An Essay upon the Use of the Bile in the Animal Oeconomy, Founded on an Observation of a Wound in the Gall-Bladder. By Alexander Stuart, M. D. Physician to Her Majesty, and F. R. S.

II. An Essay upon the Use of the Bile in the Animal Oeconomy, founded on an Observation of a Wound in the Gall-Bladder. By Alexander Stuart, M.D. Physician to her Majesty, and F.R.S. The Case of Mr. Menzies, Sergeant in the Second Troop of Horse-Grenadier Guards, wounded in the Gall-Bladder, with the Appearances in the Body after Death, and the Symptoms during Life; with some practical Inferences drawn from it. He was wounded about Three o’Clock in the Morning, the 30th of October, 1728, and died the 5th of November following in the Morning, being the seventh Day after he was wounded, in the fortieth Year of his Age. Appearances in the Body, opened by Mr. Coldham, Surgeon, in the Presence of Messieurs Fiquel and Black, Surgeons, with several Gentlemen, and myself. I. The Abdomen appeared distended as in a Tympany, or Ascites, and the Skin of the Belly tinged yellow as Saffron in many Places. II. A triangular Wound appeared about two Inches on the right Side of the Navel, the Direction slanting upwards obliquely through the Integuments. III. The Belly being opened, discovered the Wound to have penetrated through the Peritoneum, and the Sword had slanted upwards from thence along the Omentum, grazing slightly upon it, which was superficially ruffled, but so as to be hardly perceivable. IV. A small triangular Wound appeared in the Bottom of the Gall-Bladder, which had penetrated through the Membranes into its Cavity, but had nowhere wounded the Liver, nor any of the neighbouring Parts. V. The Gall-Bladder was flaccid or collapsed, containing only a few Drops of Gall, which, by pressing the Cyftis slightly, flowed out into the Cavity of the Abdomen through the Wound. VI. The Guts throughout their whole Tract being distended, so as could be judged to triple the Extent of their natural Diameters, seemed to fill the whole Cavity of the Abdomen, so as to give the outward Appearance of a Tympany, or Ascites; which Distension disappeared, and the Guts collapsed, upon making several Punctures with a Lancet in their Sides, to give Vent to the Air. VII. The rest of the Cavity of the Abdomen, which was not closely filled up by the distended Guts, contained a gross muddy Water, or Serum, intensely yellow, or highly tinged with Gall, to the Quantity of three Quarts, as I was able to guess without measuring it. VIII. All the Guts and Contents of the Abdomen were highly tinged with this yellow Liquor, but no other Part of his Body, out of the Contact of this Liquor, had the least Appearance of it. IX. No Inflammation appeared in any Part of the Guts, or in any of the Viscera, or Contents of the Abdomen, which were all found and healthy. X. The Obliquity of the Wound through the Integuments, Muscles and Peritoneum, made it impos- sible for the external Air to enter into the Cavity of the Abdomen that Way. The Symptoms during Life. I was called the 2d Day of November about Eleven o’Clock in the Forenoon, being the fourth Day after he received the Wound. I. The Surgeons who had attended him from the Beginning, Messieurs Fiquel, Coldham, Wilkie and Black, being present, told me that his Belly had been distended, as I saw it, from the Beginning, giving the Appearance of a Tympany, or Ascites, and it continued at the same Pitch of Distension, neither diminished, nor sensibly encreased, to the Time of his Death. II. No Ructus or Flatus, upwards or downwards, nor Borborygmi, notwithstanding this Distension of the Belly. III. He never went once to Stool after he received the Wound, though pretty strong Purgatives and several Clysters had been given for the three Days before I came; and though no Opiat (which might have been supposed to have retarded their Operation) had hitherto been exhibited: Neither had those Purgatives nor Clysters, which I ordered afterwards, the least Effect. IV. He took what was thought a sufficient Quantity of Drink and liquid Food. V. He never slept, or but very little, by short Slumbers, of about half an Hour, or an Hour at longest, and that very rarely, notwithstanding pretty large Doses of Opiats were given to procure Rest, after I came. A a a VI. The VI. The Wound in the *Integuments* never digested in the usual Manner; but looked flaccid, or flabby and pale, almost without Pus. VII. The *Urine* in very small Quantity, at most two or three Spoonfuls at a time, clear but yellow, as if tinged slightly with