follow-
ing charaders.
   The external  furface was of  a chocolate
colour ; when rubbed off,  it  had a lighter
coloured layer underneath.
                   *3 
               [  102   ]
   On making a fedion through its centre,
it  appeared to be compofed of lamella?.
   It was" rubbed to powder very easily.
   Its tafte was moderately bitter.
   It was fufible by heat, and when inflamed,
burned like a refinous fubftance.
   Ol. terebinth, unaided by heat, diffolved
a very  large  portion ;  but alcohol,  under
the  fame  circumstances, diifolved 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
infufed  in an ounce of alcohol, and, after
previous agitation, the phial was placed in
a fand bath.   Before the  fluid had arrived 
               [   103   ]
at the boiling point,  it diffolved nearly the
whole of the fubftance.   The clear liquor,
being  poured  from  the refiduum, was
fuffered to cool.  Under cooling, the  whole
affumed the appearance of a folid chryftal-
lized mafs.
            EXPERIMENT.

   9. A small  quantity  of  alcohol  being
poured  on this  refiduum,  and affifted  by
heat as before, exhibited very little folvent
power.   Thefe experiments fhow that there
is a fmall proportion of this biliary calculus
which refifts  the folvent power of alcohol.
What is its nature I
            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.
  u. The crystallized mafs  formed by the
alcohol was next fubjeded  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 chryftallized mafs, being made

  * I fufpedt it to be of an  earthy nature, not
only from its folubility in an acid, but from  its
poffeffing no inflammability. 
               [   '05   ]
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-
leded 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 ftone, 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 fatisfadorily. 
[  io6  ]
            EXPERIMENT.

   14. The fluid mixture of the laft experi-
ment was carefully  evaporated  almost to
drynefs.  On cooling,  two kinds of cryf-
tals formed; one fpiculated, the other cubic.
The cubes, poffefling the charaders 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 he-
came immediately fenfible. 
               I  107  ]

  16. From  thefe  experiments  we  infer,
that  this fpecimen of  biliary calculus con-
fifted chiefly of a refinous  matter, with  a
fmall proportion of earth, apparently  calca-
reous, combined with the mineral and vola-
tile alkali. 
 
[  io9  J
CHAP.   IX.
OF THE USE OF THE BILE.
             SECT.   I.

 VXr 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
fome relative  connexion between  this fluid
and the colouring matter of the blood,  by
the  red particles contributing more efpecial-
ly to its formation.  An opinion very gene-
rally prevails, that the  bile aflifts in  the pro-
cefs of chylification,  by mixing  with the
                   L 
              [   no   ]
digefted  food contained in the  duodenum:
for it is demonftrably true, that the digefted
matter does not affume a chylous form  un-
til it has paffed below that part  of the in-
teftine where  the  biliary and  pancreatic
duds make their entrance.   And upon the
ground of  this fad, it has  been prefumed,
rather  than demonstrated,  that either all,
or fome of the conftituent parts of the  bile
contribute to  chylification.  What  founda-
tion exists 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  flowly out  of
its  dud,  which, when  carefully  attended
to, appeared to flow over the  furface of the
digefted matter  adhering to  the  intestine.
Upon removing the bile from the furface of
this digefted matter, it did notappear to have
mixed with it in any fcnfible 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 prefence
can be difcovered from the fenfible proper-
ties of the  chyle.
  4. Another difficulty in admitting this
as one ufe of the bile, is from the circum-
stances  of  jaundice.    In this complaint,
the paffage  of that fluid into the  inteftine
                  l 2 
               [   112   ]
is  either completely  obftruded, or  very
much impeded ; but there are no fymptoms
which clearly  manifest a  defed  of chylifi-
cation.
   5. One important ufe of  the bile is, un-
queftionably,  that of stimulating 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 digestion  and  affimilation of our
food ;  its principal  office  is  that of a natu-
ral  and habitual ftimulus  to the inteftines,
keeping up their energy and  periftaltic mo-
tion, which may be affeded  either by an 
                [   "3   ]
 increafe of its quantity,  or a change  in its
 quality,  produced by difeafe.
   When we take, however,  a view of the
 conftituent  parts of bile,  as clearly afcer-
 tained  by the foregoing  chymical experi-
 ments, it feems  very probable, that  from
 its refinous  bitter,  it may  counterad  any
 adive and fpontaneous changes  to which
 animal and vegetable matter would other-
 wife be fubjed ;  and that as  the propenfity
 to  acidity in our vegetable  aliment is ex-
 tremely  obvious,  the  alkaline matter of
 bile tends to correct it.  Bile likewife, from
 its faponaceous and foluble quality,  leffens
 the adhefive  nature of our fceces,  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  digestion is
ultimately  perfeded  in the upper  end of
the duodenum ;  and  as perfed digestion is
always  oppofed to  fermentable  changes,
                  i  3 
               [   11+   ]
the bile is well calculated to  finifh that pro-
cefs.   We  probably may err in  confining
the  ufe  of bile,  therefore,  to  any single
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-
fedive 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
 fuggefting the ufe  of  proper  remedies in
 cafes Of difeafed and defedive bile.
   It frequently  occurs that bile  is fecreted
 in too fmall a quantity, as in  hypochon-
- driacal complaints, and chlorofis j  in which
 difeafes an unufual degree of torpor  takes
 place, expreffed in the  one  cafe by dejedion
 and defpair; in the other by inadivity and
 languor; the ftools are generally of a light
 clay colour,  and the body is costive.
    Bile therefore affords a ftimulus by which 
                [   "S   ]
tone and energy are communicated from the
inteftines to the whole body,  the defed of
which on the prima? via? is more produdive
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 cecono-
my like any  other foreign  ftimulus  which
may be applied  to the inteftines.—It  like-
wife, from its. bitternefs, poffeffes antifeptic
powers,  which  are  peculiarly ufeful  in the
intestinal canal. 
 
