J■$■&&*&* '■■'•?£ ••* 1 " ^/* ft * TWO r ' - i. *t » V . "^L* 1 SURGEON GENERAL'S OFFICE | £ Section, xo.j.iL4%.J?>*. # ^S4*-*-^?-® TREATISE OF THE MATERIA MEDICA 'iflBQBMffatirfflWtt. JOHN EBERLE, M.D. Member of the American Philosophical Society; of the Academy of Natural Science* r Philadelphia; Corresponding Member of the MedicoChirurgical Society of Berlin, &c. &c. IN TWO VOLUMES\y;\v 9' jj ' r) vol. n. ^^^y SECOND EDITION, WITH C0RSECT10NS. PUBLISHED BY S. & W. MEETEER, BALTIMORE: JAMES WEBSTER, PHILADELPHIA. William Brown, Printer. 1825. !'■■■, 5 - - Eastern IHstrict of Pennsylvania, to toitt •*«•**•* BE IT REMEMBERED, That on the twelfth day of Febru- J seal. J ary, in the forty-ninth year of the Independence of the United •••*•**• states of America, A.D. 1825, James Webster, of the said District, hath deposited in this Office the title of a Book, the right whereof he claims as proprietor, in the words following, to wit: '«A Treatise of the Materia Medica and Therapeutics. By John Eberle, M.D. Member of the American Philosophical Society; of the Academy of Na- tural Sciences of Philadelphia; Corresponding Member of the Medico- Chirurgical Society of Berlin, &c. &c. In Two Volumes. Vol. II. Second edition, with corrections." In conformity to the act of the Congress of the United States, entitled " An act for the encouragement of learning, by securing, the copies of maps, charts, and books, to the authors and proprietors of such copies during the times 'herein mentioned." And also to the act, entitled, •* An act supple- mentary to an act, entitled * An act for the encouragement of learning, by securing the copies of maps, charts, and books, to the authors and proprie- tors of such copies during the times therein mentioned,' and extending the benefits thereof to the arts of designing, engraving, and etching histori- cal and other prints." D. CALDWELL, Clerk of the Eastern District of Pennsylvania. A vmxAvosas OF.THE MATERIA MEDICA AND THERAPEUTCS. CHAPTER IX. D. MEDICINES WHOSE ACTION IS PRINCIPALLY DIRECTED TO THE NERVOUS SYSTEM. /. Medicines that Ussen the Sensibility and Irritability of the Nervous System. NARCOTICS. These are stimulants whose secondary effects are a diminution of the vital powers, producing torpor, insen- sibility, and sleep. The more prominent effect of this class of remedies being a torpor of those powers of the animal economy which are dependent on the nervous system, we may infer, with reason, that the action of narcotics falls prin- cipally on the sensorium commune and its appendages. This, indeed, seems to be demonstrated by direct expe- riment with regard to several powerful articles of this class. Rrodie* has rendered it extremely probable, by a series of experiments on animals, that the essential oil * Philosophical Magazine for August, 1811. 4 NARCOTICS. of almonds, the juice of aconite, the empyreumatic oil of tabacco, and the wporara produce their deleterious effects on the system, by directly destroying the func- tions of the brain; and that death from the inflaence of these substances, takes place, because respiration, which is entirely dependent on the brain, ceases, when the functions of this organ are destroyed. It has been supposed that there is some one particular substance to which narcotics owe their peculiar effects; and many researches have been instituted to detect this supposed narcotic principle. Upon this subject, how- ever, nothing satisfactory has as yet been brought to light. v Certain substances, it is true, have been extract- ed from articles of this class, which possess, in a highly concentrated form, their peculiar virtues. Such are morphium and the prussic acid. As these substances, however, are distinct, and differ in their properties, it is evident that neither can be regarded as the narcotic principle. Besides, the greater number of narcotics contain neither morphium nor prussic acid. These two concentrated substances are, therefore, nothing else than distinct and specific narcotics, which, in their na- tural state, are found united with other substances. Narcotics have been regarded by some as producing direct sedative effects upon the system. CuUen placed opium at the head of the sedatives. An attentive ob- servation, however, of the progressive effects of these articles, cannot fail to establish,, the conviction that this sentiment is at variance with the actual phenomena arising from their action on the living system. In moderate doses, these substances increase the ac- tivity of the cerebral functions. The ideas are more vivid and rapid in their succession. Hilarity, and a ge- neral agreeable feeling of mind and body—a more ready and vigorous command of the will over the voluntary muscles of the body—a livelier and more excursive imagination—a quicker perception of the relation of NARCOTICS. 5 things—courage, and vigour, all result from the mode- rate influence of this class of remedies, and indicate the excited state of the system. If, however, they are ap- plied in augmented doses, the brain soon becomes over- excited, and torpor aiid debility is the result. If the dose be still more increased, sudden diminution of the vital powers, vertigo, delirium, coma, convulsions, and death, ensue. The class of narcotics furnishes us with some of the most important remedies we possess. They are appli- cable in almost all varieties of disease in some stage or other of their course. They are particularly indicated in affections of the nervous system, attended with pains or spasms; and in a morbid irritability of the brain and its appendages, unaccompanied by an inflammatory con- dition of the general system. They also have a tenden- cy to lessen the mucous secretions; but, in general, they augment those of the serous and urinary organs. Narcotics, more than any other class of medicines, lose, by repetition, their action on the system. It is, therefore, necessary, where a continued employment of such articles is required, gradually to augment the dose, in order to acquire their due operation. OPIUM. Opium deserves to be placed at the head of this class, whether we consider its importance as a reme- diate article, or its more decided operation as a nar- cotic. This is the inspissated juice, obtained from the capsules of the papaver somniferum, a plant indigenous to Persia, Arabia, and Egypt, and cultivated with us in gardens. This article, as it is found in the shops, is of a dark reddish brown colour externally, and internally of a dusky red. It is opaque, compact, of a peculiar disa- vol. ii.—b t> NAKCOTICS. greeable, narcotic odour, and bitter acrid taste, with some degree of warmth. It is inflammable and partly soluble in water, alcohol, ether, wine, vinegar, and citric acid. The watery solution becomes transparent on filtration, and possesses the property of reddening the colour of litmus. By adding to this filtered solution, pure ammo- nia, the carbonates of fixed alkalies, the solutions of oxy- muriate of mercury, nitrate of silver, subacetate and acetate of lead, the sulphates of copper, zinc, and iron, and the infusion of galls, precipitates are formed. Opium contains, 1. A volatile substance which passes off partly in the form of vapour, and partly in union with the water driven over in distillation. 2. Gum. 3. Re- sin. 4. Gluten which is perfectly insoluble. 5. A con- crete waxy .oil 6. Gluten, sulphates of lime and potash. 7. A peculiar alkaline crystallizable substance. 8. An acid. 9. And alumina. These constituent parts all possess, in a greater or less degree, the peculiar narcotic virtues of opium. Water distilled from this substance produces inebriety and sleep, according to the experience of Nysten. The watery extract is very active. The extract obtained by alcohol is also strongly narcotic, though less so than that which is obtained by cold wa- ter;* and Nysten asserts that it does not inflame the stomach. Paris, on the contrary, says, that the alcoholic solution of opium is more highly charged with its nar- cotic principle than the aqueous. The alkaline substance seems to be the principle to which the narcotic virtues of opium are owing, "and to which the appropriate name of morphia has been as- signed." The acid principle has been denominated the meconic acid, and exists in combination with the morphia; so that this latter substance, as it is obtained from the opium, exists in the state of a meconiate, or, perhaps, supermeconiate.f These two substances were first de- * Nysten, as quoted by Orfila. f Paris's Pharmacologia, p. 4&:, NARCOTICS. i tected by Derosne* and Sertuerner, who devoted much attention to the chemical composition of opium. Robi- quet asserts that the salt of Derosne is not a meconiate of morphia, but an acid possessing peculiar properties, which may be obtained from opium, by a somewhat elaborate process.f The meconic acid, in a separate state, does not appear to possess any active qualities. Morphia, however, is powerfully active, particularly when dissolved in olive oil.} The effects of opium are evinced, in a greater or less degree, upon whatever part of the system its application is made. When introduced into the cavity of the peri- toneum, it speedily produces convulsions and death. According to Orfila, " the effects of opium are, in gene- ral, more decided when it is injected in glysters, than when it has been introduced into the stomach." By * Annales de Chimie, vol. 45. t The following are the formulae for preparing the morphia, ac- cording to the directions of Sertuerner and Robiquet: " Robiquet s firocess.—Three hundred parts of pure opium are to be macerated during five days, in one thousand parts of com- mon water; to the filtered solution, fifteen parts of perfectly pure magnesia (carefully avoiding the carbonate) are to be added; boil this mixture for ten minutes, and separate the sediment by filter, washing it with cold water until the water passes off clear; after which, treat it alternately with hot and cold alcohol (12. 22. Be.) aslongas themenstruum takes up any colouringmatter; the residue is then to be treated with boiling alcohol (22. 23. Be.) for a few minutes. The solution, on cooling, will deposit crystals of mor- phia." " Sertuerner's firocess.—It differs from the preceding in substi- tuting ammonia for magnesia, and in adding to the sediment, sepa- rated as before mentioned, as much sulphuric acid as is sufficient to convert the morphia into a sulphate, which is subsequently de- composed by a farther addition of ammonia; the precipitate thus produced is then dissolved in boiling alcohol, which, on cooling, surrenders the morphia in a state of crystalline purity. It appears, however, that the morphia produced by this latter method is less abundant and more impure and coloured than that which is fur- nished by theprocess of Robiquet." Paris's /V/armaco/o^'a, p. 463.. t Magendie. g NARCOTICS. this we are not to understand that the same quantity produces as much or more effect when injected into the rectum, than when taken into the stomach, but simply that the medicine, when applied to the former part, in a suitable dose, acts in a more prompt and decisive way, in consequence, perhaps, of its not being subjected to the action of the digestive powers in this situation,—a circumstance which must very generally take place when it is brought into the stomach. According to Nysten and Orfila, opium acts more energetically when injected into the cellular texture of the body* The same writers state, also, that opium does not de- stroy the contractility of the muscles to which it is ap- plied; and that a heart will continue to contract for a considerable time, when plunged into a solution of opium. This, however, is contradicted by Wilson Phi- lip,! who states that, although he found opium, when applied to the external surface of the heart and ali- mentary canal, to produce no sensible effect on their muscular power; yet, when brought in contact with their internal surface, it produced " the same effect as when directly applied to the muscular fibres themselves, immediately, unless the quantity be extremely small, im- pairing their power, and destroying it instantly, if the quantity be considerable." Opium is said to produce no particular effects when applied immediately to the brain or nerves, and yet it is supposed, by the same physiologists who make this as- sertion, that the poisoning effects of this article depend on its absorption into the circulation, and its direct ac- tion upon the brain. This contradiction, as it appears to me to be, can only be reconciled by supposing that the action of this narcotic is less powerful when applied directly to the medullary substance of this organ, than * Orfila's System of Toxicology, p. 250. t Enquiry into the laws of the Vital Functions, 2d edit. NARCOTICS. 9 when it acts, through the medium of the blood, on the internal surface of its capillary vessels. The question, whether opium is to be regarded as a sedative or an excitant, has been much agitated, and it is still considered by some sub judice,—as an unsettled point.* The most prevalent opinion, however, at present is, that opium is unequivocally a stimulant. To me, in- deed, nothing seems to be more demonstrable than this point. Orfila quotes Tralles as being the first who held opium to be a stimulant.f To the celebrated John Brown, however, must be ascribed the merit of having fully demonstrated the excitant properties of this article. The effects of opium vary greatly according to the quantity given. In small doses it sensibly excites the nervous and vascular systems. The cerebral functions in particular, are rendered more active and energetic. Volition is stronger and more prompt, and a temporary vigour is felt in all the voluntary exertions of the body. Vivacity and joyfulness,—courage and ambition,—indif- ference, or rather defiance to the ills of life; and, in short, all those delightful feelings which spring from a conscious energy of mental and bodily power, and an absence from painful or unpleasant sensations, arise from a well regulated dose of this medicine. If the dose be augmented its narcotic effects become more conspicuous. A species of drunkenness ensues; the blood becomes congested in the vessels of the brain; the mind is unsettled and incoherent; voluntary motion is performed with less freedom; the sensibility is dimin- ished; the eyes are suffused, and vision is indistinct. Finally, the voluntary motions are suspended; thesenso- rium commune ceases to exercise its control over the animal functions of the system, and profound and heavy * Pharmacologic Generate, par M. Barbier, M. D. 1816.—In this work opium is considered as essentially sedative in its effects t Uusus Opii Salubris et Noxius in Morborum Medela Auc- tore. Balthas. Lou. Tralles. 4to, 1754. 10 NARCOTICS. sleep weighs down every conscious faculty. If the dose has been very large, the sleep becomes more and more lethargic; the sensorial power becomes rapidly impaired, in consequence of which respiration is imperfectly per- formed; the blood, therefore, ceases to receive its due proportion of oxygen in the lungs, which still further tends to diminish the cerebral functions, until they final- ly stop altogether, and with them all the other move- ments of the animal system. Such are the immediate effects of a large dose of opium. There are other consequences, however, which follow its long continued or habitual use, demonstrating with equal force the deleterious influence of this article upon the Hving economy, when improperly taken. The habitual opium taker, unless he is under the im- mediate influence of this potent narcotic, evinces all the symptoms of physical and intellectual imbecility. He is timid, low-spirited, and pale; he experiences a torment- ing anxiety of feeling; is totally disinclined, as well as unfit for mental and bodily exertion; he is peevish, and feels pains in different parts of the body; his extremities are cold; indigestion torments him; he cannot sleep, and feels a tremour throughout all his body. When the sys- tem is entirely free from the influence of the accustom- ed stimulant, torments of the most distressing kind are experienced. The following may be, therefore, enumerated as ascertained effects of the operation of this narcotic: 1. Its primary effect in a small or regular dose is, an increase of the force and frequency of the pulse. When given in a very large dose its primary excitant operation is extremely transient, and the pulse almost immediate- ly becomes fuller and slower. 2. It diminishes muscular irritability, and lessens the peristaltic motions of the intestinal canal. It not unfre- quently, likewise, occasions a difficulty and pain in making water. NARCOTICS. 11 3. It lessens some of the secretions, whilst it augments others. Thus, it diminishes the secretion of the gastric and pancreatic juices, and the mucus of the bowels, oc- casioning thereby a dryness of the mouth, fauces, and intestinal canal, attended by thirst, inappetency, indiges- tion, and emaciation. It lessens, also, the mucous se- cretion of the bronchia and nose. The secretion of bile,* too, is diminished, according to the opinion of some, by the action of opium. The serous secretions, on the contrary, especially that of the skin, are consider- ably augmented by the use of this article. In many per- sons it produces a singular pruritus, and in some a pa- pular eruption, on the surface of the body. It increases, also, the aqueous exhalation from the lungs.f 4. It at first excites, but afterwards lessens, the senso- rial powers; inducing torpor, insensibility, and sleep. Hence its applicability in all cases where there is pain and nervous irritability, unaccompanied with an inflam- matory condition of the system. Opium is generally employed in substance, or in the form of tincture. Where we wish to produce a sudden impression, the tincture should be given; as in this form it will be immediately diffused through the stomach, and more speedily applied to an extensive surface of its inner coat, than when given in the shape of a pill, which re- quires a considerable time for its solution and its entire application to the part upon which it is to act. Upon some individuals the effects of opium, even in very small doses, are extremely distressing; so much so, indeed, that they cannot be induced to take it, however urgent the symptoms may be which demand its employ- ment. To prevent the opium from producing such un- * " The faeces of persons," says Dr. Paris, " after the use of opium, are not unfrequently clay-coloured, from the suspension of the biliary secretion." Burdach, on the contrary, asserts tha* opium increases the secretory action of the liver. t Burdach, Arzneymittellehre, B. iii. S. 491 l£ NARCOTICS. pleasant consequences, it will generally be sufficient to exhibit it in some of the vegetable acids, as vinegar* lime juice, &c. or it may be given with, perhaps, even more advantage, in union with an alkali, particularly the carbonate of potash. One grain of opium rubbed up with ten grains of carb. potas. and dissolved in about an ounce of water, may, in general, be taken by such per- sons without the least inconvenience. The black drop,* as it is called, is also an excellent preparation, and may be taken by persons who cannot endure the opium in its solid form. Dr. Porter, of Bristol, England, states, that a solution of opium in the citric acid possesses several very important advantages.! It is said that this prepa- ration is a very powerful anodyne, " operating with less disturbance than the more ordinary forms of this sub- stance." * The following is the formula for making this useful prepara- tion: " Take half a pound of opium sliced, three pints of good ver- juice, (juice of the wild crab,) and one and a half ounce of nut- megs, and half an ounce of saffron. Boil them to a proper thick- ness, then add a quarter of a pound of sugar, and two spoonfuls of yeast. Set the whole in a w^rm place near the fire for six or eight weeks, then place it in the open air until it becomes a syrup; lastly, decant, filter, and bottle it up, adding a little sugar to each bottle." One drop of this preparation is equal to about three drops of the tincture of opium, of the London Pharmacopoeia. " This preparation," says Dr. Paris," which has been long known and esteemed as being more powerful in its operation, and less distressing in its effects, than any tincture of opium, has, until lately, been involved in much obscurity; the papers, however, of the late Edward Walton, of Sunderland, one of the near relations of the original proprietor, having fallen into the hands of Dr. Arm- strong, that gentleman has obliged the profession by publishing the manner in which it is prepared." t The following is his formula for its preparation: liquor mor- phicitratis. R opii crudi opt. 5iv. acidi citrici(cryst.) ^ii.; semel in mortario lapide contunda, dein aquae distillatae bullientis oi. affunde; et intime misceantur; macera per horas viginti quatuor» per chartam bibulosam cola. NARCOTICS. lg Dr. Paris observes, that " a watery infusion, made by infusing powdered opium in boiling water, will often operate without producing that distressing nausea and headach which so frequently follow the use of this sub- stance." When opium cannot be retained on the stomach, it may be applied by frictions to the external surface, in combination with olive oil or camphorated liniment. Dr. Chapman, however, asserts that the practice of applying opium as an embrocation, " is altogether delusive, and deserves no attention. Let it be managed as it may, opium applied to the surface, in any form, produces no constitutional impression. Yet," continues he, " as a mere local remedy to assuage pain, I have no doubt of the efficacy of such applications/' To me there appears much inconsistency in all this. If opium " assuages pain as a local remedy," it must act upon the sentient extre- mities of the part to which it is applied. I can, however, see no reason why it should be capable of " producing constitutional impressions," when acting on the sentient extremities of the stomach, and not do the same thing when it acts on the nerves of the surface. I am, indeed, entirely convinced, both from my own experience and the testimony of others, that the opinion so confidently advanced by Dr. Chapman, upon this point, is wholly without foundation. It will, also, act promptly when in- troduced into the rectum, either in a solid form or dis- solved and injected as an enema.* Incompatible substances: oxymuriate of mercury, acetate of lead, alkalies, infusion of galls and of yellow cinchona, infusion of coffee. I shall now proceed to an account of the practical application of this article in the cure of diseases, which will tend still more fully to develop the nature of its im- portant properties. * Paris's Pharmacologia, p. 469. VOL. II.—C 14 NARCOTICS. As, along with its excitant virtues, it possesses the power, by its secondary effects, to allay the sensibility and irritability of the system, it is applicable in all those febrile diseases where any of the vital organs are in a state of morbid irritation, or mobility, and unattended by high inflammatory vascular action. In the advanced stage of typhous fever, when there is much restlessness, vigilance, and a small, frequent, and weak pulse, attended with delirium, subsultus tendinum, and other symptoms of nervous irritation, opium is one of our best remedies. In such circumstances, Cullen says, it may be employed freely and generally in large doses, repeated every eighth hour, unless sleep, and a remission of the delirium should allow of longer inter- vals.* In typhus, attended with local inflammation, opium, combined with camphor, and a very minute portion of tart, antim. often affords very considerable advantages. During the epidemic typhoid pneumonia, which raged in almost every section of the United States, during the cold seasons of the years 1812-13-14, I had frequent opportunities of witnessing the good effects of this com- bination. Where the pain in the chest was very severe and the pulse small, weak, and frequent, I generally de- rived much advantage from the exhibition of a quarter of a grain of opium with five grains of camphor and one- sixteenth of a grain of tart, antim. every two hours. Dr. R. Grattan, in a late report of the Dublin Fever Hospital, speaks in very high terms of the employment of opium in the delirium of typhus. " Where delirium prevails," says he, "to a considerable extent, and no sleep has been procured after the head has been shaved, the temporal artery opened once or twice, the nape blistered, and purgatives administered, and more parti- cularly should it be near the close of the disease, an * Cullen's Materia Medica, vol. ii. p. 166. Barton's edition. NARCOTICS. 15 anodyne, with from twenty-five to thirty drops of the tincture of opium, and as many of the vinum ipecacu- anhae, repeated every third or fourth hour until sleep is procured, will be found to produce a marked change for the better."* Opium has been recommended in every stage of in- termittent fevers. Dr. Trotterf gave it in the cold stage, and he speaks in the highest terms of this practice. A full dose of this article, taken a half or a whole hour be- fore the accession of the paroxysm, exhilarates the spi- rits; the surface becomes relaxed, the countenance flushed, and assumes a calm and cheerful appearance; and the pulse, from being weak, oppressed, frequent, and irregular, becomes full, equal, and more natural. Stork says, that this practice has been sometimes at- tended with injurious consequences. I have, however, frequently employed opium in this way, and generally with evident advantage, but never with any injurious effects. By Lind, Cullen, Hegewisch, and others, this medicine is recommended in the hot instead of the cold stage. When given in this stage, it produces, according to the observation of Lind, the following salutary effects. L A curtailment and diminution of the violence of the paroxysm. 2. Relief to the disturbance and pain of the head, abatement of the burning heat of the surface, and a copious perspiration. 3. Refreshing sleep, from which the patient awakes bathed in sweat, and nearly free from all complaint. The sweat which follows the exhibition of opium, brings on an agreeable softness of the skin, and lessens very much the burning sensation which at- tends the sweating stage. It is said, also, by Lind, that the employment of opium in this way, renders the ope- * Transactions of the Association of Fellows and Licentiates of the King and Queen's College of Physicians, Ireland, vol. ih\ p. 440. t Medicina Nautica. 15 NARCOTICS. ration of the bark more efficacious. From a very con- siderable experience in this disease, I am led to regard the use of opium, in its hot stage, as a very useful, and by no means hazardous practice. It certainly very ge- nerally expedites the accession of the sweating stage, and thereby shortens the paroxysm. In gastritis and enteritis, whether idiopathic or secon- dary, opium is often of great service. 40 NARCOTICS. hours, are the only means we possess upon which any , reliance ought to be placed, for arresting the fatal pro- gress of this disease. After its inflammatory symptoms have been subdued, and much prostration exists, cam- phor may be used with advantage. In such cases"it is best given in union with opium. In -bilious fevers, camphor may often be used with very good effects. Callisen has published an account of an epidemic bilious fever, in which this remedy, given in very large doses, was attended with remarka- ble success. He says that it was administered in doses of half a drachm every three or four hours, and almost always with the effect of rendering the respiration more easy, the pulse better, and the skin moist and comforta- ble.* In the latter periods of the more violent forms of this disease, such doses may, perhaps, be necessary; but in the milder cases of our bilious remittents, it would undoubtedly be hazardous to employ the remedy to this extent. After the alimentary canal has been well evacuated of its contents, if the skin remain hot and dry with a full and frequent, but compressible pulse, small doses of camphor, in union with nitre and tar- tarized antimony, are an exceedingly useful remedy.f Barthez states, that he employed camphor in union with nitre, with excellent effects, in intermittent fevers accompanied with nervous symptoms. In the exan- thematous fevers, where, from deficiency of excitement, the eruption appears imperfectly, or where it has been repelled, camphor is a useful remedy. It is said to be particularly beneficial in cases of this kind when the urinary passages are affected, and the urine is pale and * Alibert, Mat. Med. torn. ii. p. 108. Callisen, dans le premier volume des Memoirs de la Societe Royale de Copenhague. f Pulv. nitri. 3i. pulv. camphorae gr. xvi. tart, antimon. gr. i. M. in chartulas viii. divid. One of these to be taken every two or three hours. NARCOTICS. 41 watery, accompanied with a sensation of distention and pain in the lumbar region. This remedy may also be given in rheumatic affec- tions with much advantage. It is especially useful in this disease when the skin is dry and hard, and may be very efficaciously exhibited in union with spiritus min- dereri, opium, or antimonials. In chronic rheumatism I have given it in conjunction with sulphur, tartarized an- timony, and gum guaiac. with decided benefit. Tourtuel speaks highly of a solution of one part of camphor in eight parts of sulphuric aether, together with two parts of caje- put oil, as an external remedy in rheumatic affections.* In the treatment of spasmodic and convulsive affec- tions, camphor has been much recommended by the" German and French physicians. In epiiepsy it is stated to have been given with complete success. Cullen says he found it useful in this disease. " I have not, indeed," says he, " known an epilepsy entirety cured by camphor alone; but I have had several instances of a paroxysm, , which was expected in the course of a night, prevented by a dose of camphire exhibited at bed-time; and even this when the camphor was alone; but it has been es- pecially useful when given with a dose of cuprum am- moniacum, of white vitriol, or of the flowers of zinc."f Richter observes, that camphor is of no service in the ordinary cases of epilepsy, continued from habit; but where it depends on a suppressed cutaneous eruption, or on onanism, or where it is connected with unusual venereal desires, he considers it a remedy of great utility.J It is also much recommended in those cases of epilepsy which come on about the age of puberty, and which are attended by considerable disturbance of the mind.§ * Burdach. f Cullen's Mat. Med. vol. ii. p. 213. | Richter's Specielle Therapie, vol. vii. p. 681, § Locher's Observat. Practic. p. 42. 42 NARCOTICS. In mania camphor was formerly very often prescribed; and many cases are on record of its having been success- fully given.* The late professor Barton, in a note to Cul- len's Materia Medica, says: " I have certainly employed camphire with advantage in some cases of mania. In one case, which occurred under my care in the Pennsylvania Hospital, it effected a complete cure." Dr. Gooch thinks camphor, with hyoscyamus, the best soporific with w7hich we are acquainted in mania and melancholia. He gives ten grains of each at bed-time, after the use of the tepid bath.f In the treatment of nymphomonia, this article is said to be particularly useful. Alibert states, that he placed Very little confidence in its powers in this respect, until he observed its effects in a female, who was suffering under symptoms of furor uterinus, with occasional ma- nifestations of mental derangement. The students of the hospital St. Louis, gave her one drachm of camphor. She experienced no inconvenience from it. But her excessive venereal desires were entirely allayed. These, however, returned, but were always removed by the camphor. At last the medicine brought on a great dis- position to syncope, vertigo, and excessive pain in the head, which obliged the patient to lay aside its use.J Camphor has also been used with success in the cure of chorea. Pitt employed it with benefit in union with valerian and the cold bath;§ and Wilson reports a case in which he gave it in conjunction with asafoetida, with perfect success. He carried the dose to the extent of eighteen grains of the camphor four times a day.|| Rich- ter states, that when the disease appears as the effect of cold, and is attended with a dry and harsh skin, great * Philosophical Transactions, vol. xxxv. t Transact. Lond. College of Physicians, vol. vi. for 1820. J Alibert, Mat. Med. vol. ii. p. 109. § Abhandlungen. f. Pract. Aerzte. b. v. st. 2, p. 218. || Medical Commentaries of Edindurgh, vol. ii. p. 463. NARCOTICS. iS debility, and a pale relaxed appearance, and especially where there is an irritatio seminalis, camphor is pecu- liarly advantageous.* In eclampsia, or puerperal convulsions, camphor has been recommended by some writers. Where the disease occurs in hysterical females, and the countenance re- mains pale, with a corded and irritated pulse, important advantages may, no doubt, be gained from this remedy. In patients, however, of a full habit of body, and where the convulsions are attended with a powerful determina- tion to the vessels of the head, it ought not to be resort- ed to. In cases of this kind our chief dependence must be placed on the free use of the lancet. Richter says, where there is much congestion in the vessels of the brain, very copious and repeated bleeding, both topical and general, is indispensable.f Dr. Dewees, too, places his principal reliance on venesection. The reader is re- ferred to his essay on this subject, published in the se- cond volume of the American Medical Recorder, for a full and satisfactory exposition of the utility of blood- letting in this disease. In amaurosis, connected with a leucophlegmatic habit of body, camphor, given in doses gradually increased from a few grains to one scruple, three or four times a day, has been employed with complete success.| This article has been much recommended for the purpose of relieving strangury from cantharides and other causes. [ have myself derived unequivocal advan- tages from its use in such cases. There are many, how- ever, who deny its powers in this respect. It appears to possess a tendency to lessen the excitement of the geni- tal organs. Of this fact I have had very decided evi- dence. Several years ago, I was consulted by an elderly * Specielle Therapie, vol. vii. p. 764. t Ibid. vol. vii. 543. i Burdach's Mat. Med. vol. ii. p. 397. 44 i NARCOTICS." married man, of rigid moral habits. He informed me that he suffered very much from painful erections, and an incessant propensity to venery. He was naturally of a doomy disposition, which was much increased by bis complaint. I ordered him camphor, in two-grain doses, to be taken three times a day. In a week he re- turned and told me,he was almost entirely relieved; and by a further continuance with the remedy, he was com- pletely rid of his tormenting complaint Camphor is also an excellent medicine in painful menstruation I have frequently given it in cases of this kind, and generally with much advantage. Dr. Bodtcher, a Danish physician, has lately published some interesting observations on the employment of the vapour of camphor as a remedy in various diseases. He found it particularly useful in the .complaints affecting the-cavities of the nose, the throat, and the chest. In cases of complete stoppage of the nose, commonly called snuffles, a piece of camphor kept before it is said to af- ford complete relief in a few minutes. Dr. Bodtcher also found it very useful in cynanche, when held before the nose or the open mouth. The vapour of camphor has likewise been employed in spasmodic coughs, with great benefit.* Camphor may be given either in the form of powder, emulsion, or solution. By adding a few drops of alcohol to it, it may be readily pulverized. Its solubility is much increased by triturating it with carbonate of magnesia, and hence it is best given in this way when employed in substance. The mixture is, however, much the most agreeable form for exhibiting this remedy.f The dose of camphor is from two grains to one scruple. * American Medical Recorder, vol. v. p. 568. t R Pulv. camph. 3ss. pulv. gum. arab.-3ii. tere simul etadde gradatim, aquae fontanae gviii. syrupi simp. |i. M. Dose, a table- spoonful every two or three hours. NARCOTICS. 45 HUMULUS LUPULUS.—THE HOP. I have already spoken of this plant, when treating of tonics. It remains, therefore, in this place, only to no- tice its narcotic powers—powers which it possesses to a very considerable degree, ;c and capable of producing all the phenomena of opium." The flowers are the only parts used in medicine, although the leaves are not with- out some anodyne properties. A pillow of hops is a very common mode of procuring sleep, in domestic practice. The narcotic principle of the hop seems to be particu- larly applicable to those cases where want of sleep and restlessness are kept up by an irritable state of the nerv- ous system, and where opium cannot be taken from idiosyncrasy. It may be given in the form of an extract or of tincture. The tincture is made by infusing five ounces of hops in two pounds of proof spirits. The dose of this is from 3L to |ss. The extract is given in the dose of from gr. x. to 9ii. pro re nata. HYOSCYAMUS NIGER. This plant is every where found in abundance on the continent of Europe. Its root bears a considerable re- semblance to that of the parsnip, and fatal mistakes have happened by taking the former root for the latter. The taste of this plant is nauseous, and its odour, which is almost wholly lost on exsiccation, stupifying. It contains resin, mucilage, extractive matter, gallic acid, some salts, and an alkaline element, which has received the name of hyocyama.* * Paris's Pharmacologia- VOl/. II.—G iG NARCOTICS. Water extracts the narcotic powers of hyoscyamus very freely; boiling water, however, destroys them. The best menstruum is diluted alcohol. The whole plant acts as a poison on the human system; but sheep, deer, and some other animals eat it with im- punity. Taken in a very large dose, it occasions a hard, small, and irregular pulse; anxiety, beadach, vertigo, diminu- tion of sensibility, intoxication, a sensation of falling downwards even when in a recumbent position, delirium, coma, apoplexy, double vision, or entire loss of sight, subsultus tendinum, convulsions, risus sardonicus, para- lysis of the tongue, a blue colour of the face and whole body.* Alibert states that a gangrenous eruption on the skin, particularly of the lower extremities, is sometimes a consequence of a very large dose of this substance. Or- fila says, that two persons, who had eat some young shoots of hyoscyamus dressed with oil, were, according to the report of Mr. Choquet, affected in the following manner: dilatation of the pupils, difficulty of breathing, pulse small and intermitting, aphonia, trismus, risus sar- donicus, loss of sense, which, connected with a strong propensity to sleep, exhibited a complete state of typho- mania. The extremities became cold, the superior ones were agitated; the inferior paralysed,! and to these symp- toms was added a deep carphologia. Stork, Mayerne, Greeding, and others regarded it as possessing very considerable curative powers in epi- lepsies, convulsions, and other spasmodic affections. Later experience, however, does not confirm these fa- vourable sentiments of its virtues. In its remediate properties it approaches a good deal to those of opium. It differs, however, from this sub- stance in heating the system much less, and in acting as * Burdach, Arzneymittellehre, B. iii. s, 525. t Toxicology, p. 256. NARCOTICS. 