Saffron, and without Sediment. VIII. His *Pulse* was full, strong and even, but not quick. IX. No feverish Heat to be felt in the *Skin*, on any Part of the Body. X. His *Tongue* not hard, rough or black, as in a Fever, but of its natural Colour, with a silky Drinefs, and very little *Saliva*. XI. He was not in the least delirious, from the Beginning to the Time of his Death. XII. He had some slight Fits of the Hickup the second Day after I saw him, and some few Reachings to vomit; some Intermissions in his *Pulse*, sometimes one in 10, 15, 20, or 30 a Day before his Death. In order to make some Use of this Case, it is necessary to premise, that as Reasoning without a Foundation, in Facts and Experiments, does rarely lead to any Certainty in Natural Knowledge, so Observations of Facts and Experiments themselves, would be, in a great Measure, fruitless, if we did not endeavour, by Reasoning, to draw obvious, useful and practical Conclusions from them: In order to which, it must be observed, That the great *Apparatus* in the *Liver* and *Spleen*, two of the largest *Viscera* in the Body, confessedly designed for the Preparation and Secretion of the *Bile*; and the Place of the *Intestines*, into which it is immediately deposited, afford indeed a strong Argument gument for the universal Use of it in the Animal Oeconomy; but do not directly point out what, or how many these Uses are, about which there has been a great Variety of Opinions. But this singular Case, which must have happened very rarely, if ever before (wherein none of the Inwards, or Viscera, but the Gall-Bladder only was wounded, and by that Wound nothing but the Gall was lost or misplaced) by shewing how many Functions in the Animal Oeconomy were impaired or destroyed by the sole Loss or Want of it, does at the same Time point out or demonstrate the Use and Necessity of it towards Health, or the Perfection of these Functions; and perhaps may lead to some Indications of Cure, in Cases wherein it is known to be deficient, faulty or redundant. There was no other apparent or assignable Cause for these various Symptoms during his Life, of Death itself, and of those several Appearances in the Body dissected after Death, but this Wound in the Gall-Bladder: And as this Wound could not affect any of the Parts, nor produce these Symptoms in any other Sense than as it gave Vent to the Gall into the Cavity of the Abdomen, and deprived the Cavity of the Intestines and the Blood of it: Therefore from this Loss and Misplacing of the Gall, all these Symptoms and Appearances may justly be concluded to arise, and I think may be accounted for from that Cause in the following Manner. I. The Abdomen was distended, as in a Tympany, or Acites, from the Beginning, and the Guts appeared inflated to their utmost Diameters. It is true, that this Inflation and Distension happens to most a few Hours before Death, and to all soon after after Death, and ariseth from the Spring, or Elater of the Air included, getting the better of its Antagonist Spring, or Elater of the muscular Fibres of the Stomach and Guts, which have no longer the Assistance of the Blood and Spirits to contract them, and keep up their peristaltic Motion. But the Inflation and Distension here spoken of, was several Days before Death, and, as I have been told, the very next Day after he received the Wound, though the Pulse was apparently strong and equal, and therefore a Defect of Blood and Spirits not to be suspected: And therefore it may be justly concluded, that the Influx of the Gall into the Cavity of the Guts, is as necessary to the Strength of their Contraction and Perfection of their peristaltic Motion, as that of the Blood and Spirits into their Sides; and that these three are the conjunct Causes of this Motion in Health, which would be defective by the total Want of any of them. Hence we see that in Scyrrhositie of the Liver, where the Secretion, and therefore the Excretion of the Bile is more or less defective; and in the Jaundice, where, by some Obstruction in the Biliary Ducts after Secretion, a Part of it is forced back, and regurgitates into the Blood, and very little of it is thrown into the Guts: I say, in those Cases we observe an uncommon Distension in the Guts, and Costiveness; which, if the Case proves incurable, terminates in an Acites, or Dropsy, in the Cavity of the Belly. It may also be worth while to enquire, whether that which is commonly called an Hysteric, or nervous Cholic, generally attended with a lesser Degree of such like Distensions, with Flatus's and