[  n7  ]
 OF THE DISEASES OF THE LIVER
DEPENDING ON ITS FUNCTIONS AS
    AN ORGAN OF SECRETION.
CHAP.  I.
ON THE INCREASED SECRETION
            OF BILE.
             SECT.  I.
 1 he Inhabitants of warm  climates  are
extremely fubjed  to  difeafes  arifing from
the increafed  fecretion of bile,  and  the
excefs of its quantity in  the primas vias,
which,  either by regurgitating into the fto-
mach, produces a general languor  of  the
body,  together with  mufea,  foul tongue, 
               [   rr8   ]
lofs of  appetite,  and indigestion;   or,  by
being direded to the  inteftines, excites a
painful  diarrhoea,  ultimately  tending  to
weaken their tone,  and difturb their regular
peristaltic  motion.  It  generally  happens
that, during the excefs  and prevalence of
bile  in  the  first paffages, 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  thirft, with an increafe of heat, the
ufual fymptoms  of fever.   The body be-
comes  emaciated,  and the general  afped
of the patient is extremely unhealthy.
   2. Under  fuch circumstances, a change
of climate becomes neceffary, by which the
fecretion of  bile  is gradually diminifhed,
its powers,  perhaps,  rendered lefs  adive,
and the  healthy  fundions of the  ftomach
and  bowels are  again  restored.   A  fea
voyage  from a warm to  a  colder  climate 
               [   "9  ]
generally effeds this  purpofe, fuppofing, 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  effeds of  a
warm climate on healthy constitutions, 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  situations, contribute to
 produce difeafe.
   4. The natives of warm climates are lefs
 fubjed to the inconveniences  arifing from
 the increafed fecretion of bile than Euro-
 peans  who inhabit thofe  countries,  and
 whofe  constitution,  by former habits, is ill
 prepared to admit fuch increafed excitement
 of the liver, or fuch additional irritation on
 the primae viae, without much derangement
 of the  animal ceconomy.   The  bile  in
 warm  climates is,  perhaps,  more bitter and 
               [   120   ]
more faturated  with its  component parts
than in colder countries ; it  is therefore a
more adive emetic or purgative ; and, al-
though it was not fecreted in a larger quan-
tity, its effeds on the firft paffages would be
more feverely felt.
   5. We have had  occasion, in treating of
the nature and properties of bile,  to corred
a common and prevailing opinion of its be-
ing extremely putrefcent; experiments, ex-
ecuted with great  accuracy  and  fidelity,
fufficiently  prove that it is lefs difpofed to
putrify than any other animal fluid ;  and
that it even preferves,  in a fweet ftate, ani-
mal fubftances,  which,  when expofed to
fimilar circumstances of  fluidity  and heat,
without the admixture of bile, would  in a
fhorter time have  aflfumed the charader of
putrefadion.   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 conftitution 
           .    [  12'   1
than in colder countries ; and by its being
more bitter and more adive, it poffeffes a
greater antifeptic power than the milder and
more diluted  fluid of a colder climate ;
hence it  is better  fitted  to  corred and re-
strain the propensities 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
primes 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 defed in the quantity of this fluid,
than to carry off its excefs;  it is even more
eafy to diminifh  its  acrimony th^n to in-
creafe its power, and thereby render it more
adive, and better fuited  to anfwer the  vari-
ous and ufeful purpofes intended by it to the
animal ceconomv.
                    M 
[  I**  ]
   j. I have been  frequently confulted by
 perfons whofe  appetite and digestion have
 been much difturbed 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 affiftance of  medicine, with
 a view to destroy the tendency  to exceffive
 fecretion, and finally to reftore ftrength and
 vigorous adion.
   8.  After obtaining all  the information
which I fuppofe neceflfary refpeding the con-'
ftitution and habits of the patient, the ori-
ginal and  progreffive ftate  of fymptoms,
and the effeds of fuch remedies as have been
employed,  I  proceed to afcertain how far
any local or organic affedion of any  of  the
vifcera has  taken place.-»-If,  upon  inveftiga-
tion,  I find that  the  conftitution has only
fuffered by the prevalence or the excefs of
bile,  and that the difpofition to that morbid
increafe of fecretion ftill remains, difturb- 
               [  *«3   1
ing the  fundions of the ftomach, and irri-
tating the bowels, I recommend it to  rey
patient, every morning before breakfast, to
dilute  the contents of  the  ftomach,  by
drinking from half a pint to a pint of water,
of a temperature  from 90 to 114 degrees of
Farrenheit's thermometer, likewife to  take
a moderate degree of exercife before break-
faft.  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  analysis  of  mineral
waters has been of  confiderable advantage,
                  M 2 
               [  124  ]
knee, besides the difcoveries which it  has
made with refped 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 \.)fe of  warm wa-
ter  in dyfpeptic cafes ;  and in anomalous
gout, it feems to allay the irritation of the
ftomach, to promote and diffufe a generous
warmth in the extreme  parts, and,  if taken
at night, will generally produce fleep.  Per-
haps it  ads  upon  the principle of tepid
bathing ;   with  this difference,  that any
adion on  the ftomach  has a more extenfive
influence on the fyftem,  than the fame adion
would have on the'furface of the body. 
               [   125   ]
   io. Water heated to a certain degree,
 when  taken into the ftomach will produce
 giddinefs of the head, while the fame water,
 of  a  lower  temperature,  will  produce no
 fuch effed : this is the  reafon why patients
 at Bath  are direded to  drink the  water of
 different fprings, though not differently im-
 pregnated, and it gives  rife to a refinement
 in pradice which has for its foundation only
 the different effeds of temperature*  It is
 not improbable,  but that more benefit will
 arife when the temperature is carried to that
 degree which  produces fome fenfible effed
 upon the head ; it is impoflible to lay down
 any general rule on this fubjed ;  it  is trial
 alone  on the individual that can determine
 the point of adion.
  11. 'I consider the waters of Bath,  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 
               [   126   j
peratures  entitle  them  to fome preference,
and render them proper to be deunk by per-
fons whofe stomachs 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 study, accompanied with
a fedentary life.
   12.  In  Sick  headachs,   which  generally
arife from bile  in  the ftomach,  half  a pint
of warm water taken at bed-time has a good
effed.  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 inteftines.   In almost all cafes
where vomits are given,  bile,  during their
adion,  is forced from the duodenum into the
ftomach,  which would otherwife have been
carried  off by  the  inteftines;  indeed, the
adions  of naufea and vomiting increafe  its
fecretion.   In general,  bile is  a- purgative 
               [   i«7   ]
sufficiently ftimulating for its own evacuati-
on,  only  requiring the affiftance 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 moft 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
effed.   Perhaps it would be more advan-
tageous to take it every other morning than
to ufe it daily :  it  may be fuccefsfully and
well imitated by  artificial means,  fo as to
be drunk at a distance from the fpring near-
ly with equal effed as at Cheltenham.
  14. The ftomach, in its energy and pow- 
                [   128  ]
er,  is greatly affifted by warm clothing,  ef-
pecially 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,  fhould be
moderate in quantity, and of eafy digestion.
This will neceffarily 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 waters
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- 
               [   I29   ]
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.
  16. The patient  is feized with a violent
difcharge of a dark coloured fluid, in large
quantity,  and fomewhat  of a bitter  tafte,
both from the ftomach and inteftines, with
much pain and anxiety about the pracordia,
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 Auguft
and  September, fo  as to  be confidered as 
               t   130   ]
an autumnal epidemic.  It frequently takes
place fpontaneoufly, and  independently of
any fenfible occafional caufe being applied ;
at other times it is evidently conneded with
a fudden change  of temperature  in thofe
months.
   i8; It  may likewife arife  from the in-
temperate ufe of food of difficult digestion,
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 August  and
September, are obvioufly connected with
the ftate  of  the  biliary fecretion, and  ap-
proach in their nature to fuch as prevail in
warm climates.
   19. The fluid difcharged  in the Cholera
Morbus is evidently bilious,  but it is  bile in
a very difeafed ftate, by no means correfpond-
ing with the charader of  the  natural  or
healthy ftate of that fluid.
  20. It  feems  probable,  that  from,  the 
[   '3'   ]
quantity fecreted, and the rapid manner in
which  it is  poured  into the   duodenum,
there is not time fufficient for a perfed 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 veffels into thepori biliarii, and unit-
ing with a  portion of  bile, are carried by the  '
hepatic duds into the duodenum.
   21.  The varied and increafed adion of a
 gland has much influence  in  determining
 the  nature of the fluid fecreted.  Ih  fome
 cafes bile  is  difcharged, of a green colour,
 and extremely acrid, not poffeffing the qua-
 lities of healthy bile.
   22.  The  cure of  Cholera Morbus is belt
 effeded, 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 
               [   132   ]
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 confeclio opiata, and  of mufk in large
dofes.  Every thing which has a tendency
to vomit or purge  adively fhould be avoid-
ed, but emollient glyfters may be frequently
employed.   If, in  the firft ftage of  the dif-
eafe, fymptoms of fever and inflammation
fhould occur, the patient may lofe a cor.fi-
derable quantity of blood, and a large blister
fhould be applied to the abdomen.   In f >me
cafes the warm bath may be employed with
advantage; it is, however, chiefly to diluents
and opiates that we trust for a cure.
  23.  The fecretion of bile is frequently
increafed and  hurried by  cjjufes ading on
the ftomach, fuch  as fea  ficknefs, and eme-
tics ; the difcharge of bile  by vomiting is,
therefore, no proof of its having existed in
the ftomach before the exhibition of the vo- 
               t  133  ]
mit, or of its having been the primary caufe
of naufea and indigeftion : it  is only  the
effed of dired adion 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  ftomacl},
which  has  no  tendency  to produce  the
fever; it is only an effed, and not the caufe
of the difeafe.
  25. In warm climates, contagious  and
febrile poifons have a great tendency to ad
on  the hepatic fyftem,  and hurry much the
fecretion of bile ;  indeed, hemorrhages from
the iiver, accompanying the increafed fecre-
tion of bile, frequently take place, and  dif-
fedion generally fhows congeftion and  a
turgefcent ftate of that organ; this naturally
fuggefts the ufe of adive purgatives in thofe
fevers, fuch as calomel, jalap, and the neu-
tral falts ;  indeed, fo fpecifically  lias  the
N 
               [   13+  ]
liver been  fuppofed  affeded in thefe cafes,
that fome late writers on the fubjed of the
contagious  yellow  fever now raging in the
Weft Indies, have recommended the ufe of
mercury, in order to produce a falivatyon ;
under which,  we are allured, all the fymp-
toms of malignancy have fubfided. 
t  135  ]
CHAP.  II.
OF THE DIMINISHED SECRETION
              OF BILE.
             SECT.  L

 Trom what  has been  already obferved
on the ufe of bile and its application to the
purpofes of the animal ceconomy, it is ob-
vious, that a confiderable diminution of the
quantity fecreted will be followed by difeafe.
The liver may be rendered incapable of
fecreting the ufual quantity of bile by any
defed in its ftrudure ; and that this is, fre-
                  n 2 
                [   '36  ]
 euently,  the impeding caufe, appears from
.diffedion.
   i. It  is an organ  very fufceptible of
 chronic   inflammation,   which,   without
 alarming  in the firft inftance, by painful or
 adive fymptoms, gradually induces obstruc-
 tion ; 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 fubjed to  occafional pain  in  the  right
 hypochondrium, extending to thefcapulae, 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 flefh, the patient
 has a pale or fallow complexion.    Such
 fymptoms are accompanied with a  defed
 in  the fecretion of bile, and a torpid ftate
 of the inteftines. 
               [   i37   ]
  3. It is probable, that under  thefe cir-
 cumstances,  the  original mifchief is in the
 ftomach  and duodenum,  and that the fym-
 pathetic adion on the liver is lefs, on which
 perhaps  healthy  fecretion  may  depend ;
 hence  dyfpeptic  complaints generally pre-
 cede affedions of the liver, and arife from
 intemperance either in eating  or  drinking,
 but  are  more  particularly  induced by the
 abufe  of fpirituous liquors,  even  though
 diluted with water.   The ftomach, by long
 fasting, has its digestive powers much weak-
 ened, by which the fecretion of bile is dimi-
 nifhed, and  a difeafed ftrudure 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 wiil
do the  fame.
  4. Hypochondriacal complaints aie al-
ways attended with fymptoms of dyfpepfia
 and diminifhed fecretion,  and great torpor of-
                   N3 
              [   '38   ]
the alimentary canal.   In the chlorofis of.
women we have likewife a diminution in the
quantity and adivity of bile.
   5. When the   diminifhed  fecretion  is
preceded by affedions of the ftomach, fuch
as lofs of  appetite, indigeftion,  and flatu-
lent erudations,  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 ; almost: 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 5 but- 
               [  x39  1
tcr,  rendered  rancid  by  being  melted,
fhould 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
adion of the liver will be restored.
   6.  I am perfuaded that the ftomach digests
folid  aliment more eafily than  liquid  and
bulky food; and that foups and broths are
more quickly difpofed  to  run  into adive
fermentation, and require the  exertion  of
more vitality  to restrain 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 fhould be regular.  Nor is there, 
               [   ho   ]