47 an aperient on the bowels. It may therefore be em- ployed with advantage where we wish to allay pain and irritation, and where opium is inadmissible on account of its stimulating and constipating properties. It is highly recommended by Bree as an antispas- modic, in some cases of asthma.* In union with cam- phire, Dr. Gooch recommends this substance, in the dose of ten grains each, as one of the most useful ano- dynes in mania and melancholia.f In haemoptisis attended with great irritability of the system, and a violent spasmodic cough, olive oil, in which a certain portion of hyoscyamus has been boiled, is re- commended by RichterJ and others as a very efficacious remedy. Borda speaks strongly in favour of the virtues of this article in spasmodic and inflammatory coughs, whether the result of protracted peripneumony or aris- ing from nervous irritability.^ In tic doloureux hyoscyamus niger, in combination with valerian and the sublimed oxide of zinc, has been greatly praised. It was used, as we are informed, with much success by Dr. Meglin, of Colmar, in Fi ance. * His formula is this: R Tinct. Scillae. g". x. Acidi Nitrici. gM. vi. Extract, hyoscyam. gr. iii. Aq. fontanae §iss. Misce. Fiat haustus, horis tertiis vel quartis durante parox- ysmo repetendus. t Observations on puerperal insanity. In the sixth volume of the Trans, of Lond. College of Physicians. 1820. \ Richter gives this formula: R, Ol. hyoscyam. coct. 5ss. G. mimos. 3vi- Syrup, althaea §i. Misce intern et affund. sensin. Aq cerasor. nigr. §vi. M. S. a table-spoonful every hour. Richter's specielle Therapie, vol. iii. p. 296. Harles, in Hufe- land's Journal der Pract. Heil-kund, vol. ix. No. 2, p. 56. § Prima: Linae of S. Borda. 48 NARCOTICS. Hufeland, also, speaks favourably of its powers in this painful affection. The leaves form an excellent anodyne cataplasm, and the smoke from its seeds, when applied by a funnel to a carious tooth, is recommended in severe fits of odontalgia.* Cullen thinks that this substance is more apt to pro- duce delirium than opium. This accords with my own experience. I once prescribed the extract to an ex- tremely nervous female; the first dose, which amounted only to one grain, produced the most perfect delirium. In another case I observed similar effects, though much less powerful. This article is employed, either in the form of tincture or extract. The extract is given from gr. ss. to as much as the patient will bear. The tincture, made in the proportion of |ii. 3ii. of the dried leaves of the plant, to tfei. of proof spirit, may be taken in the dose of g". to 3i. CONIUM MACULATUM. This is a very ancient article of the materia medica. The extract of cicuta is mentioned by Dioscorides as "multiplicis in medicina usus." It does not appear, however, that it was used internally either by the Greek or Roman physicians. As an external application it was employed in phagedenic and other ill-conditioned ulcers; but its introduction into practice as an internal remedy did not take place until near the middle of the eighteenth century. "There is no instance," says Dr. Cullen, "in which the fallacy of experience appears more strongly than in the history of this article. Storck, speaking from his * Paris's Pharmacologic NARCOTICS. 49 own experience, alleged, that it is the most efficacious remedy we possess for the cure of various glandular diseases* Dr. Cullen, however, and, since his time, physicians in general, have not found it to answer the high expectations which the experiments of Storck were calculated to excite. Still it must be confessed that it is an article of strong powers, and capable, under cer- tain circumstances, in a variety of diseases, of doing a great deal of good. Even Cullen admitted its occasional valuable effects. " We have known it," says he, " use- ful in healing ulcers, which had come upon scirrhous tumours, and which continued to be surrounded with such scirrhosity; and in some ulcers certainly that ap- proached to the nature of cancer. Even in cases that might certainly be considered as truly cancerous, I am so far from being o{ the opinion of Bierken, of its rather aggravating the disease, that I have found it in several cases to relieve the pains, and mend the quality of the matter proceeding from the sore, and even to make a considerable approach towards healing it; though I must own that I never was concerned in a cancerous case in which the cure of the sore was completed."! Dr. Chap- manj is, therefore, wrong in asserting that " its utility has been denounced by Cullen." He gave it all the credit which can be conceded to it at the present day. He, however, justly regarded the praises of Storck as extravagant; a judgment which is fully confirmed by general experience. The leaves of this plant possess a strong narcotic odour, and are slightly bitter and nauseous to the taste. * Ant de Storck Libellus, quo demonstratur cicutam non solum usu interno tutissime exhiberi, sed esse remedium valde utile in multis morbis. Vindobon. 1760 8vo. Ejusdem Libelus secun- dus, 1761. Ejud Supplement: necessarium de cituta, 1761. Cum tabulis 8. t Cullen's Materia Medica, vol. ii p. 189. t Elements of Therapeutics, vol. ii. p. 239, first edition. 50 NARCOTICS. Exsiccation destroys their acrid quality, without lessen- ing, in the least, their narcotic principle. The active properties of the plant reside in a resinous matter, which may be obtained by evaporating its etherial tincture on hot water. This resinous substance is of a dark green colour, "and has the peculiar odour and taste of the hemlock in perfection." It has received the name of conein,* When taken in a moderate dose, it produces no sensi- ble effects except vertigo and slight pain of the head. Taken, however, in a very large quantity, its effects are of the most violent kind. Anxiety about the praecordia is first felt; this is immediately followed by vertigo, great pain of the stomach, convulsions, discharge of blood from the mouth and ears, loss of sense, and trismus. As a remediate article cicuta admits of pretty exten- sive application. It appears, however, to be now almost universally admitted, that very little if any advantage can be expected from it in the treatment of genuine cancer. Alibertj states, that of more than one hundred women affected with scirrhous cancer of the uterus and other parts of the body, who were treated with this remedy, in the hospital Saint Louis, not one received the least benefit. In scrophulous ulcers, however, cicuta is a remedy of value; and when united with minute doses of muriate of mercury, it forms an exceedingly useful medi- cine in almost every species of old and obstinate ulcer.J Dr Percival has published some interesting cases of the good effects of hemlock in internal ulcerations.^ Dr. Odier, of Geneva, also gives an account of a most dis- tressing instance of obstinate ulceration in the oesophagus * Paris's Pharmacologia. t Elemens de Therapeutique, vol. i. p. 412. \ Gataker. Essays on Medical subjects, with an introduction: relating to the use of hemlock and corrosive sublimate, &c. in cancerous disorders. Lond. 1764. § Bibl. Brit. Sc. et Arts. vol. xxxviii. p. 58. NARCOTICS. ol effectually cured by this remedy. His patient com- menced with a small dose, and gradually increased it to the extent of eighty grains a day.* Dr. Rutty, in a letter to Dr. J. Fothergill, gives the result of a large ex- perience with this article, in the treatment of scrophu- lous and other malignant and corrosive ulcers; and it appears from this statement, that it is a remedy from which we may frequently expect important advantages in such cases.f Dr. J. Fothergill also states, that he has often used it with success in sanious ulcers with gleety and painful discharges of the vagina.J It is a medicine of very considerable powers in allay- -mg morbid irritability. As a palliative for quieting pul- monary irritation, Dr. Paris considers it by far the most efficacious remedy we possess. Although my own ex- perience does not allow me to speak so favourably of its virtues in this way, yet I have witnessed in several in- stances its soothing effects in troublesome coughs. - Dr. Donald Monro states, that a deeply consumptive young lady took six grains of the extract of hemlock every night on going to bed, and that it always procured her rest, without heating her, or producing the uneasiness inva- riably felt from the use of opium. Cicuta has also been found serviceable in syphilis. Hunter recommends it combined with mercury in in- dolent buboes and swelled testicle. In syphiloid chan- cres, of an irritable and spreading character, cicuta, given in very large doses, will often do much good. In an extremely troublesome case of this kind I have lately obtained prompt and effectual relief from exhibiting this substance with the nitrate of silver. Narcotics were formerly much resorted to in the treat- ment of insanity. It seems, however, to be pretty gene- * Manuel de Medecine Pratique, p. 60, in a foot note. f Med. Observ. Sc Inquir. vol. iii. p. 229. t Ibid. vol. iii. 418. 52 NARCOTICS. rally admitted at the present day, that they can afford but little benefit in the diseases of the mind. Examples, however, do occasionally occur, of the beneficial opera- tion of this class of remedies in mental diseases. The records of medicine, too, furnish us with proofs of their occasional efficacy in such affections; and we are, there- fore, not permitted to regard them as entirely useless in this respect. Dr. Anthony Fothergill of Bath, has re- corded several instances of the successful employment of cicuta in the treatment of insanity. Of the utility of this remedy in cutaneous diseases I can say nothing from my own observations. It has, however, been recommended as a remedy of considera- ble value in leprous affections and elephantiasis. I have employed it a good deal in the treatment of chronic rheumatism, and I am satisfied, that, if given in strong doses, it will often afford useful results. It is, however, much inferior, in this respect, to stramonium, of which I shall presently give an account. Cicuta has also been resorted to with success in ticdo- loureux. Dr. Fothergill* speaks well of its efficacy in this disease. Dr. Jackson, of Boston, has also published cases in which the good effects of this article are strik- ingly illustrated-! Dr. ButlerJ has strongly recommended this medicine in the treatment of hooping-cough. His extravagant praises of this article have, however, never been confirm- ed by other practitioners. I have used it very frequent- ly, but never with any decided advantage. Belladonna is so greatly superior to the cicuta, in this disease, that it deserves a preference, perhaps, in all instances where a narcotic is wanted. The cicuta has also been employed in asthma ; but it * London Medical Observations and Enquiries, vol. v. t New-England Medical Journal, vol. ii. No 2. \ A Treatise on the Kinkcough, with an Appendix on Hemlock, by Wm. Butler, M. D. Lond. 1775. NARCOTICS. 53 does not appear that it deserves any attention for its reme- diate powers in this disease. The same may be said of its use in epilepsy, chorea, and hysteria. In the cure of jaundice the powers of this article seem to be better established. Dr. J. Fisher, of Beverly, Massachusetts, has found it an exceedingly successful re- medy in that variety of this disease which is occasioned by a spasmodic contraction of the biliary ducts. Drs. Bigelow and Jackson of Boston, give their testimony in favour of this article in the cure of this disease. " When the dose is gradually increased until its effects are dis- tinctly felt in the head and stomach, the yellowness of the skin and eyes, in most cases, begins to disappear by the second day, and the disease is soon removed."* In whatever disease this remedy be given, it ought to be used in large doses. Dr. Fothergill has published some excellent observations on this subject. He ob- serves, that its efficacy will always depend on its being given in as large a dose as the patient can bear. It should be given in sufficient doses to produce some ob- vious effect on the system. Vertigo seems to me the most certain mark by which to judge of the necessary influence of the medicine ; and it is probable that we can never derive any decided ad- vantage from its use, unless we give it to the extent of producing this effect. Not a little of the contradictory experience which has been published with regard to the remediate powers of this article may, perhaps, be ascribed to the great diver- sity which it exhibits in its strength as it is found in the shops. M. Orfila instituted a set of experiments with a view of ascertaining the comparative strength of the ex- tract of hemlock properly prepared and that which is usu- ally sold in the shops. A drachm of this article prepared by himself was sufficient-to poison a dog, whereas it re- • Thacher's Dispensatory, p. 196. VOL. II.—H 54 NARCOTICS. quired an ounce and ten drachms of that obtained from the shops to produce the same effect.* The extract is given in the dose of two or three grains, and gradually increased until some effect is produced. The powdered leaves, which, if good, have a fine lively green colour, are to be given in the dose of gr. iii. and increased until their inffuence becomes manifest. " Vinegar is considered its best antidote."f Hemlock has been mistaken for the following plants: chaerophyllum bulbosum and silvestre, aethusa cynapium, cicuta virosa, scandens odorata, caucalis anthriscus, and the common parsley. It is distinguished by the ferrugi- nous spots on the stalks. ATROPA BELLADONNA.—DEADLY NIGHTSHADE. This is an European plant, and an exceedingly ener- getic narcotic. Its leaves are inodorous and of a slightly * Orfila gives the following directions for preparing extracts; " 1. The plant must be taken when in full vegetation, and the flowers completely devel»ped. Dried leaves treated with water are perfectly useless. " 2. The juice is to be expressed, if the plant be succulent, if it be not succulent, water must be added, and then expression em- ployed. In both cases expression is to be made without heat. " 3. The juice thus obtained is to be evaporated by a gentle heat in a very broad vessel, and in a water bath. When thus prepared the extract of hemlock is of a gold yellow and slightly reddish co- lour, whereas in the shopp it is usually black." In the tenth volume of the London Medico-Chirurgical Trans- actions, Mr. J. T. Barry gives a communication concerning a new mode of preparing pharmaceutical extracts. He evaporates the expressed juice in vacuo. Professor Jaenisch, of Moscow, about the same time, proposed a similar mode for preparing such ex- tracts. The superior quality of extracts made in this way must be obvious. t Paris. Orfila NARCOTICS. 55 nauseous, sweetish, subacid taste. It does not appear that they lose any of their peculiar properties by drying. According to the analysis of Vauquelin, this plant con- tains an albumenoid substance, salts with a base of potash, and a bitter extractive principle, in which the active pro- perties of the vegetable reside. It appears from recent experiments, to contain also an alkaline element, to which the name of atropia has been given. The wThole plant is extremely active. The berries, however, seem to be more intensely poisonous than the other parts ; " and from their beautiful and inviting appearence they have often tempted the unwary" to fatal mistakes. In the Journal de Sedilot, Decembre, 1813, p. 364, there is an account given by M. E. Gaultier de Claubry, of the symp- toms experienced by upwards of a hundred and fifty sol- diers who were poisoned by eating the berries of this plant. They were affected by the following symptoms: " Dilatation and immobility of the pupil; insensibility, almost complete, of the eye to the presence of external objects; or at least confused vision; injection of the con- junctiva by a bluish blood; protrusion of the eye, which, in some, appeared dull, and in others ardent and furious, dryness of the lips, tongue, palate, and throat; deglutition difficult, or even impossible; nausea not followed by vomi- ting; sensation of weakness; lipothymia, syncope; difficul- ty, or impossibility of standing; frequent bending forwards of the trunk; continued motion of the hands and fingers; gay delirium, with a vacant smile; aphonia, or confused sounds, uttered with pain; ineffectual desires of going to stool; insensible restoration of health and reason, without any recollection of the preceding state."* Alibert states, that in three children who had eaten the berries of this plant, nausea immediately came on; the pulse became feeble and irregular, and a delirium of the most singular character supervened. They cried, sang, * Orfila's Toxicology, p. 286, Dr. Nancrede's translation 56 NARCOTICS. and laughed alternately,, and exhibited the most ridicu- lous and apparently involuntary gestures; the whole body was in agitation, and the countenance haggard and fix- ed.* Belladonna possesses very important remediate powers. By some it has been a good deal praised for its virtues in the cure of cancer. Cullen's success with this article, as he informs us, was various. He cured entirely a cancer of the lip with it. He also employed it with success in a scirrhosity of a woman's breast, and in a sore of a can- cerous nature below the eye. In other cases, however, it proved entirely ineffectual. Alberti and Juncker speak favourably of it in scirrhus of the intestines and stomach. Haller, De Haen, Heister, and more recently Rahn of Zurich, have, however, not only not confirmed these fa- vourable accounts of the powers of Belladonna in scir- rhous and cancerous affections, but have, on the contrary, found it injurious in such cases. For the cure of hooping-cough this remedy enjoys, at present, a very high character in Europe. Borda speaks in terms of unlimited praise of the advantages he has de- rived from it in this disease. Children, says he, to all appearance past recovery have been saved by means of this remedy.f Hufeland, Shaeffer, and Marc, speak of it in similar terms of praise. They consider it, indeed, as almost entitled to the character of a specific in this dis- ease. WetzlerJ is equally warm in its praise; and Alibert states, that in France a similar success has attended the employment of this remedy. I have prescribed it in * A. M. Giraudy has written a dissertation entitled " Le delire cause par la Belladonna a-t-il un caractere que lui soitpropre?" t Primae Lineae. ' 4 Wetzler recommends this remedy to be given in this way: Take of the powdered root, mix it with a sufficient quantity of su- gar, and divide it into parts containing one fifth of a grain each. This is a dose for a child under one year old, which must be re- peated night and morning. NARCOTICS, 57 about a dozen cases. In two of these its good effects were promptly and strikingly manifested. In five or six, its advantages were much less obvious, and in a few it pro- duced no change in the disease whatever. I apprehend, however, that the extract which I employed was not very good; it was old, dry, and black. From the very nume- rous and respectable testimonies we have in favour of its powers in this disease, it certainly has claims to attention in the treatment of this harassing and intractable affection. According to Mr. Q,. Bailey's experience, belladonna is the most efficacious remedy we possess in tic dolou- reux.* He records many cases of extreme violence, which were effectually cured by this remedy, after every other mode of treatment had been tried without success. He usually exhibited from two to three grains of the extract, or from twenty to thirty minims of the tincture every four or five hours, while the paroxysm was vio- lent, and in smaller doses when the pains were mitigat- ed. He informs us that the employment of this remedy sometimes produces vertigo, impaired vision, insensibili- ty, tightness across the breast, and a sense of suffocation and dryness in the throat; but these effects do not con- tinue long, and have never been observed to leave any unpleasant consequences. It has been much spoken of by some German writers, as a remedy for hydrophobia.f M. Munch, of Hanover, and Bucholz, of Weimar, speak of their success in this way. Burdach also speaks favourably of its powers in this frightful disease. It is, however, but too certain that all such hopes are fallacious, and that we are yet entire- ly without any effectual means for arresting its dreadful and fatal course. By some physicians this remedy has been a good deal * Observations on the use of Belladonna in painful disorders of the head and face. London, 1818. t T. H. Munch kurze Anweisung wie die Belladonna in toller: bund biss Anzuwenden ist. Gottingen, 1783. 58 NARCOTICS. extolled for its powers in epilepsy. Greeding and May- erne have published observations favourable to the em- ployment of belladonna in this disease. Subsequent experience has not confirmed these expectations. The belladonna has also been employed in mania and melancholia.* It is said to be particularly applicable to cases consequent to a suppression of some accustomed evacuation, or the repulsion of cutaneous eruptions. I know nothing of its powers, from my own experience, in these affections. That they are but inconsiderable, may be inferred from the almost total neglect of this ar- ticle in the treatment of these diseases. Mr. Baileyf states that in a violent case of hysteria, which had withstood all other remedies, the efficacy of this article was conspicuously shown. It has also been recommended in other spasmodic diseases, such as chorea, asthma, spasmodic ischuria, dysphagia, &c. Burdach speaks of its successful employment in amaurosis, sciatica, loss of speech, and hemiplegia. The belladonna, in common with some other plants of this class of remedies, possesses the property of di- lating the pupils of the eyes in a remarkable manner, whether it be taken internally or only applied upon the external parts of the eyes. Advantage is taken of this property to dilate the pupils, in order to facilitate certain operations on the eye, as couching, &c. Hufeland states that he has been in the habit of em- ploying the fumes of narcotic plants, in convulsions, epilepsy and other nervous affections with very consider- able success. He takes equal portions of belladonna and hyoscyamus with a few grains of opium and exposes them to the heat of an alcoholic lamp on a thin iron plate in vapour bath. The patient remains in this bath from * Observations practicae circa usum Belladonna in Melancho- lia, Mania et Epilepsia. J. H. Munch. Gotting. 1783. t Observations on the use of Belladonna. NARCOTICS. 59 fifteen to twenty minutes, care being taken that the fumes do not reach the face. The immediate effects are copi- ous perspiration, succeeded, commonly, by a sense of fulness, and occasionally also with tremors, vertigo, dif- ficulty of breathing, and very rarely spasms. Hufeland gives an account of twelve cases of epilepsy, all of which were cured in this way.* The most convenient and effective mode of adminis- tering the belladonna, is by employing the powdered leaves or root. One grain of the powder of the leaves may be given to an adult morning and evening, and gra- dually increasing the dose to as much as can be borne. The root, if well dried, is somewhat stronger than the leaves, and must, therefore, be given in smaller doses. The extract is extremely variable in its strength If good, it must be commenced with in the dose of gr. ss. An over-dose produces so great an insensibility of the stomach as to render it almost impossible to excite vo- miting by the strongest antimonial emetics. Vinegar is accounted the best antidote to this poison. It renders the operation of emetics more certain and prompt. STRAMONIUM.—THORN-APPLE. This is a very common plant in this country, known familiarly by the names of Jamestown weed, thorn-apple, or stink-weed. It is a powerful narcotic, and has of late become of considerable importance for its remediate powers. It contains gum, resin, carbonate of ammonia, and an alkaline principle which has received the name of Daturia.f On being received into the stomach in an over-dose * Revue'Medical, 1822. t Paris's Pharmacologia. 60 NARCOTICS. its effects are exceedingly violent. The pupils dilate very much, vertigo, delirium, tremors, retching, exces- sive thirst, mania, and convulsions come on. The mania is of a very singular character, being attended with the most antique gestures, screaming, laughing, crying, and distorting the face continually. A deep coma comes on before death. We are indebted to baron Stork for the introduction of this powerful article into regular practice. He used it in mania, epilepsy, and other convulsive affections; and the result of his experience was much in favour of its remediate powers.* Sidren also adds his testimony in behalf of the efficacy of this remedy in convulsive dis- eases.f The experience of Wedenberg and OdheliusJ was less favourable; nor has later experience, upon the, whole, confirmed the hopes which the trials of Stork and others were calculated to inspire. The late profes- sor Barton, however, considered it " a medicine of great and valuable powers," in the treatment of mental, as well as other diseases. He advises large doses in mania. In one patient he carried the dose from two grains of the powdered leaves to sixty. " When the patient (a maniac,) had continued upon this dose for some time, she broke out into boils, upon various parts of the body, and was at length discharged from the hospital cured."§ This article has also been successfully employed in epilepsy. Dr. J. Fisher, a practitioner of high standing in Massachusetts, speaks very favourably of its employ- ment in this disease occurring in young persons, and at * Ant. de Stork Libellus, quo demonstratur, stramonium, hyoscyamum, aconitum, non solum tuto posse exhiberi, &c. Vin- dob. 1762, c. iii. tab. 8. t Sidren de Stramonii usu inmorbis convulsivis. Upsal, 1772. In Baldinger's Sylloge, vol. ii. \ Wedenberg de Stramonii usu in morbis convulsivis. § Collection for an Essay towards a Materia Medica of the United States, p. 48. NARCOTICS. 61 regular periodical intervals. This article is more likely to prove beneficial when assisted by the simultaneous use of chalybeates. The patient should be kept under the constant inffuence of the medicine. He recommends the employment of a saturated tincture as most conve- nient for children. The dose is to be regulated by the dilatation of the pupil. It has also been used in chorea, tetanus, and palsy. I have never employed it in any of these affections; but I have no doubt, from its general properties, that like many of the articles belonging to this class, it may be occasionally found successful in such cases.* Its chief importance, however, consists in the excel- lent effects which it produces in chronic diseases attend- ed with violent pain. Dr. Marcet is the first who noticed particularly its salutary operation in affections of this kind. " If I were called upon," says he, " to express in a few words the general opinion which I feel inclined to form from the opportunities I have had of studying the properties of stramonium, I should say that the most common effect of this remedy, when administered in ap- propriate dbses,f in cases of chronic disease attended with acute pain, is to lesseu powerfully, and almost im- mediately, sensibility and pain; to occasion a sort of ner- vous shock, which is frequently attended with a momen- tary affection of the head and eyes, with a degree of nausea, and with phenomena resembling those that are produced by intoxication; to excite, in many instances, nervous sensations which are referred to the oesophagus, * In the New England Medical and Surgical Journal, vol. iv. p. 226, a singular case of spasmodic cough is reported, which yielded readily to the extract of stramonium, after a very great variety of othes remedies had been tried in vain. The cough was attended with convulsions, subsultus tendinum, and other dis- tressing nervous symptoms. t From one-eighth of a grain to a grain a dose, which should not be exceeded until its effects have been observed. VOL. II.—I 62 NARCOTICS. or bronchiae, or fauces, and which sometimes amount to a sense of suffocation; to have rather a relaxing than an astringent effect upon the bowels; to have no marked influence upon the frequency of the pulse, though, in a few instances, it has appeared to render it somewhat slower; to produce but a transitory and inconsiderable dilatation of the pupils; and to have but little immediate tendency to induce sleep, except from the state of com- parative serenity and ease which generally follows the symptoms I have just described."* The diseases of this kind in which this remedy ap- pears to be most efficacious, are chronic rheumatism, sciatica, tic doloureux and the violent pains which some- times attend cancerous affections. Dr. Scudamore states that he had succeeded with it in relieving gouty pains, dependent or immediately connected with spasm. He found the stramonium more decidedly useful when given in combination with lactu- carium. " From reflection on my experience," says he, " I am tempted to affirm that the former acts most as an anodyne, the latter as a sedative; and whenever both effects are desired, they will be most favourably procur- ed from the union of the two preparations."f I have employed stramonium in rheumatism and scia- tica, and the result of my trials has been exceedingly flattering. It appears to me to be the most efficacious remedy we possess in those cases of chronic rheuma- tism which are attended by an irritable, quick, but weak pulse, swelled joints, and unattended by any great pain, unless on being moved. I have used it in three cases of sciatica within a year past, and in every instance with the most decided advantage-! * On the Medicinal properties of Stramonium,. 8cc. by A. Mar- cet, M. D. In the Medico-Chirurgical Transactions, vol. vii. p. ii. t A Treatise on the nature and cure of Gout and Rheumatism, 8cc. p. 129. 11 have seen the stramonium employed in domestic praqtice NARCOTICS. 63 Dr. Marcet tried it in three cases of tic doloureux. One case was essentially benefited by it; in another its effects were equivocal, and in the third it failed entirely. Dr. Bigelow, of Boston, found it decidedly useful in a case of this kind.* In asthma it has been much employed by smoking the root and dried leaves in a common tobacco pipe. I have prescribed the use of it in this way in a number of in- stances, and my patients have occasionally expressed themselves considerably relieved by it. An ointment made of the leaves of this plant fre- quently affords great relief when applied to painful and irritable ulcers, and hgemorrhoidal tumours. Dr. Bige- low states, that the stramonium ointment with the oint- ment of acetate of lead, forms one of the best applica- tions in this affection. Like the belladonna, it produces great dilatation of the pupils, when applied to the external parts of the eyes. The following doses of the stramonium must be com- menced with: Of the powdered leaves, one grain. powdered seeds, half a grain. Of the inspissated juice or extract, one grain. extract of the seeds from one-fourth to half a grain. tincture, from fifteen to twenty drops.f for the cure of rheumatism, above twelve years ago, while prac- tising in Lancaster county. I recollect that a rheumatic patient, upon whom I had in vain exhausted all the usual resources in this disease, was cured in less than two weeks, by an old woman, who administered a saturated tincture of stramonium seeds, in the dose of a tea-spoonful three times a-day. * Bigelow's American Medical Botany, vol. i. p. 23. t lb. vol. i. 64 NARCOTICS. ACONITUM NAPELLUS.—WOLFSBANE This is a powerful narcotic poison, and was well known as such to the ancients. Ovid alludes to its bane- ful properties, and the fatal purposes to which it was sometimes applied by the wicked. Lurida terribiles miscent acontia novercse. Metam. i. 148. There are four species of aconitum possessing pretty nearly the same powers. The aconitum napellus, cam- marum, neomontanum, and tauricum, all of which are indigenous to the alpine regions of Europe. The aco- nitum napellus is, however, almost exclusively employed in medicine. The juice of this species has a disagree- able smell, and a nauseous acrid taste. According to the analysis of Bucholtz, the fresh root contains a green resin, albumen, a bitter and acrid extractive matter, with nitrates and acetates, gum, malate and citrate of lime. The acrimony of the plant is almost entirely destroyed by exsiccation. When taken in excessive doses it pro- duces sickness, giddiness, delirium, fainting, cold sweats, asphyxia, spasms, involuntary stools, apoplexy, and- death. It has been known, on being introduced into a small wound of the thumb, to produce " pain in the fingers and arm, cardialgia, anxiety, with fear of suffo- cation, lipothymia, agitation, and finally gangrene, and copious suppuration."* When the leaves of this plant are chewed in small quantity they cause a sensation of numbness in the gums and lips, which continues for two or three hours.f Aconitum has been a good deal employed in the prac- * Orfila's Toxicology, by Dr. Nancrede, p. 220. Alberti Juris- prudentia Medica, torn. vi. p. 724. t Brodie ; in the Philosoph. Transact. An. 1811, p. 185. NARCOTICS. 65 tice of the German and Italian'physicians;.and it seems still to enjoy no inconsiderable reputation among them. Storck first introduced this article into regular practice. The character, however, which he gave it was upon the whole too flattering; and later experience has not fully confirmed the favourable account which he gave of its powers. There is, notwithstanding, sufficient testimony extant in its favour to establish its claims to our atten- tion ; and I am led, independent of such testimony, from my own experience, to regard it as an article possessing valuable medicinal virtues. It is often of decided advantage in rheumatic and syphilitic pains, consequent to a mercurial course. I have been in the habit, for several years past, of giving a dose of the extract of this plant to such of my patients as are suffering from pains of this kind, as an anodyne, on going to bed, and I have often had reason to be satis- fied with its effects. Borda,* an eminent Italian physi- cian, commends its powers very highly in these affec- tions. It has also been extolled for its virtues in chronic rheumatism and gout.f In a case of the former of these diseases I employed it in large doses, and derived some advantage from it. Its virtues appear to be much en- hanced by being united with antimonials in cases of rheu- matism. It is, however, so decidedly inferior to stramo- nium in this respect, that it may very properly be neglected for this latter remedy in these affections. Borda praises it as one of the most valuable remedies we possess for relieving morbid secretions of the trachea and bronchia. " Crebro," says he, " etiam obstupui ani- madvertens extractum aconiti nedum sputorum redun- dantiam ocissime repellere, sed naturam eorum ita im- mutare ut mihi omnem praeperceptum abstergeret me- * Primae Linese. t Bohmer de usu salutarii extracti aconiti in Arthritide. Halae, i 1768. 66 XARC0T1CS. turn proximse desperatae phthiseos cui mors quasi saxum tantali impendet." Burdach states that it has been applied successfully to the cure of obstinate quartans. It has also been used with advantage, according to the same writer, in amau- rosis. I need scarcely say that its once reputed powers in the cure of cancer, are entirely fallacious. Yet in the treatment of scrophulous, venereal, and other obstinate ulcers, it has been known to be of unequivocal advan- tage.* We have also accounts of its efficacy in goitre, scirrhous breasts, mesenteric obstructions, and nodes. The aconitum is generally employed in the form of an extract. Half a grain is sufficient to commence with, if it be good, and gradually increasing the dose to as much as can be borne without inconvenience. The tinc- ture is to be commenced with in the dose of g". x. and gradually increased. SOLANUM NIGRUM. This is a very common plant in the United States, and generally found growing in gardens. It possesses a slightly foetid odour; its taste" is insipid and herbace- ous. Alibert,f states that a boy aged eight years, eat some of the black berries of this plant, #which induced a state of coma and torpor, attended with fever. He com- plained of great pain in the-pit of the stomach, and was * Vogler recommends the following compound in the treatment of arthritic and rheumatic cases: & Succ. inspiss. aconiti. napel. Antim. sulphuret. precipit. aa gr. i. Magnesia, gr. x. M. To be taken for a dose. t Nouveaux Elemens de Therapeutique, &c. torn. i. p. 417. NARCOTICS. 67 harassed with nausea and retchings. According t6 the experience of M. Dunal, it would appear that the ex- tract of this plant is not very poisonous, but that it has the power of slowly destroying sensibility and irritabi- lity.* That the berries, however, are an active narcotic poison, I have had the most satisfactory evidence in a little girl, while I practised in Lancaster. Being called to visit this little patient, I found her lying in a deep apo- plectic stupor—entirely insensible, all the muscles re- laxed, the face flushed, and the pulse full and irregular. „ She continued in this state about six hours, and then gradually recovered. When she had become sensible again it was ascertained that she had eaten of the ber- ries of this plant. y The solanum nigrum was very early introduced into the materia medica. It was used among the ancients as an external application, either in the form of poultice or its expressed juice, in a great variety of diseases.f Caesalpinus states that it was frequently employed as an internal remedy in inflammations of the stomach and bowels, and for ardor urinae.J It had, however, fallen almost into entire neglect, until the attention of the pro- fession was again called to it by M. Gataker, surgeon of Westminster hospital, in a paper read to the Boyal So- ciety, in 1757, and afterwards published in a separate work, under the title of "Observations on the internal use of the Solanum, or Nightshade." The account which this writer gives of the medicinal properties of the solanum nigrum, is highly interesting, and, I conceive, in no degree exaggerated. He describes the following as its effects when exhibited in proper doses: " I found,"* says he, " from repeated trials, made with great caution, and safety to the patient, that so small a quantity as one * As quoted by Orfila. t Dioscorides, lib. iv. c. 71. t De Plantis, 213. 68 NARCOTICS. grain weight of the leaf, infused in about an ounce of water, and the liquor afterwards strained from the leaf, and taken at bed-time, would sometimes have a consi- derable effect; but that two or three grains seldom failed either to vomit, sweat, or purge the patient moderately, or to increase the quantity of urine. It sometimes oc- casioned a giddiness, especially when it made the patient sick; but neither the sickness nor giddiness were con- stant symptoms; and when they happened, they gene- rally abated or entirely ceased after the first dose. The most common effects that I have observed to ensue upon taking the medicine were, a heat or warmth diffused in a few hours over the body, a plentiful sweat succeeding thii heat, and a purging the next day. If a sweat did not break out an extraordinary discharge of urine was the consequence, and frequently followed likewise by purging. One or more of the natural evacuations were almost always increased."