Borborygmi; I say, whether this Distemper, wherein the ani- mal Spirits are so much, and only accused, does not partly arise from a sluggish Secretion and Excretion of the Bile, occasioning a Defect in its Quantity; or from its Acrimony and great Viscosity, occasioned by its Stagnation in the Gall-Bladder; or from both these, as well as from a defective or unequal Distribution of the Blood and Spirits in the Parts affected. In confirmation of which, I have generally observed, that at some time or other in the Cure, a great Evacuation of porraceous viscid Bile, brought away either by Art or Nature, as well as a great Profusion of pale Urine, finished the Cure for that Time. The Vomiting of porraceous Bile, very common in such Cases, proves the same; and, I believe, it is generally allowed, that the ferruginous, porraceous and black Colour of the Bile, are owing to shorter or longer Stagnations of it, chiefly in the Gall-Bladder, which the sedentary Life of those who are subject to these Cholics, will sufficiently account for, even if there was no other Error in their Way of living; and whoever has observed the high yellow Colour and Contents of the Urine in a Jaundice, arising from a Redundancy of Bile in the Blood, will readily acknowledge that an uncommon watery Pale-ness in the Urine, where no more than the usual Quantity of Fluids has been taken down to dilute it, does shew a Defect of Bile in the Blood; and I believe it is easy to account for the Flatus's, Borborygmi, Inversions of the peristaltic Motion, the Pila Hysterica, Palpitations, Scotomia, Vertigo, and other Symptoms of these Distempers, which are called Nervous and Hysterick, from the same Cause. And hence it is, that Bitters and Steel, known Deobstruents of the Liver, and Correctors of the Bile, with gentle Chologogues in in very small Doses, are of so much Use in such Cases; though it be certainly true, that all strong stimulating Purgatives are very hurtful and improper. II. But to return to our Case, there was no Rutus's or Flatus's upwards or downwards, nor Borborygmi, notwithstanding this Distension of the Belly and Inflation of the Guts. This, I think, shews very plainly that the Guts had lost all Motion, and were Paralytic by a total Want of Bile only, as much as if their Nerves had been totally obstructed: For had any Motion remained in them, whether the natural and regular peristaltic Motion, or a preternatural convulsive one, the Contraction of them either Way, would have propelled the contained Air from one Place to another, and would have occasioned Borborygmi, or would have expelled a Part of it upwards or downwards, when Nature had so much need of it to relieve the distended Guts, and Art had contributed to that Intention by Clysters and Purgatives given. Which serves to illustrate what has been said above, concerning the defective and convulsive Motion of the Guts in Hysterick Cases, where, through a Defect in the Quantity or Quality of the Bile, or from both these, the Motion of the Guts becomes defective, irregular or convulsive, but is not totally lost through a total Want of it, as in this Case. III. He never went to Stool after he received the Wound; and the strongest Purgatives and Clysters that could be reasonably given, had no Effect. This seems also to be owing to the Want or total Loss of the peristaltic Motion; and plainly shews, that the strongest purging Stimulus has not the Power to restore it, without the Assistance of the Gall: For had it been in any Degree restored, the Belly would have fallen proportionally, and some Evacuation of what was lodged in the Prima Via would have followed. If then the Power of Purgatives depends upon the Co-operation of the Bile, it will follow, that where it is most active or redundant, their Operation will be, ceteris paribus, greatest; and where it is unactive or deficient in Quantity, they will have proportionally a less Effect. Though it be true that a great Quantity, or morbid Acrimony of the Bile, by a too strong and violent Irritation, will bring the Intestines into such Spasms, as to stop all Excretion by Stool; and the strongest purging Stimulus added to it does only increase the Spasms and Costiveness; as in Bilious Cholics, which are always attended with exceeding Costiveness, not conquerable by the strongest Purgatives, if they be not joined with Opiats, to allay the Spasms, and obtund the Acrimony of the Bile. He took what was thought a sufficient Quantity of liquid Food and Drink; but if the Elater of the Guts, and their peristaltic Motion were lost, it