any good foundation for  diverfifying our
meals ;  fo that breakfast and dinner fhould
be made up of different kinds of  food.
The fecretion of bile would be thereby more
regular, and the  quality better preferved
under fuch a regimen.   A ftomach,  vitiat-
ed by bad habits, is with  difficulty reformed,
but may ultimately be reconciled to simple
and healthy  aliment.  There  are fome sto-
machs which rejed milk when it has been
medicinally  recommended;  but  they  are
fuch to which milk has been a perfed stran-
ger ;  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 ftomach to any larger
quantity, which may be thought neceffary.
The condition of the gaftric fluid, and the
adion of the ftomach, accommodate them-
felves to that regimen, to which the ftomach
has been accustomed.
  7. There are fome ftomachs  which are 
               [   hi  i
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;
hut in all cafes the ftomach fhould never be
perfedly 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 ; 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 breakfast, and a lunche-
on at noon, will prove the  best remedies.
I believe  that chlorofis, atrophy, tubercle,
and other  glandular affedions,  would  be
beft obviated by fuch a regimen, and females
 acquire more vigorous and adive health by
fuch a plan as is now recommended.  With
refped to  the quality of our different meals, 
[   H2   ]
we feem  to  depart more from the custom
of our hardy  ancestors, with regard to break-
faft, than any other meal.*
  A very leading fymptom of  a weak fto-
mach, and an enervated conftitution,  is the
loathing of food at breakfast; while a vigor-
ous ftomach difcovers  more energy  in the
morning than at any other time of the day.
Digeftion is  best promoted by a ftate of reft
after eating,  and the exercife of the body is
best adapted to restoring energy, and pro-
moting the neceffary fecretions.f

  * A  Maid of Honor, at  the Court of Queen
Elizabeth,  breakfafled upon beef, and drank ale
after it;—while the Sportfman, and even the Day-
labourer, now frequently breakfaft upon tea.
  f Dr. Harwood, the Profeffor 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 in the ftomach of  th»
©ther dog that procefs was fcarcely begun. 
[   *43   ]
  6. The  temporary lofs of  bile  may be
applied  by  various  bitters,   occasionally
united  with rhubarb, aloes,  and the like.
The excefs of acidity may be correded by
alkaline remedies  and lime water.   In in-
fants  the bile is frequently not fufficiently
adive,  and generally fecreted in too fmall a
quantity,  which in them induces difeafes of
prevailing acidity.'*

  * We may obferve farther, that the ftomach,
in its office of digeftion, may derive affiftance from
the liver, by the latter counteradiag fome of thofe
effeds which arife from the difeafed adion 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 Stomachs, are digefted with difficulty,
and are very apt,  in  bad Stomachs,  to occafion
fymptoms of acidity.  Flatulence and diftention
frequently fucceed the taking of thefe fubftances 
[   i4+  ]
    7.  In  cafes of difeafed  ftrudure  of the
 liver,  producing a diminution of fecretion,
 and particularly when fuch change of ftruc-

 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 effed ; whilft thofe fubftances which
 have no dired  tendency  to acefcency,  may yet
 prove an indired caufe of it,  by weakening the
 tone of the ftomach, and thus difturbing the di-
 geftive and assimilating fundions.
   But there feems  to be a power in a healthy fto-
 mach of counterading thofe fpontaneous changes
 which would take place out  of  the ftomach, or in
 a difeafed  ftomach.   It is not, perhaps, too much
 to exped,  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-
bk^pf afilmilating fome fubftances which are vari-
ous and heterogeneous, and, therefore, it  is fair
to conclude, that  it is equally capable of ading
upon fome which are more Simple. 
                 I   Hi   I

ture has arifen from inflammation, mercujy
has been found ufeful, even carried to  the
degree  of  producing  a  flight  falivation,

  If,  then,  the ftomach poffeffes a power, when
in a healthy ftate, of counterading 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 ftomach. The queftion then to be anfwer-
ed is,  " Can  the  liver contribute any thing to-
u wards the prevention of fuch an effed as this ?'*
  It has  been already  proved, in  the courfe of
thofe experiments which have been  before related,
that there is in bile 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 refifting the fermentation going on in
the ftomach, and alimentary  canal, when any of
its contents are difpofed to  run  into this  ftate.
When it comes into contad  with thefe fubftances,
it may ad as a chymical agent, and produce fuch
a change upon them as fhall prevent  that proofs
to which  they are difpofed.
  That this  is  the effed of the  vegetable bitter on
other  occafions, conftant  experience evinces, in
                       o 
[   H6  ]
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 difcovered 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 effeds,  which
might  arife from its continuance in that  ftate,
during its paffage through other parts of the fyf-
tem.  We are to remember,  that if this change
does not take place till after it has paffed 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 obferve 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 effeds which might arife  from its continuance
in*diat ftate, wbilft  it is  palling through other
parts of  the fyftem.
   But not only to this acefcent  ftate of the con-
tends of the prima; vire, but alfo to that of putref- 
[   H7   ]
   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  hedic fever, I  have
feen advantages  from  tepid bathing,  the
temperature of the water  being 90 degrees
of Farenheit's thermometer.   The pradice
of tepid  bathing may  accompany the ufe
of mercury, and  may  moderate  the  dan-

cency, the bile offers a proper corredive.  The
foregoing experiments ferve to prove the  greater
power which bile has of refifting putrefaction than
the blood.  Without referring,  at prefent, to the
relative difpofition to putrefcency betwixt the two
fluids, we may remark, that if the bitter property
of bile have this tendency,  this is a circumftance
which at once explains the effect referred to.  But
when we confider that to preferve the general tone
and vigour of the fyftem is the beft mode of obvi-
ating putrefcency,  we may attribute this effed to
the bile, which, by its immediate influence on the
inteftine,  and its more remote influence on t^$e ge-
neral fyftem, through the medium of the ftomach,
may produce it.
                      o  2 
                [   H8   ]
 gerous exhalement which may  fometimes
 arife from it.
   8. Sea ficknefs, and a fea voyage, con-
 tribute very much to reftore  the  fecretion
 of healthy bile,  fo neceflfary to the welfare
 of the animal ceconomy;  and fymptoms
 of dyfpepfia and diminilhed fecretion, which
 are now rendered more confpicuous among
 females from  their fedentary life,  are moft
 effedually 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 dud  as  it  enters
 the duodenum : this will be removed moft
 effectually by calomel, fcammony, or jalap,
which  feem  in their operation  to stimulate
and evacuate  the duodenum,  while  many
other purgatives ad moft  forcibly on  the
lar^ inteftines.
   io. In  the infantile  fever of children, 
               [   H9  ]
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 ufe of calomel
and fcammony, efpecially in the  early ftage
of the difeafe.
   n. There feems much  fympathy be-
tween  the brain and  the liver;  and  in
maniacal perfons, in  whom there is  gene-
rally  a defed in   the  fecretion  of  bile;
this evil is best removed by  the  means al-
ready recommended.
° 3 
% 
[  i*i   ]
CHAP.  III. •
OF OBSTRUCTION TO THE FREE
  PASSAGE OF BILE INTO THE
           DUODENUM.
              SECT. I.

