be of considerable service. The trunk of the body may be also sponged twice daily with the same acid solution. From the experiments detailed in the "Sketches of the Diseases of India" (p. 193), it is evident that the mineral acids dissolve and separate the viscid mucous secretion that sometimes is formed in the course of the disease, and lines the internal surface of the alimentary canal; and it would appear, from the experiments of Leuret and Lassaigne*, that "when the villous coat of the duodenum was exposed and cleaned, and then touched with diluted vinegar, the membrane exhaled a clear fluid, and the choledochus duct discharged much bile and pancreatic juice." These considerations, added to the fact that the gastric secretions are also acid, must show that, in cases where the healthy character of the gastric secretion is altered by disease, the nitric and muriatic acids may be used with benefit.

Great attention should be paid to the beverages used by the patient. The decoctions of barley, either the simple or compound, may frequently be taken with advantage, and common toast water may also be used, either simply, or rendered agreeably acid by equal proportions of the nitric and muriatic acids, as recommended above. But on all occasions he should avoid every kind of spirituous or fermented liquor, and adopt whatever may prove most soothing and least offensive to the sensibility of the stomach. Imperial, made with a small proportion of cream of tartar, and weak lemonade, or barley-water, with a small proportion of nitre, may be tried, and taken as long as they are found to agree with the diseased organ.

SECT. V.-Precautions for the Adoption of those who are subject to Disorders of the Stomach upon Change of Climate, as respects Diet and Regimen, Air and Exercise.

I shall close the consideration of the Disorders of the Stomach by reference to some precautionary measures, having particular relation to those who are liable to disorders of this organ upon change of climate, and shall make some suggestions as respects diet and regimen, air and exercise. The general observations previously stated will be considered in these as in all other cases to which allusion is made in this work, to apply; but it is necessary

* Recherches Physiologiques et Chimiques, pour servir à l'Histoire de la Digestion. Paris, 1825.

here also to give to the intertropical residenter some precautions which it is important he should observe upon departure from, and return to, his native country.

Upon departing from Europe, the visitor of warm countries should endeavour to adopt that kind of diet and regimen which he intends to pursue upon his arrival, provided that both the one and the other be on an abstemious or moderate scale. He should avoid, as much as possible, the use of salted provisions upon the voyage; and water should be his principal beverage. The state of his bowels ought regularly to be attended to; and he should take as much exercise as circumstances will admit of, without exposure to the sun. The same precautions ought to be observed upon his arrival in the country: and if any of the symptoms of disorder of the stomach supervene, he should endeavour to remove them by abridging his diet, rather than by taking medicine of a stimulating or tonic nature, such as brandy bitters, which often aggravates the disorder, or procures merely a temporary relief. If medicine be at all employed, it ought to be of an aperient and cooling kind. Those who have delicately constituted digestive organs should avoid the fruits of the country upon their arrival, unless they be perfectly ripe and mild, and then they should be taken in small quantity. Above all, recent visitors of warm climates ought to avoid, as much as possible, all exposure to the direct rays of the sun; yet exercise is absolutely requisite, and should be used, without incurring fatigue, in the morning and after the sun has declined in the evening, and in every respect they should rigidly conform to the injunctions laid down for their guidance in a former chapter.* They should also conform their dress, as far as circumstances will permit, to the temperature of the climate and to the sensations of the individual. The subject of dress is of greater importance to Europeans in India than is generally considered.

More attention should be paid to the digestive organs, upon removal from an intertropical to a cold or temperate country, than the subject has usually received. Many, in consequence of the want of such attention, have left a warm climate in comparative good health, and have experienced disease upon their arrival in that country to which they had been so anxious to return. This has arisen entirely from their neglect of warm clothing upon their first approach to a colder temperature, and to insufficient care of the functions of the stomach, liver, and bowels. When an individual,

* See page 127, et seq.