is easy to prove that none of his Food or Drink could enter the Latteals for want of the peristaltic Motion; and therefore that he died starved. And this will account for all the rest of the Symptoms mentioned. To prove that this was his Case. All that have seen live Dissections, intended to shew the Nature of the peristaltic Motion, and the Course of the Latteals, must have observed, that the Guts have an alternate Systole and Diastole, or Contraction and Dilatation called the peristaltic Motion, the superior Section con- contracting itself, while the immediate inferior is dilated; and this Motion is carried on in several Parts of the Guts at the same time; and the contracting Part, by expelling the Blood and Chyle out of its Sides, in its Contraction looks pale, while the Parts dilated look florid, and the Vessels full of Blood and Chyle. Now the Part contracting must necessarily force the Chyle from the grosser Parts of the Food or Aliments, towards the inner Surface of the Guts, where the perforated capillary Extremities of the Lacteals in the villous Coat are ready to admit, or rather to absorb it by Attraction, as far as the larger and visible Branches of the Lacteals on the Coats of the Guts, into which it easily flows in the Time of Dilatation, or Diaftole, which expands and unfolds these Vessels at that Time for its easy Reception; from which it is farther propelled by the next Systole, or Contraction, into the primary or first Order of the Lacteals in the Mesentery; and by the same repeated Impulses of the contracting Sections of the Guts, is forced farther through the second Order of Lacteals in the Mesentery, into the Receptaculum Commune, and the Thoracic Duct; assisted by Valves, and promoted by the incessant Motion of the Muscles, and of all the Contents of the Abdomen and Thorax in Respiration, it is at last poured into the subclavian Vein, for a perpetual Recruit of the Blood in a healthy State. But if the first Movers in this Series fail, that is, if the muscular Fibres of the Guts have lost their peristaltic Motion, as in this Case, then the Expression, Absorption and Progress of the Chyle described, cannot succeed, the Blood must be deprived of its Recruit, and the Person die starved; which, as I have said said before, seems to have been this Person's Case, and will sufficiently account for the rest of the Symptoms above recited. First, His Want of Sleep, and the Inability of Opium to procure it, might be owing to a Want of Recruit of Chyle in the Blood: As we see that those who live sparingly, sleep very little, and those who feed plentifully, require by so much a greater Number of Hours to sleep; and in all chronical Cases, where the Body ceaseth to be nourished, the Sleep also fails, and Opiats have but little Power; whereas in Children, where a great Part of their Food goes towards both Nourishment and Acretion, the greater Part of their Time is spent in Sleep. It may indeed seem difficult to conceive how a Want of Rest should ensue so soon after the Accident. But considering that the Loss of one Meal in a Day, especially of Supper, to such as have been accustomed to sup, has occasioned fewer Hours Rest in the following Night, it will follow, that such Persons require at least some small Recruit once in six or seven Hours, in order to rest their usual Number of Hours; and therefore in our Case, where all Recruit must have ceased soon after the Accident, he might be sensible of the Impairment of Rest in six or seven Hours after it, and those about him might well observe the Encrease of that Symptom, at least in the following Night. Another Difficulty ariseth from the Observation of Swallows and Tortoises, &c. who sleep most in Winter, when they eat and drink nothing. In answer to which, there seems to be no Parity between the natural Constitution of their Blood and Humours, and that of Men: To these, and such like Animals, with regard regard to Recruit and Nourishment, Action and Rest, the Spring and Summer are as one Day, and the Winter as one Night; and their Blood and Humours seem to be fitted by God and Nature, not only to bear, but even to require such long Periods of Rest and Action. And probably there is as little Parity between the Crisis and Constitution of the Blood and Humours of a healthy Person, and of those in soporific and cataleptic Diseases, who are reported to have slept for Weeks or Months without Food of any kind: And therefore, I say, where the Crisis and Consternation of the Blood and Spirits are nearly the same, that is, \textit{ceteris