 I f, after bile is fecreted, its free admiffion
into the duodenum be impeded,  fo that an
accumulation of it takes place in the excre-
tory duds.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 
               [   15*  1
Jaundice;  the hiftory and cure of which
I fhall now endeavour to explain.
  2. Jaundice  may  be defined a yellow
colour of  the  fkin, and tunica conjundiva
of the eye, with  urine of an obfcure red,
tinging  linen with  a yellow hue,  and with
the faeces  generally of  a light and clay-like
appearance in confiftence and colour.
  3. This is  a difeafe to  which  women
are more  fubjed  than men,   and  adults
than children; though it takes place occa-
sionally  in perfons of all ages and  of both
fexes.  It is  attended  with a fenfe of lassi-
tude and languor,  a fenfe of pain and  ten-
sion,  or  weight and oppreffion about  the
praecordia j  there is frequently much anxie-
ty, and  fome degree of difficulty in breath-
ing.  The eyes and roots of the nails first
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   ]
cy, acidity,  and indigeftion ; and  the far-
ces,  which are commonly of a white colour,
have not the ufual  faeculent fmell.  Solid
food generally taftes bitter in the mouth in
fome,  and in  the  moft unfavourable  ftateT
of the difeafe there  occurs hiccup,   and oc-
cafional paroxyfms  of rigor,  or  chillinefs.
The pain is fometimes extremely acute in the
right hypochondrium,  or in the  epigastri-
um.   The ftate of the pulfe varies ; in ge-
neral it is quicker than natural,  though  in
fome cafes,  efpecially during the paffage of
a gall ftone,  it is flower.   It very feldom
or never happens,  that objeds 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,  oppreffi-
on, or  uneafinefs  about  the praecordia;  a
return  of  appetite and digeftion ; the colour 
               [  i54  ]
of the urine becomes more diluted;  it is
fecreted in a larger quantity;  the stools ac-
quire a yellow colour, are more copious,
and more eafily procured;  fometimes  hard
and concrete matter is found in the faeces.
   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  ftrength
and flefh,  with occafional chilliness, watch-
fulnefs, and  melancholy; under thofe  cir-
cumstances,  he becomes fubjed either to
profufefweating or hasmorrhagy. When thefe
fymptoms attend  it,  the difeafe frequently
terminates in a confirmed afcites.
   7. Under  fuch circumstances we may
conclude, that  though fome  bile muft 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
ftrudure,  or organization,  materially  dif- 
               [   '55   1
eafed,  a circumftance which,  though  fre-
quently attendant  on jaundice, is  by  no
means neceflfary to constitute the difeafe.
  8. On  diffedion,  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  fome of the larger
branches  of the hepatic duds, are found
fometimes obliterated  by  difeafed struc-
ture.  Gall  ftones  are often found  in the
 dudus communis,  but more frequently in
 the gall bladder and cyftic  dud.  In  fome
 a thickening and difeafed  ftrudure of the
 dudus  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 ;  hence a 
                [   '56  ]
jaundice may  arife  from preffure during
pregnancy.  The bile has been  found of a
very vifcid,  and pitchy confiftence, efpeci-
ally in the gall bladder,  paffing  from the
cyftic  to the  common  dud, and thereby
perhaps  refitting the  paffage of  the more
fluid  hepatic  bile, which would  otherwife
flow freely into the duodenum.
   9. The  chlorofis,  to which young women
are extremely  fubjed,  to a  fuperficial ob-
fervcr, puts  on the  appearance  of jaun-
dice.   In the chlorofis, the tunica conjunc-
tiva is not more difcoloured 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 imperfed  ftate  is,
perhaps,  in common to all the other fecreti-
ons of chlorotic fubjeds,  and may poffibly
arife from the  watery ftate  of  the blood, 
               [   '57   ]
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 primae viae, than a
deficiency.  Perhaps  the  quantity  of bile
which is fecreted is fo very confiderable, that
though the greatest part of it efcapes into *
the primas vise,  the whole may not  readily
find a paffage;  and the furcharge thus occa-
sioned  may  give rife to  regurgitation and
abforption.  The reafon for this may proba-
bly be, that the  diameter of the  common
dud,  or of the larger branches of the pori
biliarii, though fully  adequate to tranfmit
the whole of the bile fecreted in the healthy
ftate of the liver, yet may be infufficient to
convey the excefs produced under an hurried
and imperfed  adion of  that organ ;  and
therefore with  every appearance of a large
                    p 
               C   158   ]
fupply of  bile in the prima? viae,  a jaundice
may take place.
   11. The fymptoms of pyrexia, and other
phenomena of febrile miafmata ading on the
body under this difeafe,  the delirium,  the
quick prostration  of ftrength, after early
fymptoms of local inflammation,  either in
the duodenum, or   region  of the  biliary
duds, diftinguifh it very readily from jaun-
dice.
   12.   The fecretory  ceconomy  of the
liver,  in common with  that of  moft other
organs in  the body,   is very much under the
dominion of the  pafllons.   Anger,  it  is
well known,  produces   strongly   marked
effeds ; it not only  augments the quantity
of bile fecreted very confiderably, but like-
wife vitiates it:  hence it is, that by being
carried into the duodenum in large quanti-
ties,  and thence  regurgitated into  the fto-
mach, it produces effeds like thofe of  an
emetic. 
               [   '59   ]
  13. If the dudus  communis  does  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  veffels produce jaundice.
  14. It ftldom  happens,   when a fecreti-
on is hurried by  the excefs of adion,  that
the  fluid  fecreted poffeffes its natural  and
healthy properties;  hence arifes the  varia-
tion in appearance of bile,  which, in fome
acute cafes,  as  in  cholera morbus,  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 ftate,  than the bile.
Such a fluid may be confidered as fomething
between blood and bile, and carried  off fo
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 ftrudure,
                  p 2 
               [   160  ]  ■
for it is inftantly  removed by opiates  and
other means which may restrain immoderate
adion.
  15. Men 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 adion which the biliary duds
can perform, as they poffefs a very fmall de-
gree  of irritability;  but  are aflifted prin-
cipally from the agency of the  diaphragm,
abdominal  mufcles, and  peristaltic  motion
of the inteftines; and more efpecially from
the agitation which the hepatic fyftem  fuf-
fers duringbodily exercife.  Thewant there-
fore  of a degree of exercife fufficient to affift
the biliary duds in their excretory fundion,
muft neceffarily lay an ample foundation  for
morbid affedions.  And the neceffity of this
external aid to  the perfed adion of the li-
ver,  feems more  obvious from the circum- 
                [   '6i   ]
ftances of its venous  circulation, which  is
always more languid than in thofe fecretory
organs where the fluids are kept in a ftate of
more rapid  motion  by  arterial  impulfe.
Horfe exercife feems peculiarly well calcu-
lated to affift the adion  of the  abdominal
vifcera,  in cafes of defedive excitement in
the hepatic fyftem.  •
   16. The bile,  during its stay in the  gall
bladder,  acquires a vifcid confiftence,  per-
haps, in fome meafure,  from the  abforption
of its more aqueous parts, arid likewife from
a propensity  to fpontaneous feparation,  by
which its coagulable part may detach itfelf.
Though this circumstance is lefs obvious in
bile than  in  blood, and  though it may re-
quire more time to be effeded, 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
fprrituous  liquors  difpofes  to  jaundice,
evidently  of the  moft unfavouruble kind ;
                   r  3 
                 [    162   ]
 becaufe generally  accompanied  with  dif-
 eafed ftrudure..  They may ad  by  firft al-
 tering the ftrudure of the ftomach and duo-
 denum,  and  afterwards,   by  fyrfipathy  of
 contiguity,  affect lhe biliary  duds  of the
 liver.  In the diffedion of thofe  who have
 been intemperate dram-drinkers,  the difeaf-
 ed ftrudure 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 Stomachs of dram-drinkers are generally found
in a flabby and  inelaftic ftate, capable of*fecreting
only difeafed fluids :  this lofs  of tone in  the Sto-
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 afped takes place.
  The urine is  fecreted in a fmall quantity,  of  a
deep colour, though not tinging linen of a yellow 
               [   '63   ]
  18.  However  remotely  fituated fome
parts of the body may be from others ;  yet
a difeafed adion is  quickly propagated to a
distance,   without   affeding  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 fuppreffion
of iflfues, cutaneous eruptions, and haemor-
rhoids, are followed, in fome cafes, by mor-
bid affedions of the lungs, in others of the
hepatic  fyftem, and thefe do  not always
Subside  on  restoring the difeafed adion  to
the organ firft affeded.   In confirmation  of
this opinion,  I have feen a jaundice  with a
fenfe  of  pain  and oppreffion on the right hy-
pochondrium, correfpond and alternate with

hue.  This is  frequently a more dangerous ftate
of difeafe than jaundice, which indicates only a
refiftance to the. paffage of bile into the duodenum,
and may  take  place in the moft healthy ftate of
the liver. 
               [   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 duds are
very paflive, that they fubmit very eafily to
mechanical diftenfion from calculi, without
contrading afterwards like fenfible 0'*  irri-
table parts ;  therefore  when jaundice   has
arifen from  very acrid emetics, or griping
purgatives, or colic, or hysteria,  the refift-
ance to the free paffage of bile  is either at
the very extremity of the dudus communis,
or during its  oblique  courfe  through  the
fubftance of the duodenum,  at which  part
it is liable to compreffion from the mufcular
adion of that inteftine.   And perhaps, like-
wife, the increafe of the quantity  of bile in
the inteftine may depend on an  adion com-
municated to the dudus communis.   In
the one cafe the dud may be clofed,  in  the
other it may be  aded  upon  by  fuccefilve 
[  i65  ]
motions, by which it emulges more quickly
its contents.
  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 neceffity 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-
fedion it appears that they very rarely exift
in the hepatic  duds, fometimes met with  in
the dudus communis, more frequently  in
the dudus cyfticus, and  are most common
in the gall bladder.  The bile accompany-
ing them is more  vifcid than ufual,  a d
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 
               [  '66  ]
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 stone nearly the fize and figure of the
gall bladder itfelf, fo  as nearly to fill the
whole cavity.  Thefe  large calculi are lefs
frequently the caufe of jaundice than fmaller
ones :  for, from their bulk, there is but
little probability of their entering the dudus
cyfticus, and  afterwards of  obftruding the
dudus  communis.  It is from  calculi  of
fmaller dimenfions that fuch obftrudions
are occasioned.   However  the  rule  is not
without exceptions, and from  diffedion it
appears, that  calculi  of confiderable bulk
muft  have pasted,  for the dudus communis
has been enlarged to  an  inch in diameter,
an inftance of which  has been met with  by
Dr. Heberden.
   12.  But calculi have pasted,  during life,
of fuch a bulk as to occafion a doubt whe-
ther they efcaped into the inteftines by the 
I   '67  ]
natural canals,  or  made their  way thither
by  a  preternatural  paffage.  Dr. Chefton,
fome  years  ago,  met with a cafe where a
gall  ftone of  an  unufual magnitude paffed
during  life,  and  the patie*nt got  well.
Some years   after  fhe  died  of   another
complaint,  and cei examination it appeared
that this large gall ftone  had made a  pre-
ternatural paffage through the gall  bladder
into the inteftine.  Mr. Cline,  in his excel-
lent colledion 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
compreffing the hepatic duds: a fchirrous
enlargement  of  the pancreas, has fome-
times  produced this  effed.  Excefllve vo-
miting,  and violent exercife,  perhaps by
forcing ftones from  the gall  bladder into
the  cyftic dud,  and from thence into the
common  dud, have produced the difeafe. 
                [   168   ]
  There is  an inftance where jaundice arofe
  from the  feeds of goofeberries being found
  in the extremity of the  dudus communis
  as it enters the duodenum.  In fhort, what-
  ever can obftrud or impede the paffage of
  the bile into the duodenum, muft be confi-
  dered as a caufe fufficient to produce jaun-
 dice : but in what way the bile paffes from
 the biliary veffels  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 ftrudure of the liver,
 or from  the tumour of  furrounding  parts,
 and more efpecially if accompanied with fe-
 ver and gradual diminution  of ftrength and
 flefh,  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- 
                [   '69   ]
vourable   circumstances  above  remarked,
it is feldom of long duration, and  by a ju-
dicious treatment  may  be  effedually re-
moved.
   26.  The cure of  jaundice  consists in the
removal of exciting caufes,  and in allevi-
ating urgent  fymptoms.   Calculi  are  the
moft frequent exciting caufes.
   27.  It appears  from   experiments that
fome calculi  are foluble  in  an  alkali,  in
fpirit of wine, and oil of turpentine ;  but
it is altogether  impradicable to  make  a
dired   application  of thofe  fubftances  to
calculi  in the biliary duds,  as we  have no
fads 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 power.   It remains yet
to be  proved, that the  proportion of al-
kali in the  bile  is increafed by  alkaline
remedies.
  23.  Many  faline remedies pafs into the 
               [  *7°   1
urine unchanged,  and may ad on  calculi
in the bladder ; but we  cannot deted the
prefence of alkaline or other folvents in the
bile.  The analogy,  therefore,  between the
adion 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
adion 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 effed 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 stimulated
by calomel  combined with  fcammony or
rhubarb,  and in cafes of a defed of bile in
the inteftinal canal,  the .deficiency may be
fupplied with a purgative bitter, by an infu- 
                [  '7'  ]
fion of camomile flowers,  with tind. 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, vcnre
fedio and  the antiphlogistic regimen ir.ay
be ufed with  advantage.
  31. Gentle exercife on horfeback is par-
ticularly  ufeful in promoting the paffage of
calculi, and  preventing the Stagnation  of
bile in  the gall-bladder,  which probably
renders it vifcid,  and liable to obftrud the
free paffage into the duodenum.
  32. In jaundice from  tumour or preffure
of furrounding parts,  fmall dofes of calo-
mel,  or  fome  other mercurial preparation,
may be  ufeful,  unlefs fymptomatic fever
fhould take place,  in which cafe mercury is
hurtful.  Chalybeate waters may be ufed to
advantage with a view of giving tone and
                   0,2 
[   nl   ]
 energy to the fyftem,  fo  very  defedive  in
 cafes of jaundice.*