* The disorders in the cure of which he found this plant to be more particularly ad- vantageous, are, foul and painful chronic ulcers; pains in particular parts of the body; scorbutic eruptions, and ulcers of a cancerous nature. He relates a number of cases of each of these diseases, as having been success- fully treated by this remedy, in his own practice, and he gives some on the authority of others, equally favourable to its powers. From my own experience I am entirely convinced that the remediate virtues of this plant are by far too much neglected, and that they are capable, in certain cases, of affording important advantages. While practising in the country, I very frequently exhibited this species of solanum in obstinate herpetic eruptions, and foul and painful ulcers, and often with the most decided benefit. I have also employed it with much advantage in syphilitic eruptions attended with nocturnal pains. The dose, however, which I gave was much larger than * Observations on the use of Solanum, p. 8. NARCOTICS. 69 that mentioned by M. Gataker. I commonly commenced with two grains of the dried leaves made into a pill, night and morning, and increased the dose until considerable nausea was excited, or until effects indicating its com- plete influence, such as vertigo, tremor, and debility, or pain in the stomach, arose. As an external application it has been highly com- mended for the cure of erysipelas. SOLANUM DULCAMARA. The Dulcamara is a native of Europe and this coun- try; though with us it is most commonly found cultivated as a garden shrub. It is a climbing plant, with woody, brittle stalks,—it flowers in July, and bears red berries. The young twigs and leaves are the parts employed for remediate purposes, and should be collected early in spring. It does not appear that this species of solanum was employed by the ancients as a medicine. Neither Theophrastus nor Dioscorides mention it in their works.* The narcotic properties of this vegetable are much feebler than those of the plants I have already mention- ed. It is not, however, destitute of active qualities; for when taken into the stomach in very large doses, it is capable of producing vomiting, spasms, delirium, convul- sions, and insensibility. Dr. Bigelow states, that he has known the dulcamara, when collected in full vigour, to produce vomiting, in the dose of a few grains of the powdered leaves, or of a small cup of the decoction. It generally, too, acts pretty strongly as a diuretic, and its effects on the bowels are almost constantly aperient. * Gataker on theSolana. VOL. II.--K 70 NARCOTICS. This plant was formerly regarded as a very important remedy; and it is still thought by many to possess medi- cinal properties of very considerable value. From what I have myself seen of its effects, I am in- duced to regard it as a valuable article. It is of unques- tionable service in herpetic and syphilitic eruptions. Dr. Crichton, physician to the Westminster hospital, states, in a letter to Dr. Willan, that he has found only two cases out of twenty-three of lepra grsecorum to re- sist the curative powers of the dulcamara.* Willan and Bateman add their testimony in favour of the utility of this remedy in the treatment of cutaneous diseases. The latter says, " One of the most effectual remedies in lepra, under all its varieties, is the decoction of the leaves and twigs of the solanum dulcamara."f Alibert,} however, regards it as of doubtful efficacy in affections of this kind. From a very considerable experience with this remedy in the hospital St. Louis, he is led to consider it as at most but a useful auxiliary to more vi- gorous applications. Much of the contradictory expe- rience in medicine depends, perhaps, on the different modes and doses of exhibiting remedies. It appears from the writings of this physician, that the medicine was employed in much smaller doses in his practice than is generally used by the English and American physi- * The following is his method of employing this remedy : Take of stalks of dulcamara one ounce; water, one pound and a half; boil to a pound, and strain when cold. Of this decoction two ounces is to be administered at first, morning, noon, and night, and then gradually increased until fhe patient takes of it to the amount of a pint a day. At the same time the skin is to be wash- ed with a stronger decoction. If it produces giddiness, syncope, or palpitation, the dose is to be decreased. The good effects of this treatment are generally not observed until it has been con- tinued for eight or nine days. t Practical Synopsis of Cutaneous Diseases. By Thomas Bateman, M.D.F.L.S. p. 34. £ Elemens de Therapeutique. NARCOTICS. 71 cians. It is, therefore, not improbable that Alibert's want of full success with this remedy, arose, in part, from his having used it in insufficient doses. It should, I think, always be given in doses sufficient to render its influence upon the system manifest, by the vertigo, pal- pitation, &c. which it produces. I have found the extract of dulcamara a very useful remedy for chronic venereal pains and stiffness of the muscles^ Boerhaave and Werlhop speak highly of the powers of this remedy in phthisis. It need hardly be observed that subsequent experience did not confirm their senti- ments on this point. Linnaeus recommends it as a most powerful remedy in jaundice, rheumatism, and asthma.* From its diuretic properties it has sometimes pro- duced useful results in dropsy. It is stated in the Ga- zette de Sante, that a Flemish lady " who had the repu- tation of possessing a specific for dropsy," employed the dried stalks of this plant. Dr. Thacher states, that " the bark of the root, sim- mered moderately for some hours, in fresh butter or cream, forms one of the most efficacious ointments to be applied to excoriated nipples of nursing women ."f Bergius observes that the narcotic properties of this plant are lost by drying; and that, of course, the fresh plant is much more powerful than when in a dry state. N The best mode of exhibiting this remedy is in the form of decoction or infusion. The following formula, altered from Quarin, is the one which I have commonly prescribed: Take of the stalks (or twigs) of dulcamara §i. cut them into small pieces and bruise; steep them in a proper quantity of hot water for half an hour; boil afterwards for a minute or two over the fire. To a quart of the strained liquor, add of spirit, cinnamon. L. Ph two ounces. Dose, a cup full three times a clay .1 * Materia Medica, § 95. t The Am. New Dispensatory \ Thesaurus Medicaminum, p. 113. n NARCOTICS* DIGITALIS PURPUREA. I have already treated of this article, under the head of Diuretics; but as all its other operations seem to depend, or, at least, are intimately connected with its narcotic properties, I have reserved for this place the principal part of its remediate history. This is a biennial plant, growing abundantly in the mountainous forests of Switzerland, and cultivated with us, both for the beauty of its flowers and for remediate purposes. When properly dried it possesses a faint nar- cotic odour, and a bitter, nauseous taste. " It contains extractive matter and a green resin, in both of which its narcotic properties reside.* It is also said to contain am- monia and some other salts. When taken in an excessive dose, it produces heavi- ness of the joints, indistinctness of vision, nausea, syncope, trembling, vertigo, pain in the forehead and in the bottom of the orbits, drowsiness, slow and tremulous pulse, vo- miting, and occasionally diarrhoea, with pain of the bow- els, cold sweats, coma, convulsions, and apoplectic death. It has also been known to produce an inability to retain the urine. Small and frequently repeated doses, occasion a peculiar distressing nausea, attended with anxiety and depression of spirits, debility, vertigo, false vision, great diminution of the frequency and force of the pulse; redu- cing it sometimes slower than forty strokes in a minute; langour both of body and mind. It sometimes renders the pulse irregular and convulsive, without diminishing its fulness. Its narcotic effects are by no means tran- sient, they are, on the contraiy ,apt to continue long, and even occasionally to reappear after having subsided.f In administering this powerful remedy, we ought always * Paris's Pharmacologia. \ Burdach, Arzneymittellehre, B. iii NARCOTICS. 71.1 to bear in mind, that it will occasionally manifest no opera- tion for many days, and then all at once display its powers, and bring on very suddenly the most alarming prostration. Dr. Baildon states a fact in the Edinburgh Medical Jour- nal, July, 1807, which is extremely interesting as well as curious. After having got his own system under the sedative influence of digitalis, he found his pulse not lessened in frequency when he stood erect, beating then at the rate of above a hundred in a minute; when he sat down it beat considerably slower, and when lying on his back it fell as low as forty. He tried this experiment on himself repeatedly, and always found the pulse to vary- in the same manner. He states also that he observed the same results in other persons to whom he gave the digitalis. Other practitioners have observed similar vari- ations in the pulse, in persons under the narcotic influ- ence of this medicine. To Withering belongs the merit of having first regular- ly investigated the medicinal virtues of this plant. But, as is frequently the case with those who introduce a new remedy to the notice of the profession, he, without doubt, estimated its powers too highly. It is, notwithstanding, very deservedly considered as an important article of the materia medica; and although physicians do not now place much reliance in its powers as a remedy in phthisis, there are still enough virtues left to entitle it to very great at- tention. The question whether digitalis be sedative or stimu- lant in its primary operation, is still a subject of controversy. Dr. Sanders, who has written an excellent work on the foxglove, strongly advocates the latter doctrine, whilst others, with more correctness, contend for the former opi- nion.* I am entirely persuaded that its operation is im- * " If any person were inclined to write a satire on medical evi- dence, the different testimonies respecting the properties of this single plant would furnish abundant materials. «It is a diuretic,' says one physician. < It has no diuretic power,' says another. ii. coque ad dimidium; strain, and with the decoction and lintseed meal make a poultice. When it is necessary to exhibit this remedy repeat- edly during the day, its effects ought to be watched with the strictest attention, to prevent the alarming and even fatal consequences which may arise from administering this powerful medicine incautiously. NICOTIANA TABACUM. Tobacco is endued with very active poisonous pro- perties, and may be applied to important remediate pur- poses. It possesses a narcotic foetid odour, and a some- what bitter and extremely acrid taste. By chemical analysis it is found to contain "mucilage, albumen or gluten, extractive matter, a bitter principle, an essential oil, nitrate of potass, and a peculiar principle upon which the properties of the plant are supposed to depend, and which has been named nicotin." Vauquelin considers this substance as approaching the volatile oils in its pro- perties; it is colourless, of an acrid taste, and has the peculiar smell of tobacco; it occasions violent sneezing; " with alcohol and water it produces colourless solutions, from which it is thrown down by tincture of galls."* The active matter of tobacco is readily extracted both by water and by spirit, but more perfectly by the latter. By distillation the leaves afford an oil which possesses the peculiar powers of the p^nt in a highly concentrated stated When tobacco is received into the stomach in a large dose, or is applied to any other part of the system sus- ceptible of its influence, it produces nausea, great dis- * Paris's Pharmacologia, p. 534. NARCOTICS. 81 tress of feeling, cold sweats, vomiting, trembling, vertigo, spasm, insensibility, &c. WThen taken in an enormous dose it destroys life very speedily. Brodie,* from a number of experiments which he performed on animals with this plant, was led to conclude that it destroys life by rendering the heart insensible to the stimulus of the blood, and thus stopping the circulation. Orfila assertsf that the action of tobacco is more energetic when inject- ed into the anus than when received into the stomach. It seems to be almost equally active when applied to the external surface in parts where the skin is broken. Orfila mentions, upon the authority of Vandumond, instances where the decoction of the leaves applied to parts affected with itch, excited violent vomitings and convulsions. J I saw a child a few years ago thrown into alarming convulsions and syncope, by the imprudent application of tobacco ointment to an obstinate pustular eruption on the top of its head. As a remediate article tobacco may be very usefully employed in many instances. Stall! recommended an extract of it, made by long boiling, as a very effectual and safe expectorant and diuretic remedy. Paris states, that long coction weakens the powers of this plant; the extract recommended by Stahl, may therefore be a safer and more effectual remedy in consequence of having its poisonous parts dissipated by the long continued boiling. whilst its aperient, expectorant, and diuretic properties, may not suffer any material diminution by such a pro- cess. Tobacco has been successfully employed in the cure of dropsy and dysury. Dr. Fowler§ has written a work expressly on its virtues in these diseases: and he speaks * Philosophical Magazine, for August, 1811. t System of Toxicology, article Tobacco. t Recueil Periodique, torn. vii. p. 67. § Medical Reports of the effects of Tobacco in the cure of Dropsies and Dysenteries, by Thos. Fowler, M-D. Lon 1785. $2 NARCOTICS. of it as a remedy which, if properly administered, is" capable of producing copious diuresis. He used it in the form of infusion, of which he gave about eighty drops. He observes, that the best time for administering it is two hours before dinner, and on going to bed. He asserts that he found it equally effectual in nephritis cal- culosa. Mr. Earl, surgeon of the foundling hospital, London, has published an interesting paper on the effi- cacy of tobacco injections in retention of urine.* The cases to which he considers it as particularly applicable are those which depend on a spasmodic state of the urethra, and which sometimes supervene in consequence of accidental causes " in persons who have been long subject to strictures in the urethra, but who are still able to void their urine in a small stream/' In instances of this kind it is often impracticable to introduce instru- ments into the bladder, and it becomes necessary to over- come the retention by other means. Under such cir- cumstances, therefore, Mr. Earle has employed tobacco injections with great success in three cases, after all the usual means had been resorted to ineffectually. With a similar intention of removing constriction, tobacco is employed in cases of incarcerated hernia, and frequently with complete success. For this purpose either an infusion or the smoke of the plant is injected into the rectum. The very great relaxation which is thereby produced throughout the whole body, generally enables the surgeon to reduce the protruded parts very readily. The same practice will often produce almost imme- diate relief in cases of obstinate constipation depending on a spasmodic constriction of the bowels. In employ- ing tobacco injections it is, however, of the utmost im- portance to proceed with very great caution. If the quantity injected be too great, it will produce the most * Medico-Chirurgical Transactions, vol. vi. »t NARCOTICS. gg alarming symptoms; such as vomiting, cold sweats, uni- versal prostration, syncope, and even death. I have known an empiric destroy, in less than twenty minutes, the life of a charming little boy,—the son of a gentle- _ man at Lancaster, whose family I attended while resid- ing in that place, by an immoderate injection of the in- fusion of tobacco. In general a half a drachm of the" leaves infused in eight or ten ounces of water, will be as much as can with safety be thrown into the rectum at one time. A cataplasm composed principally of this plant, ap- plied to the pit of the stomach, was employed with suc- cess, both in epilepsy and obstinate intermittents, by Dr. James Currie of Liverpool. The application was made about half an hour before the accession of the paroxysms of these diseases. As an external application either in the form of an ointment or infusion, it has been a good deal recom- mended in porrigo, and other cutaneous diseases. I have used it in two instances in this affection, to a very great extent, without, however, deriving any ♦ permanent ad- vantage from it. The late professor Barton was in the habit of applying a poultice of tobacco leaves pounded in vinegar to the region of the stomach, in cases of worms. " In consequence of this application," he ob- serves, " worms are often discharged after powerful anthelmintics have been exhibited internally in vain."* I have, in several instances, resorted to this practice in cases of worms, without the slightest benefit, although the existence of worms in the bowels was rendered cer- tain by the frequent spontaneous discharge of them. * Collections for an Essay towards a Materia Medica of the IJnited States, p. 63. 84 NARCOTICS. STRYCHNOS NUX VOMICA. The tree which affords this article is indigenous to the eastern continent. It is particularly abundant along the coast of Coromandel, Malabar, and at Ceylon. Jts fruit, which is a berry of the size of a small orange, con- tains in its pulp the seed which is the officinal nux vomi- ca. The deleterious effects of this article on cats, dogs, foxes, and certain birds, were long since observed by Gessner, Wepfer, Bunner, and others. By the more recent experiments of Desportes, Magendie, and Delisle, the peculiar powers of this substance have been more particularly elucidated. When given to dogs as a poison, it produces great anxiety, laborious and confined breathing, retching, and nausea, tremors, violent convulsions, tetanic spasms of extraordinary force, asphyxia from immobility of the thorax, and death. In animals thus killed, Delislo, Ma- gendie, and Desportes never found the least trace of in- flammation. It appears to extinguish life by destroying the power of the respiratory muscles, and thus produc- ing asphyxia. According to the experiments of Delisle, no effects whatever are produced when this substance is applied directly to an exposed nerve. When, how- ever, thrown into the cavity of a serous membrane, it speedily proves fatal. Murray appears therefore to be wrong in attributing the deleterious effects of the nux vomica to its immediate operation on the nervous sys- tem.* Its effects upon the human system are similar to those which it produces in animals. Magendie and Delisle observed, that it has the power, when taken in a proper dose, of exciting strong spasmodic contractions of the voluntary muscles without materially affecting the more * Alibert, Elemens de Therapeutique, &c. t. i. p. 435, NARCOTICS. 85 important vital organs of the system. M. Fouquier, phy- sician of the Hospital de la Cliarite, taking advantage of this singular property, conceived (he idea of applying it to the cure of paralysis. He accordingly administered it to a number of patients affected with paraplegia and hemi- plegia, and obtained from it very important results. The effects of a sufficient dose were, invariably, strong muscular contractions of more or less permanency; con- sisting sometimes of sudden and transient starts, and at other times of clonic contractions of a tetanic charac- ter. These contractions are, in general, stronger in the paralytic parts than-in those which are healthy. M. Fouquier observes, that a very strong dose has some- times produced general tetanic convulsions, without however doiug any mischief. Dr. Lescure* relates several cases of paralysis in which the nux vomica proved successful. He gave four grains of the extract, divided into two doses daily, to a patient who had been for four years affected with paraplegia. The dose was gradually increased to six grains in the second week; the patient then began to feel heat in the stomach, a sense of constriction in the abdomen, difficulty of void- ing urine, and now and then slight contractions of the muscles of the lower extremities. The remedy was now omitted for a short time. On being resumed and continued for some days, forcible and sudden contrac- tions seized the paralized limbs, and the retention of urine was more complete than on the former occasion. On again omitting the medicine these symptoms disap- peared. It was then resumed in the dose of eight grains, and at the termination of three weeks, he again was tak- en with tetanic contractions, which continued four hours. The patient now gradually recovered the use of his limbs. The nux vomica has also been employed in intermit- * Journal Universel des Sciences Medicales, torn. xi. VOL. II.—M 86 NARCOTICS. tents, mania, epilepsy, gout, rheumatism, cutaneous eruptions, hydrophobia, scrophula, and hypochondriasis. Hagstrom, a Swedish physician, asserts that he found it of great service in an epidemic dysentery. It was given in the dose of twenty grains of the powdered nut once a day in some barley-water, after the bowels had been duly evacuated by laxatives. It is also particular- ly commended by Hufeland, for its good effects in an epidemic dysentery that occurred at Jena in 1795. A late German writer of great respectability, states that,he used it in an epidemic dysentery that prevailed at Melle, a town in the principality of Osnaburg, in 1800. He gave it in doses of two and a half grains every two hours. " It sometimes allayed the pain, though in a few individuals it increased it.'* It does not appear, upon the whole, that its efficacy in this disease is such as to entitle it to any particular attention. MM. Pelletier and Caventou have obtained a peculiar substance from this article, which contains its active properties in a highly concentrated state. It has receiv- ed the name of strychnine.f This substance "is highly alkaline, aiid crystallizes in very small.four-sided prisms, terminated by four-sided pyramids; its taste is insup- portably bitter, having a slight metallic flavour; it has' no smell; it is so extremely active and violent, that in doses of half a grain it occasions serious effects, and in larger ones convulsions and death. 'J It is sparingly soluble in water; in ajcohol, however, it dissolves very readily; it forms neutral salts with acids; which become " blood-red b> the action of concentrated nitric acid " This remedy is given either in substance or in the form of an extract. Four grains of the powdered nut, or two of the extract, may be given three, four, or five times a * Summa Observationum Medicarum, &c. L. I. Schmidtman, M. D. Beraline, 1819. t Annals de Chimie, vol. viii.—x. \ Paris's Pharmacologia- NARCOTICS. 87 day, and continued until its operation on the system is adequately manifested. It will in general be necessary to increase the dose gradually, in order to obtain its pe- culiar effects. The alcoholic extract alone is employed. In cases of poisoning from nux vomica, Orfila recom- mends two spoonfuls of the following mixture every ten minutes, after the contents of the stomach have been evacuated: r aether vitriol, ji. ol. lereb. 3ii. sacch. albi, |ss. aqua pura, |ii. RHUS TOXICODENDRON, VEL RADICANS. POISON OAK—SWAMP SUMACH. This is a very common shrub in this country-, and. well known by its property of inflaming the skin to a very alarming extent, simply on coming in contact with its leaves, or even by a close approach to it, in persons who are particularly sensible to its influence. Mr Van Mons of Bruxelles, has published a chemical examina- tion of this species of rhus. He asserts that the poison- ous exhalation of this shrub is a carbonated hydrogen gas. It contains also a considerable quantity of tannin, some gallic arid, a small portion of green fecula, and a still smaller quantity of gum and resin. It does not appear that it possesses any very deleteri- ous properties v\ hen taken internally. Orfila observes that it blunts the activity of the nervous system after be- ing absorbed. Alibert,* however, states that a M. Boul- lon inoculated himself, in his presence, with the juice of the rhus toxicodendron, with perfect impunity. On the skin, however, its poisonous properties act with great energy. When touched or handled it produces in the course of two or three days very serious symp- * Elemens de Therapeutiques, torn, i. p. 452. 88 NARCOTICS. toms. The skin inflames and swells, being attended with a very distressing burning pain. If the face be af- fected the eye-lids are so tumefied as to close up the eyes; the whole head is swelled and covered with little blisters containing serum. Sometimes the whole body is enormously swelled and covered with serous vesicles. WThen the inflammation and swelling has in some degree subsided, the epidermis begins to separate in little squa- ma3, and an intolerable itching is felt for some days longer. The arterial system, during an affection of this kind, is very considerably excited.* These symptoms bear a very close resemblance to those of erysipelas; and it is observed by Mr. Van Mens, that they yield to the remedies commonly employed for the cure of this latter affection. M. Gouan recommends aqua ammonia, diluted in water, as a useful application, but I believe nothing has as yet been discovered more effectual in such cases than the application recommend- ed by the late professor Barton, namely, an aqueous solution of corrosive sublimate. The rhus toxicodendron has been a good deal praised for its remediate powers in the treatment of paralysis, herpes, and consumption. M. Dufresnoy, professor of botany at Valencia, speaks in very high terms of its efficacy in these affections. The experience of Ver- deyen, itoch, Van Baerlem, Rumpel, Burdach, and others is also in favour of its employment in these and other affections. M. Pou, professor at Montpellier, cured a paralytic patient in a very short time with the extract of this plant. M. Gouan was equally successful in curing a young lady affected with hemiplegia. Dr. Alderson relates seventeen cases of paralysis, in all of which this remedy was usefully employed.f * Alibert, Elemens de Therapeutiques, torn. i. p. 454. t An Essay on the Rhus Toxicodendron, &c. by J. Alderson, M. D. NARCOTICS. 89 The dose of the extract is at first about grs. xx. to be gradually increased until some effects on the system are produced. The powdered leaves are given in the dose of from one grain to ten, three or four times a day. TELA ARANEARUM. The spider's web has been long known as a domes- tic remedy for the cure of agues; and we find it men- tioned in the dispensatory of Schroder, published in 1644, as possessing such remediate powers. It is to Dr. Robert Jackson, however, that we are indebted for a more particular and satisfactory account of its powers, and consequently for the attention which it has lately received from the profession. This respectable physi- cian, in a communication published in the Medical and Physical Journal,* states that Dr. Gillespie of Edinburgh had succeeded in curing a very obstinate case of ague by the spider's web, after various other means had been tried ineffectually. He then details his own experience with this substance in the treatment of intermittents, the result of which goes directly and strongly in favour of its remediate powers. " I think," says he, " I may ven- ture to say that it prevents the recurrence of febrile paroxysms more abruptly and more effectually than bark or arsenic, or any other remedy employed for that pur- pose with which I am acquainted; that, like all other remedies of the kind, it is only effectual as applied under a certain condition of habit; but that the condition of susceptibility for cobweb is at the same time of greater latitude than for any other of the known remedies. The cobweb was rarely given before the subject was pre pared by bleeding, emetics, or purgatives." * Medical and Physical Journal, vol. xxi. 90 NARCOTICS. The more obvious effects of this remedy when taken into the system is to allay irritation, to tranquillize the mind, and to induce easy slumbers. Dr. Jackson de- clares that the cobweb allays " morbid irritability, and calms irritations both of body and mind, in a degree far exceeding any drug or remedy within the circle of our knowledge." He further observes that the effects which it produces characterize it as powerfully stimulant. When the pulse is quick, frequent, irregular, and irri- tated, it becomes slow, calm, and regular by its ope- ration. In general the surface becomes relaxed and covered with perspiration. If the pulse is slow, regular, and nearly natural, it generally becomes frequent, small, irregular, and sometimes intermitting. Where languor and depression exist, " sensations of warmth and com- fort are diffused about the stomach, and increased ani- mation is conspicuous in the appearance of the eye and countenance." I have taken it very often, and have uniformly found it to produce a calm and delightful state of feeling, succeeded by a disposition to sleep. This accords with the experience of Dr. Oliver of Salem, who found it to produce in himself " the most delicious tran- quillity, resembling the operation of opium, and followed by no bad effects." In consequence of these soothing properties the cob- web has been found an excellent palliative in the ad- vanced stage of consumption. Dr. Jackson details a remarkable case of asthma, in which the tranquillizing effects of this substance were conspicuously evinced. The complaint was hereditary and connected with malformation of the chest. The patient was unable to lie down in bed from a sense of suffocation, and was obliged to take the little sleep he could get in a half-sitting posture, being supported by pillows. In this distressing condition he one night took twenty grains of the spider's web, and obtained from it a sound and uninterrupted sleep all night, " a blessing NARCOTICS. 91 to which he had been an entire stranger above six years." The same writer states that he has found it very useful in the spasmodic complaints of females, which resist the powers of ordinary remedies. In chro- nic hysteria I have employed it with much advantage. I. have found it particularly serviceable in women of a re- laxed habit of body, accompanied with morbid irritability of the nervous system. In a case which I have at pre- sent under my care, my patient derives evident advan- tage from this article, in combination with the cyanite of zince, lately introduced into practice by Dr. Hufeland of Berlin. Dr. Webster* of Boston, adds his testimony in favour of the remediate virtues of this substance. He has found it to produce very good effects in rheumatic headaeh, asthma, and chronic coughs. He has also de- rived much advantage from it in allaying the irritation which sometimes attends a mercurial course. He men- tions the following remarkable effects of this remedy in an old and infirm asthmatic: " Slight but pleasant deli- rium was produced, and from the report of the persons who slept in the room with him, the effect, though of longer duration, was very similar to that of a dose of nitrous oxide gas, the muscular energy having been ex- ceedingly increased, the patient could not be confined to bed, but danced and jumped about the room nearly all night: in the morning I found him quietly asleep. No unpleasant symptoms ensued." The same writer observes that the cobweb is an excellent application to irritable sores. It is generally given in the dose of five or six grains, repeated every third, fourth, or fifth hour. According to the experience of Dr. Jackson, a dose of five grains produces nearly the same effects as one of twenty. * New England Medical and Physical Journal, new series, vol iv. p. 218. 92 NARCOTICS. HYDRO-CYANIC ACID.--PRUSSIC ACID. The prussic acid is the most prompt and fatal poison known. When perfectly pure, and brought into contact with a wound, or simply applied to the eye or tongue of an animal, it destroys life almost instantaneously. When diluted^ however, to a proper degree, it appears, from some late accounts of its employment in diseases, to be capable of very important remediate applications. The prussic acid, as it is usually prepared for medi- cinal purposes, is transparent, without colour, of a bland and sweetish taste at first, becoming acrid and hot after- wards. Its specific gravity, at seven degrees of Reau- mur, is 0.70583. It reddens the tincture of turnsole slightly. It boils at the temperature of 26° 5', under a pressure of 0.76ra; and at 15° it congeals* It is so ex- tremely volatile, that when a portion is dropped upon a piece of paper, the part which almost instantaneously evaporates, produces a sufficient degree of cold to crys- tallize the portion of the acid remaining on the paper. Its odour is strong and characteristic, resembling that of peach-blossoms and bitter almonds. When exposed to light it is soon decomposed, resolving itself into carbonic acid, ammonia, and carburetted hydrogen gas. It is therefore necessary to keep it excluded from light, otherwise it will very soon become inert and useless. It is found in a variety of vegetable substances;—in bitter almonds; the kernels of black cherries; in the flowers and leaves of the peach-tree, and particularly in the ker- nels of the peach, and in the leaves of the prunus lauro- cerasus. For medicinal purposes it is usually obtained from this latter plant, or from the prussiate of iron. This acid was discovered by Scheele, in 1780. It was soon afterwards ascertained to be highly poisonous, by * Thenard Traite de Chemie, torn. iii. p. 462. NARCOTICS. 93 Schrader, who found that a few drops, or even its vapour, very speedily killed some birds which he subjected to its influence. Its deleterious properties were afterwards more fully ascertained by the experiments of Ittner, Emmert, Coulon, Robert, Orfila, and more recently by those of Magendie. Ittner poured twelve drops of the acid into the mouth of a middling-sized dog. The ani- mal immediately staggered and fell. His respiration was quickened, and his faeces passed involuntarily. He was seized with violent opisthotonos, and died in about an hour after the acid had been given him. The effects, however, of the highly concentrated acid are still more violent, and indeed truly frightful. Magendie states,* that on plunging into the throat of a dog the extremity of a glass tube, that had been previously dipped into a phial containing some pure prussic acid, the animal in- stantly made two or three long and rapid inspirations and fell dead. Not the smallest trace of sensibility in the muscular organs could be detected after death. In an- other experiment he applied an atom of the acid to the eye of a dog, " and the effects were as sudden and as fatal as the preceding experiment." " In short," says Magendie, " the prussic acid, prepared according to M. Gay-Lussac, is, without doubt, of all the known poisons, the most active and the most promptly mortal. Its dele- terious and powerful influence permits us to believe what the historians have related of the criminal talent of Laucustus; and render the accounts of those extraordi- nary and sudden cases of poisoning, so frequent in the annals of Italy, less marvelous and incredible." The action of this acid appears to be immediately directed upon the nervous system. The excitation, however, which it produces in the system, is extremely transient, inducing almost immediate debility and torpor. When the dose is very large its action is so rapid and * Journal of Science and the Arts, for 1818, No. viii. VOL. II.—N 94 NARCOTICS. intensely energetic, as to cause, like lightning, an almost instantaneous extinction of the vital properties. As a consequence of its power to lessen irritability and sen- sibility, it diminishes the action of the heart and arteries, though in general this effect is not conspicuously mani- fested, unless the dose be excessive. Dr. Thomson, in a letter to Dr. Granville, observes that he has never seen its sedative effects preceded by an increase of the action of the heart and arteries, "a circumstance which dis- tinguishes it from all other substances belonging to the class of narcotics." It does not appear to be capable of producing any inflammation in parts to which it is ap- plied. Bitter almonds, however, whose active principle consists of this acid, inflame the stomach when swal- lowed. It is only of late that this acid has been extensively employed for remediate purposes; and if the accounts we have had of its good effects be not greatly exagge- rated,—a suspicion which can hardly be admitted, as they proceed from sources so respectable and various, it is undoubtedly entitled to very great attention. Bitter almonds and lauro-cerasus, both of which owe their active properties to the prussic acid they contain, were formerly employed as remedies in the cure of in- termittents. Hufeland states that he has known two or three bitter almonds, swallowed a short time before the paroxysm, sufficient to prevent its accession.* Bergius,f also, says that cases of ague have been cured by the bitter almond, after having used the cinchona and other re-medies ineffectually. MM. Duvignon and Parent,J of Paris, state that during the first invasion of the allied army in 1814, a young English physician attached to the Russian imperial guards, effectually treated tertian * Bibliotheque Med. torn. viii. s. 386. t Rergius Mat. Med. p. 400. \ Medical Recorder, vol. ii. p. 510. NARCOTICS. 95 intermittents with Scheele's prussic acid, combined with other substances, in strong doses. Substances containing the prussic acid, as well as the acid itself, have also been employed successfully in the cure of some nervous disorders. The aqua lauro-cerasus, which is but a very diluted form of the prussic acid, has been much recommended by Hufeland.* Thomasen, Thuassen, Baillie, Wurzer, and others, in mental dis- orders. Dr. Oliver of Salem, states that in two instances of mania in females, the prussic acid has been of essen- tial advantage.f It has been particularly extolled for its good effects in hypochondriasis depending on disorders of the abdominal viscera, or on onanism. It has also been thought particularly adapted to the cure of mania arising from suppressed excretions. J Dr. Shallern asserts that he derived very considerable advantage from the employment of laurel-water in com- bination with belladonna, in cases of hydrophobia. M. Dupuytren, however, employed the prussic acid in two instances of this hopeless malady, without the least be- nefit. A very large mass of testimony has of late been pub- lished, which goes directly and strongly in favour of its powers in the treatment of chronic nervous coughs, and phthisis pulmonalis. Magendie was, I believe, the first who employed the prussic acid in diseases of this kind.