paribus}, he who feeds, and is nourished most, will sleep longest, \textit{et e contra}. The Position here advanced is farther confirmed by the Inefficacy of the Opiats given, they being capable of entering into the Blood through the Pores of the Stomach in Contact with them; by which quick Passage they have been observed to procure Rest soon after they have been applied outwardly, or taken down into the Stomach, as in this Case they may justly be supposed to have done: Though, for the Reasons above-mentioned, neither they nor any thing else could pass by the Latteals: But as the Aliments could not pass that Way, viz. by the Pores of the Stomach, nor by the Latteals into the Blood, there could be no Recruit nor Nourishment: And therefore the Opiats, though they did enter into the Blood by the Pores of the Stomach in Contact with them, could not procure Rest. Thus it would seem probable, that Opiats do produce their Effect by detaining the Chyle crude longer than usual in the Mass of Blood, and thereby lengthening Sleep beyond the usual Time; and that they are ineffectual where there is no Chyle in the Blood to be detained. But to explain how Opiats do contribute to retain the Chyle and other Crudities in the Blood, longer than usual, would require a Disquisition too tedious for this Place: But their Power of retarding or suppressing all or most of the Secretions and Excretions; their palling or obtunding the Appetite; their enabling one to fast long, and supporting one in Journies and Labour for a long Time without Food (Effects well known to the Turks and Asiatics in their Journies through Deserts, &c.) these, I say, and some other known Effects of Opium, do very much favour this Opinion. Secondly, The Want of Pus in the Wound was probably owing to a Want of Recruit of Chyle in the Blood; and the Flabbiness and Paleness of its Lips, to a Shrinking of the Parts for want of daily Nourishment. Thirdly, The small Quantity of Urine was probably also owing to a Want of Recruit of Fluids from the Prime Via: For these, in a healthy State, find their Way to the Urinary Passages very soon. The slight Tincture of Yellow, which it had, must have been from the Bile spilt in the Abdomen, and filtrated through the Duplicature of the Peritoneum, and Bottom of the Bladder: For it could not be supposed to derive its Colour from the Blood, into which no Bile could now enter by the common Way. Fourthly, The Want of Saliva, and the silky Dri-ness of the Tongue, seems to have been owing to the same Cause, a Want of Recruit of Fluids in the Blood, and a Loss of so much of them as fell into the Abdomen. Fifthly, Fifthly, If it be supposed that such a small Wound through the Integuments and Muscles of the Abdomen and the Peritoneum, was capable of producing a Fever, then his not having any Symptoms of a Fever, must be owing to a total Defect of Bile and Chyle in the Blood, none of which could enter the Lacteals for want of the peristaltic Motion, as has been said. Lastly, The few Fits of Hickup, Reachings to vomit, and Intermissions in the Pulse in declining and dying Persons, seem to arise not only from a Defect, and therefore an unequal Distribution of the Blood and Spirits, but chiefly from the Corruption and irritating Acrimony of them, as the immediate Cause of Death in this and most other Cases. Which will be farther explained in the following Pages. Objection I. It may very reasonably be objected here, that the Ductus Hepaticus would carry a Sufficiency of Bile, for the Uses of the Animal Economy, into the Cavity of the Intestines, though none came by the Ductus Cysticus; and Nature seems to have provided the Ductus Hepaticus for this Purpose, that if any Obstruction or Defect should happen in any of these Secretory Channels, the Secretion and Excretion might go on for the Benefit of the Economy, in the other: As Nature has provided two Kidneys, and double Organs of Sense, for the same Reason. But the Effect will not be the same in a Wound, which is the Reverse of an Obstruction; because by a perpetual Evacuation through it, such a Revulsion and Derivation is made, as drains and desiccates all the neighbouring Parts, and either lessens or or entirely frustrates the Secretion and Excretion by them: And this we find to be true, where the Secretory Organs and Ducts concerned in the different Secretions, lie at a great Distance from one another; as in the Diabetes we generally see a very great Desiccation of the Salival Glands, a Defect of Saliva, and a perpetual Thirst; and Sweating and Looseness lessen the Secretion