   * Mr. Dick, a gentleman high in the profeffi-
 onal line, in Bengal, and of much pradice in Cal-
 cutta, in a letter to me, fays,----" I have been for
 "  the laft Seven years in the habit of giving calo-
 "  mel in the  jaundice, in dofes from two to five
 "  grains every night,  till the mouth was affeded,
 "  and in every  cafe the jaundice went off as foon
 "  as the mouth became fore.—I now fcarcely ufe
 ff  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 effeds
 "  of mercury, in liver complaints,  as it deferves.
 "  I have been confirmed more and more by late
 "  pradice, in my opinion, of its effeds in the  jaun-
 "  dice, though I do not attempt to reafon upon it.
   " In recent  attacks of liver complaints,  after
" 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 ;  and, if I be not
" much miftaken, it is in fuch cafes that it has the
" beft effeds.—In chronic cafes,  where there is 
[   *73   ]
" no fever, but only an obtufe pain in the fide and
" Shoulder, with a fullnefs in the fide, and about
" the pit of the ftomach,  keeping up  a conftant
" uneafinefs,  mercury  feems to me  to  have but
" little good effeds :  when ufed freely it removes
c< the fymptoms at the time, but they generally re-
" turn as fo.on 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 iffue made in the
" fide, and with fucccfs far beyond my expeda-
" tions."

  Thefe  being  the  remarks of  a gentleman of
much pradice andobfervation, I have given them
in his own words, being convinced that they de-
ferve the particular attention of thofe who prac-
tice in India.
"K3 
 
[  i75   ]
CHAP.   IV.
OF THE DISEASES TO WHICH THE
  LIVER IS SUBJECT IN COMMON
   WITH OTHER ORGANS OF A
    GLANDULAR STRUCTURE.
            SECT.  I.

 Ihe  liver is fufceptible  both of acute
and chronic inflammation ; perhaps of the
former,  as  being  more immediately  con-
neded with its arterial or nutrient, the latter
with its venous or fecretory fyftem.  W.hen 
                [   i76  ]

 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 recolledion of the
 patient; to thefe fucceed an increafe of heat
 and quicknefs of pulfe.   The pain in the
 right hypochondrium,  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 crust, 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 
               [  177  J
difeafe.   If the  inflammation  attack  the
convex furface of the liver,  fo that the  pe-
ritoneum becomes affeded, 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 shooting
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 cheft, are apt to mifleadan un-
wary praditioner; 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  fto-
mach is fo extremely irritable,  that violent
retching or vomiting occur, fymptoms in-
fluenced,   perhaps,  by  the  inflammation 
                [   i?8   ]
 being in the vicinity of that organ.  In most
 cafes the fecretion of bile is increafed under
 adive 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  fuppuration  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
dired the operation of  the  furgeon  to  an
artificial opening by the caustic or the lancet.
During the formation of  pus frequent  rigors
are felt, and a fenfe of weight  and oppreffion
fucceeds that of acute pain.
   7.  It frequently happens  that  pus  is
formed  either in the vicinity of  the  duels,
or in the concave part of the liver; fo that
no external tumor can be perceived.   The
ufual  fymptoms of fuppuration, however, 
               [  i79   ]
may be obferved in all cafes where  matter
is produced; 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  unpromising.   If again,  on  the other
hand, the pus is difcharged either throuoh
the  diaphragm  into  the  cavity  of  the
thorax,  or  more   diredly  into  that  of
the abdomen, the difeafe generally  proves
fatal.
   8.  With refped to the manner in which
the difcharge is effeded in thofe cafes where
it  paffes off by  the  inteftines,  it muft  be
clear that fome of the  branches  of the  he-
patic dud are involved in the fuppuration,
and confequently destroyed by the ulcerative
procefs.
   9. We fhould then  naturally fufped that
the pus would insinuate itfelf into thofe orir
flees of the hepatic duds, which  ulceration
had formed,  and by thofe channels make its 
                [   180   ]
 way into the duodenum.—But this explana-
 tion  is not unattended with difficulty :  for
 it muft be recolleded, that wherever fuppu-
 ration  and ulceration are going forward,
 there adhesion is an attendant.
   10. It would  be  departing  from  the
 main  objed of this  work to  branch  off
 into a  digreffive inquiry on the advantages
 resulting to the machine from this connexi-
 on of inflammatory ftages,  as thofe advan-
 tages are as much  diversified  as the parts
 which are the feat of inflammation.  It is
 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  paffing  through  inflamed veffels, that
the parietes of that abfcefs become foldered
into a folid  compad mafs.   Thus an abfcefs
which, under contrary circumstances, would
have diffufed itfelf  to an  indefinite extent,
now becomes determined and circumfcribed. 
               [   i8i  ]
  n. These considerations prepare us for a
change,  which muft neceffarily be induced
on  the ulcerated  branches  of the hepatic
dud;  the coagulable lymph, which is eve-
ry where poured out upon the internal fur-
face of the abfcefs, will, in all probability,
fo obftrud the ulcerated orifices of the bili-
ary duds, that no pus can make its way by
them into the inteftines.
   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 dud, that it may  ulce-
rate through its coats,  and allow the matter
to pafs into  the  duodenum.  Whether  we
may be able  to diftinguifh fuch a cafe in the
living fubjed is rather  doubtful; but  I
fhould fufped 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 abfceffes by the intestinal canal
                   R 
              ■■[   18a  ]
is that where an adhesion takes place between
the  fuppurating  part  and  the  inteftines,
an  ulceration enfues,  and the contents of
the abfcefs have a ready paffage into the in-
teftines.   This may happen in different parts
of  the intestinal  canal,  according  to the
fituation  of the  abfcefs.—When it is feated
at the concave part,  the duodenum may be
favourable for that purpofe; 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 fubjed
 many years ago,  in  his publication called Patho-
 logical Inquiries and Obfervations,  a work not
 lefs diftingnifhed for accuracy of obfervation than
 valuable  for the judicious remarks it contains. 
               C   '83  ]-
   14. The difeafes which are mistaken  for
hepatitis  are  peripneumony,   inflamma-
tion of the ftomach,  and rheumatic affec-
tions of the  mufcles  in  the neighbouring
partSc
   15. The  hepatitis  is  lefs eafily diftin-
guifhed  from  peripneumony  when   that
part of  the liver is affeded which  is feated
within the falfe ribs, and where it  enlarges
itfelf in fuch a diredion as to make a preffure
on the diaphragm fufficient to diminilh the
cavity of the cheft : and it is probable, like-
wife,  that from the extension of the inflam-
mation into the fubftance of that organ, its
operation as an inftrument of refpiration may
be  much impeded.—Under thefe circum-
stances a troublefome cough, with difficulty
of breathing,  comes on ;  fo  that  the  dif-
eafe affumes the appearance of thoracic  in-
flammation.
   16. It is  more  eafily distinguished  from
the inflamed condition of the  ftomach, by
                   r 2 
               [  -i8+  ]
its not being accompanied with that extreme
fenfe  of heat and pain with which that or-
gan is affeded, 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 mufcular 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-
tnre  of the  body:  it generally  alternates
with  rheumatic pain in  one or more joints
of the body.
   18. When the hepatitis terminates fpon-
 taneoufly and  favourably there is fome eva-
cuation l-y  hcemorrhagy,   diarrhoea,   per-
fpiratior., 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 j  anrj it is not
 improbable but that a fuperficial  difcharge
 of coagulable lymph may  promote this re- 
               [   i8S   ]
folution, though  afterwards  produdive  of
adhesive inflammation.
   19.  It  has  frequently  happened that a
large  abfcefs  has  very  quickly formed,
which,  either by corroding the large blood
veffels, 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 tranflation 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 varies 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 which  have been adopted.
  11. The fymptoms of fuppuration are not
always, however,  very  obvious; the mcft
                 *3 
               [   186  ]
striking 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  accefllon of fever  towards  the
evening, with flufhings of the countenance, a
propenfity  to profufe  fweating,  and  other
fymptoms of  hedic fever.   In many cafes
the fluduation  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,  deliquium,  and
death : fo that there has  been reafon  to fuf-
ped that this organ may on fome  occafions,
though  much lefs frequently than  others,
become gangrenous.
   23. The  hepatitis frequently terminates
in the enlarged and  fchirrous ftate of the
organ ;  and v/e may obferve,  on the inflec-
tion of dead  bodies,  fuch a variety in  the
appearances, as to  fuggeft  the idea  of  dif- 
                f   i«7   3
 ferent  kinds  of fchirrous  affedion, which
 will  be belt explained by attending to  thje
 progrefs  of chronic  inflammation  in  the
 liver,  to which fpecies  it  is more fubjed
 than to the acute.   It is  indeed  fufficiently
 evident  from diffedion,  that the  liver is
 fubjed to inflammation,  which did not ob-
 vioufly appear  from  any prevailing fymp-
 tom  before death :  though  perhaps a more
 accurate attention to circumstances 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 mistaken  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
ftrudure of the liver, the" reader may confult the
Morbid  Anatomy of the Human Body, by Dr.
Baillie ;  a moft excellent and ufeful book. 
               [   188   ]
of pain, which he falfely attributes to the
ftomach;   and its  continuance is  fo fhort,
and  the degree of it frequently  fo incon-
fiderable,  that no alarm refpeding the fu-
ture health of the patient is produced.  The
relief obtained by  erudation and difcharge
of air tends to 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  diftention 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 circumstances
will  enable us w th  fome  certainty to dif-
tinguifh the difeafe.
  25. In  thofe cafes  where  the  liver  is
affeded, confiderable  pain  is felt in  the
parts near  the fcrobiculus cordis  and epi-
gaftric  region, upon any degree  of pref-
fure; and  as  the  difeafe advances, an in-
creafe  of  heat, a quicknefs of pulfe, and 
              [   189   ]    *■