§ Observing its remarkable property of diminishing general sensibility, without materially affecting the respiration and circulation, he was led to the opinion that it might * Journal der Practish. Arzeheyk, B. ix. s. iii. t Thatcher's New Amer. Dispen. p. 433.—1821. t Duvignon and Parent, in the Med. Recorder, vol. ii. p. 545. § Since writing the above I have seen an article in the New Eng- land Medical Journal, communicated by B. Lynde Oliver, M. D.of Salem, in which he states that he administered both the distilled water and saturated tincture of lauro-cerasus, in phthisis pulmona- lis, as early as 1810, and generally with much advantage. 9b NARCOTICS, be advantageously employed in cases depending, as these affections appear to do, on a morbid increase of sensibi- lity. He accordingly prescribed it to a young lady who had been affected with a distressing dry, short cough for above eighteen months. He ordered her " six drops of Scheele's prussic acid, diluted with three ounces of a ve- getable infusion, to be taken by spoonfuls every two hours," and in four days her cough disappeared entirely. He states that he afterwards employed the prussic acid in numerous instances of nervous and chronic cough, and always with the greatest success. Having found it thus efficacious in the treatment ,of dry and convulsive cough, he resolved on trying it in consumptive cases. The result of his experience, as given in his first report, is that out of fifteen persons affected with pulmonary consumption, he invariably found the prussic acid, administered in small and repeated doses, "to diminish the frequency of the cough, moderate and render more easy the expectoration. and lastly to procure the patients some sleep at night, without any colliquative sweats." In 1820, Dr. Magen- die published a small work "On the use of Prussic Acid in the treatment of Diseases of the Breast, and particu- larly in Phthisis Pulmonalis," in which much interesting evidence is offered, in addition to what he had already given, concerning the efficacy of this substance in con- sumption and other pulmonary affections. Dr. Granville too, in a late work on the medicinal uses of the prussic acid, adds his testimony in favour of its powers in pulmonary and other diseases.* He relates seventy-nine cases of different diseases, all of which were cured or relieved by this potent article. A consi- derable number of these were phthisis in the early stages of the complaint, and a few of them were already far advanced. We have also some observations from Dr. * Further observations on the internal use of Prussic Acid. London, 1820. NARCOTICS. 97 Scudamore, which strongly indicate the good effects of this remedy. This respectable physician prescribed the acid in the dose often drops a day to two young patients labouring under all the usual symptoms of confirmed phthisis. They both had a fatiguing cough, frequent pulse, were much emaciated, debilitated, and harassed with night sweats and copious purulent expectoration; they also had that peculiar form of the nails which usually accompanies these symptoms. These two patients were perfectly cured by the employment of the acid. In the practice of professor Macneven of New-York, this remedy has been known to produce excellent effects in incipient phthisis. " I have used the prussic acid,'' says he, " with great advantage. It almost always re- moves cough, which accelerates and favours tubercular inflammation in predisposed habits, and thus in many cases prevents the disease."* I have employed it in five cases of phthisis. In two of these the cough, night sweats, and hectic symptoms were considerably relieved. In two I observed no obvious advantages from its use, and in one case it did manifest harm, by the excessive prostration which it produced. In the cure of hooping-cough this new remedy appears, from ample testimony, to be very efficacious. Haneman recommends the aqua lauro-cerasus as exceedingly use- ful in this distressing affection. Dr. Oliver declares, that of all the various medicines which he has employed he has never found one which operated so suddenly in hooping-cough; and Dr. Granville asserts that in no case need hooping-cough be suffered to proceed longer than eight or ten days, if timely and cautious recourse be had to the prussic acid. We have, moreover, the evidence of Dr. John Elliotson, who has recently pub- lished an interesting work on the prussic acid, in favour * American Medical Recorder, vol. iii. p. 574. 98- NARCOTICS. of the good effects of this remedy in the present disease. He has also employed it successfully in a case of chorea; and in pyrosis and various other diseases of the stomach, he considers it a very valuable remedy. He does not, however, offer any thing which goes to confirm the acr counts that have been given of its curative powers in phthisis; and he fears that it must be added to our list of remedies that have been fruitlessly applied to the cure of this disease. It has also been prescribed with advantage in asthma. Dr. Granville states that he has known it afford signal relief in this affection. Dr. Oliver also speaks of it as a valuable remedy in this disease.* In chronic rheumatism the prussic acid has been em- ployed with evident advantage. Dr. Coatesf of this city, in a statement of the result of the use of the prus- sic acid in the Pennsylvania Hospital, in the summer of 1819, observes, that "in two cases of severe chronic rheumatism, and in one of mania, the prussic acid was eminently serviceable, and in combination with subsi- diary means effected permanent cures." Dr. Magendie prefers the pure prussic acid, as pre- pared by the process of Gay-Lussac, and diluted with six times its volume of distilled water, or eight times its weight of the same, to that prepared by Scheele's pro- cess, which is not sufficiently uniform in its power, on account of the liberty which the process leaves to the preparer. The difficulty of procuring this acid of an uniform strength, and the still greater difficulty of pre- serving it from deterioration, has hitherto been a very great objection to its employment in practice. It is therefore very desirable that so valuable and powerful a remedy as this is should be obtained in a more per- manent form than the aqueous solution, which decom- * New-England Medical Journal. t American Medical Recorder, vol. iii. p. 145. NARCOTICS. 99 poses by light, by air, and by the water itself. Profes- sor Thomas Cooper has introduced a preparation that promises to answer this purpose. The following is his process: Into strong rectified alcohol, surrounded by ice, throw a quantity of the prussic acid gas, obtained from the prussiat of mercury. One ounce of such alcohol will, at 32° of Fahrenheit, absorb all the gas that can be procured from four hundred grains of prussiat of mer- cury slightly moistened with about fifty or sixty drops of muriatic acid, and exposed to a gentle lamp-heat in a small retort. Not more than two drops of this acid can be given in a day in doses of one-sixteenth part of a drop.* * The following very interesting remarks and experiments on the effects of hydrocyanic acid and its counter-poisons have been lately published by John Murray, Esq. F. L. S. M. W. S. &c. " I had always found, that the violent head-ach which some- times occurred in preparing hydrocyanic or prussic acid, was re- lieved and removed by ammonia, which induced me to think that the antidote to that acid, and virulent and formidable poison, might be found in ammonia. A small portion of hydrocyanic acid was given to a healthy young rabbit, which proved fatal in ten minutes. Soon after its administration, the head declined on one side, violent spasm su- pervened, while the eye lost its lustre, and the animal'died in dreadful convulsions. On dissection after death, the lobes of the lungs appeared paler than usual, coagulable lymph was found lining the trachea, as in cynanche trachealis, and the stomach was found inflamed near the pylorus. The brain was not examined. The muscular fibre was still excitable by voltaic agency, but the excitability soon declined. A drop or two of hydrocyanic acid on the head of a frog soon proved fatal. The colour promptly changed to an unwonted paleness. The sciatic nerves of the prepared limbs were moistened with hydrocyanic acid, but no suspension of the voltaic excitement su- pervened. It was accompanied by a tremulous movement of the muscular fibre, connected with the lines of the nerves: and this spontaneous irritability seemed increased by the application of alcoholic solution of iodine. It is a singular fact, that not unfrequently an alcoholic solution IQO » NARCOTICS of iodine, dropped on the muscular fibre of a frog, excited pheno- mena similar to the action of the voltaic apparatus. It seemed also to renew excitability when the susceptibility had declined or was lost. When the symptoms were verging to a fatal issue in a frog, a drop or two of ammonia on the head effectually restored the animal. A greater quantity of hydrocyanic acid was given to a young rabbit than proved fatal in the cases detailed. Ammonia was oc- casionally applied to the mouth on a sponge. The animal ex- hibited no unhealthy symptom whatever. A considerable quantity of hydrocyanate of ammonia with ex- cess of base, was administered to another rabbit, but without any deleterious effect. Half a drachm of hydrocyanic acid was given to a healthy young rabbit. The effects were prompt. Respiration became labo- rious and difficult, with a grating in the throat, the eye lost its brilliancy, the head dropped, it raised a sharp cry, and was con- vulsed. Strong ammonia was dropt into the animal's mouth, and it was repeatedly moistened with a sponge dipped into ammonia. It almost instantly revived, and even licked repeatedly the finger which sometimes applied the ammonia, apparently quite sensible of the instant and continued relief afforded. The animal effect- ually recovered Its lips were excoriated by the ammonia. Conscious of the complete antidote of this formidable poison found in ammonia, I took a quantity of hydrocyanic acid sufficient to produce violent head-ache, stupefaction, &c. but diluted am- monia afforded me instant relief. I occasionally applied it to the olfactory organs, and bathed the forehead. Since hydrocyanic acid has been introduced into our pharma- copoeia, and employed in phthisis pulmonalis, and accidental poi- soning may be anticipated, it is of much moment to know an ef- fectual barrier to its virulence ; and such is my complete con- viction of the antidote, that I would feel no hesitation whatever in taking a quantity sufficient to prove fatal, provided there stood by a skilful hand to administer the remedy." CHAPTER X. II. Medicines that increase and equalize the JVervous ANTISPASMODICS. Dr. Cullen, on entering into the general consideration of this class of remedies, says : "Thisis the most diffi- cult subject that has occurred to me ;" and it must be confessed, indeed, that there is no object of the materia medica surrounded with greater obscurity than the modus operandi of antispasmodics. Spasm occurs under such a variety of circumstances, and in such opposite states of the system, that almost every article in the materia medica may, under peculiar circumstances, and in such opposite states of the system, that almost every article in the materia medica may, under peculiar circumstances, act as an antispasmodic. Tous spasm may depend on general debility, in which case tonics and general stimulants are serviceable. On the other hand, spasm may also proceed from, or at least, be attended by, a plethoric condition of the system, as is sometimes observed in cases of hysteria, and then we derive advantages from bleeding. Thus too, spasm very commonly arises from gastric irritation, in which case we resort to emetics and cathartics as the best antispas- modics. But although remedies of this kind may occa- sionally produce antispasmodic effects, yet they do this in an indirect manner; that is, by removing either the debility or the plethora, or the irritating cause upon which the spasm depends, and not by any indirect in- fluence over irregular or morbid muscular contraction. VOL. u.-—Q 102 ANTISPASiMODICS. They are, therefore, not to be ranked with the antispas- modics strictly so called, any more than venesection is to be placed with the stimulants, because, in certain states of congestion, its employment produces strength and fulness of the pulse. There are, however, substances which seem to exer- cise a more direct influence over spasmodic muscular motion. Of the modus operandi of these medicines we know but very little: nor can the utmost ingenuity hope to remove the veil which covers this subject, until the physiology of muscular motion and nervous influence shall be better understood. All that can be said, with any degree of plausibility, on this point is, that as the functions of the muscular system, are not only under the influence, but probably directly dependent on those of the nervous system, we may infer that the remedies which calm the irregular actions of the former must do so by their action on the latter. ASAF03T1DA. This is the inspissated milky juice of a perennial plant, indigenous to Persia, and known to botanists by the name of ferula asafoetida. It is brought to us in dry, hard pieces, somewhat unctuous to the feel, of a brownish, or reddish colour, interspersed occasionally with little shining tears of a whitish hue. Its odour is strong, foetid, and alliaceous, and its taste bitter and acrid. According to Brugnatelli, it contains sixty parts of gum, thirty of resin, and ten of essential oil. Alcohol and aether extract all its virtues. Asafoetida is one of our most penetrating nervine stimulants. Taken in a large dose it excites a more lively flow of spirits, increases the action of the heart and arteries, and induces vertigo. It also acta as a gen- ANTISPASMODICS. 103 tie laxative: but its long continued use is said to weaken the muscular power of the intestines.* I have, how- ever, never observed such an effect from the use of this remedy, although I have frequently employed it for a long time and in large doses. It possesses considerable powers as an expectorant, and may be very usefully employed in cases where we wish to promote expectora- tion, and at the same time stimulate the general system, or allay spasms or nervous agitation. As a palliative in nervous diseases, asafoetida is one of our most efficacious remedies. To allay histeric symp- toms its employment is extremely common; nor do 1 know any other medicine more promptly beneficial in such cases than this one. It may also be advantageously employed to obtain tem- porary relief in hypochondriasis. Independent of its cheering influence in this affection, it is useful by awak- ening the dormant sensibility of the system to the action of other remedies. In the advanced stages of typhus, when the system is much debilitated, and subsultus tendinum, tremor, and slight delirium exist, asafoetida, given in combination with other and more permanent stimulants, is often of very great service. It may also be employed with much benefit in all spasmodic affections of the alimentary canal, unattended by any active inflammation in this part. Much was formerly said of its employment in asthma and croup, and there can be no doubt that it may fre- quently afford much relief in this disease. In the latter disease Miller recommends, in strong terms, a mixturef of this substance in powerful and repeated doses. In the advanced stage of this affection, when by a success- * Burdach's Arzneymittellehre, B. iii. s. 322. t Rj G. asafoetida, 3ii. aq. ammoniae acetat. ^i. aq. pulegii. giii. Solve. Dose, a table-spoonful every half hour to a child two years old. J Q4 ANTISPASMODICS. ful antiphlogistic treatment, the inflammatory condition of the system and of the parts affected have been con- siderably subdued, I have known the asafoetida to do much good in relieving the dryness and hoarseness of the cough, and establishing a more healthy secretion from the lining membrane of the bronchia. In hooping-cough, also, asafoetida will occasionally afford considerable ad- vantage. I have, in a few cases, united this remedy with antimonials, so as to excite vomiting after a few doses have been taken; and it appeared to me that the relief obtained was both more complete and more per- manent than is usually derived from emesis alone. In spasmodic pains of the stomach and bowels from indigestion, asafoetida is a remedy of very considerable importance.* In my own person 1 have found it parti- cularly advantageous for the relief of such symptoms when combined with small doses of opium. Richter states that a combination of asafoetida and ox gall is one of the most effectual remedies we possess for correcting that morbid condition of the stomach which favours the formation of acid. " Some patients," says he," are con- stantly tormented with acid, eat what they may, and even though they take nothing but animal food. In such cases equal parts of asafoetida and ox's gall are of so great use, that I can now, from experience, recommend them almost as a specific"! In cases of habitual costiveness, asafoetida often acts as a useful and invigorating aperient. It is particularly serviceable when the torpor of the bowels is connected with nervous symptoms. In such cases this article may be very advantageously combined with the compound extract of colocynth. Asafoetida has been highly recommended in the treat- ment of caries. J Given in large and frequent doses it is * Cullen's Mat. Med. article Asafoet. t Medical and Surgical Observations, p. 191. j Smucker's Chirurgishe Scriften. See also C. L. Snrjalz Beo, ANTISPASMODICS. JQ£ said to promote the exfoliation of the dead parts and to improve the discharges. It is, however, of more unequi- vocal advantage in the cure of old and ill-conditioned ulcers; and it appears to be more especially efficacious in' cases that are attended with a scrophulous or rheu- matic habit of body.* Asafoetida is given either in substance, emulsion or tincture. The dose in substance is from gr. iii to 9i. or even more, according to the urgency of the symptoms. An emulsion of two drachms of asafoetida, two yolks of , eggs, eight ounces of water, and one ounce of syrup, is to be given in the dose of one or two table-spoonfuls, pro re nata. GALBANUM. This substance is the inspissated milky juice of a pe- rennial plant indigenous to Africa, and known to botan- ists by the name of bubon galbanum. Galbanum is a tenacious substance, of a whitish co- lour when recent, changing to a yellowish red when old. When broken it presents a variegated appearance from the number of white tears with which it is interspersed. Its taste is bitter and acrid, and its odour foetid and strong. One fourth of its weight will be dissolved if triturated with wine, water, or vinegar. To effect a permanent suspension in these fluids the addition of half its weight of some mucilage, or the yolk of eggs, is necessary. The best solvent, however, is a mixture of two parts of bachtungen viberdieguten Wurkungen des stinkenden Asants, by drusen-und knochengeschwiilsten, auch bey dem Beinpasz. In Loder's Jour. f. Chir. ii Bd. iv st. No. 7. * Burdach's Arzneymitt. Lebi. B iii. p. 327. IQQ ANTISPASMODICS. rectified spirits and one of water; this will dissolve all but the impurities of this substance. Galbanum has been a good deal recommended in hys- teric affections ; it is said to be peculiarly adapted to cases of this kind attended with a relaxed state of the system, and a deficiency or a suppression of the cata- menia. I have never employed it in spasmodic diseases. But in one case of habitual asthma, attended with a troublesome cough, I have found it exceedingly useful. In spasmodic and flatulent colic galbanum will often afford very considerable advantage. For this purpose I have known it to be combined with the ol. ricini, with very good effect. In addition to its antispasmodic vir- tues, it possesses no inconsiderable expectorant powers. In the latter periods of pneumonia, attended with consi- derable cough, and a difficulty of expectorating the tough mucus of the bronchia, a solution of galbanum in vine- gar of squills is said to act very beneficially. It has been thought to possess very considerable de- obstruent and discutient properties. It enters into the composition of Smucker's visceral pills, so highly recom- mended by Richter and others in the cure of gutta se- rena.* Externally galbanum is applied to discuss indolent tu- mours. The sum is given in the form of pills in the dose of from §\. to 3i. Dose of the tincture is from 3i. to 3iii. * The following is Smucker's formula: R G. galbani, G. sagapeni, Sapon. venet. 5a 3i. Pulv. rhaei. 3ss. Tart. emet. in aq. font. q. s. sol. gr. xvi. Succ. liquiritiae 3i. M. finat. pil. gr. i, Sumat quotid. No. xv. ANTISPASMODICS. 107 GUM AMMONICUM. According to Wildenow, this is the inspissated juice of the heracleum gummiferum, an umbelliferous plant, indigenous to the interior parts of Africa, the desert of Barka, and the western regions of Egypt. Externally this substance is of a brownish and internally of a whitish, reddish, or deep yellow colour. It has a faint balsamic odour; its taste is nauseous, at first sweet, soon becom- ing bitter and acrid. It is composed of gum, resin, glu- ten, and some volatile oil. Neither water nor alcohol dissolve it completely. In vinegar, aetherial oils, and nitric aether it is, however, perfectly soluble. The antispasmodic powers of this substance do not appear to be of much importance. In spasmodic colic it may, however, be given with much advantage. In this affection, when given in large doses, it not only tends to allay the spasm of the intestines, but also to promote their discharges. In chronic hysteria connected with a cachectic state of the system, and a deficiency of the catamenial discharges, it is very advantageously com- bined with tonics, and particularly with chalybeates. This substance has been thought to possess very im- portant deobstruent properties. It has, accordingly, been much recommended by the German physicians in obstructions of the glandular viscera of the abdomen, and for the cure of such affections as are more or less intimately connected with derangement of those organs. Richter has employed this remedy in combination with other medicines with much success, in the cure of gutta serena; a disease which appears to be not unfrequently dependent on functional disorder of the abdominal visce- ra. " Experience," says this eminent writer, " confirms me more and more in the opinion that the cause of gutta serena is most frequently seated in the abdominal vis- cera, and daily justifies me more in recommending the j0g ANTISPASMODICS. use of deobstruent visceral medicines. I can affirm, that I have frequently performed a complete cure in cases where I hardly expected it, and in some where the dis- ease had actually continued for several years.* G. ammoniac has also been used in hypochondriasis, chronic rheumatism, caries, ulcers, and cutaneous erup- tions. As an external remedy, it enters into the compo- sition of a variety of plasters; and forms an excellent ap- plication to discuss chronic and indolent swellings and glandular indurations. For this purpose it is softened by vinegar, or the vinegar of squills, and spread on leather. Of its expectorant powers, which are very consider- able, I shall speak particularly when I come to treat of that class of remedies. The most agreeable way of exhibiting ammoniac is in the form of an emulsion. 5ii. of this substance must be triturated with the yolk of an egg or 3ss. of gum. arab. gradually adding liv. of water. The dose of this is one or two table-spoonfuls every two or three hours. It is also conveniently given when dissolved in the liquor am- monii acetat. Two drachms of the former may be dis- solved in three ounces of the latter. MUSK. This substance is produced by a quadruped of the ruminant kind called moschus moschifenis, a native of Thibet, Tartary, China, Siberia, and the kingdom of Tangut. The fluid which forms this substance is secre- ted principally by the male; that which is obtained from the female possesses but little odour. It is secreted most * He recommends the following pills: R. G. ammon. assafoetid. sapon. venet. rad valerian, summitat. arnic. aa 3ii. tart, antim. gr. xviii. pil. pond. gr. ii. quarum sumat ter quotid. No. xv. ANTISPASMODICS. 109 Copiously by the animal during its periods of venereal incalescence. The bag in which this secretion is formed is situated immediately behind the umbilicus. It is about three inches long and of an oval shape, having one side convex and the other flat. The musk comes to us in round thin bladders, covered with light brown hairs, of the size of a pigeon's egg. It consists of small grains of a dark brown- ish colour, having a somewhat unctuous feel. Its odour is very peculiar, diffusive, and durable, "and it has the curious property, when added in minute quantity, to augment the odour of other perfumes, without imparting its own." Its taste is bitter. It contains resin combined with volatile oil, a mucilaginous extractive matter, minute portions of albumen, gelatine, muriate of ammonia, and phosphate of soda. TEtius is the first who mentioned this substance as an article of the materia medica. Since his time it has been generally regarded as a very important remediate article. It is undoubtedly one of the most diffusive, penetrating, though fugacious stimulants we possess. It acts parti- cularly on the nervous system, giving a lively impulse to its powers, and a temporary exaltation both to the mental and corporeal energies. It elevates the pulse without increasing the heat of the body. Cullen thought it the most powerful antispasmodic we possess, and there appears to be reason to think that, in this respect, he has estimated its powers too highly. In all spasmodic affections it has accordingly been much employed, and its effects in this way have often been exceedingly useful. Dr. Cullen relates the case of a gentleman affected with spasm of the pharynx, prevent- ing deglutition, and almost respiration. This case was effectually relieved by this remedy, after a very great va- riety of other medicines had been used abortively. Dr. Owen relates a striking example of the efficacy of musk VOL. II.—p 110 ANTISPASMODICS. in an obstinate convulsive affection of a young lady/ Dr. Hillary speaks favourably of its powers in the treat- ment of tetanus, as it occurs in hot climates.f Dr. Richard Huck, also, adduces strong testimony in favour of its remediate effects in this disease. He gave it to the extent of half an ounce, with a drachm of opium, in the course of twenty-four hours,~and by this treatment cured a considerable number of tetanic patients. J Dr. Wall states that he found this remedy highly efficacious in convulsive hiccups, given in the dose of ten grains.§ When given in doses under six grains, he never saw it produce any perceptible advantage. Its powers in the cure of mania, though recommended by several writers of high respectability, are more doubt- ful. In hysteric mania I have seen it given in one case * This case occurred in a young lady who, having received a slight electric shock from a charged vial, felt, in a few hours after, slight convulsive motions, which recurred once or twice a day. The convulsions gradually increased in violence, until they became extremely alarming. " Her fits always began with a disagreeable, rather a painful sensation at her stomach; almost at the same in- stant her mouth and all her features became distorted. Her head was suddenly and violently drawn down to her breast, and the next moment backwards. Her legs, arms, and in short every muscle of her body, at one time or other of the fit. seemed to be violently agi- tated, and became spasmodically contracted. Her paroxysm used to continue ten or fifteen minutes, at the decline of which, as if na- ture was quite exhausted or overcome, her muscles became at once relaxed, and she fell into an hysteric fit of crying, which was suc- ceeded by a comfortable sleep." After oleum succini, with small doses of musk, valerian, opium, bark, steel, cold-bath, aether, cas- tor, and the foeted gums had all been tried ineffectually, he ordered her half a drachm of musk, to be taken every hour. " It was no sooner in the stomach, than the fit, at the beginning of which the first dose was taken, began to abate, and in a minute or two en- tirely went off. In four days she was entirely free from the dis- ease."* t Cullen's Materia Medica. \ Medical Observations arjd Inquir. vol. iii. p. 330. § Philosoph. Trans. No. 474 * Med. Observat. and Inquir. vol. iii. p. 186, ANTISPASMODICS. Ill with evident advantage; though its beneficial effects were but temporary. From its antispasmodic powers it has, indeed, been employed in every variety of spasmodic disease:—in subsultus tendinum, epilepsy, spasmodic colic, spasms of the stomach, cholera, cynanche trachealis, asthma, and even in hydrophobia. Berger, a Swedish physician, recommends musk as a highly efficacious remedy in hooping-cough. He gave it to children in doses of fifteen grains every six hours, and he asserts that the fits of coughing were very generally prevented after six or eight doses had been taken. In gout the good effects of this remedy are much ex- > tolled by Pringle and Cullen. " In another disease," says the latter, ' I can vouch for the powers of musk, and that is in several circumstances of gout." When the gout falls upon the stomach, musk, according to this writer, is an invaluable remedy. In retrocedent gout, affecting the stomach, lungs, or head, large doses are said to give very speedy relief. Having never used it in this disease, I can say nothing either for or against its employment. In the advanced stage of typhus, when great debility, subsultus tendinum, tremors, hiccup, delirium, pale urine, pale and cold skin, and a frequent, small, and corded pulse are present, musk is one of our most valuable remedies. It is also a very useful medicine in the typhous stage of the exanthemata, as well as in the latter stages of peritonitis, enteritis, and pneumonia, when typhoid symptoms supervene. Schmidt, a very respecta- ble German writer, says that musk is particularly useful in the typhus of habitual drunkards. Musk is said to afford much relief in the morbid vigilance, which sometimes attends hypochondriasis. It has also been recommended in vertigo unconnected with any evident fulness of the cerebral vessels. This 112 ANTISPASMODICS. remedy has been employed with advantage in combina- tion with opium or ammonia, to check the progress of mortification.* Musk is generally given in substance, in doses of from six to thirty grains, repeated according to circum- stances. It may also be exhibited in the form of a julep.f There is an article made with the oil of amber and nitric acid, which having nearly, if not altogether, the powers of musk, has received tjie name of artificial musk. It is made by pouring three and a half drachms of nitric acid on one dracnm ofol. succini, and then carefully wash ing the product. This substance appears to be nearly equal in all respects to the natural musk, and is given in the same dose. In pertussis it has been highly recommend- ed; nnd I have, in my own practice, found it decidedly useful in this disease. CASTOR. This substance is obtained from a small animal found in Canada, Poland, Russia, Siberia, the north of Ger- many, &c. and known to naturalists by the name of castor fiber. Near the anus of this animal, there are four small membranous bags, two of which are principal, the other two accessory. These bags contain a fluid which thickens on being exposed to heat, and forms an * Observations on Gangrenes, Mortifications, &c.by C. White. F. R S. 1790. t R Mosch. 3ii. Sacch. albi. ?i. Pulv. g. arab. %\\. Aq. font. |vi. M. Pose, a table-spoonful every two or three hours. ANTISPASMODICS. 113 unctuous concrete substance. It is this substance which forms the castor. The castor has a brownish black colour, possessing a peculiar penetrating, disagreeable odour, and a taste somewhat bitter and hharp. The best castor is brought from Russia and Poland; it comes to us in large black bags, and has a very strong odour. It contains volatile oil, resin, mucilage, extractive matter, iron, and small portions of the carbonate of potash, lime, and ammonia. It contains also, accordiug to the analysis of Laugier, a small portion of benzoic acid. Castor was formerly esteemed as one of the most active articles of this class of remedies. Its reputation, however, as an antispasmodic does not seem to be considerable at the present day. It was at one time re- garded as possessing narcotic properties, but this opinion appears to be entirely without foundation. In combination with assafoetida and aether, I have very frequently employed it in hysteria. I have also occasionally given it by itself with considerable advan- tage in hysteric affections. To derive any advantage from it, however, it should be given in very large doses. Instead of giving from thirty to sixty drops of the tinc- ture, as is commonly directed, I generally administer from two to three tea-spoonfuls of it at a dose. It often affords considerable relief in spasmodic and flatulent colic. It has also been recommended in asth- ma, epilepsy, vertigo, and in the delirium of typhus. Burdach speaks well of its employment in irregular labour pains. Dr. M. Morris, physician to the Westminster Hospital, speaks \ery highly of the efficacy of this article in com- bination with Peruvian bark, in the cure of hooping- cough. He gave eight grains of castor and fifteen of the bark every four hours, with perfect success.* * Medical Obser. and Inquir. vol. iii. p. 283. I J 4, ANTISPASMODICS. Alcohol and proof spirit extract its active properties; water does so but feebly. It may be given in the form of tincture or in substance. ALLIUM SATIVUM. This is one of the most diffusive vegetable stimulants we possess. Taken into the system its peculiar odour very soon manifests itself in the perspiration, the urine, and the pulmonary exhalation. It contains an acrid aetherial oil, which readily inflames the skin, a viscid gummy substance, a sharp extractive matter, resin, and some salts.* Garlic does not appear to possess any very important powers as an antispasmodic. It is, nevertheless, some- times of considerable advantage in cases where expec- torant and antispasmodic remedies are indicated. It is accordingly recommended in spasmodic asthma; and in pertussis and croup it is much in use as a domestic remedy. It cannot, however, be employed with safety in these diseases until the inflammatory symptoms have been subdued by depletory measures. In the advanced stage of croup, when the disease has lost its acute char- acter, I have employed it, while practising in the country, with considerable advantage. In chronic, catarrhal affections, attended with a cold, phlegmatic habit of body, this article is often very serviceable. It is also recommended in the treatment of hysteria, gastric pains from flatulency, and nervous tremors. Dr. Chapman asserts that it is an exceedingly useful remedy in those vertiginous affections which sometimes trouble gouty and intemperate persons. - Pfaff. . ANTISPASMODICS. 115 Its employment in the cure of intermittents, though sanctioned by the authority of Bergius, is of very little consequence. Garlic may be ranked, in this respect, with that host of unimportant articles which have at one time or other been employed to cure agues, and which, though no doubt sometimes Serviceable, have not suf- ficient power to entitle them to any particular con- sideration. Lind and Cullen recommend garlic in the cure of scurvy; and Sydenham speaks well of its powers in dropsy. This substance is a very common domestic remedy for the expulsion of worms. I have known it to be given with decided advantage for this purpose. It is generally administered in the form of a decoction, with L milk, on an empty stomach. VALERIANA. There is perhaps no medicine which has been more extravagantly praised on the one hand; and neglected on the other, than valerian. In some of the modern works on the materia medica it is not even mentioned, whilst in others its virtues are greatly extolled. That it possesses medicinal powers worthy of very considera- ble attention is, however, too well established to admit of a reasonable doubt. The valerian is a perrennial plant, indigenous to England and Germany. The root, which is the only part employed for medicinal purposes, is fibrous, with a central knob, and possesses a strong, peculiar, and un- pleasant odour, and a warm, bitter, and sub-acrid taste. It contains gum, resin, fecula, extractive matter, and an essential oil possessing the peculiar odour of the root, but is considerably milder in taste. 116 ANTISPASMODICS. The root of this plant, when growing on a dry and elevated soil, contains much more essential oil, and is therefore stronger than that which is found growing in low and moist grounds. It loses much of its strength by being kept long, and it ought to be preserved in closed vessels. In its general Operation it acts as a stimulant, producing considerable antispasmodic effects. It excites the action of the heart and arteries, promotes perspira- tion and diuresis, and when taken in very large doses, produces anxiety, vomiting and purging. For some time after Fabius Columna had cured himself of epilepsy by means of this substance, it was regarded as almost a specific in this disease. A more extensive experience, however, showed that, though not destitute of valuable properties, its powers had neverthe- less been greatly overrated. At present, indeed, its reputation in this disease seems to be almost entirely gone. Alibert states, that he tried it with a number of epileptic patients in the hospital St. Louis, and he assures us, that during an experience of, six years, he obtained nothing but negative results.* By Quarin, however, this medicine is highly recommended in cases of epilepsy in infants, depending on some irritation; as, for instance, the irritation produced by worms in the stomach and bowels; and Burdachf says, that it is par- ticularly applicable in cases of this disease depending on a suppression of the catamenia in young females. In hemicrania and vertigo assuming a regular peri- odical form, valerian has been recommended as an efficacious remedy by Cullen. Dr. Barton, also, adds his testimony in favour of its employment in this affection. Cullen, who placed considerable reliance in its anti- spasmodic powers, speaks favourably of its use in hysteria and other spasmodic diseases. In chronic hysteria hi * Elemens de Thferapeutiques, Sec. t Burdach's Arzneymittellehre, B. iii. p. 342. ANTISPASMODICS, 117 females of a cold, phlegmatic temperament, valerian in combination with bark is a valuable remedy. I have employed it in such cases with evident advantage. Hill,* who wrote a small book on the employment of this remedy in nervous disorders, speaks very highly of its powers in such complaints. In every form of asthenic fever, valerian may be very generally employed with advantage. In typhus or ner- vous fever, either in its simple or complicated form, when there exists a spastic condition of the system, cha- racterized by a small, quick, and frequent pulse, a rapid and short respiration, cold and pale skin, trembling and delirium, it has been recommended as very useful, when given in large doses and combined with ammonia or bark. Vaidy considers it preferable to the cinchona in this dis- ease. It appears, however, well established by the ex- tensive experience of M. Chaumeton, that it is, upon the whole, considerably inferior to this latter article f A decoction of this root, administered in the form of a clyster, is strongly recommended by Horn, for the re- lief of tormina and tenesmus. It has also been much employed as a remedy in gutta serena. Both Richter and Smucker speak favourably of its virtues in this dis- ease. It is best given in substance. The dose of the pow- der is from 3ss. to 3iii. three or four times a day. It may also be given in the form of tincture, in the dose of 3ii.