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whose cutaneous surface has constantly been kept in a state of free and copious perspiration, is exposed to the chills of a colder climate, the balance of the internal and external circulation, which had been so long maintained, is disturbed, and the blood is repelled from the surface to the internal viscera, which, in time, suffer from the load, in proportion to the disposition to disorder which they may possess. The liver, bowels, and stomach itself, often suffer more or less in this way, and not unfrequently the lungs become the seat of disease from the same cause. Now the indication in those cases is sufficiently apparent. The low temperature of our native climate suppresses an abundant secretion and excretion, which had been maintained upon the surface of the body for many years in a hot country, and which cannot be permanently restored whilst exposed to a cold atmosphere. We should, therefore, most obviously look for some other natural outlet for the exhalations and excretions now diminished or entirely checked upon the cutaneous surface; and at the same time maintain the accustomed transpiration of the skin by every suitable means. Conformably, therefore, with this view, the healthy functions of the stomach should be promoted by light and digestible food taken in moderate quantity, and by temperance and regularity in the hours of diet and repose. The functions of the liver should be regularly attended to, and the actions of the bowels promoted by appropriate means. Amongst these, the blue-pill, or this with the aloes and myrrh pill, or the latter only, should be taken at bed-time, according to circumstances; and a draught, consisting of infusions of gentian and senna, with some neutral salts, in the morning. These may be repeated, or continued, according to the effects produced and the peculiarities of the case. Warm clothing ought to be adopted and proportioned according to the temperature of the atmosphere, and the temperament and ailment of the individual. Flannel should be worn next the skin, and the feet be especially kept warm at all seasons.

The chief danger to which those returning to Europe with impaired digestive organs are liable, is the supervention of either hepatic or pulmonary diseases. Many cases have occurred of individuals who had never complained of disorder in the liver whilst they remained in India, and yet, upon residing for some time in England, and paying little or no attention to the state of their stomach and bowels, hepatic disease of the most serious aspect had supervened, and in some cases proved fatal. Upon arrival in Europe, the invalid should endeavour to take exercise, especially upon horseback; and even those who have returned with little or

no ailment should take sufficient exercise to promote the cutaneous functions, without carrying it to the length of fatigue, and, equally with those who have impaired their digestive functions and their health generally, ought to attend most scrupulously to the early signs of disorder in the chest; and, upon the first appearance of cough, or oppression, or tightness, or pain in this cavity, resort to depletions, and to such remedies as are calculated to promote the actions of the great secreting viscera and surfaces, and to carry off any morbid secretions or excretions which may have accumulated in the first passages. But it is not a mere discharge of such accumulations which ought to be attempted, but a continued action of the secreting and excreting organs ought to be promoted; and the diet, at the same time, should be regulated in such a manner as to diminish vascular action when it exists, and to keep up the strength, so as to enable suitable purgation to be instituted when debility commences. Much advantage will occasionally be experienced from a dose of calomel given at bed-time, and followed by an active cathartic draught in the morning. The common black draught will answer the purpose sufficiently well; and will carry off those morbid secretions which will continue to accumulate from time to time in those who have resided in a warm climate, after they have returned to their own country. But the occasional exhibition of this more active medicine should not prevent the patient having recourse to gentle aperients, in order to keep up a regular action of the liver and bowels. For this purpose there is scarcely any thing better suited than the pills already noticed and when chronic disorder exists about the liver, the artificial Cheltenham salts may be taken in addition, and the natural waters resorted to when the patient arrives in England.

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BOOK III.

ON THE DISEASES OF THE LIVER AND OF THE BILIARY

APPARATUS.

DISEASES of the liver may be considered as endemic in the eastern hemisphere. The annual average per-centage of hepatitis in the East Indies is at least treble what it is in the western hemisphere. In the different divisions of the Bengal army, the annual per-centage of inflammation of the liver varies from three per cent. to twenty-five, giving an average of thirteen per cent. in the effective strength. But this calculation is made with the nominal admissions. Calculating, however, from the imperfect data in our possession, the actual per-centage of admissions is much below what is now stated, and would appear to vary in this presidency from two to sixteen per cent., averaging between eight and nine per cent. in the effective strength. In the different divisions of the Madras army, the actual admissions are ascertained with more precision; and although, of course, much below the nominal admissions, they vary in these divisions from six to thirty-five per cent.,—the lowest per-centage being in these provinces which more nearly approach those under the Bengal presidency, and the highest in the more southerly and most parched districts. These facts render it probable that the difference in the per-centage of diseases of the biliary organs, particularly acute inflammation of the liver, is dependent, in a great degree, upon the nature of the soil and climate, and in the mean annual height of temperature; hepatitis being more frequent in the Coromandel coast and southern provinces of India, where the annual range of temperature is highest.

The influence which various morbid actions exert on the biliary secretions, the numerous changes which that secretion undergoes in disease, the particular local and constitutional affections which these changes induce, and the variety of disease and morbid structure observed in different countries in the substance of the liver, are objects worthy of more serious attention than has hitherto been bestowed by practitioners in the different regions of the earth.