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  East  Indies, and
very generally  terminates in  fuppuration.
When the fymptoms of adive inflammation,
however, have been  checked,  though  not
effedually  removed, by the antiphlogistic
pradice,  the difeafe. frequently   becomes
chronic,  and terminates in a  fchirrous  in-
duration of the organ.
   27.  On  this fubjed much information
may be obtained by obferving the coun-
tenance of the patient,  which, though not
wearing  the  appearance of jaundice,  yet 
               [  19°  1
has a peculiar  fallownefs,  exprefllve  of a
morbid condition of  the liver.
   28. The  two  complaints  are  not more
diftinguifhed by their fymptoms than they
are by the  different  flares  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 charaderife acute and adive
inflammation, there are manifest signs of  in-
dolence and  want of adion 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;  it
affumes an afh or clay-coloured hue, evident-
ly conneded with a diminifhed fecretion.
   30.  This kind of liver  is  obvioufly
fmaller, it undergoes a  change in fhape;
the lower edge,  which  is naturally  thin,
efpecially of the left lobe,  becomes rounded
and gibbous. 
               [   19'   ]
  31. If we cut into its fubftance, we find
uniformly a folid compad appearance,  in-
terfperfed  with  foramina,  evidently   the
orifices of divided veffels; 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  compad 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
confolidition of its fubftance; or, in other
words, that it  has  gained in compadnefs
what it has loft in external bulk.
  32. If  this  explanation  were just 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 
               [   l92   ]

into the general  mafs of fluids,  agreeably
to a law of the abforbent fyftem.
   22-  But  I  strongly  fufped  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  expeded,  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 imperfed fecretion 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 muft  be evident that
the  immediate  caufes  can  admit but  of 
                [  T93  ]
 little  variety.    To  produce  an increafed
 fecretion  of bile, it  muft be  evident  that
 there  muft  be  an increafed  adion of the
 branches  of  the vena  portarum, and an
 accelerated   circulation  of fluids through
 thofe  branches :  hence a condition of  vef-
 fels is  induced, approaching in fome refpeds
 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 veffel.
   26.  The  effed of  this adion,  efpecially
 when  protraded to a confiderable  extent,
 muft  neceffarily be   that of inducing an
 alteration in the structure of the part—an
 alteration similar to  what obtains in other
 organs labouring under  indolent and chro-
 nic inflammation.
  37.  This  change of  ftrudure, from its
 folidity and  compadnefs,  feems to depend
 on  the effufion  of the  coagulable  lymph
into the parenchymatous fubftance of  the
                     s 
               [   194  ]
liver,  with this peculiarity, that while it
is,  in  adive inflammations,  depofited by
arteries,  it is,  in the chronic kind, effufed
by the veins.
  33.  Thus   we are in  poffeffion of  a
caufe which appears  to offer  an  explana-
tion of  that diminifhed 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 fubject of
the proximate caufe.
  39.  If the pofition just stated be true,  it
muft be admitted  as a confequence, that
fuch livers  are not  performing their  full
fhare of  that office in the machine to which
they were destined  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
ftiould do,  are confidered  as ufelefs bodies, 
               t  195  ]
and are fit fubjeds for the adion of thefe
veffels: hence  it is  that there is a greater
diminution  of  fubftance  in  thofe  fchir-
rofities which are of  long  standing,  than in
fuch as are of more recent date.
  4.T.  To  inquire  in what  consists   the
proximate caufe of  inflammation of   the
liver,  is to investigate what  is the  proxi-
mate  caufe of inflammation in  general.—
The  limits  prefcribed  to  this  work do
not allow us to enter extensively into this
queltion,  as it would involve an examin-
ation  of  the prevailing  theories on  this
fubjed.
  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  which are ferviceable
in one  inflammation are  injurious in ano-
ther :  now,  admitting the axiom,  " that
" fimilar  caufes produce  fimilar effeds un-
                    s 2 
               [   196   1
" der fimilar circumstances,"  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 veffels,  or, in other words,
the  proximate  caufe of  thofe  fymptoms
denominated inflammation,  is not always
the fame.  Hence arifes  a confiderable fhare
of the difficulty attending the  inveftigation
of proximate caufes in general.
  43. The  phenomena  of  inflammation
evidently  fhow, 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  conjundiva  of  the eye,
where, from its tranfparency,  and the white
fubjacent tunica albuginea, we have an op-
portunity of feeing  clearly the commence-
ment and progrefs of inflammation. 
 »

               [   197   ]
  44« The  firft 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 veffels become diftend-
ed,  until  at  length the whole  eye affumes
almost one uniform red appearance.
  45. Now,  on what peculiar  ftate of vef-
fels does  this diftention  depend ? Are the
powers  that  ad  in  propelling the  blood
from  the  larger veffels to  the  fmaller ones
increafed, while the refitting 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 veffels ?
  46. There are good reafons fof believ-
ing that each of thefe conditions exifts in  its
turn : at  leaft  the methods employed with
fuecefs to remove inflammations of this parr
lead to that opinion.  For  it is a fad well
                   s .1 
               [  '98  1
eftablifhed  in  the treatment of  thefe com-
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 adion 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.
  The liver may be inflamed in confequence
of external injury.  In fuch cafes it is pro-
bable that a violent and ftrong adion will
take place, analogous to what  would happen
in the eye from the prefence of an extraneous
bodv;  and  that a plan of treatment evi-
dently fedative  or  antiphlogiftic  is  moft
likely to  be efficacious in both.
  48. On the other hand,  the fame organs
may be  in a ftate of inflammation without
the application of  any obvious ftimulating 
               [   *99  I
caufe.  In the  eye, experience has evinced
that this kind of opthalmia is moft fuccefs-
fully treated by  bark, and  fuch external
applications  as  tend to ftimulate and give
tone ; evidently fhowing  that the effential
charader of that  inflammation is debility.
And further, it is now well understood that
an inflammation of the eye,  which was  of
the adive   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 our fubjed to
inveftigate in what way an adive 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 congestion be relieved at its commence-
ment, by leffening the distending caufe, the
veffels,  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 veffels, their tonic power neceffarily
 becomes diminifhed, and  fuch  means only
 can avail, as  tend  to leffen the column of
 the blood, and increafe the contradile power
 of its veffels.
   Thefe  reafonings  may  ferve   to  givo
 fome  idea of the  two States of the veffels
 as  conneded  with active  and  indolent in-
 flammation.
   50. As the principles  laid down apply to
 inflammations of any organ, we  fhall  en-
 deavour to fhow, by  confidering  the  na-
 ture of remote caufes,  in what  way  they
 may  produce  this ftate  of veffels  in  he-.
 patitis.
   51.  Many remote  caufes of  hepatitis1
 may be enumerated, fuch as affections of
the mind, particularly anger, long protract--
ed  fummer heat,  the  intemperate  ufe  of
fpirituous  liquors, &c.   But  to  produce: 
               [  aoi   ]
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-
sist in inducing a ftate of excitement in the
circulation of  the  liver :  the accelerated,
though imperfed, fecretion  of bile,  toge-
ther with the fenfe of fulnefs in the region
of the  liver  antecedent  to inflammation,
tend to  perfuade us that hepatitis is gene-
rally ufhered  in by  fymptoms of existing
congeftion.
   52. If proper methods be  taken  to re-
lieve this congeftion  on its firft attack, fuch
as diminifhing*the  rolumn  of  blood,  or
inducing a determination of it  to  conti-
guous parts, the tone of the veffels 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 veffels to recover that tone which
they were beginning  to  lofe.  But  if the 
               [  202   ]
congestion has been of fome  duration, and
the tonic ftate of the veffels confiderably
impaired, if the moft adive  means are not
employed, the confequence  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 adive
kind at its commencement,  changes  in its
progrefs into a ftate of fchirrofity.
   52-  Or, a ftate of fchirrus may be gra-
dually  induced  on the liver,  without any
pre-existing adive inflammation,  as  hap-
pens after a long  refidence in a warm cli-
mate,  where,  from   frequent  accelerated
fecretion of  bile, the hepatic veffels,; 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 
[   203   ]
lymph of  the blood changed in a peculiar
way.*   This is the morbid ftrudure of the
liver, which generally terminates in afcites.
   54.  But there  is  an  appearance  fome-
times met with  on  diffedion that  is per-

