Symptoms, &c. cause a most unpleasant sensation at the pit of the stomach, or in the right side, as if something dragged there. Indeed, if the patient be attentive to his own feelings, some internal uneasiness will always be found to precede the pain on external pressure; at least 1 invariably found it so in my own person, and it has more than once admonished me of my danger.-The same remark has been made to me by intelligent patients. Disturbed sleep, and frightful dreams, precede and accompany this disease, in almost every case. Nothing harassed me more than this unpleasant symptom; and on inquiry, 1 always found my patients make the same remark; but they will seldom mention this, unless they are interrogated. When all, or several of these symptoms, make their appearance, a few doses of calomel and cathartic extract, administered so as to keep up a regular increase of the alvine evacuations for some days, together with the strictest abstinence and caution in avoiding the extremes of heat, or sudden vicissitudes, will often anticipate the attack of this insidious disease, and entirely check it in embryo. If these means, however, do not remove the morbid train of premonitory sensations above described, mercury should be slowly introduced, so as to produce a brassy taste in the mouth, and kept at this point till the return of health, which would hardly ever fail to result. It will be readily understood, that the warning symptoms above mentioned, can only be expected where the disease is coming on gradually, from effects of climate, and the more moderate application of such causes as hasten these effects. Where the excitantia are strong and evident, such Hepatitis. as great intemperance; sudden exposure to considerable atmospherical vicissitudes, particularly to cold after perspiration; violent exercise, &c. then the interval between them and actual disease, will not always afford many admonitory sensations, or permit us to put in force the very desirable precept of the poet "Principiis obsta:-venienti occurrite morbo." TREATMENT. The medical practice of India is more simple than that of Europe; evidently from the great connexion which experience has traced between many apparently dissimilar diseases in the former country; rendering it only necessary to vary, in some degree, the same methodus medendi. During the first twelve months after arriving in the country; whenever the patient was at all robust, the pyrexia evident, or the pain considerable, I bled at the very commencement, and not with a sparing hand. I did so with a twofold view. One was to relieve the febrile symptoms, by lessening the inflammatory congestion in the liver and portal circle; the other, to lower the tone of the constitution, which, experience taught me, accelerated the effect of that medicine on which my principal reliance was Treatment. placed. To further both these objects, one or two doses of calomel, or the pil. hydrarg. with opium and antimonial powder, were given, and followed by castor oil or jalap, which never failed to bring down a copious alvine discharge, consisting of any thing but natural fœces, or healthy bile. For in the flux attending Hepatitis, the violent straining and griping are succeeded by nothing but mucus and blood, accompanied by a distressing tenesmus, unless when laxatives are taken, and then diseased secretions only, with occasionally a hardened scybala, or other focal accumulation, are passed. It appears, by Mr. Curtis, that the hospital practice at Madras in his time, [thirty years ago] was to give three grains of calomel, with some rhubarb and soap, night and morning, till ptyalism came on; and if it was necessary to have the mouth sooner affected, a drachm of mercurial ointment was rubbed in on the affected side every night. No opium was then thought of; but the hypothetical prejudice against that valuable article is now, I believe, pretty well worn off; and I know, from pretty ample experience, that, in conjunction with antimonial powder, it forms a most admirable auxiliary to the mercury; not only soothing many uneasy sensations of the patient, but determining to the surface, and promoting a diaphoresis, which is of infinite service in this, as in most other diseases. In all urgent cases, I seldom gave less than twenty-four grains of calomel or pil. hydrarg. in the twenty-four hours; and generally in the following manner :— Hepatitis. R. Submur. Hydrarg. Pil. Hydrarg. gr. vj; M. ft. bolus-sexta quaque hora sumend. During the exhibition of these medicines, an occasional dose of castor oil, or other laxative, and emollient injections, contributed to mitigate the griping and tenesmus; while blisters often relieved the local pain of the side. But these were only secondary considerations; and the grand object was to get the mouth affected, when the flux and other symptoms were sure to give way. The secretion of healthy bile-the flow of saliva from the mouth-and a gentle perspiration on the skin, were synchronous effects of the medicine, and certain indications of the approaching cure. But it was necessary to keep up these by smaller doses of the medicines alluded to, not only till every symptom of the disease had vanished, but till the clear countenance, keen appetite, and regularity of bowels had returned, and health and strength were completely restored. Indeed, a degree of obesity generally succeeds the administration of the medicine, and the cure of the disease; nor need we wonder at this, when we consider the previously deranged state of the digestive organs, to which a renewed energy is now communicated. Treatment. But, in effecting these salutary objects, I have often been obliged to push the mercurial treatment in a much bolder manner than above described. I have myself taken calomel in twenty grain doses, three times a day, without experiencing the slightest inconvenience from the quantity; nay, I always found large doses sit easier on the stomach, and occasion less irritation in the bowels than small ones. At this time, too, I was using every exertion, by inunction, to forward the ptyalism; yet it was several days before I could produce any effect of this kind. These doses may astonish those who do not know the difficulty of affecting the mouth with mercury in a hot climate, when the liver is verging to suppuration. The idea of their purging and griping at these times is truly chimerical, Indeed, I never saw any of those terrible cases of hypercatharsis which people so much talk of, except where cold was applied, and perspiration checked during salivation, when certainly, as may naturally be supposed, a severe bowel complaint is the consequence. But in that dangerous state of the liver which I have mentioned, when a few hours, perhaps, must determine, whether healthy secretion or destructive suppuration is to result, a tardy, irresolute practice, is pregnant with mischief "No season this, for counsel or delay, Unfortunately, at this critical period, such is the torpor throughout the lacteal and lymphatic vessels, that the largest doses internally, and |