Hepatitis appeared more in the Company’s artillery, and in the 10th regiment, than in any other corps of the army. For its predominance in the latter corps, one reason has been assigned, and which to me appears to have had the most powerful influence.
But on the whole, this disease, once so formidable to us in India, gradually ceased to appear in the returns of the sick.
The treatment of hepatitis it is unnecessary to dwell on: for no disease are we provided with a more effectual or sure remedy. If the season for applying the remedy be not lost, we are nearly, I think, as confident of a cure by mercury, and the analogous remedies, as we are in a case of syphilis by the same remedies.
To whom the world is indebted for the successful treatment of hepatitis by mercury, I cannot correctly say. The oldest written account of this practice, that I have seen, is in a very sensible pamphlet by Dr Paisley, formerly of Madras. There is another very distinct account of it in a pamphlet by Dr Girdlestone, of Yarmouth, formerly surgeon of a regiment in India.
For the general introduction of mercury, through the western side of the peninsula of India during the last twenty years, for the application of nitric acid to the same purpose, and for the discovery of some other preparations analogous to these, we are indebted chiefly to the ingenious Mr Scott, of Bombay. About ten years ago, from some experiments which he made on the calces of mercury, he discovered the analogy between them and nitric acid, and he was the first to apply this acid to the cure of hepatitis. Subsequently, he was led to the use of nitric acid and other analogous remedies in hepatitis and other diseases, which are curable only by mercury, a practice, of which, on a large scale for the last six years, I have observed the best effects, and which is now likely to get into general use in India.
I have said, that the species of hepatitis which we met with, at last, in Egypt, was not that usually seen in India, and a corresponding change was required in the treatment. Previously to giving mercury it was found necessary to premise the anti-phlogistic regimen.
In the use of mercury great address is often required; and, in substituting nitric acid and the analogous remedies, I am convinced, that much advantage may often be gained. Sometimes one of these remedies will succeed when the other has failed; and not unfrequently have I seen their combined use succeed where separately given they had failed. In obtaining a new agent we have acquired a great deal more power in the management of a disease, the most formidable to Europeans in the eastern world.
Sometimes in Egypt, and in many instances in India, I have observed, that I could not affect the gums with mercury, or with acid, till venæsection was performed. After this operation, I have often succeeded, and induced a flow of saliva, in cases which had long resisted a liberal use of mercury and nitric acid.
If the modern practice of giving but little mercury, and to make it only touch the gums, as it is called, without exciting a flow of saliva, be proper in the venereal disease, undoubtedly it is not in hepatitis. This disease never yields till the saliva flows freely—the explanation of this I do not attempt; but the fact is as I state it, and it is well known to every man who has practised extensively in India. Whenever the gums are hard, and insensible to the effects of mercury; when, instead of a salivation, they are red, painful, spongy, or blue, the prognosis is very unfavourable: in ninety of such cases out of the hundred we lose our patients.
In the first stage of this disease, I have derived benefit from cupping and blistering the side; but I never allow these remedies to interfere, or to delay the principal indications—the affecting the gums.