  * DROPSY is a very general confequence of  a
difeafed liver ; which, from previous inflammati-
on, may have  fuffered in its  ftrudure in fuch a
way as to produce a confiderable impediment to
the tranfmiftion of blood by the vena portarum.
  Such dropfies 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 fhould
impute this apparent want of uniformity in na-
ture.
  This explanation muft be fought for in the laws
of the circulation.  Whatever fhare a diminifhed
adion of the abforbent fyftem may  have  in pro-
ducing an accumulation of watery fluids, it muft
be evident that a  confiderable degree of effufion
from  the  exhalant fyftem is effentially necelfary,
and which excefs of effufion can arife only from
an excefs of vafcular adion.
   Admitting this pofition, it  muft follow as a con-
fequence, that  when the adion of  the whole ex-
halant fyftem of the body is  increafed,  the effa- 
C   204  ]
 haps  a  little  difficult to  explain  on  this
 fyftem  of  reafoning—this  is a  tubercular
 ftate of  the fubftance of  this organ, con-
 fifting of a feries of circumfcribed  inflam-
 mations,  interfperfed  through the apparent

 fion, which is the effed of it, muft be as exten-
 five as the caufe : and on the contrary, when the
 accelerated adion 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-
 sive or limited adion ?  As all accelerated adion is
 to  be referred to ftimuli of fome defcription, we
 naturally inquire how  that condition of veffels
 can be produced fometimes in the whole exhalant
 fyftem, 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 effeds on the exhalant fyftem,
 either limited or extenfive.
  To fatisfy ourfelves refpeding 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 effed of this
experiment will be, that the veins below the prefix-
 ed  part immediately become diftended, the limb 
[   205   ]
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  effeds
fo partial and circumfcribed.  But the dif-

fometime after becomes enlarged, and  if preflfed
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 thefe effeds.—It is evident,
that the return of venous blood was firil impeded
by preffure, and that a refiftance was formed to
the adion 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
effed,  an effufion of  their watery  contents fol-
lows as a confequence ;  hence the oedema,  or in
other words,  a local dropfy.
  The  produdion of the effed 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 bleed, and the
confequent accelerated adion of the capillary and
exhalant  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 instances  of  circum-
fcribed inflammations  and  abfceffes  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 effed
produced by it.
  Let us now 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 produdion of afcites.
  That ftate of the liver, which more particularly
Jifpofes to this difeafe, is the fchirrous orindurat-
ed one:>-that, which when examined by making
flices of it,  manifests a folid and clofe compaded
mafs, as if  there had been depofited interftitially
within its fubftance,  folid matter fufficient  to des-
troy its parenchymatous charader.  Indeed the
fad 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 adion 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
 eftablifh,  but fhow that the difeafed  condi-
 tion of veffels  we have before  pointed  at,
 may  exist in  a  number of  fmall  parts of

 an inflammation arofe in this way, it was to be re-
garded rather as of the paflive than of  the adive
 kind ; or a fpecies but little difpofed to terminate
 in fuppuration.  Its effeds are rather  thofe  that
 charaderize indolent parts, fuch  as induration,
 fchirrofity, &c.  But this  confequence neceffiri-
 ly enfues,  that though venous inflammation has
 not adivity 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 veffels, more ef-
 pecially  of the  vena portarum :  and thus an im-
 pediment  to the fite  paffage of blood through
 that fyftem is formed.
   Having  thus fhown  the  probability of an  ob-
 ftrudion   exifting  to  the paffage  of  the  blood
 through the liver, in what manner does this bear
 a refemblance to the  effecls of a ligature on the
 principal vein of an extremity ?     *
  .Before we can anfwer  this queftion, we  muft
 recall to the  attention  of our readers  what  has
 been faid in a former part of  this  work  on the
 fubjed, relative to the circulation of blood through
                    T 2 
[   208   ]
 any organ,   while  the greater  part of its
 bulk  ftiall  be in a natural ftate; or  that
 there may  exist  a  confiderable  number of
 ftimulating  caufes  in the  fubftance of the
 liver,   each  having its own fphere of adion*
 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 neceffity, that  whenever the
 liver is affeded 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 veffels and exhalants in the pe-
ritoneal vifcera to greater adions;  and the effufi-
 on  of  Jymph from thofe parts follows as a  con-
 fequence.  Such appears to me to be a rational 
               [   209   ]

  55« The  explanation juft  given  is  not
offered  as the  mere  Suggestion  of theory,
but admits of a  degree of probability ap-
proaching  to  demonstration.    This  last
opinion feems  strongly supported  by  the
refult of an experiment that was  made  for
the  purpofe  of  investigating a  point   in
phyfiology,  not conneded with the prefent
question.



             EXPERIMENT.

   56". Two  drachms  of  crude   mercury
were injeded by means of a proper  appa-

explanation of afcites, as founded on a fchirrcus
aitection of the liver.
  On  the  fame principle may be explained   the
hylrothorax,  as originating in the excitement of
inflammation in  the cavity of the cheft ;  or in
any mechanical  obftacle to  the free paflage of
bf nd from one fide of  the heart to th>- other, or
from the preffure on the diaphragm  arifing from
an enlarged liver,  or an afcitic dropfy.
                     T 3 
               [   2IO   ]
ratus  into  the  crural vein of a  dog.  It
produced no  effeds that were obvious for
at leaft a whole day ;  but afterwards there
were evident marks of  increafed  adion in
the vafcular  fyftem, attended with a quick
and  hard  pulfe.  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 affedion of  the  lungs, which daily in-
creafed  until he died.   His  lungs,  on ex-
amination,  were found in a tubercular ftate ;
many of thefe tubercles  had fuppurated and
formed  vomicae.
   57. The question here is,  whether thefe
tubercles and  vomicae arofe from  the intro-
uudion  of  the mercury  ?
   The  anfwer  is very clear.   The animal
was  in  perfed  health before.   This is only
a prefumptive evidence.   But a minute ex-
amination of the tubercles put the matter
out of doubt ]  for on making fedions into 
                [   an   ]
 the fubftance  of  them,  each contained a
 globule of  mercury,  forming  a kind   of
 nucleus to the circumfcribed inflammation
 or tubercle.   Whether thefe mercurial glo-
 bules   aded  on  the  principle  of  Simple
 ftimuli, or in a fpecific way, is not a fubjed
 for our prefent inveftigation  : but the in-
 ference intended to be drawn is, that fymp-
 toms of general excitement may exist in the
 whole  body, and that  only a  particular
 organ may  fhow  marks of  difeafe -,  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 ftrudure.
   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
just recited.   This  caufe may  confift  in
 local  alterations in  the tone of the veffels
 in particular parts of  an organ -, and that. 
               [   212   ]

