In the cure of this complaint, we are first to ascertain whether it depends upon a scirrhus of the liver, or any other structural disease of this organ, in which case our remedies must be obviously directed to this circumstance. If we suspect it to arise from a mere mechanical ob struction, we generally have recourse to purgatives ; and these remedies are proknly the best that we can employ in Jaundice that is more strictly idiopathic. The more active purgatives are usually found to be the most efficacious, and it is generally thought desirable to com bine them with calomel. An emetic is often indicated by the state of the stomach ; and by this remedy we not only free this organ from its load of oppressive con tents, but it appears that the agitation which is produced by the act of vomiting occasionally removes obstructions from the ducts of the liver. The disease is sometimes attended with very acute pain, for which opiates are ne cessary ; and besides the immediate relief which they afford, they sometimes tend to the radical cure of the complaint, by relieving certain spasmodic contractions of the parts which aggravate the disease, by increasing the obstruction to the passage of the bile along its natu ral channels. After the disease itself has been subdued, the impaired state of the digestion often renders it ne cessary for us to have recourse to stomachics and tonics, of which colombo appears to be the most useful. Con siderable benefit is sometimes produced by a long con tinued employment of the saline mineral waters, to which the fresh air and exercise which form a part of the usual regimen in such cases will materially contribute.
One of the causes of Jaundice, depending upon a me chanical obstruction to the passage of the bile, is the formation cf the peculiar bodies called biliary calculi, giving rise to the disease of Cholelithia or Gallstone, a disease which properly belongs to the or der of the Apo cenoses, hut the consideration of which we have defer red to this place, on account of its connexion with Jaundice. These substances are partly composed of inspissated and hardened bile, and partly of a crystalline animal matter, which concretes into rounded masses, formed in concentric layers, and possessed of specific chemical properties. In what way they are generated, or what particular states of the liver and its secretions are favourable to their production, is not ascertained, nor are we acquainted with any method by which their formation can be prevented. When they are impacted in the ducts of the liver, they cause very acute pain, which is generally referred to the pit of the stomach, and is often attended with severe vomiting, and by this operation the obstruction is occasionally removed ; the same effect is sometimes produced by brisk purgatives. Opium and warm fomentations relieve the pain, and likewise the spasmodic contractions, which, as was re mat ked above, seem to exist in these cases, and tend to aggravate the complaint. There are instances in %vhicli
the distention produced by Gallstones is so great as to produce inflammation, when bleeding roust obviously be had recourse to, at the same time that we may try the warm bath and emollient injections.
Ischuria, or a difficulty in the excretion of the urine, is perhaps in all cases a symptomatic affection, either occurring in connexion with some other more general disease, as Dropsy, or depending upon some obvious mechanical obstruction, as in Lithiasis. We shall there fore pass on to Amenorrhoea, or the deficiency of the menstrual discharge. It occurs under two forms, that of retention and of suppression : the first, where the discharge does not make its appearance at the proper period of life ; the second, where, after it has appeared, it does not return at the usual intervals. There is ano ther affection which ought perhaps to be regarded as a mere variety of Amenorrhoea, in which the discharge takes place at the proper times, but is in small quantity, and is attended with considerable pain : this has receiv ed the name of Dysmenorrhoea. NN'hen Amenorrhcea, in any of its forms, has continued for some time, it pro duces various constitutional derangements; there are pains in different parts of the body, especially in the neighbourhood of the uterus ; the appetite fails, the bowels are torpid, the head is oppressed, Anasarca su pervenes, the breathing is short, the pulse is weak, and the whole body becomes languid and enfeebled. In some cases, particularly in those where the discharge does not take place at the proper age, there is a remark able sallowness of the complexion, from which cir cumstance the disease has obtained the name of Chlo rosis ; it is likewise attended with a singular tendency in the patient to take into the stomach various articles of an indigestible nature, which would seem to be the mere effect of caprice, did we not observe this morbid appetite to exist, where we have no reason to suspect this disposition from auy other circum stance, and where the stomach is evidently in an un natural state. The proximate cause of these com plaints is evidently, in the first instance, the same, a defect of power in the vessels of the uterus, by which they are unable to propel the blood into the capilaties with due force and in the proper quantity. In who.' way this condition of the capillary vessels produces the general symptoms is perhaps not easy to explain; and indeed it may be suspected, that, at least in a great number of cases, the peculiar state of the uterus is ra ther the effect than the cause of the constitutional irre gularity.