In diseases of the head, from the effects of cathartics just mentioned, we may expect the greatest advantages; and we find from experience, that they chiefly relieve every accumulation on the cerebrum. In every case of apoplexy, carus, and lethargy, cathartics are remedies of peculiar utility; and, in the course of our labours, we shall find many diseases connected with such accumulations that have not been suspected to originate from this source.

The great utility of cathartics is, however, conspicuous in febrile diseases. We cannot explain the foundation of the advantages derived from them at present; but can only observe, that in every fever the balance of the circulation is apparently destroyed; that in some cases the liver, in others the head, often both organs. suffer from accumulation. Cathartics relieve both; and, in checking fever on its first formation, seem to be the most useful remedies. Emetics have had the chief credit in destroying fever in the bud; but, unless succeeded by, or accompanied with, laxatives, they have failed, or performed their office imperfectly. During the whole course of febrile diseases, a regular, and very often an active, discharge from the bowels is necessary: and stools, so far from weakening, add to the strength of the patient. Care, however, must be taken that the discharges be actually feculent. We have known the motions numerous without relief: they have been found' only mucous evacuations from the rectum. They have been reported to be copious; but, on examination, have appeared to be only water scarcely coloured. Even when motions have appeared most decidedly feculent at the conclusion of the fever, some matter has been seemingly retained; since discharges of peculiar foetor and putridity have accompanied or followed the crisis. On this account the lenitives, though often recommended, have not appeared to us the best form of cathartics in this country. In warmer climates, where the bile is highly acrid and stimulating, lenitives only are admissible; since laxatives would add to a stimulus already in excess. We now make this distinction, but would subjoin a caution in the words of Baglivi, when he apologizes for a practice which might be suitable only in his own situation: "Romae ago et Romano in aere."

It may be asked, are laxatives so peculiarly useful in every epidemic? We dare not say so; for we have found some truly asthenic fevers in which they have appeared to have effects highly debilitating. The instances have, however, been very few; and, in general, on the appearance of every epidemic, the practitioner must cautiously examine its nature in every point. He will, however, err most seldom in examining the effects of laxatives if he tries them to some extent. He can soon check his career; and, in the very earliest stages, they scarcely ever are injurious. We must, however, in a future article, point out the fevers which are less adapted to this remedy.

To pursue the particular kinds of fevers in which cathartics are most useful, we must first remark that bilious accumulations are particularly conspicuous in intermittents; and from hence arose the anxiety of former physicians to bring the fever to a regular intermission, previous to the exhibition of the bark. In fact, the end really attained was, by previous evacuations, to prevent accumulations in the liver, which the bark might still further impact; nor have we a doubt that the accusation, formerly brought against this remedy, of its producing the tumours styled ague cakes, may have had some foundation. It has been alleged, that these tumours were more common before the introduction of the bark than since. This, indeed, we believe; but the cause was the long cor-tinuation of the disease without the use of any active remedy.

In remittents, diseases of a similar nature, the same remedy is useful; and of continued fevers, it is chiefly employed in the inflammatory fever, to cool by the discharge from the exhibition of lenitives; and in bilious fevers, to clear the liver from the accumulations with which that organ is oppressed. In the more common epidemics, styled putrid, or nervous, there appear to be accumulations in the liver and the head. We are told by medical authors to prevent costiveness; but we have only succeeded when we have carried the evacuation further. On these subjects we must again enlarge

In the topical inflammations, cathartics arc less generally useful. In phrenitis, indeed, they are essential remedies; but, in pneumonia, often injurious. In an-gina they arc not singularly beneficial; and, in gastritis, often inadmissible. In enteritis they are of the greatest importance; and, oil their management in this disease, the cure almost wholly depends. In nephritis and peritonitis, lenitives arc remedies of importance; and, in cystitis, laxative clysters are highly useful.

In the exanthemata, also, laxatives are employed with much discrimination. The bowels and skin, as we have said, alternate in their discharge; and, cutis sic-citas, alvi laxitas, is an axiom two thousand years old. By purging, therefore, we may always moderate a cutaneous eruption; we may sometimes prevent it: and, whenever previous fever threatens a copious eruption of small pox, next to cool air, active laxatives are the most effectual remedies. In measles we have found nothing prevent so effectually the peripneumonic symptoms as a loose belly: and, from one instance, have suspected that purging may be carried to a greater degree than has yet been practised. The child was tender and delicate, with apprehension of weak lungs; the peripneumonic symptoms violent. The cathartics were urged with unusual activity; the disease was mitigated, and the recovery unusually rapid. The instance is, however, a single one. In erysipelas and scarlatina we know not that cathartics have been urged, or that they have been urged with success. In gout we have said they are injurious: in rheumatism they are inconvenient. Yet we have thought the doses of calomel, in an active form, have been useful as laxatives.

In haemorrhages of the brain the most active laxatives are useful; but here their benefits seem in this order to end: in the other hemorrhages, the mildest lenitives only are employed with advantage, to cool rather than to evacuate.

In various diseases, arranged by Dr. Cullen under the class neuroses, laxatives are highly useful. In all comata, even though not febrile, they are essential. In the spasmi they are apparently less beneficial; but, in warm countries, these often arise from acrid bile, and the trismus infantum is well known to be owing to this cause. The chorea, too, as we shall soon find, is greatly benefited, often effectually cured, by active cathartics. In colic, cholera, and diarrhea, laxatives are appropriate remedies; but particularly useful in the first: in the two last the discharge requires only to be regulated, sometimes to be rendered more effectual.

In the whole of the class vesaniae, cathartics in different forms and degrees are necessary; and, in the caehexies, particularly in tabes mesenterica, we have already remarked their utility. On the subject of dropsy we have nothing to add to the observations under the articles Ascites and Anasarca, q. v.

The manuscript of the foregoing article was sent to the printer before we had an opportunity of perusing

Dr. Hamilton's "Observations on the Utility and Administration of Purgative Medicines." It gave us great pleasure to see this confirmation of our opinions, drawn also from the sick bed, by a gentleman with whom we Were once personally acquainted, and whose abilities we highly respected. He recommends purgatives in chlorosis, chorea, chronic diseases, haemateme-sis, marasmus, scarlatina, and typhus. Under the separate respective articles we shall more particularly attend to his observations: our opinions, in general, are before the reader.

With scarlatina, he speaks of its frequent concomitant, the ulcerated sore throat. The peculiar disease which we have described under the article Angina gangrenosa is scarcely, if at all, known in Edinburgh; at least, in the course of five years, we never saw it: and, in the lectures of Dr. Cullen and Dr. Gregory, this kind of sore throat was spoken of so indiscriminately, as if they were little acquainted with the complaint. In the ulcerated throat as it appears in England, purgatives are certainly not admissible; and we have seldom found them very advantageous in scarlatina. Dr. Hamilton means by purgatives what we have called laxatives, but administers them in separate doses.