—§ss. The infusion formed of 3ii. of the root to |vii. of water, is given in the dose of |ii. two, three, or four times a day. Decoction impairs the powers of this article. The amrnoniated tincture is a very useful pre- paration. Its dose is 3ss.—3ii. twice a day. * Valerian, or the Virtues of that Root in Nervous Disorders, London, 1758. 8vo. t Alibert, Elemens de Therap. torn. ii. p. 119. VOL. H.—Q 118 ANTISPASMODICS. SYMPLOCARPUS FC3TIDA.—SKUNK-CABBAGE. This is a very common plant in the United States. It grows in wet and marshy situations, and is easily re- cognised by its exceedingly offensive odour, being almost entirely similar to that of the skunk or polecat. The inflorescence which appears in April, consists of a boat- shaped, inflated spathe, variegated with red and yellow spots, acute and incurved at the top, containing an oval spadix, having perfect tetrandrous flowers. The fruit, which consists of the maturated spadix, is a globular fleshy mass, containing large oval seeds. The spathe, with its spadix, is the first part of the plant which ap- pears above ground; the leaves afterwards shoot forth, and bear some resemblance to those of cabbage. This plant is perennial. The skunk-cabbage possesses very considerable an- tispasmodic powers. Shoepf, speaking of the root of thh plant, calls it " incidens, califaciens, expectorans," and mentions it as useful in phthisical coughs. As a palliative in the attacks of spasmodic asthma, it is very highly recommended by the Rev. Dr. Cutler and others. I have, in several instances of this disease, de- rived very considerable advantage from the employment of this remedy. The powdered root, in the dose of from thirty to fifty grains, is to be given during the paroxysm, and repeated according to the urgency and obstinacy of the symptoms. The medicine ought to be continued for some time after the paroxysm has entirety subsided. Dr. Thatcher of Boston, states, on the authority of a correspondent, that two tea-spoonfuls of the powdered root of this vegetable, gave very prompt and effectual re- lief in a case of hysteria, after the ordinary remedies for such cases had been used without benefit. The same writer states that it has afforded much advantage in chro- ANTISPASMODICS. \ ] Q nic rheumatism, in wandering spasmodic pains, and in hooping-cough. In chronic cough attended with a cold, phlegmatic habit of body. I have employed the powder- ed root of this plant with the most decided benefit In an old man, who had been for many years afflicted with a very troublesome cough and difficulty of breathing, I found nothing to give so much relief as this substance administered in forty-grain doses once or twice a day. I was, indeed, much in the habit of prescribing this plant, while practising in the country, in cases of chro- nic catarrhal and asthmatic affections, and very gene- rally with evident advantage. The seeds are said to be stronger than the root. "In spasmodic affections of the abdominal muscles during parturition, or after delivery, this root has proved an effectual remedy."* The plant should be kept in close stopped vessels, as its active pro- perties seem to be of a very volatile nature. Decoction greatly impairs its virtues. SULPHURIC JETHER. ^Ethers are the product of the distillation of acids with alcohol. They are limpid, extremely volatile, and light, very odorous and inflammable. The sulphuric aether is the one most commonly employed in medicine. It is of 739 sp. gr. and boils at a temperature of 98°. When perfectly pure this aether consists of oxygen, hydrogen, and carbon; " the rectified aether, however, still contains some water and alcohol, for Lovitz obtain- ed an aether of 632." It is converted into a species of oil by soda and potash, and it robs metallic oxydes of their oxygen. It is only partially soluble in water; but * Thatcher's Dispensatory, 120 ANTISPASMODICS. it unites in every proportion with ammonia and alcohol. It is a powerful solvent of oily and resinous substances, and " takes up about a twentieth part of its weight of sulphur." This aether is an exceedingly diffusive stimulant. Its immediate operation is to excite the brain and nervous system, inducing as its secondary effect a considerable degree of stupor, listlessness, and disposition to sleep. Alibert observes, that when taken a long time, and in strong doses, it is capable of destroying the mucous lin- ing of the digestive organs.* This is one of the most important antispasmodics we possess for the cure of the hysteric paroxysm. When given in combination with opium, its beneficial effects in cases of this kind are generally prompt and decisive, ft may also be usefully employed in various other spasmo- dic affections. It is capable of affording great relief in asthmatic complaints, or where dyspnoea arises from a spastic condition of the respiratory organs. In such cases the simple inhalation of the aetherial vapour is fre- quently sufficient to put a stop to, or at least greatly to mitigate the difficulty of breathing. In catarrhal com- * Dr. Robert Reid, of Dublin, a gentleman of eminence in the profession, in a very interesting paper " On the Pathology and Treatment of Fever," observes, " aether acts directly sedative upon the spinal system. Some time since, I had an opportunity of see- ing the sedative effects of this fluid on the spinal system remark- ably evident, in a case of tetanus. The patient had not been able to swallow the smallest quantity of any thing for two days. I pro- posed that he should get a common enema, with the addition of one drachm of aether. This was done. In a few minutes the pa* tient said he felt a warm glow within; the spasms totally relaxed; he sat up; complained of languor, and ate a bowl of jelly. This fluid is essentially different from alcohol in its effects on the ani- mal economy, though the effect may appear stimulant in the first moment."t f Transactions of the Association of the Fellows and Licentiates of the King and Queen's College of Physicians in Ireland, vol. iii. p. 56, ANTISPASMODICS. 121 plaints, attended with difficult respiration, I have some- times directed the inhalation of this vapour with mani- fest benefit. Alibert states that Pinel and he employed the inhala- tion of the vapour of sulphuric aether with great advan- tage in croup. It is also given to check vomiting and sea-sickness; and has been used with advantage in hooping-cough, chorea, singultus, nervous headach, and vertigo. In the treatment of typhus, this remedy has been a good deal employed in combination with other stimu- lants; and there can be no doubt that it may often act beneficially in this disease, especially when symptoms of spasm attend. It is obvious, however, from the transient nature of its effects, that it ought to be given in very fre- quently repeated doses; and even under its most advan- tageous mode of exhibition it can never be regarded otherwise than, at most, but a useful auxiliary in this disease. It has likewise been prescribed for the cure of intermittents.* Being the lightest and most evaporable fluid known, it produces, in consequence of its rapid evaporation, a sudden and very great reduction of the temperature of those parts to which it is applied; and hence its ex- ternal employment is capable of answering very useful purposes. Charles L. Smalz, physician at Pirna, has published some very interesting observations concerning the utility of this article as an external application in strangulated hernia. In two cases of this kind, after all the usual means of reduction had failed, aether was poured on the hernial tumour. From the cold produced by its evaporation the hernia immediately softened, di- minished, and was readily returned.! Many cases have ♦Rochefort, Cours Elementaire de Matiere Medicate, vol. i. p U8. t Alibert, E16mens de Therap. torn. ii. p. 144. 122 ANTISPASMODICS. since occurred to other practitioners, in which the ap- plication of the aether was found to produce similar good effects. In rheumatism and gout also, the external application of this remedy has afforded very great relief. We are told by Sedillot, who has published a memoir on this subject, (in the Recuiel Periodique de la Societe de Med. de Paris,) that the acetic aether is still more deci- dedly beneficiar as an external remedy in rheumatism and gout, than the sulphuric aether.* A mixture of sul- phuric and muriatic aethers evaporates with so great a rapidity, as to produce a degree of cold several degrees below 0. of Fahrenheit's thermometer. The liquor anodynus Hoffmani, is nothing else than sulphuric aether with the admixture of a small portion of alcohol and oil of wine. The sulphuric aether is liable, according to Gay Lussac, to undergo spontaneous decomposition, when kept a long time without disturbing it; "acetic acid, perhaps some alcohol, and a particular oil, are produced from it." This article is given in the dose of 3i.—5iii. and re- peated according to the exigencies of the case. OLEUM SUCCINI. Amber, which affords this essential oil, is a solid bi- tuminous substance, of a yellowish brown colour, clear and transparent, possessing very little taste or smell. It is dug out of the earth, and found along the coast of the Baltic and Mediterranean. This substance was much esteemed by the ancients, not only for its supposed remediate powers, but also as an ornament worn by the Roman ladies at their public games. * Alibert, Elemens de Therap. &c. torn. ii. p. 144. ANTISPASMODICS. 125 ................stillataque sole rigescunt De ramis electra novis ; quae lucidus amnis Excepit et nuribus mittit gestanda latinis. Ovid. Met. L. if. 1. 364. Amber was called electrum by the ancients, from its property of becoming electric on being rubbed. The essential oil obtained from it by distillation, pos- sesses an acrid pungent taste and bituminous smell. It is very sparingly soluble in alcohol. When taken inter- nally this oil evinces considerable stimulating properties; it heats the system ai d excites the secretions. It has been much recommended in tetanus, hysteria, and other spasmodic complaints. Dr. Chapman says it is very useful in pyrosis, especially if attended with spas- modic pains. I have never employed this article in spasmodic affections, and can therefore give no opinion concerning its powers. Hufeland speaks very highly of the good effects of amber in union with musk, in the cure of gangrene. Leutin also adds his testimony in favour of its employ- ment in this disorder. Liniments of which this oil forms a principal part, have been used with advantage against fixed rheumatic pains, torpidity, and slight paralysis. The oil of amber is given in doses of from ten to thirty drops. By the continental physicians it is fre- quently administered in union with caustic ammonia. Ten or fifteen drops of the oil are put into a glass con- taining a small portion of caustic ammonia, which is to be shook until it becomes of a milky appearance.* * Alibert. CHAPTER XI E. MEDICINES WHOSE ACTION IS PRINCIPALLY MANI- FESTED IN THE CIRCULATORY SYSTEM. Stimulants. The term stimulus, used in its most extensive significa- tion, is applied to whatever agent is capable of exciting the vital energies, or, as it has been expressed, of produc- ing sensation, motion or thought. It is not however in this wide and indefinite sense, that this term is employed in the classification of the materia medica. It is re- stricted to the designation of those remedies which, without producing any evacuations, increase the action of the heart and arteries, and of the nervous power. The articles, however, which, according to the meaning of the term, come under the general title of stimulants, differ very materially from each other in relation to the particular effects which they produce in the animal economy. Thus, a certain set of remediate substances, besides their general stimulant effects, produce, as a se- condary result, insensibility, sleep, and if the dose be very large, apoplectic stupor and death. These are called Narcotics, and appear to act more especially on the nervous system. Another set of stimulant remedies operate with great rapidity, producing an immediate, but transient increase of the action of the heart and arteries, and calm irregular muscular motions, by their power of exciting and equalizing the nervous energy. These are the antispasmodics. A third class of stimulant sub- stances, act more exclusively on the heart and arteries, STIMULANTS. 125 producing a full, strong and frequent pulse, a general warmth and fulness on the surface, and a temporary vigour of the general powers of the system, without manifesting any particular tendency to allay pain, or spasm, or to produce sleep and insensibility. These are the incitants, or stimulants properly so called; and con- stitute the class of remedies which is the object of the present chapter. Stimulants, however, differ from each other, not only in relation to those general effects, by which they are distinguished into narcotics, antispasmodics and incitants, but also in the more intimate or specific impressions which they produce in the animal economy. By Brown and his followers, it was imagined that the operation of all stimulating articles is essentially alike, and that they differ from each other, simply in the degree of activity which they possess. The hypothesis, however, could not stand long before the positive evidence of experience and observation; and it is now, I believe, almost uni- versally abandoned. That stimulants, though agree- ing in their general or obvious effects, are essentially diverse, as regards their specific impressions on the system, is sufficiently evident from the fact, that when the system becomes in a degree insensible to the im- pressions of one stimulus, from frequent repetition, it still retains nearly, if not entirely, its ordinary sensibility to the operation of another agent of the same kind. Thus a person habituated to the use of ardent spirits, will be but triflingly affected by a dose of alcohol, which, in one of temperate habits, would produce very powerful effects, and yet both will be nearly equally affected by the same quantity of opium. If the excitement which these agents produce were not essentially diverse, it would be impos- sible to conceive how this circumstance could occur. But, independent of considerations of this kind, the phe- nomena which result from the action of different stimu- VOL. II.—R Jgfi # STIMULANTS. lants, at once establish the fact of a radical discrepancy in the excitement which they produce upon the organi- zation. By no management, for instance, can asafoeti- da, alcohol, or any other stimulus be made to produce precisely the effects which result from a proper dose of opium. What is here said in relation to stimulants applies, with equal propriety, to every article capable of affect- ing the animal economy. When two phenomena suc- ceed each other as cause and effect, their relation towards each other is positive. The one necessarily follows the other, and whilst the former remains the same, the lat- ter cannot possibly vary. It is evident, therefore, that no agents that are in the slightest degree dissimilar in character, can affect the living system in exactly the same manner, and that the nature of the excitement produced by remedies, must be as various as the reme- dies themselves. If these observations.be correct, then the utility of a copious materia medica, is at once ob- vious. For it cannot be doubted, that our means of controlling morbid excitement, will be in proportion to the extent and variety of the impressions we are enabled to produce on the system. As a general rule, stimulants are forbidden in all cases when bleeding is indicated. When debility is connected with much torpor and insensibility, as in the latter stage of typhus fever, it is necessary to begin with large doses. Where however prostration depends on direct depletion, or is connected with an excitable state of the system, it is of the utmost importance to begin with small doses, and gradually to increase them, as the susceptibility to their influence is lessened by repetition. The power of stimulants appears to be much enhanc- ed by giving them in combination with each other. "There are perhaps no remedies," says Dr. Paris, 'which receive greater mutual benefit by intermixture with each other, than the individuals which compose the STIMULANTS. 127 class of stimulants; they not only thus acquire increased efficacy, but at the same time they lose much of their acrimony; if for instance any one spice, as the dried capsule of the capsicum, be taken into the stomach, it will excite a sense of heat and pain; in like manner will a quantity of pepper; but if an equivalent quantity of those two stimulants be given in combination, no such sense of pain is produced; but, on the contrary, a plea- sant warmth is experienced, and a genial glow felt over the whole body; and if a greater number of spices be join- ed together, the chance of pain and inflammation being produced, is still farther diminished." CARBONAS AMMONIAS.—VOLATILE ALKALI. . The carbonate of ammonia is obtained in the form of white, semitransparent masses, of a fibrous texture, and efflorescing when exposed to the air. It has a pungent and peculiar odour, and an acrid taste. The degree of its solubility is not accurately ascertained. According to Mr. Phillips it is soluble in four parts of cold water; Dr. Duncan says in two parts. It is insolu- ble in alcohol. When dissolved in boiling water, it un- dergoes a partial decomposition with effervescence. The carbonate of ammonia is a very active stimulant, and may be employed as such in a variety of cases, with peculiar advantage. In typhus fever it has been particu- larly recommended by Huxham, Pringle, and others, and some have considered it superior in this disease to any other stimulant we possess. " In the more advanced stages of the disease," says Dr. Chapman, " when the indications of increased debility come on, the volatile alkali, either alone or in combination with opium and wine, is, of all the remedies which I have ever tried, one of the most decidedly useful" In my own practice 128 STIMULANTS. I have been much in the habit of employing this remedy, and it has appeared to me to do more good in the ad- vanced stages of typhus, than the other stimulants usu- ally resorted to in this disease. It may in general be given at a much earlier stage of the disease than other remedies of this kind; for, instead of producing a hot and dry skin, like wine, camphor, &c. when given be- fore the stage of excitement has passed by, it commonly excites a gentle diaphoresis, rendering the skin moist and comfortable, while the action of the heart and arte- ries is raised. " In one respect," says Dr. Chapman, "the volatile alkali differs from every article of the class to which it is attached, and it would seem from all other medicines. The peculiarity to which I allude is this, that the excitement it raises approaches more nearly to that of healthy action, and hence it may be recurred to earlier, than stimulants generally, in the inflammatory affections." In puerperal fever, where the inflammatory action has subsided, and the system is sinking, ammonia has been much used, and it is undoubtedly one of our most im- portant remedies, in cases of this kind. This remedy has also been recommended in the cure of pneumonia. In the latter stage of the disease, when, after much depletion has been practised, expectoration is imperfect, and the pulse is small, and the skin dry, the volatile alkali is a remedy of unquestionable efficacy. It is obvious, however, that so long as bleeding is indicat- ed, this, as well as all other stimulants, cannot be employ- ed without impropriety and mischief. In the typhoid pneumonia which prevailed through the United States a few years ago, I often administered the ammonia in com- bination with a decoction of serpentaria, from the very commencement of the disease, with unequivocal advan- tage. In general the carbonate of ammonia may be re- garded as an exceedingly and peculiarly useful stimulant. STIMULANTS. 129 whenever a hot and dry state of the skin exists, with much prostration of the vital powers. Ammonia may also be given with advantage in the latter periods of phthisis. " Where the cough is trouble- some, the pulse weak, and great debility prevails, the ex- hibition of ammonia is attended with excellent effects. It does not flush the cheeks like most other stimulants."* The volatile alkali has also been much recommended in some affections of the alimentary canal. It is given in flatulent colic, unconnected with inflammation; and in cardialgia, depending on acidity in the primal viae, I have frequently known it to afford very speedy relief. Dr. Chapman slates, that in the nervous or sick headach, " a dose of the volatile alkali will in some instances afford almost instantaneous relief." In the gastric affections which are common to persons of intemperate habits, this remedy is, in general, very beneficial. It is also said to produce excellent effects in diarrhoea and dysentery de- pending on a debility of the intestinal canal.f In these affections it is usually given in combination with opium, and I have myself employed it in this way with benefit. It is only, however, in the chronic form of dysentery that we can venture on the employment of this remedy. When the discharges are not attended with much tor- mina, and seem to depend more on a relaxed, than on an inflammatory condition of* the bowels, it will act very beneficially, not only by giving tone to the intestinal canal, but also by establishing a gentle diaphoresis, and, perhaps, by neutralizing acidity in the primae viae. In chronic rheumatism ammonia may often be used with considerable advantage. Dr. Barton employed the carbonate of ammonia with excellent effect in this dis- ease.! It is more particularly applicable to those slight cases of wandering rheumatic pains and swelling which * Barton's MS. Lectures on Mat. Med. t Burdach, Arzneymittellehre, vol. iii. p. 417. t MS. Lectures on Mat. Med. 130 STIMULANTS remain as the sequelae of an attack of the acute form of the disease. In several instances after the inflammatory symptoms had been subdued by antiphlogistic measures, and pain and stiffness, with a small and irritable pulse remained, I have given the liquid volatile alkali in doses of twenty drops, three or four times a day, with manifest advantage. I am at present treating a case in this way, and the effects of the remedy are such as to encourage me to proceed with it. Dr. Kuhn of this city, was in the habit of employing this remedy in regular gout, with great success.* In the treatment of humoral asthma, pertussis, and catarrhal affections, the volatile alkali has been a good deal recommended by some of the older writers. It does not, however, merit any particular attention in these affections. Dr. Paris states, that he has found it very useful in hoarseness depending on a relaxed state of the throat. In the hoarseness which succeeds measles it is an excel- lent remedy. This salt has also been applied to the treatment of croup. Grittfeld caused his patients to respire the va- pours of it, with a view of exciting cough and expelling the membrane which is commonly formed in the trachea. M. Rechon, a French physician, employed it both exter- nally and internally in this disease; and, as he informs us, with much advantage.! No one at present, however, would, I hope, be willing to place any reliance in this remedy. Nothing but the most prompt employment of depletory measures can be relied on with any degree of confidence in this formidable malady. Bleeding, emetics, calomel, and the warm bath,judiciously employed in the early stages of the disease, will in general rescue the pa- * MS. Lectures on Mat. Med. t Observations et Reflexions sur le Croup; Recueil Periodique dela Societe de Medicine, vol. xxii.—Traite de Matiere Med. par .1. A. Schwilque, torn. i. p. 410. STIMULANTS J 3] tient from danger. After the inflammatory symptoms have been subdued, and a dry cough, with much debility and a harsh skin, be present, the volatile alkali may, per- haps, be employed with some advantage. But in the first or inflammatory stages of the complaint, it would be the height of imprudence, I conceive, to use this remedy. It has also been prescribed in tetanus, epilepsy, and other convulsive diseases. In the treament of apoplexy espe- cially, it was at one time a good deal recommended, but excepting in what has been called nervous apoplexy, or in that variety of the disease which is not connected with cephalic congestions, it is evidently an improper remedy. In cases attended with a pale couutenance and a small and feeble pulse, the, volatile alkali may be a very proper remedy; but where the vessels of the head are turgid with blood, and the face is livid and puffed up, we cannot em- ploy stimulants without greatly endangering the patient's life. This remedy has also been highly recommended in the treatment of syphilitic affections. Peyrilhe, a French physician, speaks in extravagant terms of its efficacy in this disease,* but the experience of others has not yet confirmed the statements made by this writer. Roche- fort says, that he gave the volatile alkali in venereal affec- tions without ever deriving the least advantage from it.f This remedy has also been recently proposed, as a means for arresting hemorrhages. For this purpose the vola- tile alkali is to be dissolved in three times its weight of water, and applied to the bleeding vessels, by means of dassils of lint. Mr. Lapira, a Sicilian chemist, who first recommended its application in this way, made many experiments with it on sheep and dogs, and found it in * Essai sur la Vertu Anti-venerienne des Alkalis volatiles. t Cours Elementaire de Matiere Medicale, par Dem. Dubois de Rochefort, torn. i. p. 136. 132 STIMULANTS. some instances to arrest the bleeding from the divided crural arteries of these animals with much promptness. The volatile alkali, in conjunction with guaiacum, is an excellent remedy in certain states of dropsy and in visceral obstructions. " I have succeeded," says Dr. Barton, " with this medicine when foxglove and squills made no impression on the disease* To counteract the effects of the bites of venomous reptiles and insects, the volatile alkali was formerly con- sidered a very efficacious remedy. It was first recom- mended for this purpose by M. Bernard de Jussieu, who states that he employed it with complete success in a stu- dent who was bitten by a viper. Dr. Ramsay, of South Carolina, has also recorded several instances of its suc- cessful use in cases of this kind; but the late Dr. Bar- ton, who paid a good deal of attention to this subject, considered it as useless in this respect. The Abbe Fon- tana, too, made a number of experiments in relation to the antidotal powers of this remedy, and the result of his experience is, that it is not only ineffectual, but in many cases evidently injurious. Larenti, who has also attend- ed to this subject, found the volatile alkali entirely inef- fectual in every case in which he tried it.f The volatile alkali has also been applied to the treat- ment of cancerous affections. Martini, an Italian, and Hufeland, have published favourable accounts of its effects in this disease. Mr. Home also states, that he cured a scrophulous cancer of the lip, by administering fifteen drops of aq. amnion, three times a day, and gra- dually increasing it to forty drops. After using this re- medy for three months, the ulcer was entirely healed. It is not, however, entitled to any particular attention in this respect. Aq, ammonia is said to possess the singular property * Barton's MS. Lectures. t Ibid. STIMULANTS. 133 of obviating the inebriating effects of alcoholic liquors. This fact was first publicly stated by Dr. Girard of Lyons. Dr. Chantourelle, who was appointed to make a report on this subject to the Medical Society of Paris, thought it might be supposed that this effect arose from the de- composition of the wine by the ammonia; chemical ex- periments, however, showed that such was not the case.* As an external remedy, this article will again be noticed when I come to speak of the Rubefacients. It may be given either in the form of powder or julep.f The dose is from five to twenty grains. The incompatible sub- stances are, sulphuric and nitric acids, nitrate of silver, acetate of lead, muriate of mercury, sulphate of zinc, tartarized iron, the fixed alkalies, lime, alum, magnesia, and sulphate of magnesia. OLEUM TEREBINTHIN.&. This is a limpid essential oil, possessing a strong pe- netrating odour, and a hot, bitter, and pungent taste. In hot alcohol it dissolves without difficulty; but on suffer- ing it to cool, it again separates. It is completely solu- ble in six parts of sulphuric aether. It unites with sul- phur, wax, resins, and balsams, when exposed to a gentle heat. The alkalies have no action on it. The oil of turpentine is an exceedingly active and pe- netrating stimulus; and admits of a great variety of im- portant remediate applications. As a general stimulus in the low states of fever the * Lond. Med. and Phys. Journ. No. 270. t R ammon. carbonat. 3ss. aq. menth. pep. 3vii. syrupi aurantii Jss. M. sumatur octava pars. R ammon. carbonat. ^tiss. G. arab. Sacch. albi aa. Z'l. aq. cin- nam. 5ii. aq. font. 5iii- Dose a table spoonful. VOL. II.—S 134 STIMULANTS. turpentine is but seldom prescribed. It has, however, been recommended in the treatment of yellow fever, by some practitioners both of the West Indies and of the United States. Dr. Physick was, I believe, the first who employed it in this disease. He prescribed it, with much benefit, for allaying the irritability of the stomach, and consequent violent vomitings, which occur in this fever. It does not appear, however, from the experience of other practitioners, that it deserves any very particular notice in this respect. Lately the oil of turpentine has been much recom- mended as a remedy in puerperal fever. Dr. Brennan of Dublin was the first who administered it in this dis- ease, and his report of his experience with it is very fa- vourable.* Other English practitioners have since em- ployed it with benefit in this dangerous malady; but I am not aware of its having, as yet, been employed with any particular advantage by the physicians of this coun- try. In genuine puerperal peritonitis, I should, indeed, be very unwilling to employ this stimulant. It is not improbable, I think, that the cases in which it has been given with success, were of that variety of puerperal fever which seems to depend entirely on intestinal irri- tation, and which simulates, very perfectly, genuine puerperal peritonitis. In the treatment of epilepsy the spirit of turpentine is a valuable medicine. Dr. Latham speaks in high terms of its effects in this disease; and Dr. William Money, surgeon to the Royal Metropolitan Infirmary for sick children, employed it with much ad- vantage in cases of this kind;f Dr. Paris also thinks it may prove beneficial in cases of this kind by unloading the bowels, and by the peculiar cerebral excitement which it produces, when given in large doses, and which * Transactions of the Fellows and Licentiates of the King and Queen's College of Physicians of Dublin. t Medico-Chirurgical Review and Journal, Sept. 1822, p. 451. STIMULANTS. 135 is evinced by a species of intoxication, " unaccompanied by that hilarity and elevation of thought that so usually follow the potation of spirituous liquors. I am inclined to believe, however, that it often acts beneficially in cases of this kind by destroying worms in the alimentary canal. a very frequent cause of epilepsy." Turpentine is a medicine of very considerable utility in chronic rheumatism. In sciatica, especially, it was employed with much success by Dr. Cheyne and Dr. Francis Home.* Of its efficacy in this form of rheuma- tism I have, in several instances, had unequivocal evi- dence. Cheyne gave it with honey, in doses of from one to four drachms, three times a day. Home, how- ever, used it in much smaller doses, and his success was not less than that of Dr. Cheyne. I have commonly given from twenty to thirty drops, three times a day, on sugar, and at the same time directed frictions with the camphor liniment, recommended by Home and Ferriar, for lumbago.f This remedy has lately been much extolled for its ef- ficacy in removing obstinate obstructions of the bowels. Dr. Kinglake gives an account of two cases in which the turpentine manifested decidedly beneficial powers. The first case was one of extreme obstinacy; " bleeding, the warm bath, blistering, lenient and brisk cathartics, with repeated clysters, were assiduously but unavailingly used. The case appeared almost hopeless, when the spirit of turpentine was administered in doses of two drachms, conjoined with half an ounce of castor oil, every two hours. The first and subsequent doses, to the number of four, remained on the stomach, when full and complete catharsis was produced. "| Dr. Paris also adds his testimony in favour of the utility of turpentine * Clinical Experiments. t Pulv. camph. ^n-IJngt. basilic. §i. sapon.commun. fiss.pulv sem. sinap. 3i. Fiat unguent. JLond, Med. and Phys. Jour. No. 271. 136 STIMULANTS. in cases of this kind. " In obstinate constipation de- pending on affections of the brain, I have lately had se- veral opportunities of witnessing its beneficial effects. In an unfortunate instance of hydrocephalus acutus, in a boy of thirteen years of age, it brought away an accu- mulation of feculent matter almost incredible as to quan- tity, after the total failure of the strongest-doses of ordi- nary purgatives."* In chronic cases, attended with flatulence, acid eruc- tations, a sallow countenance, a foul tongue, with grip- ing and acrid stools, the oil of turpentine will frequently produce highly beneficial effects. Dr. Prichard declares, that he never employed any remedy with so much bene- fit as oil of turpentine, in cases attended with such a state of the bowels. " It occasions moderate and regu- lar evacuations, corrects the tendency to a frequent re- petition of griping and irritating stools, and relieves, or completely removes flatulence. At the same time the oil of turpentine exerts a peculiar sedative or tranquilliz- ing power on the nervous system; it lessens irritability, the disposition of starting and convulsive twitching of the muscular fibres, and promotes sleep."f Formerly the spirit of turpentine was frequently em- ployed in hepatic obstructions, and especially in jaun- dice from the obstruction of the bile-ducts by biliary concretions. Its use in these affections is now, however, entirely neglected. In the treatment of obstinate gleets, turpentine, ad- ministered internally, will often produce very good effects. I have also known it to be employed with success in gonorrhoea; but in recent cases it is too irritating to be early given in this affection. As an external remedy turpentine admits of a great variety of useful applications. In the treatment of burns * Pbarmacologia, p. 540. t Prichard on Diseases of the Nervous System, p. 263, STIMULANTS. 137 and scalds it is undoubtedly a remedy of great utility. Kentish, who first employed the turpentine in cases of this kind, directs that it be mixed with a portion of basilicon ointment, with which pieces of linen are to be spread, and laid on the injured part, being careful not to let the ointment extend over the sound skin. When this is done very soon after the burn has been received, it hardly ever fails, in a short time, to remove the burning pain and violent inflammation of the part, and to esta- blish a regular suppuration. Mixed with oil, and introduced on cotton into the ears, turpentine has been found serviceable in deafness arising from a diseased action of the ceruminiferous glands* I have already spoken of the vermifuge powers of this article, under the head of Anthelmintics; and I shall hereafter again have to notice it when I come to speak of rubefacients. As an anthelmintic, turpentine is given in doses of from one to three ounces. When used as a stimulant or diuretic, it is given in doses of from ten to forty drops. Two ounces of the oil, incorporated with a pint of mu- cilage, forms a very valuable clyster, in obstructions of the bowels and flatulent colic. Dr. Nimmo recommends the following method for purifying the oil of turpentine for medicinal use, " with- out diminishing its efficacy, but greatly lessening its disa- greeable taste and its injurious effects upon the kidneys: To eight parts of the oil add one part of the strongest alcohol, and let them be well agitated; in a few minutes a separation takes place; the oil, unless very impure, falls to the bottom, and the alcohol, having dissolved the impurities, floats at the top. Pour off the alcoholic portion, add an equal quantity of alcohol as before, agitate and separate the liquids. If this be repeated * Paris's Pharmacologia. 138 STIMULANTS. three or four times, the oil becomes nearly tasteless, al- most without smell, and when a portion of it is evaporated, it leaves no residue. The oil, however, speedily under- goes alteration, and returns to its original state of greater or less impurity." phosphorus. i Phosphorus is a compact substance, of a pale yellow colour, readily cut with a knife, and exhibiting when broke a vitreous fracture. It is exceedingly combustible, inflaming at the medium temperature of the atmosphere. It has an acrid taste and a strong alliaceous odour. It becomes fluid when put into hot water, and assumes the appearance of an oil. Alcohol and water do not dissolve it; but in the essential and fat oils, and in sulphuric aether, it is quite soluble. Phosphorus is one of the most active and penetrating excitants with which we are acquainted; producing, when incautiously taken, exceedingly violent and dan- gerous effects. When rubbed upon the skin it imme- diately creates a burning pain and inflammation of the part to which it is applied. Taken inwardly, in the dose of from one-eighth to one-fifth of a grain, it pro- duces an agreeable warmth, and temporary vigour of the powers of the system, and increases very considerably the secretion of urine. In somewhat larger doses it produces restlessness, heat, an irritated and feverish pulse, furred tongue, engorgement of the vessels of the head, stricture and dryness in the breast, violent burning and pain in the stomach, nausea, and bilious vomiting. Two or three grains produce excruciating burning pains in the stomach and bowels, attended commonly with distressing vomiting and hiccup; a sinking of the pow- ers, the pulse becoming gradually imperceptible, and the STIMULANTS. 