by Urine; an Issue drains and emaciates the neighbouring Parts; and it is mechanically demonstrated by Bellini, that the Flux of the Blood, and of all the Humours, will be most and strongest towards the Part where the Resistance is taken off; as in Bleeding, to which this perpetual Flux of Bile, through the wounded Gall-Bladder, seems to have a great Affinity; and therefore would probably promote the Afflux of Blood and Secretion of the Bile so much and so strongly towards the Vessels, Glands, and Secretory Ducts leading to the Cyttis, as very much to lessen, or totally to hinder the Secretion by the Ductus Hepaticus into the Guts by that Channel: And therefore, in this Case, the whole of this useful Juice seems for this Reason to have been totally lost to the Animal Economy. Objection II. Another Objection is, that as the Guts and other Contents, and even the Muscles and Integuments of the lower Belly, were highly tinged by the Bile, it is probable that some of it has got into the Cavity of the Guts, where it might, by its Stimulus, keep up the peristaltic Motion, and by the Lacteals get into the Blood, for the Use of the Animal Economy; as it appears that some of it got into the Bladder in that Manner, and tinged the Urine. It is not unlike that this might happen when the Bile came to be very redundant in the Cavity; but in passing through the Interstices of the Vessels and Fibres of the Guts, as through a Filtre, the grossest, saline and sulphurous Particles of it, which are the most pungent and active Parts, must have been left behind; which the muddy Thickness, as well as Deepness of the Colour of the Liquor found in the Cavity of the Abdomen, compared with the transparent Clearness of the Urine of a much lighter yellow Colour, without Sediment, does seem to prove: And it is not likely that such a small Quantity of filtrated Bile, as may be supposed to have passed that Way, deprived of all its active Particles, could either in Quantity or Quality be sufficient to assist in any Function of the Animal Economy, whether Natural, Vital or Animal: And, in Fact, if any passed that Way, it appeared plainly insufficient to promote the Contraction and peristaltic Motion of the Guts, which remained preternaturally distended, as has been said, from the Beginning to the Time of his Death. Objection III. It has been also objected, that an Animal which dies starved, dies delirious and feverish, the Experiment having been made on Cats and Dogs: And therefore this Person, who had no Fever, nor Delirium of any kind, cannot be supposed to have died starved. I will not dispute these Facts, especially the Experiments upon Cats and Dogs, though I have not made any myself, nor do I remember to have had any just or or accurate Account of the Symptoms of such who have died of Hunger and Thirst, in Sieges, and at Sea; though many Instances have been, and no Notice, that I know of, has been taken of their having died mad, delirious or feverish, though these Symptoms are so remarkable and affecting. But supposing these Facts, these Cases will differ very much from this before us: For an Animal starved to Death purely for Want of Food, has the Gall flowing continually into the Cavity of the Intestines, unmixed and undiluted with Chyle, and from thence by the Lacteals into the Blood; so that in a few Days this acrimonious Juice must become more redundant there, than any other Humour; which joined with the constant Attrition of the Globules in Circulation, must soon render the Blood very acrimonious, rancid and alcalin; that is, must reduce the whole to a Mass of Putrefaction, capable of stimulating the Brain and Nerves, so as to produce a Fever, Delirium or Madness: But in the Case under Consideration, no Gall could enter into the Blood: And therefore this Degree of Putrefaction, and the Effects of it, could not happen; though it must be owned, that, through a Want of Recruit and Dilution, a lower Degree of Putrefaction of the Blood and Humours must have followed, even in this Case, from the continual Attrition in Circulation; such at least as was sufficient to render the whole Mass in a few Days unfit for any of the Uses in the Animal Economy, or the Functions of Life: And therefore may be justly supposed to have been the immediate Cause of Death: For all the passive Principles or Materials of Putrefaction, being actually in the Substance of the Blood, and all the active Princi- ples of Heat and Attrition being at work upon it to produce this Effect, it could not fail to be brought about in a few Days; and