 in confequence of an accelerated circulation
 through its whole fubftance, thefe debilitat-
 ed  parts may readily fall into  a ftate of
 chronic inflammation.
   S9-  In considering the adive  and indo-
 lent inflammations of the liver, we  have
 referred  the  former to  the hepatic artery
 or  nutrient  veffel  ■,  while the  latter  has
 been confidered as  an affedion of its fecre-
 tory veffel.  As this opinion  is  not  taken
 up  on the ground of mere conjedure, 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-
 neded 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 effeded
from venous blood inftead of arterial.
  61.  It  is a fad well eftablifhed in phy-
fiology,  that  the living  power  or eneray 
               [   2I3   ]
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 adive and vigorous
purpofes ;  the  proofs of  this  pofition are
fo numerous, that they muft occur to every
one.  Now when we  recoiled  that by far
the  greater portion of blood  that  paffes
through the liver is  of  the venous kind,
and  when  it is remembered likewife that
this  blood is lefs  fitted to adive 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 adive
kind are imputable to the hepatic artery.
   62.  In the  adive and  acute inflamma-
tion of  the liver,  as well as that of  other
organs,  the  antiphlogiftic practice fhould
be  adopted ; and as  the attention of the
praditioner  fhould be directed to the pre- 
               t   214   ]
vention of fuppuration,  he muft be guided
by  the circumftances of  each  individual
cafe in forming his judgment to what  ex-
tent that pradice may  be purfued.  Here
much depends  on his difcernment, as well
refpeding the extent  of the antiphlogiftic
pradice, as in determining the pree.ie  pe-
riod when  it is likely  to  be moft ufeful :
for it muft  be  obvious, that if any confi-
derable advantage is to be  expeded from
this pradice,  it  muft be looked for in an
early ftage of the difeafe,  when the inflam-
mation has not advanced beyond the proba-
bility of refolution.
   62-  The  more prominent part of  the
antiphlogistic  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  effed
upon the pulfe,  and by the  circumftances
©f each individual cafe. 
               [   2i5   ]
  64. Blisters,  applied  to the region of
the liver,  co-operate very ftrongly  with
the views of  blood-letting, and therefore,
in attempting  refolution,  recourfe  fhould
be  had to them very early  j and here again
the fame  difcrimination  is necesfary  with
refped 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 justified the pofition,
that a quick  fucceffion of blisters  to the
vicinity of an inflamed organ prevails more
over the adivity of inflammation, than the
long  protraded  difcharges  from a  single
 vefication.   My own  experience  having
abundantly confirmed the truth of this doc-
 trine, I cannot recommend it to the pradi-
 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 
               t   ai6   ]
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 ftridly antiphlogiftic,  but  are lefs
liable  to occafion naufea and  other  dif-
agreeable fenfations in the ftomach.
   66.  In blood-letting,  blisters, and lax-
ative medicines appear  to confiit the more
effential  parts of  antiphlogiftic  pradice j
but there are other refources  of which  we
can  avail ourfelves,   and  which, though
fubordinate  in point of adivity, are  found
from pradice 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  moifture  upon  the fkin  ;  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. 
               [  217   ]
  67* By  the  means  above recited,  the
praditioner,  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  East 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
refitted even by  the moft  adive pradice j
 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
 utmost 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  affiftance, or the unavailing
                      u 
                [  ai8  ]
 efforts of the  antiphlogiftic plan of treat-
 ment,* the  inflammation fhall  have pro-
 ceeded to the  fuppurative ftage, different
 phenomena occur, according to the parti-
 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 refped,  as well as in moft
'others, is regular and uniform.
   70.  From  obfervation  we ► learn,  that
 hepatic abfceffes fometimes open fpontane-
 oufly into the intestinal  canal in the manner
 explained, at fome length, in a former part
 of this work ;  at others,  they make their
 way  through  the diaphragm  into  the  air
 cells of  the lungs,   from  whence  the
 matter is  difcharged  by expedoration -, or
 an adhefion takes place 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. 
                  [   219   ]
     71. 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 portion fuppurates,  the air
   Cells of the lungs favour  the efcape;  and
    fuch abfceffes as form towards the  anterior
    furface,  ufually  extend  themfelves  to  the
    integuments,  through  which  they either
    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 nearest outlet.  But
     experience  has  evinced  that  thefe are
     not  all equally favourable to  her ultimate
                        u 3 
                [   220  ]
 views;  and  fome hepatic abfceffes,  which
 have been difcharged by the lungs, appear
 to  have produced their fatal effeds more
 from an  extension  of fuch abfceffes into
 the  fubftance of thefe organs,  than from
 any derangement  the conftitution had fuf-
 tained from  the affection of the liver.   I
 feel myfelf warranted the more  in  main-
 taining this  idea,  not  only  from  having
 repeatedly feen  the  fymptoms of  hepatitis,
 in  its latter  ftage,  evidently  transformed
 into  the  charaders  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 abfceffes,
 either by  the inteftines  or  the  abdominal
furface, is much preferable, as in "the for-
mer,  the organ,  though important  and even
vital, is affeded 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 effed are very
obvious ;   for in all thefe cafes the opening
is furrounded  by  adhefions  fo effedually,
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  abfceffes  are feldom in
hafte to heal, nor  is it  desirable,  until the
cavity  of  the abfcefs  fhall have been filled
up by  healthy  granulations.    During  this
procefs, Avhich is  fometimes  tedious, the-
health  gradually returns ;  and I  have  had
                   u 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 progreffive ftate of amend-
ment,  and at  length was  perfedly  eftab-
lifhed.
  75. Such instances, though  furprifing,
are  not  mysterious,  for a part only  of the
liver has been  concerned  in the abfcefs.
During the  period  of adive inflammation,
the conftitution partook of  the effeds, 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 exped, 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 adive
phlegmonous  inflammations it will  obviate
fuppuration.  This opinion appears to have 
               [   223   ]
bten founded on an idea, that there is fome-
thing very peculiar in the inflammation ©f
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 lhown to  be  reltevable by
mercury.   The fuccefs in thefe cafes has per-
haps led  to an empirical pradice,  and due
difcrimination  may  not  always have been
made  between inflammations of  a  more
 indolent, and  fuch as are of a more adive
 nature.
   78. To  exhibit a remedy without  due
 difcrimination is to abufe it, and at length
 to bring  it into negled;  and in  this  way
 the world has been deprived, for a time,
 of  the benefit of fome of the moft valuable 
                [  224  ]
 articles of the materia medica, which, how-
 ever, have been restored 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 administration of  it,
 it be incautioufly employed  in the adive
 periods of  inflammation,  when,  from  its
 ftimulant 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 praditioners in warm climates
 to the early  ufe of mercury, may havearifen
 in part  from the great debilty confequent
 on the previous excitement of the fyftem,
which debility is fuppofed to prevail the
moft, where there had been much evacuati-
on ;  a'id this prejudice has perhaps been car- 
               [  225  ]
ried to a dangerous extreme.   But there are
not wanting fome, who are perfedly aware
of the neceffity of proper diftindions,  and
who pay due regard to them  in their prac-
tice.
  81. In the East Indies, where this com-
plaint is endemic, I am informed,  on the
beft authority, that many judicious and fuc-
cefsful praditioners feldom  administer mer-
cury until  the violence of the inflammato-
ry adion  has been moderated by bleeding,
adive purging,  and the antiphlogiftic plan
of treatment.    Then  it is,  that mercury
is employed to the greatest advantage.   But
it  appears,  on attentive obfervation,  that
the tranfition of  adive  inflammation into a
ftate of  refolution, is  not immediately fol-
lowed by  a healthy  condition of the  part,
but"it remains for a time  debilitated and
difpofed to lapfe into a chronic ftate.  This
will probably be found the proper period for
the exhibition of mercury, which ads  as a 
              [   226   ]

fpur on the vafcular fyftem  of this organ,
and by its  moderately ftimulating effeds,
occafions a degree  of adion, which, when
protraded to a proper length, terminates in
health.
   82. But  the difpofition of hepatitis to
terminate in a fchirrous and difeafed struc-
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 adion.
Here' we are to take the advantage of its
more adive operations;  and, inftead of in-
ducing a flight change upon the pulfe,  with
only a tendernefs of  the  mouth,  we ought
to extend its effeds to the produdion  of  a
gentle falivation,  which, when  continued
for  a length of time,   generally effeds  a
cure.
   83. In  the  exhibition of mercury for
this purpofe,  a preference  has  been given
to fridion;   and the part  on which the
mercurial  ointment  has  been  rubbed,   is 
               I   227   ]
the right hypochondrium,  from a  notion
of its  efficacy being greater when applied
to the  vicinity of the difeafed  organ,  than
to a distant 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
effeds  produced on  the general fyftem are
equally ftrong.
   84.  The knowledge we derive from  ana-
tomy of  the ftrudure, origin,  and diredi-
on of the  lymphatic  veffels,  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,  ad on the  liver but by
being firft introduced into the blood veffels.
It is fometimes difficult in cafes of difeafed
liver,  efpecially  if attended   with  dropfy,
to introduce mercury into the conftitution ;
under fuch circumftances, the  best abforb- 
                [  228  ]

 ing furface  fhould be employed for the
 purpofe of fridion : fuch parts of the body
 as have the finest cuticle,  as  between the
 fingers,  in the axilla, or groin, abforb moft
 readily,  and if the  cuticle be removed by
 blifters, from any part  of the  body, fuch
 a furface will be found best  adapted  to the
 purpofe of abforption.    Ulcers  frequently
 abforb  better than entire furfaces,  and ia
 many cafes  fuch  artificial means of pro-
 moting abforption may  be admitted.—It
 is  likewife a  fubjed  worth  considering,
 whether ftill  greater  advantage can  be
 derived from  the. introdudion  of   adive
 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 anyone time,
in a ftate of adion in the body, is fo fmall 
                 [   229  ]
 as to  elude  all the  powers of  chymical
 inquiry.   By various  and accurate  tests, 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  conneded
 with  other difeafes;  and  is  thought  by
 men  of   obfervation  and  experience,   to
 ftand 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 diffedion,
 to  be  accompanied  with  difeafes of  the
 liver.  In  fome  instances,  the  whole fub-
 ftance has  been in a  fchirrous  ftate;   in
others,  abfceffes and the ufual appearances
of hepatitis have been  met with: the fad
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  muft  affed,  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 affed the in-
testinal   canal  by its paffage through  it ;
hence may  follow ulcerations of the inter-
nal  furface,  giving  rife  to the  common
fymptoms of dyfentery.  But if  it  be  an
eftablifhed fad, as has  been afferted   by
high  authority,   that   the  dyfentery  is
always contagious ;  there  would  feem to
be  a  neceffity  for calling in fome  other
principle of adion,   in   addition   to  the
acrimony of the bile.    But waving  this
controverfy,  which cannot  be  protraded
to  a greater  length,  without  evidently
digreffing  from  the  main purpofe of this
chapter,  it is in place here  to obferve, that 
               [   23I   1
thefe dyfenteries are fo far congenial to the
hepatic affedions with which they are com-
bined,  that they are  generally relieved  by
mercury  adminiftered under  the  caution*
we have already laid down.
FINIS. 
 
KUa -^isk,
^•\