139 whole surface of the body cold, and death. The inflam- mation in the stomach and bowels is generally of small extent. The stomach is commonly found much distend- ed, and the intestinal canal closely contracted in different places. It is said, that when given even in moderate doses, it is apt, on being long continued, to produce indurations of the stomach, chronic vomiting, constipa- tion, atrophy, and death. Weikard states, that he once gave to a paralytic patient two grains of phosphorus incorporated with some conserves. On the following day the dose was increased to three grains, and he pro- posed augmenting the dose progressively, when all at once, on the third night, the patient was seized with violent contractions. Blisters were applied, and copious draughts of mucilaginous drinks given. Nevertheless the patient sunk and died on the fourth day.* Brera relates a similar occurrence in his practice. He ad- ministered two grains to a paralytic woman. After the first dose she appeared to be better; on taking the fourth dose, however, she began to complain of violent burn- ing pain in the stomach and bowels, and in forty-eight hours after she died.f Mentz, a German physician, is said to have been the first who published any thing relative to the remediate employment of this article.]; It is highly recommended by some authors in the treatment of typhus fever. Lob- stein says, that when given in this disease the effects frequently appear after four hours, but sometimes not till twenty-four. " The vital warmth returns, transpira- tion is restored, the pulse improves, the urine is voided freely, and commonly turbid, with a sediment; the abdo- men loses its tension; the excrements have a sulphure- * Alibert, Matiere Medicales, 8cc. vol. i. p. 192. t Brera Rifflessione Medico-prattishe sulF uso interno de Fosforo. Pavia, 1798. t Menzius, Dissertatio de Phosphori loco Medicinse Assumti Virtute Medica. Wittemb. 1751,—in Haller's Disp. Pathol, torn vii. p. 288. 140 STIMULANTS. ous smell, and shine in the dark; the delirium ceases, and the patient recovers his recollection, the mental ' faculties return, and a beneficial sleep restores the strength in a few days."* I do not doubt that its cau- tious Use in the latter stages of this disease may often be followed by salutary consequences. Still, however, as it is an exceedingly active substance, and apt to produce dangerous effects when improperly taken, its use should not be ventured on without the utmost caution. Bur- dach states that it is especially efficacious in the typhus of the exanthemata, where the eruption has receded or does not come out sufficiently, from deficiency of action in the system. Phosphorus has also been given with success in spas- modic and convulsive diseases. Handel mentions seve- ral cases of epilepsy which were cured by this remedy. He relates the case of a girl who had frequent attacks of epileptic convulsions, and who was entirely freed from the disease by taking, in a mistake, some water out of a vial containing phosphorus. Instructed by this case, he says that he afterwards gave it to other epileptic patients, and with much success.f Alibert, on the contrary, states that he gave this substance in one-grain doses, every twenty-four hours, to six epileptic patients, and continu- ed its use for nearly two months, not only without deriv- ing any advantage, but, in the majority of cases, with evident injury. Lobstein, who appears to have paid great attention to the remediate employment of phos- phorus, attributes the dangerous effects which have been observed to arise from its use, to the improper mode in which it has been usually administered; namely, in pills, electuaries, or emulsions. Its beneficial effects, he ob- serves, are only produced when the remedy is completely * J. F. D. Lobstein Recherches et Observations sur le Phos' phore a Strasburg, 1815. Vid. Lond. Med. and Phys. Journal; for October, 1816. t Alibert, Mat. Med. vol. i. p. 192,. - STIMULANTS. 141 dissolved in its vehicle. He found, from much experi- ence, he says, that its solution in vitriolic aether, with the addition of some aromatic essential oil, is a sate and convenient mode of exhibiting this medicine. From one-eighth to one-fourth of a grain of the phosphorus may be thus given at a dose; and experience has shown, that one grain in twenty-four hours is, for the most part, quite sufficient. It is said that phosphorus agrees much better, and can be borne in larger doses, when the atmos- phere is dry and clear, than in cold and damp weather. " It ought never to be taken on an empty stomach, but always an hour after the patient has taken nourishment; salad and acid food, and drink in general, even beer, is improper. To quench the thirst, a mucous solution of salep, with sweet and generous wine, is the best beverage; the patient must also refrain from drinking immediately after having taken phosphorus. In acute diseases, where there is commonly but little appetite, broth, with a little nutmeg, or vermicelli, sago, &c. may be taken; but in chronic disorders, where digestion is not impaired, veal, beef, and mutton, either boiled or roasted; also light vegetables, such as carrots, French beans, &c. are a fit diet. Cabbage, turnips, onions, radishes, rape, cole, peas, &c. must be avoided, causing a sensation of fulness in the region of the stomach, together with anxiety, insup- portable heat, and often vomiting and diarrhoea. The food must neither be too hot nor too cold. In case the patient go out, it is of the greatest importance to be on his guard against catching cold, which is apt to occasion vertigo and diarrhoea, or a relapse "* From what we know of this substance, therefore, there is much reason to believe, that, in the hands of a prudent physician, and employed with the precautions * Lond. Med. and Phys. Jour, for Oct. 1816. See also Lob- stein's Monograph, already referred to, and Lobstein Lobel's Ob- servations, in Horn's Archiv. 1810, B. ii. No. 2. VOL. II.--T |4£ STIMULANTS. mentioned above, it will be found a safe and valuable remedy. ALCOHOL. This is a colourless and transparent fluid, obtained from vinous liquors by distillation. Its specific gravity is .815. It boils at the temperature of 176°, and does not congeal at any known degree of cold. It burns with a pale blue flame, and leaves no residue. In a state of perfect purity, alcohol consists of a combina- tion of carbon, hydrogen, and oxygen. " It dissolves soap, vegetable extract, sugar, oxalic acid, camphoric, tartaric, gallic, and benzoic acid; volatile oils, resins, and balsams; it combines also with sulphur and the pure fixed alkalies, but not with their carbonates." Alcohol is an exceedingly active and diffusible stimu- lus. The effects which arise from its action on the living system, are so well known that it would be surperfluous to give a description of them. Brodie, who made expe- riments with alcohol on living animals, concludes that it is not absorbed, and that its general effects depend on a sympathetic impression on the brain by means of the nerves of the stomach. This he infers from the follow- ing facts: 1. Animals that die from the action of alcohol exhibit a decided inflammation of the stomach, but the brain is never found inflamed. 2. The effects produced by this fluid follow its application so rapidly that it would seem impossible that there could be time for its absorp- tion. 3. Persons labouring under the influence of spiri- tuous liquors are frequently restored by vomiting. 4. When alcohol is introduced into th stomach, combined with rhubarb, this latter substance can never be detected in the urine when examined after deajh.* According to ♦Philosoph. Trans, for the year 1811, p. 178, first part. STIMULANTS. 143 the experiments of Orfila, however, it appears that alco- hol is sometimes absorbed into the circulation; and this opinion is corroborated by other authenticated facts.* Be this as it may, it is evident the phenomena which re- sult from an over-dose of alcohol depend directly on the action which it exerts upon the sensorium commune. The effects which alcohol produces are, indeed, very analogous to those which arise from concussion or com- pression of the brain; and it is not improbable that the symptoms which arise from large draughts of alcoholic liquors, depend mainly on the inordinate flow of blood which they determine to the vessels of the brain, and the consilient compression of the organ. Alcohol in its pure state, is seldom employed as an internal remedy. In the various forms of ardent and vinous liquor*, however, it is an exceedingly common re- medy in all cases of general debility unaccompanied by local inflammations. In the treatment of typhous fever, brandy and wine have long been considered as a princi- pal remedy. When the stage of excitement is over and stimulants are indicated, there is, indeed, no remedy more grateful and beneficial than the prudent use of generous wine. Where there is great prostration it may be given in very large and repeated doses without induc- ing the slightest intoxicating effects. Whenever this is the case, and it produces a fuller, stronger and slower * A singular fact of this kind is related by Dr. Cook, in his Trea" tise on Nervous Diseases,* on the authority of Mr. Carlisle: " A few years ago," says Dr. Cook," a man was brought dead into the Westminster Hospital, who had just drunk a quart of gin for a wa- ger. The evidence of death being quite conclusive, he was imme- diately examined, and within the lateral ventricles of the brain was foundxa considerable quantity of a limpid fluid, distinctly impreg- nated with gin, both to the sense of smell and taste, and even to the test of inflammability. The liquid appeared to the senses of the examining students as strong as one third of gin to two-thirds of water." • Vol. i. p. 221. 144 STIMULANTS. pulse, and renders the skin moist and of a natural warmth, we may be assured that its influence is beneficial. If, however, it render the pulse more frequent and corded, flush the countenance, and induce restlessness, delirium, thirst, and a dry and burning skin, then its effects will be injurious, and we are admonished of the necessity of at once laying aside its use. Wine has been employed with much advantage in tetanus. Bush says, " it should be given in quarts, and even in gallons, daily." Currie saw a patient cured of this disease, in the Liverpool Infirmary, "by drinking nearly a quarter cask of Madeira wine." Dr. Hosack also speaks highly of wine in this disease, and advises.its being given without any other stimulant.* In the chronic form of bowel complaints, the use of the red wines, particularly of port, is almost invariably attended with salutary effects. The slight astringency which these wines possess, renders them peculiarly serviceable in such cases, and wherever a stimulus is indicated and a looseness of the bowels exists, they ought never to be neglected. During the state of convales- cence, from acute diseases, when the vital powrers return slowly to their wonted vigour, wine may be employed with very great benefit. In the debility of old people, wine is especially useful; Pliny, speaking of its salutary effects, says: ..........vino aluntur vires, sanguis Calorque hominum. And it has indeed been emphatically called, " the milk of old age." In relaxed and cachectic subjects, the moderate en- joyment of wine is commonly attended with very agreea- ble and salutary effects. It imparts vigour to mind and * Rush's Medical Inquiries, vol. i. p. 186. STIMULANTS. 145 body, and infuses a genial glow throughout the whole system. Ovid well understood its benign influence. Vina parant animos, faciuntque caloribus aptos, Curafugit multo, diluiturque mero. Tunc veniunt risus, tunc pauper cornua sumit, Tone dolor et curae, rugaque frontis abit, Tunc aperit mentes aevo rarissima nostro Simplicitas, artes excutiente Deo. Alcohol is also used as an external application to sprains and rheumatic swe'lings; diluted with water, it has been much recommended as an application to burns. CAPSICUM ANNUUM.--RED PEPPER. This is a native of South America; cultivated in large quantities in the West-India islands, and frequently also in our gardens, for the beauty of its red pods The taste of the pods, which are the only parts of the plant employed either for medicinal or economical purposes, is exceedingly pungent and acrimonious. They con- tain an oily matter, extractive and fecula. Oersted has obtained the acrid principle of pepper separately, which appears to possess some of the characteristic properties of an alkali. The virtues of the capsicum are entirely extracted by alcohol and aether. This substance is an active and agreeable stimulus, and admits of very useful remediate applications. Ber- gius recommends it as an effectual remedy in obstinate intermittent fevers, connected with much debility and torpor of the digestive organs and intestinal canal. Capsicum has also been prescribed in the latter stage of typhus; and in certain circumstances of this disease, it undoubtedly is a very useful remedy, as I have in several instances experienced in my practice. When the alimentary canal becomes torpid, and ceases to ex- 146 STIMULANTS pel the flatus, giving rise to symptoms of tympanitis, the capsicum with spirits of turpentine, has afforded me very great advantages. I do not think, however, that this article is well calculated to answer our purposes, where we wish merely to excite the general powers of the sys- tem. It is, as Dr. Chapman correctly observes, more a local than a general and diffusive stimulant, and answers therefore exceedingly well, where general debility is ac- companied by much torpor or relaxation of the alimen- tary canal. In the treatment of cynanche maligna, capsicum has been much recommended, both as a gargle and an in- ternal remedy. Mr. Stuart,* in particular, speaks very highly of its powers in this disease. He directs " two table-spoonfuls of the small red pepper, or three of the common Cayenne pepper, and two tea-spoonfuls of fine salt to be beat into a paste, on which half a pint of boil- ing water is to be poured, and strained off when cold; an equal quantity of very sharp vinegar being added to this infusion, a table-spoonful every half hour is a proper dose for an adult." Mr. Stephens gave it to four hun- dred patients labouring under this disease, and u it seem- ed to save some whose state had been thought des- perate." It was also employed with great benefit in this disease by Mr. Collins. He observed, that swallowing the infusion produced slight convulsive motions, and a sensation of heat in the oesophagus and stomach, and in a short time after a general glow over the body was felt, without materially changing the state of the pulse. Mr. Collins also used this remedy successfully in intermit- tent fevers.f Dr. Makitrick states, that he has found this medicine very serviceable " in that morbid disposition which he calls the cachexia africana, and which he considers as a * Medical Commentaries, vol. xii. t Wilson on Febrile Diseases, vol. ii.p. 141. STIMULANTS, I47 most frequent and fatal predisposition to disease among the slaves." Capsicum has also been used in partial paralysis; and Dr. Wright says, that it is an excellent remedy in lethar- gic affections. Lately this medicine has been recommended as highly useful in the advanced stages of acute rheumatism. About five years ago I employed it in a case of this kind, in large and frequent doses, with evident advantage; and I have heard of other practitioners who have given it in this disease with favourable results. Capsicum may be given in the form of pills or tinc- ture. The dose of the powder is from ten to thirty grains. CARVOPHILLI AROMATICA.--CLOVES. These are the unexpanded flower-buds of a beautiful tree of the family of myrtles, indigenous to the Molucca islands, and now carefully cultivated by the Dutch, at Amboyna. The whole tree is strongly aromatic; but the flower-buds, which are collected in October and No- vember, when they are still green, and dried in the sun, after having been exposed to smoke for a tew days, are the only parts met with in commerce, or employed for domestic or medicinal purposes. The taste of cloves is highly aromatic, pungent, and permanent. Their odour is strong, fragrant, and aro- matic. By distillation they yield about one-eighth their weight of an essential oil. Water extracts from them a nauseous and slightly astringent extract, containing very little of their peculiar aromatic taste. All its vir- tues are completely extracted by alcohol and aether. Cloves are the most stimulating of all the aromatic remedies, and may be used with advantage in all cases 148 STIMULANTS. where we wish to produce a strong local impression on the stomach. They have accordingly been frequently prescribed with very good effect in flatulent colic, and in cholera morbus. In the latter affection I have known the tincture of them administered with prompt relief to the patient. The cloves are, however, much more com- monly employed as adjuncts to other remedies than in an uncombined state. The essential oil is used as a local application in tooth-ach. They may be taken in doses of from five to fifteen grains. ZINGIBER.--GINGER. This is the root of a plant* growing spontaneously * in the East Indies, and now abundantly cultivated in ■ some parts of the West. The root is tuberous, a little compressed, and marked with irregular prolongations, which often give it a palmated appearance; the surface is of a pale or ash colour, and sometimes purple. Its taste is exceedingly acrid, producing a glowing heat throughout the whole cavity of the mouth. Its odour is highly aromatic, frequently producing sneezing when* held to the nose. It contains, according to Vauquelin a peculiar acid, a resino-extractive matter, fecula, and an essential oil. The watery and alcoholic extracts are extremely acrid. Ginger is a powerful, but not very diffusible stimu- lant, and appears to possess very useful remediate pow- ers. In an atonic and torpid state of the alimentary canal, attended with colic pains and other dyspeptic symptoms, ginger often affords very great relief. The dyspeptic symptoms and pains in the stomach which are common in gouty persons are frequently much relieved * Amomum Zingiber, Linn. STIMULANTS. 149 by taking the infusion of this root. It has also been employed with success in the cure of intermittent fevers accompanied with torpor of the abdominal viscera;* and in hooping-cough, where the lungs are much oppressed with slime, it is said to be a remedy of very considerable utility. It is usually given in the form of an infusion. By decoction its aroma is dissipated. The dose of the powder is from ten to twenty grains.f PIPER NIGRUM.—BLACK PEPPER. Pepper contains, according to the analysis of Pfaff, a mild essential oil, having the peculiar odour of the pep- per: a dark brown extractive, possessing no acrimony; and a green, acrid, inflammable resin. Alcohol and asther extract all its virtues, but water does so only partially. Pepper is a very permanent and general stimulant, and may be employed in a variety of cases with considerable advantage. Lately it has been recommended as an effi- cacious remedy in intermittent fever. Dr. Louis Frank, privy counsellor and principal physician to her majesty Maria, duchess of Parma, has published a summary of his experience of the utility of black pepper in this dis-, ease, from which it appears that its powers in this respect are not inconsiderable. Dr. Frank states, that by the use of this remedy fifty-four out of seventy patients were completely cured in a short time, without relapse. The mode in which he gave the pepper was, to dip the seeds * Burdach. f Ginger Beer.—" The following is the receipt by which this popular beverage is prepared : Take lump-sugar half a. pound, of cream of tartar half an ounce, bruised ginger an ounce, boiling water one gallon. Ferment for twenty-four hours with yeast." VOL. II.—U 150 STIMULANTS. into mucilage of gum arabic, and afterwards into some powdered colomba to disguise it, and then to administer them as pills. The dose is from five to eight pills twice a day.* None of his patients required more than from seventy to eighty pills for perfect recovery. In an atonic and torpid state of the intestinal canal, a few giains of pepper swallowed two or three times a day, are often very beneficial. Pepper has also been employ- ed in chronic rheumatism with good effects. It is. how- ever, more frequently given in combination with other substances, particularly with tonic bitters; and it may be thus employed with much advantage in weakness of the digestive organs, paralysis, and intermittent fever.f * Journal Complementaire du Dictionnaire des Sciences Medi- cales, No. 22. t Ward's celebrated paste for fistula and piles, contains a large proportion of pepper. It is thus prepared : Take black pepper and elecampane, powdered, of each 5viii. powdered fennel seeds 5xxii. honey and sugar, of each ffe1.; beat, and mix them well together in a mortar. Dose, the size of a nutmeg three times a day. CHAPTER XII. F. MEDICINES ACTING SPECIFICALLY UPON THE ORGANS OF SECRETION. J. Medicines that act on the Cutaneous Exhalants. DIAPHORETICS. These are medicines that increase the natural transpi- ration by the cuticular exhalants. When they augment this discharge to such a degree as to produce sweat, they are called sudorifics; the term diaphoretic being usually applied to such articles as increase the insensible perspiration. But as these two terms express simply a stronger or weaker operation of the same kind, it is cus- tomary in classifications of the materia medica to employ only the latter as a general appellative for the remedies of this class. Obstructed perspiration may depend on very opposite states of the general system. We find it connected with high febrile action, and also with a slow and languid cir- culation. It is evident, therefore, that the remedies which are calculated to restore this function when its defect or loss i> associated with high vascular action, must be very different from those which are calculated to excite it in an opposite state of the system. In the former case our diaphoretics must be such as have a di- rect tendency to lessen the action of the heart and arte- 152 DIAPHORETICS. ries, and at the same time to relax the mouths of the transpiratory vessels. Hence cold ablutions, refrigerants, antimonials, and bleeding are very often directly and manifestly diaphoretic. Wrhere, on the contrary, torpor of this function is accompanied with a languid circula- tion, and with a pale, shrivelled, and cold skin, recourse must be had to diaphoretics of a stimulant character. Although, perhaps, every stimulant may, under certain circumstances, produce sweating, simply by increasing the action of the heart and arteries, yet it must not be supposed that the stimulant diaphoretics act solely by giving a general increase of momentum to the blood, since many of these remedied undoubtedly possess a pe- culiar tendency, not only to determine the circulation to the capillaries of the cuticular surface, without mate- rially augmenting the action of the heart and arteries, but also specifically to excite the activity of the perspi- ratory vessels. Diaphoretics, therefore, act either by relaxing the mouths of the perspiratory vessels, or by increasing their activity, or by establishing an increased flow of blood to them, or, finally, by at once producing both the former and the latter of these effects. Although many of our diuretics are manifestly stimu- lant in their primary operation, yet by the increased eva- cuation which they produce, they are ultimately anti- phlogistic in their effects. Those of the refrigerent class are eminently so, and they therefore constitute very im- portant remediate means in all acute febrile disorders. It is not, however, simply by depleting, that they act be- neficially in acute affections. Much advantage, it may be presumed, is derived from the evaporation and con- sequent abstraction of morbid heat which constantly takes place during diaphoresis. In this way a very con- siderable source of irritation is obviated. There is an- other effect by which these remedies do good, especially in the inflammatory affections of internal organs. They increase the flow of blood to the skin, and thereby re- DIAPHORETICS. 153 lieve, in some degree, the internal inflamed vessels, by a kind of local abstraction from the affected organs. Health is very intimately connected with the regular performance of the perspiratory function. Whenever the transpiration by the skin is suddenly checked, more or less derangement of the system is invariably the con- sequence. That portion of the circulating fluid which nature designs to be cast off by the cutaneous emunc- tories, as no longer fit for the purposes of the animal economy, is retained, and becomes a source of morbific irritation to the heart and other organs. That obstruct- ed perspiration may prove detrimental to health in this way, can, I think, hardly be doubted; for it is obvious, that the accidental obstruction of any important emunc- tory must give rise to an accumulation of recrementi- tious elements of the blood, and impart to it morbific qualities. Frequently the injurious consequences that might result from the retention ol the perspirable matter is in part, if not wholly, obviated by the vicarious action of the internal emunctories, and particularly of the kid- neys. There is, however, another mode in which the sudden repulsion of the perspiratory e'ischarge may ex- cite morbid phenomena in the animal economy: It dis- turbs the regular current of the circulation; the blood retreats to the vessels of the interna! organs, giving rise to congestions, inflammation, and fever. One of the most frequent external causes of obstructed perspiration is exposure to a cold and humid atmosphere. When the body is exposed to the influence of this cause, the circulation in the sub-cutaneous vessels is immediately and manifestly diminished, both in velocity and in vo- lume, and the skin becomes pale, shrunk, and cold. As a natural and necessary result of this condition of the circulation on the surface, the blood is repelled to the internal vessels, and much of that recrementitious fluid which nature intends, and the welfare of the economy requires, to be cast off by the skin, is retained in the 154 DIAPHORETICS. system. There is, therefore, under these circum«^nces, a superabundant portion of deteriorated blood forced upon the heart, which, acting upon it as a preternatural stimulus, brings on sooner or later re-action, or the stage of febrile excitement. From the manifest influence, therefore, of the perspi- ratory function over the health of (he body, it i- obvious that those remedies which are calculated to restore the regular action of the cutaneous exhalants,mtist beof much importance in the cure of diseases. Sudorifics have, indeed, been among the earliest and most common reme- dies in every nation. Valuable, however, as their judi- cious employment undoubtedly is, there is perhaps no other class of medicines which has been so frequently and perniciously abused in the treatment of diseases. Van Helmont and his followers, believing that acute diseases were to be cured by expelling some morbific matter after its proper concoction, employed the most stimulating sudorifics together with high temperature, in every gtade of febrile exacerbation. This practice appears to have been exceedingly common during the seventeenth and early part of the eighteenth centuries. It is easy to per- ceive that its effects must have been highh pernicious. It is not, however, to be concluded from this that dia- phoretic remedies are injurious, even in the most vehe- ment febrile excitement. Quite the contrary, indeed, is the fact; for diaphoresis is, perhaps, always salutary in fevers of high excitement, and the more so in proportion as the arterial action is vehement. The utility or per- niciousness of this discharge, in acute disorders, depends on the means that are used to excite it. It is tKe em- ployment of heating or stimulating remedies for this purpose, that renders the practice so injurious. If we elicit perspiration by cool applications, or by the use of diaphoretics of the refrigerent kind, we in general derive unequivocal advantage from it. Having premised these general observations concerning DIAPHORETICS. J 55 the nature and employment of diaphoretics, I come in the nex place to say something relative to their particu- lar application in certain diseases. Diaphoretics are in general strongly indicated in all those febrile affections which arise from the infl jence of atmospheric vicissi- tudes. As the first link in the chain of morbid actions in diseases from this cause, is torpor of the perspiratory vessels, it is always of great consequence to attend to the full re-estabhshment of this important function in their treatment. In the phlegmasia?, diaphoretics are indeed among our most common, and certainly also among our most useful remediate means, when judiciously employed. But it must not be forgotten, that where the febrile ex- citement runs very high, the stimulating diaphoretics will often do injury, unless the inordinate action of the heart and arteries be previously moderated by bleeding, and evacuations from the intestinal canal. It is not so, however, with the refrigerent or relaxing diaphoretics; these may be resorted to with advantage, in fevers of the most violent inflammatory excitement. In the treatment of remittent and continued fevers, diaphoretics are among our most common and useful remedies. A hot and dry skin is invariably attended with augmented distress, in whatever disease it may oc- cur. When this is the case, nothing affords so much reliefto the patient as a free flow of the pespiration. In general however it is not necessary to excite copious sweating, as every advantage derivable from this source, may be obtained by a degree of diaphoresis just sufficient to keep the skin moist. Before resorting to remedies of this class, the contents of the alimentary canal should be well evacuated. An attention to this is especially neces- sary in cases where there is reason to suspect the exist- ence of vitiated secretions in the bowels. When the action of the heart and arteries is of a high grade, re- course must be had to cooling applications, and to the refrigerent or relaxing diaphoretics, such as nitre, anti- 156 DIAPHORETICS. mony, acids, &c. But in fevers of low vascular excite- ment, attended with a dry and burning skin, the stimula- ting diaphoretics must be used, in conjunction with relaxing applications to the external surface, such as cool or tepid affusions, &,c. In the congestive forms of typhus, nothing is of greater importance than the application of such external means as are calculated to excite the action of the skin and sub-cutaneous vessels. The application of heat, by means of bladders or bottles filled with hot water, and the use of rubefacient frictions of the most active kind, tend in a powerful manner to draw from the congested vessels of the oppressed internal organs, and to re-establish the equilibrium of the circulation. Al- though we should endeavour to keep the skin soft and gently moist in every stage of typhus, copious sweating is not to be encouraged, except in the early stages of the complaint, before the system has become greatly debili- tated. The very intimate sympathetic connection which sub- sists between the cutaneous surface and the lungs, renders the employment of diaphoretics particularly advantageous in the treatment of the inflammatory affections of these organs. When the skin is moist with perspiration, the breathing is generally more free, the pain and distressful feeling in the throat less severe, and expectoration easier. In the treatment of acute rheumatism, diaphoretics are very commonly employed, and they are undoubtedly sometimes of much service. The advantages, however, arising from copious sweating in this disease, are gene- rally but temporary. It mitigates, for a while, the vio- lence of the pain, but is apt to produce much debility, and to render the system exceedingly sensible to the influence of atmospheric vicissitudes. Gentle diaphoresis is not liable to this objection; "and the employment of antimony, in conjunction with calomel and purgatives; or of anti- mony or ipecacuanha with opium in moderate doses, so DIAPHORETICS. 157 as to produce a favourable determination to the surface, is entitled to our fullest regard in this disease."* Some writers speak very favourably of the employment of diaphoretics in gout. It will certainly always be use- ful to preserve a moisture and comfortable temperature of the skin; but profuse sweating can seldom be of ad- vantage, and must often do harm by increasing the sus- ceptibility to the influence of atmospheric changes. Medicines of this class, as is observed by Dr. Scudamore, are also apt to weaken the digestive organs, a circum- stance which is to be particularly avoided in this disease. Whether gout be primarily seated in the stomach or not, it is certain that it is invariably attended by much de- rangement of the digestive functions, and it is therefore a matter of some importance, when we wish to excite a diaphoresis, to use such articles of this class as have the least tendency to weaken the powers of the stomach. When the skin is hot and dry, much relief may be ob- tained by sponging the body with tepid vinegar and vvater, by cool drink, and a moderate temperature.f I have known a gentleman who always, in his attacks of gout, derived much advantage from a weak infusion of the eupatorium perfoliatum, a plant which, along with its diaphoretic, possesses considerable tonic powers. In no class of diseases are diaphoretics more certainly useful than in the bowel affections. Vogeler, Stoll, Akenside, and Richter, were among the first who parti- cularly recommended sweating in the cure of dysentery. More recently, Dr. Moseley has bestowed the highest en- comiums on the sudorific plan of treating this affection. He affirms, " that the intermittent fever is not cured with more certainty by Peruvian bark, than dysentery by di- aphoretics. "J * Scudamore on the Nature and Cure of Gout and Rheuma- tism. t Ibid. $ Treatise on Tropical Diseases. VOL. II.—X 158 DIAPHORETICS. As this disease is essentially connected with a conges- ted and inflamed condition of the vessels of the intesti- nal canal, and as there exists a very intimate relation be- tween the cutaneous capillaries and those of the internal organs, it is obvious, from the general effects of diapho- resis, that it must prove salutary in this affection. It will not only act as a general depletory measure, but also, in an especial manner, derive from the vessels of the affect- ed parts, and thus aid very materially in the reduction of the disease. The influence of the morbid condition of the cutaneous exhalants on those of the bowels, and vice versa, is often manifested in a very conspicuous way. We observe, for instance, dysentery, diarrhoea, and in- flammation of the bowels to ensue from the sudden sup- pression of perspiration; and on the contrary, these dis- eases, from whatever cause they may arise, are almost invariably attended with a dry skin. By exciting the cutaneons emunctories in these affections, therefore, we break the chain of morbid actions, equalize the circula- tion, and give an exit to those recrementitious matters which nature designs to be cast off by the skin, and whose retention cannot but prove injurious to the animal economy. Useful, therefore, as the operation of appro- priate diaphoretics evidently must be in dysentery, ge- neral experience does nevertheless not warrant us in at- tributing to them all the efficacy in this disease which some writers, and particularly Dr. Moseley, have ascrib- ed to them. In cases which arise from the sudden ap- plication of cold to the body, sweating is undoubtedly our chief remedy. In the ordinary autumnal dysenteries, however, or in such as arise from the influence of marsh miasmata, our principal attention must be directed to the biliary organs, and to evacuations from the intestinal ca- nal. After the contents of the bowels have been sufficient- ly evacuated by mild mercurial purgatives, and bleeding premised if the febrile excitement run high, diaphore- tics are always highly useful. For this purpose small DIAPHORETICS. 159 doses of opium, ipecacuanha and calomel answer exceed- ingly well. This combination tends at once to allay the local irritation and pain of the bowels, to correct the bili- ary secretion, and to determine the circulation to the surface and excite diaphoresis. What has just been said of the utility of diaphoretics in dysentery, may be applied with equal force to the treatment of diarrhoea. But as in this disease the intes- tinal exhalants are rather in a relaxed than in an inflam- ed state, diaphoresis is not often adequate of itself to give substantial relief. In addition to those remedies which excite the cutaneous emunctories, and determine the circulation to the external surface, it is generally ne- cessary, also, to resort to such means as are calculated to restore tone to the intestinal exhalants; such as as- tringent and absorbent remedies. Where the diarrhoea depends on vitiated secretion, either of the biliary organs or intestinal glands, neither sweating nor astringents are of much service, unless they are aided by alterative doses of mild mercurial remedies. In the treatment of cholera infantum, much advantage may always be obtained by exciting the action of the skin. Here however we can seldom employ diaphore- tic remedies, on account of the extreme irritability of the stomach, characteristic of this disease; and we are there- fore obliged, for this purpose, to resort to external means, such as frictions, with stimulating or mildly rubefacient articles, the warm bath, flannel rollers applied tightly round the body, &,c. The application of a broad flan- nel roller round the abdomen, is especially useful in the chronic form of this disease, as well as in protracted cases of diarrhoea and dysentery. 4t By this very simple expedient.'" says Dr. Chapman, " I have done great good in these complaints, having very much used it, as is well known, both in public and private practice, long before the appearance of Dr. Dewars book, where it is parti- 160 DIAPHORETICS. cularly noticed.5'* Whatever plan of general treatment we pursue in this disease, we may always derive essen- tial advantage from the concomitant employment of such applications to (he surface as are calculated to excite the action of the sub-cutaneous capillaries. When we consider the intimate relation which exists between the functions of the skin and the kidneys, we would at once be led to expect advantage from the em- ployment of diaphoretics in diabetes. Experience, how- ever, does not furnish us with much evidence of their utility in this respect. A few cases are on record which yielded to the employment of such remedies. Cornickf and Werner| relate instances which were successfully treated with the pulvis ipecacuanha compositus, given in doses of from ten to thirty grains. But we know that opium has been used with success where no particular diaphoresis was produced, and we are therefore not fully warranted, in these cases, to ascribe the benefit derived from this powder to its diaphoretic operation. Dobson cured a case by the warm bath. As the skin is always remarkably dry and harsh in this disease, there can be little doubt that the warm bath or frictions would, in ge- neral, answer very well as auxiliary means. Diaphoretics have also been employed in dropsy. It is, however, generally exceedingly difficult to excite sweating in affections of this kind, nor does this dis* charge, if it can be induced, often afford any particular advantage. There is nevertheless very respectable tes- timony extant in favour of this practice, and it is said to be more especially useful in such cases of the disease as * Dr. Dewar's book, entitled " Observations on Diarrh&a and Dysentery. Isfc." was first published in 1801. Dr. Chapman must therefore be mistaken,as to his having used the flannel roller," both in private and in public practice before the appearance of Dr. De- war's book" f Medical Commentaries, vol. x. t London Medical Journal, 1790, vol. xi. p. 221- DIAPHORETICS. 