the same would happen to all Animals, is what is effete, corrupted or altered, so as to be unfit for the Use of the Animal, was not continually carried off by the Emunctories, and a fresh Recruit daily supplied from the Prima Vitæ; which Evacuations and Supply being kept up in their due Quantity and Proportion, do effectually prevent all Putrefaction and Acrimony, and keep the Blood and Humours in their natural Temperature, commonly (though mistakenly) called Sweetness. It is not then a Defect in the Quantity of Fluids which kills an Animal in Fasting, but a poisonous Acrimony, which the Blood and Humours naturally contract, for want of a fresh Recruit and equal Evacuation. Thus in chronical Distempers, where the Person appears extenuated and exhausted, the Quantity of the Fluids is certainly very small, yet enough to maintain Life for some Months or Years, being kept in some Degree of Sweetness or proper Temperature, by a certain Proportion of Recruit and Evacuation: But where the Recruit is entirely subtracted, the Evacuations will be proportionally lessened: And therefore the Quantity of Fluids may remain much the same, but the Quality will alter, and Putrefaction for the Reasons above assigned must take Place, and be the immediate Cause of Death, even long before the Mass of Fluids can be much diminished in Quantity, as in the Case before us. Which leads to the Answer of another Difficulty, viz. Objection IV. How the Pulse should continue full, strong and equal for several Days, while the Person was in a starving Condition, and the Blood had no Recruit from the Prime Vie? This indeed would be very unaccountable, if the Waste of the Blood and Humours were supposed to continue at the same Height as before the Accident, and the Evacuations by the Emunctories were the same as in perfect Health. In this manner the Contents of the Blood-Vessels would be soon wasted and exhausted: But Sanctorius's Observations and Experiments do shew, that the daily Recruits and Evacuations keep Pace with one another, and are nearly equal in 24 Hours in a healthy State: And therefore where the Recruits are plentiful, the Evacuations will be equally so; and where those are sparing the Evacuations are small; or where the Balance is cast too much of either Side, some Indisposition or Distemper must follow. There is no Exception from this Rule, but in Children, a Part of whose Nourishment goes to Acretion, and the Encrease of their Weight: Therefore in the Case before us, the Recruit being entirely subtracted, the Evacuations must have been little, or next to nothing: And therefore the Quantity of the Blood and circulating Humours would remain much the same, and keep up the Fulness, Strength and Equality of the Pulse for several Days, until the critical Putrefaction and Colliquation of the Blood above-mentioned, on the fifth or sixth Day, rendered it unfit for a regular Circulation, and produced Intermissions in the Pulse, Reachings to Vomit, and Hickup, all of them being local Convulsions, and the Effects of Corruption, Acrimony, Irritation, and an unequal Distribution of the Fluids, which terminated in Death in the Beginning of the seventh Day. The Sum of what has been said is, that in this Case very little, if any, Bile entered into the Intestines, and that ineffectual; and none at all into the Blood. And as there was no apparent Defect in any Part of the Body, nor any Wound that could have been either dangerous or deadly, in any other respect than as it gave Occasion to the Loss and Misplacing of the Gall; it is therefore evident, that all the Symptoms, and his Death, were entirely owing to the Loss of this useful Juice; which it seems is so necessary to all Parts of the Animal Oeconomy, Natural, Vital and Animal, that this Person could not live above six Days without it. The practical Inferences that seem to flow by necessary Consequences from this Observation, are, I. That the peristaltic Motion of the Intestines is as much owing to the Influx of the Bile into their Cavity, as to the Influx of the Animal Spirits and Blood into their Sides: And therefore that the Bile is to be looked upon as one of the prime Movers in the animal Oeconomy, by which the elastic Springs of the natural Motions, to wit, the muscular Fibres of the Guts are set to work; upon whose Motion all the subsequent vital and animal Motions do so far depend, that none of them can be long in Perfection where it is imperfect, nor subsist many Days where it is totally wanting. II. This prime Motion is totally lost by a total Want of Bile; proves