161 arise from obstructed perspiration, or appear as a con- sequence of measles, scarlatina, or rheumatism. Rich- ter speaks well of the use of diaphoretics in cases of this kind.* Monro and Cotunnius employed Dover's pow- der and opium with antimonials, with success in dropsi- cal affections;! and FrankJ states, that warm bathing is one of our most efficacious means in cases connected with arthritic affections, or arising from repelled cuta- neous eruptions. The ancients excited sweating, in dropsy, by burying the patient up to the neck in heated sand or ashes;§ and Lysons cured cases by placing his patients in rooms heated to a very high temperature. I have never resorted to diaphoretics in dropsy, but I have no doubt that they may often prove serviceable, especi- ally in such cases as depend on a primary disorder of the perspiratory function. Richter says, that they may be advantageously employed with diuretics. Before dismissing this part of my subject it will be proper to say something concerning the rules that are to be attended to in administering these remedies. When we wish to excite sweat, the patient must be confined to his bed. If the pulse be strong, full, and tense, vene- section is to be premised. The state of the general sys- tem is to determine the choice of the diaphoretics to be used. When the action of the pulse is vehement, anti- monials, neutral salts, acidulated drinks, cool ablutions, &c. must be employed. Where no inflammatory excite- ment is present, recourse must be had to stimulating diaphoretics. When the sweat once appears, it should be supported by copious draughts of gently stimulating drinks. The best time for using diaphoretics is after digestion is completed; during the performance of this function the emunctories of the skin are less disposed * Specielle Therapie, torn, iii p. 58. t Observations on the Nature and Treatment of Dropsy, $ De Curand. Homin. Morbis, 1. vi. p. 136. § Celsus de re Medicina, lib. iii. cap. 30. • 162 DIAPHORETICS. to action, WThen the sweat flows, purging and bleed- ing must be avoided, as they have a tendency to check it. The temperature of the room should be kept at a medium point; ynd sudden transitions from a warm to a cold air carefully avoided alter the sweating has sub- sided. THE AF*-<■•. MAL PREPARATIONS. The prepara:* " > ny deserve to be placed at the head of thi cla - -i i *-medies. When taken in large doses they ail produce vomiting; but, exhibited in mi- nute portions, they excite the action of the cutaneous vessels, and ^ive rise to a free transpiration by the skin. It is well knowrn that all emetic substances are capable of exciting sweat when given in nauseating doses. Nausea is invariably accompanied by great relaxation of every irritable part of the system. The cutaneous exhalants especially are always greatly relaxed when under the influence of this feeling, and are thereby ren- dered more permeable to the watery portion of the blood. The diaphoretic operation of antimony does not, how- ever, appear to depend altogether on its nauseating or relaxing effects; and in this respect it differs from the other diaphoretics taken from the class of emetics. It does not appear, for instance, that ipecacuanha has any tendency to excite the vessels of the skin when-given in doses insufficient to produce nausea. Antimony, how- ever, possesses a direct and specific influence upon the capillaries of the skin, as is demonstrated by its occa- sional effect of removing obstinate cutaneous diseases, when exhibited in minute doses. Its effects upon the cutaneous exhalants, when given so as not to excite nausea, appear to be simply an increase of the insensible perspiration; when we desire to produce free sweating DIAPHORETICS. 163 by the antimonial preparations, they must be given so as to cause some degree of sickness of the stomach. In all sthenic diseases the preparations of this metal are de- cidedly the best diaphoretics we possess. For, indepen- dently of the diaphoretic operation of tartarized anti- mony, it appears to possess the power of moderating the action of the heart and arteries,*—a virtue which must render it peculiarly adapted to cases of high febrile ex- citement. But whether it be endued with sedative pow- ers or not, certain it is,* that it has not the least tendency to augment febrile irritation, and may therefore be em- ployed during the most violent arterial excitement. It has been alleged that antimonials do most good in fevers when they do not produce any sensible evacuation by the skin. From my own observations upon this subject I am inclined to believe that there is some foundation for this opinion, and the circumstance does not appear to me to be altogether inexplicable. The function of perspiration is more or less deranged in all febrile dis- orders, from the very commencement throughout their whole course. Torpor of the cutaneous exhalants would appear, in many instances, to be the,very first link in the chain of febrile actions. This is especially the case in those fevers which depend on atmospheric vicissitudes. It is evident, therefore, that the greater portion of those recrementitious elements which nature is constantly cast- ing off in the form of perspiration, remains mingled with the mass of the blood, and becomes an additional source of febrile irritation. Now, whatever contributes most to restore the natural action of the cutaneous emuncto- ries, must also most effectually obviate this source of ir- ritation to the heart and arteries. This appears to me to be the point upon which the explanation of the cir- cumstance in question turns. When antimonials are given in very minute doses, they augment that insensible * Balfour, Lenthois 164 DIAPHORETICS. discharge of matter, the uninterrupted elimination of which is essential to health. They simply invigorate the natural secretory action of the exhalants, and enable them to throw off, in a duly elaborated form, those sub- stances which it is their function to separate from the general mass of the blood. When given, however, so as to produce copious sweating, they give rise certainly to a much greater discharge, but this discharge being more the result of a relaxation of the exhalants, and a conse- quent readier transmission of the watery parts of the blood in a crude state, than of the increased activity of the secretory excitement of these vessels, it does n»t so well answer the purposes in the animal economy which nature intends to fulfil by this emunctory. Sweat can- not be regarded as consisting entirely of recrementitious matter. It unquestionably contains a considerable por- tion of fluid whose retention could not prove detrimental to the living economy. It is not so, however, with the matter that passes off by insensible transpiration. This being a product of regular secretion, and essential to the welfare of the animal economy, is necessarily wholly re- crementitious. It is not to be supposed, however, that the regular discharge of the insensible transpiration w ill be as effectual in all instances as free sweating. The contrary is the fact. In all fevers connected with in- flammation, especially of the internal organs, copious perspiration is beneficial, both as a general depletory measure, and as a powerful means of deriving the circu- lation from the affected organs to the surface. But in idiopathic fevers, attended with a dry and constricted skin, and without any particular indication for direct de- pletion, we in general derive more advantage from anti- monials given in such doses as are just sufficient to re- store the ordinary action of the perspiratory vessels, and to give softness to the skin, than by pushing them to the extent of producing free sweating. In the account given of antimonial preparations in a DIAPHORETICS. 165 former part of this work,* I have already mentioned their use in chronic cutaneous eruptions, in which indeed they often display very important powers. When em- ployed in diseases of this kind, they are always prescri- bed in such doses as produce a slow and insensible operation on the system. They probably prove benefi- cial, chiefly by keeping up a regular discharge of the insensible transpiration by the skin. As a diaphoretic, antimony is employed in various states of preparation. Formerly a great deal was thought of James's powder, a nostrum which, according to the analysis of Mr. Pearson, consists of phosphate of lime and antimony. M. Pulli, a French chemist, has made a very rigorous analysis of this substance; accord- ing- to him, thirty-six grains of James's powder, contain fourteen grains of per-oxyde of antimony, eight of phos- phate of lime, nine of sulphate of potass, and seven of potass.f This preparation is recommended as peculiarly beneficial in febrile affections. Within a few years past Dr. Cheyne of Dublin, has published some obser- vations concerning its employment in hydrocephalic^ and apoplectic cases, from which it would appear that it possesses an obvious tendency to diminish the flow of blood to the head, and to remove the disposition to apo- plexy.J In persons predisposed to apoplexy, or fre- quently alarmed by the usual precursory symptoms of this disease; such as a sense of fulness in the head, vertigo, indistinct vision, tinnitus aurium, &c. the long continued use of this remedy is said to prove highly useful. Dr. Cheyne recommends the following method of exhibiting James's powder, in cases of moderate determination of blood to the head. The patient is to begin with about two grains at bed-time, and to increase * Vol. i. p 57. t Alibert, Elem. de Therap. torn ii. p. 363, | Dublin Hospital Reports, vol. i. 1818. VOL. II.—Y 166 DIAPHORETICS. the dose by half a grain every night, until some sensible effect is produced upon the stomach, bowels or skin. If it excite nausea, the dose must be reduced. When the skin becomes soft, or the bowels affected, the dose must not be further increased. Its use must be per- sisted in for a length of time. Dr. Cheyne says, that the addition of a little rhubarb to this powder renders it less apt to excite nausea. Drs. Crampton and Stoker of Dublin, also mention its good effects in cases of this kind. The pulvis antimonialis, which is an imitation of James's powder, is an excellent diaphoretic in febrile diseases. It is given in doses of from four to eight grains, repeated every third or fourth hour. When ex- hibited in larger doses it is apt, like all the antimonial preparations, to excite vomiting and purging. The kermes mineral, which is a hydro-sulphuret of anti- mony, is held in high esteem by the German and French physicians; and it is certainly entitled to much more attention than it appears to receive from the pro- fession in England and in this country. It is better adapted than any other preparations of this metal, to cases that require a long continued use of antimonials, or where there is much weakness of the digestive organs. Its operation on the stomach is mild, and it may be given a long time without weakening this organ, or bringing on an increased disposition to nausea or vomit- ing. It is said to be particularly beneficial in obstinate scrophulous eruptions of the skin. It is chiefly in chro- nic disorders of the eruptive kind, that its good effects have been particularly noticed. As an emetic, or dia- phoretic in febrile disorders, it is at present seldom em- ployed in any country. As an alterative, it is given in doses of from a half to one and a half grains, either alone, or in combination with guaiac, calomel, extract of cicuta,. solanum dulcamara. &c. The precipitated sul- phuret of antimony resembles kermes mineral, both in DIAPHORETICS. 167 composition and medicinal properties. Its dose is from four to ten grains. But of all the antimonial preparations the tartar emetic is unquestionably the most valuable, in every point of view. It will seldom fail to produce diaphore- sis when properly managed, and it is now almost the only preparation of this metal employed for this purpose. As a diaphoretic in febrile diseases, it is usually com- bined with some of the saline articles of this class. In union with nitre, it forms one of our most efficient re- frigerent diaphoretics, and it is in this way that it is commonl) prescribed for this purpose. When we take into consideration what has already been said concern- ing the sedative effects of this preparation, it must ap- pear obvious that it is peculiarly calculated to do good in sthenic diseases. Given in doses of from one twelfth to. one eighth of a grain, it has been known, in common with the other preparations of this metal, to produce excellent effects in chronic cutaneous affections. When employed for this purpose it may be advantageously combined with gum guaiacum, extract of cicuta, &c. or given dissolved in the infusions of sarsaparilla, solanum dulcamara, burdock, or sassafras-root. It is a singular fact that tartarized antimony has its emetic powers greatly diminished by giving it in union with Peruvian bark. A knowledge of this circumstance may some- times be turned to much advantage in prescribing this latter substance in intermittents. Cases of this disease are occasionally met with, in which the bark appears rather to do harm than good, in consequence of a gene- ral inflammatory condition of the system. In such in- stances we may unite the tartarized antimony with the bark, administer it to the extent of from one to two grains every three or four hours without producing vomiting, but with a manifest antiphlogistic operation. When exhibited with the bark in cases of this kind, it keeps up an agreeable moisture of the skin, reduces ill- 168 DIAPHORETICS. flammatory action, and thereby favours the febrifuge operation of the cinchona* I have already noticed the employment of very minute doses of this preparation in phthisis pulmonalis.f One grain of it dossolved in six or eight pints of water, and used exclusively as a common drink, is stated bv M. Lenthois to have proved successful in a number of cases in his practice. I have used it in one case with a better effect than any other remedy I have ever tried in this disease. Perhaps the very large quantity of water which is taken in this way may contribute something to its good effects. A very free use of bland drinks, with ab- stemiousness, will often do more towards restoring health in chronic inflammatory affections than any other remer dies we possess. RADIX IPECACUANHA. This article is but seldom employed by itself as a diaphoretic, nor does it appear to display any particular powers in this way. Its operation in augmenting the discharge by the skin depends, probably, entirely on its relaxing influence by the nausea it creates. It does not, certainly, evince any manifest diaphoretic powers, unless it be given in nauseating doses. Combined, however, with opium and vitriolated tartar, it helps to form one of our most valuable diaphoretics—the pulv is ipecacuanha compositus,J or Dover's powder, as it is usually called. " In this composition," says Dr. Paris, " the opium is so modified that it may be given with perfect safety and advantage in inflammatory affections * PfafiV System der Materia Medica, B. ii. p. 402. fVol. i. p. 67. J This composition consists of ipecacuanha one part, opium one part, and sulphate of potass eight parts. diaphoretics. ]69 accompanied with increased vascular action. It would seem that whilst the opium increases the force of the circulation the ipecacuanha relaxes the exhalent ves- sels, and causes a copious diaphoresis. The sulphate of potass is also an important ingredient, for experience has fully proved that ipecac, and opium in the same pro- portions, have not so powerful an effect without it." It seldom fails, by proper management, to excite free dia- phoresis, and in a variety of diseases its effects are pecu- liarly serviceable. In the treatment of dysentery, after the bowels have been sufficiently evacuated by mild purgatives, it generally proves highly beneficial. It not only determines the circulation to the surface, but also allays the pain and irritation of the bowels by its anodyne properties. In obstinate cases it may be very advan- tageously combined with small doses of calomel, and given at regular intervals until the gums become tender. In arthritic affections this composition is particularly useful. Given in small doses, two or three times in twenty-four hours, it proves a valuable remedy in the declining stage of acute rheumatism. It may, indeed, be employed with advantage in every variety of sympto- matic fever, attended with much pain and a dry skin. I know of no remedy more useful in peripneumonic in- flammations than this one, after proper venesection has been made. It at once assuages the pain and promotes diaphoresis and expectoration. Drs. Brooke, Percival, Cheyne, and Crampton, speak highly of its efficacy in hydrocephalus. Of its powers in this disease I can say nothing from my own experience; I must confess that 1 should not be inclined to employ it, since opium, in whatever shape it be given, has a manifest tendency to increase the flow of blood to the head. WThere the cephalic affection is purely sympathetic, depending on gastric irritation, opium given in this way may, perhaps, be serviceable. But in idiopathic hydrocephalus there 170 DIAPHORETICS. would be reason, I apprehend, to fear danger from its employment. This powder has also been successfully used in the cure of diabetes.* It does not appear, however, that its virtues in this respect are superior, or, indeed, even equal to simple opium. Favourable accounts have like- wise been given of its effects in dropsy.f . It is given in doses of from five to fifteen grains. When taken with the view of exciting sweat, the patient should be cautioned not to drink any thing- for at least one hour after the powder is taken, as it is very apt to produce vomiting when this precaution is not attended to. NITRAS POTASSiE. The nitrate of potass, or saltpetre, crystallizes in white, semi-transparent, six-sided, and flattened prisms, terminated, for the most part, by dihedral summits. It has a sharp, slightly bitter, and cool taste. It is soluble in seven parts of cold water, and in its own weight at 212°. Alcohol has no action whatever on it. It is not changed by exposure to the air. It is decomposed by alum, sulphate of magnesia, sulphuric acid, the sulphates of zinc, copper, and iron, and partially by the sulphate of soda at the temperature of 32°. When nitre is taken in doses of from ten grains to fifteen, its effects are gently diaphoretic, diuretic, and refrigerent. In doses of from thirty to sixty grains it generally proves aperient; and when swallowed in much larger quantities, its effects are those of an acrid poison, producing violent and obstinate vomiting, bloody stools, * Cornick, Med. Comment, vol. x. Werner, Lond. Med. Jour '790, vol. xi. p. 111,221. t Dr. Chapman's Therapeutics, vol.i. DIAPHORETICS. 171 with all the symptoms of gastric inflammation, convul- sions, and death. Taken in very large doses it often acts particularly and violently on the nervous system, giving rise to "a sort of intoxication, palsy, convulsions, and other nervous symptoms."* Dr. John Butler relates the case of a woman who became affected with a con- vulsive disease resembling chorea, after having swallowed by mistake two ounces of nitre.f The diaphoretic effects of nitre are not very manifest, its operation in this way being commonly confined to an increase merely of the insensible perspiration. It pos- sesses, however, an obvious tendency to moderate the action of the heart and arteries, and t6 diminish febrile heat; and it is consequently one of our most common remedies in diseases attended with high vascular excite- ment. When employed for this purpose it is usually combined with emetic tartar, to which occasionally a small portion of calomel is added. The emetic tartar is a very important addition. It increases its diaphoretic operation, and adds very considerably to its general anti- phlogistic powers. In fevers attended with derange- meut of the biliary organs, the nitre and emetic tartar are very advantageously combined with small doses of calomel. J By such a composition we excite at once the secretory functions of the skin and the liver, and mode- rate the action of the heart and arteries. In bilious re- mittents I commonly employ this medicine until the gums become slightly affected, interposing occasionally a saline purgative. As soon as this effect is induced we very often find the disease to assume a perfect intermis- sion, or at least to become much more mild and manage- able in its progress. In simple inflammatory fevers the * Orfila, Directions for the Treatment of Persons who have taken Poison, p. 65. t Edinburgh Med. and Phys. Jour. No. 53. $ §> Sa!. mtri. 3ss. lart. antim. gr. i. calom. ppt. iv. Divide in pulv. x. one to be given every two- or three hours. 172 DIAPHORETICS. calomel should be omitted. Dr. Wilson Philip speaks very highly of the effects of nitre in counteracting a ten- dency to inflammation in the advanced stages of indi- gestion. " Of all the medicines," he observes, " which I have employed to counteract the inflammatory tendency in the second stage of dyspepsia, I have found none equal to the nitrate of potass taken' in a considerable quantity of water in which a little gum had been dissolved."* Selle,f Richter,J and others recommend a saturated so- lution of nitre in brandy as one of the most effectual remedies in haemoptysis. A table-spoonful of it is to be given every half hour. When nitre has been taken in such quantities as to threaten dangerous consequences, the best treatment, according to Orfila, " consists in causing the patient to swallow a large quantity of suggr and water, of warm or cold water, or of a decoction of linseed or mallows ; by this means the stomach is filled, vomiting caused, and the poison ejected." If symptoms of inflamma- tion ensue, bleeding, together with leeching and blis- tering of the abdomen, and copious draughts of muci- laginous drinks, must be resorted to. PREPARATIONS OF AMMONIA. The carbonate of ammonia has a very considerable tendency to increase the activity of the cutaneous exha- lants. By itself, however, it is rarely employed as a diaphoretic; but saturated with the acetic or citric acids, it forms a pleasant and very useful medicine for this pur- pose. These preparations are usually given in doses of a table-spoonful every hour or two, and they seldom fail * Treatise on Indigestion, p. 222. t Med. Clin. t Specielle Therapie, B. iii. s. 302. DIAPHORETICS. J 73 to excite a flow of perspiration, when assisted by warm and gently stimulating diluents. They seem to hold a middle rank between the relaxing or refrigerant and the stimulating diaphoretics. They do not stimulate or heat the system, nor yet depress or relax it in their primary operation. They tend certainly, in a manifest manner, to moderate febrile excitement, but this appears to be the result simply of the increased discharge by the skin. In fevers attended with a dry and hot skin and a very irritable state of the stomach, the acetate of ammo- nia, or spiritus mindereri, is peculiarly beneficial. It allays the irritability of this organ, and, by promoting perspiration, moderates at once the action of the heart and arteries and the febrile heat. When the arterial ex- citement is not of a very high grade, and the skin is tor- pid, a small portion of laudanum may be advantageously united with this preparation. In cases of this kind I have known the aqua ammonia, given in warm wine whey, in the proportion of about forty drops of the for- mer to one pint of the latter, to produce excellent effects. EUPATORIUM PERFOLIATUM. This plant is indigenous to the United States, and well known by the various familiar names of boneset, crbwswort, vegetable antimony, thoroughwort, &c. Its stem is erect, round, hairy, branching at the top, and rises to the height of from two to five feet. The leaves are horizontal, serrated, rugose, and gradually tapering off from the middle, where they are perforated by the stem, to the extremities. The flowers are white, col- lected into large corymbs at the termination of the branches, and appear in July and August. It grows in low meadows and marshy places. The whole plant is intensely bitter, " without astrin- vol. 11.—z 174 DIAPHORETICS. gency or acrimony." Its bitter extractive, in which the medicinal qualities of the plant appear to reside, is equally soluble in water and alcohol. The decoction forms copious precipitates with muriate of tin, nitrate of mercury, nitrate of silver, and acetate of lead. It con- tains a very small portion of tannin, as is evinced by the solution of isinglass forming a slight precipitate with its tincture.* From Dr. Anderson's experiments it would appear that the leaves are the most active parts of the plant.f The eupatorium perfoliatum possesses important me- dicinal properties. When taken in large doses it excites vomiting and purging; in smaller doses it produces copi- ous perspiration, and acts as a gentle tonic. It has been much recommended by some practitioners of the United States as a remedy in intermittents. Dr. Anderson states, that this remedy was used in nearly every case of inter- mittent that occurred in the New-York Alms-house in 1812, instead of the Peruvian bark, and that it uniformly proved successful. I do not doubt that it has sometimes proved successful in this disease; but the result of my own experience with it, does not lead me to form a very high opinion of it in this respect. I have known it to remove the disease in a few instances, by producing vomiting and copious perspiration. But in the great majority of cases in which I have tried it no manifest advantage was obtained. It has also been administered with very good effects in remitting fevers; and we have the testimony of Dr. Bard and Dr. Hosack in favour of its usefulness as a diaphoretic, in yellow fever. As a diaphoretic it may generally be employed with much benefit in catarrhal fevers. In slight cases of this kind, a weak infusion of it, drank warm on going to bed, will often remove the disease very speedily. It but very * Bigelow's American Medical Botany, vol. i. p. 34. t Inaugural Dissertation. New-York, 1813. DIAPHORETICS. 175 • slightly increases the action of the heart and arteries, and may therefore be employed with advantage in every variety of inflammatory affection. In acute rheumatism the infusion of it. used as a common drink, produces very excellent effects. It seldom fails to excite a mqde- rate diaphoresis, and by this effect to procure consider- able relief to the patient. It can, however, be considered only as an auxiliary to more efficient remedies, and as such it is unquestionably an article of considerable con- sequence. In the epidemic typhoid pneumonia of the winters of 1812, 13. and 14, the eupatorium was a good deal employed by some practitioners, and its effects are stated to have been very salutary. It has also been recommended as a good medicine in obstinate cutaneous diseases. Dr. Barton speaks well of its powers in affec- tions of this kind. Dr. Thacher says, that in anasar- cous swellings of the extremities, depending on general debility, the alcoholic tincture of this plant " may be safely recommended as an excellent tonic."* Dr. Bur- gon, of Bucks county, in this state, has found it very useful in cases of anorexia consequent to drunkenness. " In such cases," he says, " I have used a cold infusion with evident benefit, and I prefer it to any article I have hitherto employed; it very speedily restores the tone of the stomach, and no unpleasant effects follow its admi- nistration."! Dr. Bigelow, also, adds his testimony in favour of its good effects as a tonic in loss of appetite and other dyspeptic symptoms, " as well as in general debility of the system " I have found it particularly useful in very old people labouring under indigestion; it gives tone to the stomach, and renders the skin soft and comfortable. The warm infusion, as is observed by Dr. Bigelow, is an excellent substitute for chamomile tea, to promote the operation of an emetic. * The American Dispensatory. t American Medical Recorder, vol. iii. p. 331. 176 DIAPHORETICS. The powdered leaves are given in doses of from ten to twenty grains, as a tonic or diaphoretic; or an infusion made by pouring a quart of boiling water on two drachms of the leaves, may be used in draughts of about a gill every three or four hours. For excellent figures and descriptions of this plant, see Dr. Bigelow's American Medical Botany, and Dr. Bar- ton's Vegetable Materia Medica of the United States. ASCLEPIAS TUBEROSA. This plant is a native of the United Slates, growing in dry and sandy soils, and well known as a domestic re- ined) by the familiar names of butterfly weed and pleu- risy root. The root, which is the part employed for medicinal purposes, is large, fleshy, spindle-shaped, or branched, of a brownish colour externally, and white and striated internally. It sends up numerous round, and generally decumbent stems, very hairy, and of a reddish colour. The leaves are scattered, narrow, oblong, hairy, waved at the edge, having footstalks at the bottom, bui none at the top. The flowers, collected into umbels at the top, are of a bright orange colour, and appear in July and August. The root of this plant has a slightly bitter taste without any traces of astringency, and yields its active principles entirely to boiling water. Its effects upon the system are those of a diaphoretic and expectorant, without in the least heating the system, or materially exciting the aetion of the heart or arteries. It produces a gentle tonic opera- tion, and when given in large doses proves mildlv laxative. It is, indeed, one of our most useful indigenous medicinal vegetables, being applicable in every case where diapho- resis and expectoration are to be promoted. In pleurisy, catarrh, and other pulmonary complaints, this root often diaphoretics. 177 evinces highly beneficial powers. The late Dr. Barton spoke in favourable terms of its employment in affections of this kind; and Dr. Benjamin Parker of Bradford, Mas- sachusetts, as is stated by Dr. Thacher, has been led, from a very extensive experience with this root, to re- gard it " as possessing the peculiar and almost specific quality of acting on the organs of respiration, powerfully promoting suppressed expectoration, and thereby reliev- ing the breathing of pleuritic patients in the most advanc- ed stage of the disease* He gave it in the form of a strong infusion, in doses of a tea-cup full every two or three hours. We have also the evidence of Dr. Bigelow in favour of the remediate powers of this article " I am satisfied," says he," of its utility as an expectorant medi- cine, and have seen no inconsiderable benefit arise from its use as a palliative in phthisis pulmonalis.f While practising in Lancaster, I frequently employed this remedy in catarrhal affections, and generally with manifest advantage. I have also witnessed its good ef- fects in pneumonia and phthisis pulmonalis: and in one case of acute rheumatism I prescribed it, with much ap- parent benefit. The asclepias has also been recommend- ed as a useful medicine in the fever, diarrhoea, and other distressing symptoms which frequently accompany den- tition. Dr. Burgon, of Bucks county, speaks very highly of its powers in this respect. " It is peculiarly adapted to the diseases of children," he says, "as they freely take it, from its not possessing any disagreeable taste or smell." He recommends the following mode of admi- nistering it. Boil two drachms of this root, in a pint of fresh milk, down to three gills. An ounce of this is to be given two or three times in twenty four hours. It very seldom fails to excite a copious perspiration, and at * Thacher's Dispensatory. t American Medical Botany, vol. ii. p. 65. 178 diaphoretics. the same time proves gently laxative.* Dr. Burgon re- commends it also in cholera infantum, and marasmus. This root may be given either in substance or in de- coction. The latter is however considered the best mode of administering it, About a gill of the strong decoction may be taken two or three times a day. The powder is given in doses of from twenty to forty grains. GUAIACUM OFFICINALE. The guaiacum officinale is a considerable tree, indi- genous to the West Indies and the Brasils. Both the wood and the resinous substance which exudes from in- cisions made into its trunk, possess important medicinal virtues. The wood is compact, heavy, of a yellowish colour, and has but little smell, and a bitterish and slightly acrid taste when chewed. The gummy resinous sub- stance, or gum guaiacum, comes to us in large irregular masses of a greenish-brown colour; it is brittle, and ex- hibits a shining uneven fracture. When reduced to powder it is of a greyish-white colour, becoming green- ish on being left exposed to the air. It melts in a mo- derate degree of heat, and becomes soft and tough when chewed. It has a sweetish bitter taste, and produces a peculiar sensation of acrimony in the fauces when swal- lowed. It has a very faint and peculiar balsamic odour, and when thrown upon hot coals evaporates in fumes, which are exceedingly irritating to the lungs. About nine parts out of a hundred of its substance are dissolv- ed by water; aether dissolves about forty parts in the hundred, and alcohol ninety-five. It is readily soluble in the solutions of the alkalies and in their carbonates. The mineral acids dissolve, and at the same time de- * American Medical Recorder, vol. iii. p. 334. diaphoretics. 179 compose it, being therefore incompatible with it* Ni- tric acid changes the tincture of guaiacum to a beautiful blue colour; which by adding water lets fall a copious precipitate of a light blue, but which soon turns to a green, and finally to a greenish-white colour. With concentrated sulphuric acid it forms a dark carmine red solution, which throws down a lilach coloured sediment on adding water. According to Mr. Hatchett, gum guaiacum is a peculiar substance, possessing neither the characteristics of a resin nor of a gum. Gum guaiacum acts as a pretty strong and general stimulant upon the system. It excites the action of the heart and arteries; increases the heat of the body; and promotes the serous excretions, especially those from the skin and lungs. When taken in very large doses it pro- duces nausea, anxiety, purging with violent pains in the abdomen, and deep sleep. Its continued use has been known to excite a gentle salivation.f Guaiacum was first introduced into medical practice as a remedy in syphilitic affections. Many of the most celebrated medical writers of the preceding century, re- commend it as one of our most useful articles in cases of this kind. At present, however, it holds but a very subordinate rank among our anti-syphilitic remedies. Mr. Pearson, who had ample opportunites of estimating the value of medicines of this kind, says that " guaiacum will often suspend the progress of certain secondary symptoms of lues venerea, for a short time; such as ul- cers of the tonsils, venereal eruptions, and even nodes; but that he never saw one single instance, in which the powers of this medicine indicated the venereal virus."! In the treatment of rheumatism also, this article has been long considered as peculiarly serviceable; and it is un- * Parish's Pharmacologia. f Burdach's Arzneymittel. B. iii. p. 163. \ On the effects of various Articles in the cure of Lues Veiterea, &c. 180 diaphoretics. questionably a remedy of very considerable value in this disease. In the acute form of this powerful affection, after the inflammatory symptoms have been considerably subdued, and wandering pains and swellings of the joints continue to harass the patient, the volatile tincture of guaiacum will often afford great relief. It is occasion- ally also prescribed in gout; but its employment in this disease can only be resorted to with propriety during the intervals of the fits, as it is much too heating to be given in the paroxysm.* In gouty affections of the sto- mach, so frequently experienced in the irregular form of the disease, the volatile tincture of guaiacum is said to prove very serviceable. Many authors speak very fa- vourably of the use of this remedy in old scrophulous affections and in various diseases of the skin. Mr. Pear- son says, " I have given the decoction of guaiacum with the best effects, to a great number of patients, in cuta- neous diseases, in ozoena, and scrophulous affections of the membranes and ligaments." in combination with sulphur, antimony, mercury, dulcamara, &c. it has been recommended as an excellent remedy in tinea capitis, herpes and psora. It is also much prescribed in affec- tions arising from the influence of mercury; and in such cases I have had several striking examples of its useful- ness. The tincture of guaiacum has also been recom- mended in gutta serena, and in painful menstruation. Dr. Dewees of this city has been long in the habit of employing it in this latter affection; and he speaks with much confidence of its efficacy in this respect. The dose of gum guaiacum in substance is from gr. x. to 5ss. The tincture is taken in doses of from one to two tea-spoonfuls. It may also be very conveniently given in the form of an emulsion, made by rubbing the * Scudamore on Gout, p. 189. DIAPHORETICS. 181 powdered gum with the yelks of eggs, and gradually add- ing water to it* DAPHNE MEZEREUM. This is a low shrub, growing spontaneously in the high and woody parts of Spain, France, and the southern districts of Germany. The bark is the only part of this shrub employed for medicinal purposes. It is thin, light, externally of a reddish grey, and internally of a yellow- ish white colour; the parenchyma or internal substance of the bark is of a dark green colour. It has an acrid and burning taste, but no smell. It contains, besides extractive matter, an acrid resinous substance, which according to Pfaff, bears a strong resemblance to the active principle of cantharides.f The bark of the root is much more active than that which is obtained from the stem or branches. Applied to the skin in a fresh state or in powder, mois- tened with spirits or water, it produces inflammation and vesication, attended with a good deal of burning and smarting in the part. Taken internally in large doses it occasions vomiting, violent pain in the stomach, in- flammation, gangrene, and death. In smaller but full doses, it sometimes produces heat in the stomach, nausea, vomiting, griping pains, diarrhoea, vertigo, headach, weakness, anxiety, convulsions, &c. It affects the re- spiratory organs, giving rise to pain in the breast, diffi- culty of breathing, cough and hoarseness. It promotes the secretory action of the kidneys; and has been known * " Jesuit drops. This is nothing more than the Elix. Anti. ve- nereum of Quincey, consisting of guaiacum, balsam of cofiaiva, and oil of sassafras, made into a tincture by spirit." t System der Materia Medica, B. iii. p. 195. VOL. II.