sluggish by a Defect in its Quantity; becomes irregular or convulsive by a great Redundancy dundancy or morbid Acrimony of it. From whence several Distempers that are called Nervous may arise, and are more likely to be cured by correcting and evacuating the redundant or faulty Bile, and disobstructing the Liver, than by most other Medicines taken from the common Class of Nervines. III. That the Power of Purgatives depends upon the Co-operation of the Bile: And therefore it is probable, that the Difference of Constitutions, at equal Ages, with respect to Purgatives, depends more upon the Quantity and Quality of the Bile, than on the Bulk or Weight of the Body, Quantity of the Blood, or other circulating Humours. IV. It also appears that the Nourishment and Accretion of the Body do in some Measure depend upon a due Quantity and proper Quality of this Juice, without which the Blood and circulating Humours could not be recruited from the Prima Vie: And therefore that Defects in it may be frequently the Cause of a Marasmus, or Waste of the Body, where it is little suspected: Which may serve to point out the Method of Cure in such Cases. V. This Observation seems to lead to the Knowledge of the immediate Cause of natural Rest or Sleep in a healthy State; to wit, a certain Quantity or Proportion of fresh Chyle in the Blood; the Want of which, from whatever Cause, will occasion Watchfulness, or some Degree of it. And this may serve to point out the immediate Effect and Consequences of Opiats, whence may be gathered how far, and in what Cases they may be effectual and useful; and in what Circumstances they may be ineffectual, useless or hurtful. Which may deserve a farther Illustration. VI. That VI. That a due Quantity of *Aliments*, at proper Intervals of Time, is necessary to keep the *Blood* and *Humours* in their natural Temperature and Sweetness, and to preserve them from Acrimony and Putrefaction: And this will be true in all Distempers as well as in Health, and is against the Practice of such as pretend to starve away Distempers, or to deny a due Quantity of Drink and liquid Food to the Sick, especially in Fevers, where the Want of this Recruit will tend to encrease the Acrimony or Putrefaction, whence the Malignity of most Fevers does arise. VII. That *Pus*, or Matter in a Wound or Ulcer is the Product of *Chyle*, and not of the *Blood* or *Serum*: Which has indeed been the received Opinion, though supported by no other Proof than the Similitude of *Pus* to *Chyle*. And as a great Redundancy, as well as a Defect of *Pus*, does sometimes retard the Cure of a Wound or Ulcer, this may serve to shew by what Means it may be encreased or diminished, to answer the Intentions of the Artist. This also makes it appear probable, that a great Redundancy of *Chyle* disposeth the Body to purulent, suppuratory and scrophulous Distempers; and seems to indicate the subtracting such Sorts of Food as afford a rich, gross or plentiful *Chyle*, and the administring of such Medicines as may strengthen Sanguification, and the other assimilating Powers, to assimilate and thereby consume it; the Sanguification and assimilating Powers being manifestly weak, as the Chylification seems to be strong in all such Cases. And this seems to be the Reason why in *Adults*, as the Sanguification grows stronger, and in *Age*, as the Voraciousnes of the *Appetite*, too common in *Youth*, Youth, declines, these Distempers do often decrease, and at last wear out of themselves: Which shews what Assurances Art ought to contribute, to bring about the same Effect in a less Time. I must here own my Omission to open the Stomach and Guts, in order to view the State of their Contents, where the Gall was entirely wanting, which might have given some Light to this Observation. This Omission happened through some Hurry at the Time, which I regret; but am apt to believe, that as most of his Aliments were Liquids, the Alterations would not have been very conspicuous or obvious to the Sight. And I hope it will not be impracticable to make some Experiments on live Animals for this Purpose, with more Care and Attention, for supplying what may have been defective in this Observation. III. Observatio Lunaris Eclipseos, Ulissipone habita die 2 Februarii, An. 1730, N. S. in Collegio Divi Antonii magni à Rev. P. Joanne Baptista Carbone, Soc. Jes. Ex ejusdem Cl. Viri Epistola ad Jacobum de Castro Sarmento, M. D. Coll. Med. Lond. Lic. & R. S. S. Temp. Ver. P. M. H. " " 13 25 o Incipit penumbra sensibilis. 40 o Fit spissior. 58 o Fit spississima. Dubi-