—a a 182 DIAPHORETICS. to bring on bloody urine. It also increases the activity of the cutaneous exhalants.* The mezereon bark has been much recommended in a variety of affections. In obstinate diseases of the skin it was formerly a good deal prescribed; and it has been particularly commended for its powers in affections de- pending on a syphilitic taint, or in such as arise from the injurious influence of mercurial remedies. Its reputa- tion in this respect does not, however, appear to be very great at present. Mr. Pearson states, that *' from all that he has been able to collect in the course of many years' observation, he feels himself authorised to assert unequi- vocally, that the mezereon has not the power of curing the venereal disease in any one stage or under any one form." Some later writers have spoken more favourably of its powers in affections of this kind, and especially in the mercurial diseases. It has also been recommended in chronic cutaneous eruptions. Dr. Cullen states, that he found it successful in diseases of this kind; and Dr. Pearson knew it to confer temporary benefit in an in- stance or two of lepra. I have not had a great deal of experience with this remedy myself, but from its effects in some old syphilitic complaints, in which I prescribed it, I am inclined to attribute to it considerable remediate virtues. Dr. Withering states, that he has known this bark to produce very good effects in difficulty of swal- lowing. He mentions one case of this kind, of very long standing, which was entirely cured in two months by chewing the mezereon root The best mode of exhibiting this remedy is in decoc- tion. Half an ounce of the bark, with the same quan- tity of liquorice root, may be boiled in three pints of water down to a quart, and given in doses of half a gill four times a day. * Burdach, Arzneymittellehre, B. iii. p. 169. diaphoretics. 183 SMILAX SARSAPARILLA. This is a climbing plant growing in low and humid situations in various parts of South America, and in the western parts of the United States. The root, which is the only part employed in medicine, is composed of a great number of long and slender creeping radicles, of a yellowish brown colour externally, and white within. It has a slightly bitter and mucilaginous taste, but no odour. It contains fecula, in which its active properties appear to reside, and vegetable albumen. Boiling water readily and completely extracts its active principles. The medicinal character of this root has been very variously represented. According to some writers, it pos- sesses no powers whatever; whilst others represent it as being endued with highly valuable properties. When first introduced into practice it was strongly recommend- ed as a remedy in venereal affections. It did not. how- ever, long sustain its character in this respect. Cullen thought it unworthy of a place among the materia me- dica; and Pearson declares, that "he feels himself au- thorised to assert, that the sarsaparilla has no power of curing any one form of the lues venerea." Lately how- ever, it has again come into notice, and many of the most respectable practitioners of the present day employ it, and speak of it as a medicine of very useful powers in complaints of this kind. It is thought to be particu- larly useful in those chronic venereal disorders which resist the influence of mercurial remedies, as well as in those affections which occasionally arise from the action of mercury. My own experience with this root has not been extensive; but from what I have seen I am inclined to regard it as capable of affording considerable advan- tages, when employed as an auxiliary to other more ef- ficient remedies. It has also been recommended in scrophulous and 184 DIAPHORETICS. rheumatic affections, and in some of the chronic diseases of the skin. Qnarin regarded the decoction of sarsa- parilla as the most useful remedy we possess in gout, when administered conjointly with antimonial remedies. Sydenham, also, considered it useful in the declining stage of this affection; and Scudamore says, it will some- times prove beneficial during the state of convalescence. It is usually given in union with other articles of the same kind, particularly with guaiacum, mezereon, sassafras root, &c* According to the experiments of Mr. Battley of Lon- don it appears that the active properties of sarsaparilla reside exclusively in the cortical part of the root, and that its virtues may be effectually extracted by infusion in cold water. The woody or central part possesses no medicinal powers whatever; and it follows, as Mr. Batt- ley observes, " that when the cortical part has been ma- terially injured, or when, in the preparation of the me- dicine the ligneous part of the root has been chiefly re- garded, the remedy so prepared must be, in a great mea- sure, if not wholly, inefficacious."! The decoctum sarsaparillae compositum of the Lon- don and Dublin Pharmacopoeias, is taken in doses of from 5iv. to gvi. three or four times a day. LAURUS SASSAFRAS. The laurus sassafras is a very common tree through- out every part of the United States. Its bark has a * The once celebrated Lisbon diet drink is made according to the following formula: R R. sarsaparillae, R. chinae, aa §i. nucum juglandis cortice siccatarum, No. xx. antimonii sulphureti |ii. lapidis pumicis pul- verizati $\. aquae distillatae ffex. To be made into a decoction. t London Medical Repository, for Feb. 1819. DIAPHORETICS. 185 fragrant smell, and an agreeable aromatic taste. It con- tains a large proportion of an essential oil, upon which its taste and odour as well as its medicinal properties ap- pear to depend. It is said also to contain a small pro- portion of camphor, and some resinous matter.* Its ac- tive principles are extracted both by alcohol and water. The watery infusion is red, possessing the peculiar odour and taste of the sassafras, and changes to an olive green colour by the addition of sulphate of iron. The bark and pith of the young branches contain a great deal of mucilage. " A very small quantity of pith, infused in a glass of water, gives to the whole a ropy consistence, like the white of eggs. This mucilage has the uncom- mon quality that it is not precipitated, coagulated, or ren- dered turbid by alcohol."f This mucilage is an exceed- ingly good application in acute ophthalmia, and it is no less useful as a demulcent in catarrhal and dysenteric af- fections. The sassafras was at one time held in very high es- teem as a remedy in syphilis, cutaneous eruptions, $cro- phula, and rheumatism. At present it is not much em- ployed in practice, but I am convinced from my own ex- perience with it, that it is entitled to much more atten- tion than it now receives. Alibert speaks very favoura- bly of its virtues in rheumatic affections. He adminis- tered it frequently at the Hospital St. Louis, and it al- ways appeared to him, he observes, to exert a manifest action on the cutaneous emunctories. He mentions a case of chronic rheumatism which yielded to the infu- sion of sassafras, after a great variety of other remedies had been tried ineffectually. He speaks also of two cases of gout in which the sassafras was employed with complete success.| I have known the long continued * Pfaff 's Mat. Med. vol. iv. p. 242. t Bigelow's American Medical Botany, vol. ii. p. 145. t Alibert, Nouveaux Elemens de Therapeutique, torn- ii. p. 302. 186 DIAPHORETICS. use of an infusion of this article effectually to cure a case of inveterate rheumatism. Sassafras enters as an ingredient into the decoctum sarsaparilla comp. It is generally employed in the form of an infusion; but the oil is the most efficient, and therefore the best preparation. When this is used it should be rubbed up with mucilage, sugar, and water. The infusion of the flowers is also frequently employed. XANTHOXYLUM FRAXINEUM—PRICKLY ASH. The prickly ash is a tall shrub, indigenous to the United States, in many parts of which it grows in con- siderable abundance. The bark is aromatic and very pungent to the taste, the pungency being perceived only after it has been held in the mouth for some time. The leaves also are considerably aromatic, but have not the pungency of the bark, and resemble those of the lemon- tree in odour. " The rind of the capsule is highly fra- grant, imparting to the fingers, when rubbed between them, an odour much like the oil of lemons. The odor- ous portion is an essential oil residing in transparent ve- sicular points on the surface of the capsules, and about the margins of the leaves. The acrimony which resides in the bark, has its foundation in a different principle, being separated by decoction, but not by distillation."* The bark of this shrub is a warm stimulant and dia- phoretic, being analogous to mezereon and guaiacum both in its sensible and medicinal properties. In this country it has been a good deal employed as a remedy in chronic rheumatism, and I have no hesitation in say- ing, from my own experience, that it is a medicine of very considerable value in this complaint. Its continu- * Bigelow's Amer. Med. Bot. vol. iii. p. 158. DIAPHORETICS. ]§7 ed use has been known to produce salivation. " A lady in Buckingham," says Dr. Burgon, " who had taken a considerable quantity of the tincture for rheumatism, was completely salivated by it, and challenged her phy- sician with giving her mercury. I have heard much of its salivating, but have never witnessed this effect from its administration: chewing the capsules powerfully pro- motes the flow of saliva."* Dr. Bigelow states that he gave the bark of this shrub in doses of ten and twenty grains, in rheumatism, with considerable advantage. "In one case," he observes, " it effectually removed the com- plaint in a few days;" but in some instances he found it entirely ineffectual.! I once employed this remedy in a case of rheumatism attended with an obstinate eruption on the skin, and succeeded perfectly in relieving both these affections. I had reason to believe that the dis- ease depended on a syphilitic taint. This article has also been recommended as an excel- lent remedy in malignant ulcers. For this purpose it is used both internally and externally. Several instances of its efficacy in this respect are related in the Medical and Physical Journal, and in the Transactions of the Medical Society of London. It has also been found very useful as a topical stimulant. It is generally given in decoction. One ounce of the bark to a quart of water, boiled down one-third, may be taken in doses of a gill, repeated five or six times in twenty-four hours. The powdered bark may be given in doses of from twenty to thirty grains. For an excellent figure and description of this shrub, the reader is referred to Bigelow's Medical Botany, vol. iii. * American Medical Recorder, vol. iii. p. 333. t Amer. Med. Botany, vol. iii. 188 DIAPHORETICS. SAPONARIA OFFICINALIS. This plant is common to France, Germany, and Eng- land, and is now naturalized and abundant in the United States. It has a long, creeping, articulated and knotty root, of a reddish brown colour externally, and white within. The stem is erect, branched, jointed, and from five to eighteen inches high. The calices are cylindric, and the flowers white. It grows among rubbish along road sides, and near neglected out-houses. It flowers in July. The whole plant has a bitterish and slightly acrid taste. The infusion of the leaves assumes a pale black colour on adding to it some sulphate of iron; the decoction of the root, however, undergoes no change by the addition of this salt. A saponaceous substance may be obtained from the decoction of the recent leaves, which appears to contain all the active properties of the plant Alcohol extracts an acrid and penetrating sub- stance.* The soapwort has been highly recommended for its medicinal powers. Alibert, whose opinion merits great deference, observes that it is surprising that this plant is not more frequently employed; its energetic proper- ties entitling it to a distinguished rank in the materia medica. In rheumatic affections depending on a syphi- litic taint, and in arthritic pains, it is stated to be an ex- ceedingly useful remedy. " It often happens," says Alibert, " that venereal affections resist the powers of mercury; the symptoms increasing instead of diminish- ing under its inffuence. In such cases the saponaria produces excellent effects. I have very frequently ad- ministered this remedy in scaly tetters, (dartres furfura- ceus,) and I have had occasion in a great variety of in- * Alibert, Elemens de Therap. vol. ii. p. 333. DIAPHORETICS. 189 stances, to be satisfied that this valuable plant is too much neglected by practitioners."* I once saw a case of herpetic eruption entirely cured by the use of this ar- ticle, after it had resisted almost every other treatment recommended in such cases. It is also said to be very serviceable in scrophulous and other ill-conditioned ul- cers; particularly in venereal ulcerations of the throat and mouth.f The saponaria is usually given in decoction; and the root is said to be much better for this purpose than the plant. The decoction may be made by boiling two ounces of the root in two quarts of water, down to one quart; the whole of which is to be taken in twenty-four hours. SULPHUR. I have already given an account of the medicinal powers of this substance in the chapter of cathartics, and need, therefore, in this place do little more than to notice more particularly its tendency to act upon the cu- taneous system. Sulphur has been long celebrated, both as an internal and an external remedy in the cure of chronic cutaneous diseases. It has also been highly recommended in rheumatic and gouty affections, and in diseases of the lymphatic system.^ Not to repeat, how- ever, what I have said upon this subject in the first vo- lume^ it will here be necessary only to add something concerning the effects of this remedy when applied ex- ternally in the form of fumes. Sulphureous fumigations * Alibert, Elemens de Th6rap. vol. ii. p. 332. t Burdach, Arzney. B iii. p. 150. t Alibert, Soemmering, De Morbis vasorum absorbentium, ke. §Page 137. VOL. II.—iB b 190 DIAPHORETICS. have been highly extolled, within a few years past, in the treatment of a great variety of obstinate complaints. Dr. Gales, of Paris, was the first who introduced this method of applying sulphur. The apparatus which he used for this purpose consisted of a wooden case, having an aperture in the upper part. The fumes arising from ignited sulphur are applied to the naked body of the pa- tient seated in this box. with his head out of the aperture at the top. Around the edge of this opening a leather bag is fixed, which being fastened round the neck, pre- vents the fumes of the sulphur from reaching the eyes, nose, or mouth. The immediate effects experienced from fumigation, is a sense of prickling heat in the skin, which is soon followed by profuse perspiration. The diseases in which sulphureous fumigation has been found most beneficial, are chronic rheumatism, psora, lepra, and herpes. Dr. Gales relates many cases of this kind, in which the good effects of this treatment were surprisingly prompt. Dr. de Carro of Vienna, who introduced the sulphureous fu- migating baths into Germany, has, also, published the result of his experience with this remedy; and we are informed that, in the majority of the cases, " the benefit derived was very striking, and the shortness of the period necessary for the cure really astonishing." Alibert ob- serves, that the pustular and papular itch are not equally benefited by( sulphurous fumigation. The former va- riety is almost always exasperated by the contact of sul- phurous vapours, whilst a liquid application, composed of a certain proportion of sulphur of potass and sulphuric acid, readily cures it. This is also the case in long standing and cachectic cases, attended with brown crusts of different sizes scattered over the arms and thighs. Frictions with sulphur ointment alternated with simple baths, are generally sufficient to remove this variety of the disease; whilst fumigations often are followed by no DIAPHORETICS. 191 evident advantage. The papular itch, however, may be treated with peculiar advantage by fumigation.* It appears from the observations of MM. Alibert and Biett, that many persons are wholly incapable of sup- porting the influence of sulphurous fumigations. It sometimes produces alarming syncope, and a sense of suffocation. Alibert points out the following counter- indications to the employment of the sulphurous vapour bath. 1. A predisposition to apoplexy. 2. Asthma and chronic catarrhal affections in old people, and a predis- position to phthisis. 3. Organic affections of the heart 4. Pregnancy. That sulphur applied in the form of fumes will often act very beneficially in cutaneous affections, cannot be doubted. It would appear however from later expe- rience, that its powers were at first considerably exag- gerated, and that its good effects are pretty much con- fined to those cases in which sulphur applied in the form of ointment, or the application of diluted sulphuric acid, has been found serviceable. It possesses however the advantage of acting much more promptly, and of exciting profuse perspiration, which latter circumstances will sometimes enable it to afford relief in rheumatic and other affections connected with torpor of the perspira- tory function. * Alibert, Elemens de Therap. vol. ii. p. 487 CHAPTER XIII Epispastics. The term epispastic was anciently applied to all such articles as produce redness, inflammation, or vesication when placed in contact with the cuticular surface. At present however it is used in a more limited sense; being restricted to those substances alone which excite the exhalants to an abundant effusion of serum under the cuticle, producing vesication, or in common language, blisters. The modus operandi of vesicatories in the cure of diseases, has been a subject of much controversy. Much of their beneficial operation was formerly ascribed to the evacuation they produce. That they do some good in this way, though not so much as has been sup- posed, I cannot doubt. I suspect however that more advantage is derived from the secondary, or purulent discharge than from the serous, or that which is the im- mediate consequence of vasication. To be convinced of the effects of discharges of this kind, we need only advert to the manifest influence which the occurrence of abscesses, or the production of artificial eruptions occasionally produce on diseases. The suppression of a small discharge from behind the ears of children, is often followed by the most dangerous consequences, and its re-establishment is, as generally, manifestly beneficial. It is frequently observed too, that the good effects of blisters do not occur until the secretion of pus com- mences. It is, after all, highly probable that the dis- charge from a vesicated surface is in the majority of cases salutary, more by its secondary effects in keeping EPISPASTICS. 193 up a new determination to the part, than by its direct influence as an evacuation. When we advert to the nature of the diseases in which blisters act most benefi- cially, it appears evident, I think, that their salutary operation must depend mainly on diverting the circula- tion and excitement from the affected organs, and di- recting them upon the vesicated part. Thus blisters applied to the side in peripneumony, establish an in- creased determination to the surface, and by this effect produce a derivation from the inflamed vessels of the pleura and lungs, and enable them to recover their healthy state. A blistered surface may be considered in the light of a new excretory organ, the formation of which requires the establishment of a new current or determination of blood. So long as the discharge con- tinues, so long will there be an especial demand of blood in the blistered part, and a consequent derivation of the circulation from the inflamed and engorged vessels of the neighbouring organs. It is by thus rendering a con- stant supply of blood necessary in blistered parts, and thereby sustaining the local determination to the sur- face, and not by evacuating any morbific matter, that the discharge from blisters, for the most part, appears to do good. It is nevertheless quite probable that blis- ters do sometimes act beneficially by their direct deple- tory effects. In erysipelas, for instance, we often derive immediate and decided benefit from blistering the affected part. To explain this, as is commonly done, by ascribing it to the establishment of a new action in the part, appears to me exceedingly vague and unsatis- factory. Is not the direct evacuation of serum from the inflamed vessels sufficient to explain the advantages obtained in cases of this kind from blistering? In erysi- pelas the cutaneous capillaries are especially involved in inflammation. Why therefore should we not expect benefit from an application which is calculated in a direct way to lessen the contents of these engorged capillaries? 194 EPISPAST1CS. Blisters have also been supposed to do good by their stimulating and cordial effects. " That these remedies," says Dr. Chapman, " are cordial and exhilarating, is proved by their efficacy in all nervous affections, whether distinguished by a preponderance of meutal or corpo- real infirmity, and weakness." It appears to be well ascertained, however, that in all cases of real debility vesicating applications can prove serviceable only when employed in such a way as simply to produce a rube- facient effect; blistering under such circumstances being almost invariably detrimental. In nervous affections, attended with weakness, blistering is without doubt often beneficial. But it must not be inferred, that the good effects of blisters in such cases are in any particu- lar degree dependent on their " cordial or exhilarating" operation. For it is to be observed, that the weakness which attends nervous affections, is frequently imme- diately dependent on irregular determinations to some of the internal organs, and that in proportion as we obviate such determinations or congestions, and thereby relieve some oppressed vital organ, so do we remove the weakness to which they give rise. It is by an opera- tion of this kind chiefly, I conceive, that vesication is found occasionally to produce invigorating consequences in nervous affections. Cullen ascribes the beneficial operation of blisters to their supposed power of relieving spasm. That the skin frequently becomes moist and relaxed from vesica- tion, is certain; but it is very questionable whether this can be properly ascribed to the direct antispasmodic or relaxing powers of such applications. By relieving pain, irritation and congestions of the internal organs, blisters may give a general healthy impulse to the various emunctories of the system, and enable the cutaneous capillaries to resume their regular action. The utility of blisters in some of the spasmodic affections, would seem to countenance the idea of their possessing direct EPISPASTICS. 195 antispasmodic powers. Their effects in this way, how- ever, must be referred to the same operation that has been mentioned in relation to their employment in ner- vous affections. In whatever manner we may account for the operation of blisters, experience has fully demonstrated their urility in a great variety of affections. In the treatment of fe- brile diseases they are capable of affording very important advantages. Physicians have, however, by no means been unanimous in recommending them in fevers. Dr. Fordyce rejected them as not only useless, but even per- nicious. The authority of this eminent physician has however not been sufficient to countervail the testimony, which the experience of the majority of the profession has brought forward in favour of the beneficial effects of blis- tering in fevers. In the treatment of intermittents, blisters cannot be considered as an ordinary remedy. Under certain circumstances of the disease, however, they may occasionally be employed with great advantage. Cases occur which are attended with an irritated pulse and a dry skin during the intermission, and which are found to resist the most liberal use of bark, &c. In such cases the application of blisters to the wrists or ancles, or a large one laid between the shoulders, will generally produce such a change in the character of the disease, as to ena- dle the bark fully to display its febrifuge powers. In continued fevers, blisters judiciously managed are undoubtedly often of great advantage. But it must be admitted, that unless they are well timed, as to the period of the disease, they are not only useless, but frequently manifestly injurious. As a general rule, blisters are inad- missible in the commencement of febrile affections. Where inflammation or dangerous congestion of some important internal organ is present, they are nevertheless sometimes of essential service, and may be resorted to in the very beginning of the disease concomitantly with vene- section and other antiphlogistic measures. But in idio- j Q0 EPISPASTICS. pathic fever, without any evident congestions or inflam- mation, they seldom fail to do harm when employed before the alimentary canal has been duly evacuated, and the action of the heart and arteries moderated by proper de- pletory measures. There is a period in the course of continued fevers intermediate between their stage of high excitement and the appearance of symptoms of collapse, in which blisters will generally produce unequivocal good effects. This is what has been called the blistering point, an expression familiar to those who are acquainted with the writings of Rush. Those who have contemplated fevers most attentively have noticed, that they often begin to decline immediately after the occurrence of some par- ticular spontaneous evacuation, or on the appearence of abscesses, &c. It is also ascertained that such "critical movements" do seldom, if ever, occur during the primary stage of febrile excitement It appears, therefore, that there is a tendency in fevers, at some period of their course, to throw a more than usual burthen upon some of the emunctories, or to establish particular determina- tions, giving rise to haemorrhage, abscesses, &c. as the first movement towards amendment. It is at this period in the course of febrile diseases, during which efforts of this kind are sometimes observed to occur, that blisters appear to be particularly serviceable. It is only, however, when the indications of a change of action in the system are obscure or imperceptible that vesicatories are admis- sible; for during what is commonly denominated a critical discharge, they would be obviously improper. The uti- lity of blisters in continued fever unattended by any par- ticular local affection, appears to me therefore to depend on giving an impulse to the sanative powers of the living economy, and at the same time establishing a new secre- ting surface, towards which the humours are especially directed. In cases attended with symptoms of particular affection of any of the important internal viscera, we employ blisters upon a different principle. In instances EPISPASTICS. 197 of this kind our object is to relieve the oppressed organ, and we accordingly apply the blister as near the affected viscus as is practicable, in order more effectually to derive the blood from the engorged or inflamed vessels. Thus, in fevers attended with delirium, and other symptoms of inflammation and engorgement of the vessels of the brain, blisters are applied to the head, not so much with a view of arresting the progress of the general disease as of re- lieving and protecting this important organ. Percival observes, that in fevers attended with a general disposi- tion to inflammation, without any one part suffering more than another, blisters always act injuriously. When, however, local inflammation of any of the internal organs is connected with the fever, vesication is almost univer- sally useful. Experience, he says, demonstrates, that in such cases blistering the skin near the affected part les- sens the flow of blood to it, and thus contributes to re- solve the inflammation, and consequently the general febrile excitement* Blisters are very important remedies in the treatment of the different varieties of phlegmasial diseases. In acute pulmonic affections especially, they are often indispen- sable. Some difference of opinion exists among phy- sicians as to the proper time for applying blisters in pneumonia. It is contended by some that they do more mischief than good when resorted to before the action of the heart and arteries has been considerably reduced: while others allege that they may be advantageously ap- plied in the very commencement of the disease. That blisters may be very early resorted to in pneumonia with advantage, I am entirely persuaded from repeated expe- rience. Without doubt, however, they will perhaps al- ways act with more decided benefit when applied after the vehement arterial excitement has been somewhat moderated by depletory measures. But they may never- * Essays, Medical, Physiological, and Experimental. VOL. II.—C C 198 EPISPASTICS, theless generally be resorted to very early with advantage; and more especially as several bleedings may be practised between the time of their application and the commence- ment of vesication, and the general momentum of the circulation be thus diminished before the stimulus of the epispastic has time to disturb the system. In relation to this point Dr. Armstrong makes the following obser- vations: "It has sometimes struck me very forcibly," says he,ists of small plates of a micaceous lustre. It is in- soluble in cold alcohol and in water. Boiling alcohoL however, dissolves it, but precipitates it again on becom- ing cool. iEther and the oils dissolve it readily. Al- though not soluble in water, it is rendered so by the pre- sence of the yellow or saponaceous substance with which it naturally exists in a state of combination. The blis- tering property is very highly concentrated in the can- tharadin. An atom of it dissolved in sweet oil, and ap- plied to the skin with a bit of paper, produces vesication in five or six hours.! Neither the black substance nor the green oil possesses vesicating powers. Cantharides have a peculiar tendency, whether taken internally, or applied as a vesicatory to the skin, to act upon the urinarv organs, and especially to produce irri- tation and inflammation of the neck of the bladder, and consequently strangury. It has been much disputed, whether strangury be produced by the absorption of the acrid portion of the cantharides, or whether it be merely the result of a sympathetic impression conveyed to the bladder. That the strangury proceeds from the absorp- tion of the acrid principle of the cantharides, is exceed- ingly probable from the fact that no other vesicating sub- stance produces this effect. It is moreover very unlikely * Annals de Chemie, torn, lxxvi. t The cantharadin may be obtained by the following process: Boil the cantharides in water repeatedly, until all the soluble parts are extracted ; filter the decoction, and evaporate it to the consist- ence of an extract. Digest this extract in concentrated alcohol, then pour off the alcohol, and evaporate it; sulphuric aether, added to this alcoholic extract, will take up the cantharadin, which may be obtained in a pretty pnre state, by evaporation.—Pfaff's Mat, Med. vol. iii. p. 243. VOL. II.—D d 206 EPISPASTICS. that the bladder should possess so extensive a sympathy with the surface of the body, as it must do if strangury from blistering be the result of a sympathetic impression; for, on whatever part of the body blisters be laid, stran- gury may be the result. Dr. Chapman observes, that " if strangury do thus arise, it ought invariably to take place on the application of a blister," which, however, is an incident of rare occurrence. But wherefore should strangury more frequently follow blistering, if it be oc- casioned by the absorption of the cantharides, than if it depend on a sympathy between the skin and bladder? We might with just as much, and perhaps more plausi- bility, say, that if strangury arise from a sympathetic connection between the external surface and the blad- der, it ought more constantly to follow blistering. We know that turpentine occasionally produces strangury when taken internally, and that it is absorbed, and con- veyed out of the system by the urinary organs. But are we to deny the absorption of this substance because it does not always produce strangury? The fact of its ab- sorption is unquestionable. Dr. Chapman also states, that " it is known that the internal use of cantharides is seldom attended by any effect, and when it does occur, it is more frequently from small than large doses of this article." Against the correctness of this statement I may with confidence appeal to the general experience of the profession. By large doses of this article stran- gury may be generally induced, whereas small doses sel- dom produce any sensible effect whatever. Nor is it a fact that the internal use of cantharides is seldom at- tended by this affection of the bladder. In a highly in- teresting paper, published by Dr. J. Klapp, on the em- menagogue powers of cantharides, nineteen cases are detailed in which this remedy was administered inter- EPISPASTICS. 207 nally, and in eight of which symptoms of strangury su- pervened.* Blisters are particularly apt to excite strangury when applied to the head immediately after the scalp has been shaved; and more especially if the skin be wounded. This may be attributed to the greater facility which the absorbents possess of taking up the active principle of the fly, when the cuticle has been abraded and wounded by shaving; and hence, when cantharides are applied from twelve to twenty-four hours after the head is shav- ed, this effect hardly ever ensues.! To obviate, or re- lieve strangury, much benefit may be derived from the free use of mucilaginous and mild diuretic drinks, as barley-water, infusions of flaxseed, parsley, melon-seed, and particularly of marshmallows, or of our common round-leaved mallows, (malva rotundifolia.) In addition to these, opium, taken into the stomach or administered in the form of a clyster, is always of essential service. Much benefit is also to be derived from warm bathing, or from fomentations to the perineum and pubis. For- merly camphor was a good deal recommended as a re- medy for strangury; and it does not appear to me to be wholly inefficacious in this respect. When speaking of this article under the head of narcotics, I adverted to its evident tendency to diminish venereal sensibility, or per- haps more properly speaking to lessen the activity of the genital organs. This effect of camphor would seem to depend on an operation directly the reverse of that of cantharides,—namely, a diminution of the flow of blood to those parts. But as the operation of camphor in this respect is slow, it can seldom be employed with any par- ticular advantage in cases of this kind, which require much more prompt means of relief. After the violence of the symptoms is over, and some pain or irritation re- * American Medical Recorder, vol. ii. p. 37. t Percival's Medical Essays, vol. i. 208 EPISPASTICS. mains at the neck of the bladder, it will nevertheless often prove useful, as 1 have in several instances wit- nessed. Cantharides seldom produce complete vesication under ten or twelve hours. Before applying a blister, the skin upon which it is to be laid, or the surface of the plaster should be moistened with vinegar or brandy. When the blister is drawn it must be opened and dressed with simple cerate spread on linen. To keep up the dis- charge from a blistered surface, an ointment made of a small portion of cantharides and lard, is one of the best applications. Savin ointment is also ver) good for this purpose. When a blister is in a state of painful irritation, sweet oil, lard, or a soft bread and milk poultice should be applied. LYTTA VITTATA.--POTATOE FLY. This insect is said to belong exclusively to the United States. It feeds chiefly on the potatoe plant, upon which it is often found in immense numbers about the end of July or beginning of August. It resembles in outward form the cantharides; being, however, somewhat small- er, and of a different colour. Its head is red, with black antennae; the wing-cases are black, with a pale yellow margin, and a stripe of the same colour along the mid- dle of them; the tarsi have five joints. " The abdomen of this insect is a hard white substance, about the size of a grain of wheat, which, when powdered, appears like meal, and when rubbed with water forms a milky emul- sion." Dr. Isaac Chapman of Bucks county, in this state, was the first who publicly noticed the vesicating properties of this species of Lytta.* According to his * Medical Repository, vol. ii. EPISPASTICS. 209 experience it is equal if not superior in this respect, to the cantharides; and this has been confirmed by the ex- perience of other practitioners. The late professor Barton gave a decided preference to the American fly. "L<»ng keeping," he observes, ^ provided it be carefully kept, does not materially impair the blistering property of the lytta vittala. At the end of three or four years after being collected I have found it equal in power to the best shop cantharides." Dr. Gorham of Boston, states, that in an extensive series of experiments with this fly, he found it equal if not superior in every respect to the cantharides. Administered internally, it produces the same effects upon the urinary organs, and is appli- cable to the same medicinal purposes as the Spanish fly. There are other native species of this genus of flies which possess valuable vesicating properties. The lytta atrata is a very common insect in this conntry. In the autumn it is found in great abundance on some of the syngenesious plants, such as aster, soledogo, &c. "Though inferior," says Dr. Barton, "to the lytta vit- tata, it is well worthy of the attention of physicians/' The lytta marginata is not so common, but is an exceed- ingly powerful vesicatory. The lytta cinerea is said to be no less powerful than the latter species; it is, however, very scarce. I may also, in this place, mention the meloe niger, which was first noticed as a vesicatory by the late pro- fessor Woodhouse. According to his experiments with this fly, it seems to possess very active vesicating proper- ties. It is about half the size of the potatoe fly, and dwells particularly on the ambrosia trifida. NITRIC ACID. The nitric acid has been recently introduced into prac £10 EPISPASTICS. tice as a very valuable vesicating application in certain rapid and dangerous affections. Dr. Kennedy has pub- lished an interesting paper on this subject in the Edin- burgh Medical and Surgical Journal. It has been found particularly efficacious in the cholera of India, a disease so rapid in its progress and fatal in its consequences, that nothing but extensive blistering of the epigastric region appears to be capable of arresting its course. Blistering with nitrous acid, being exceedingly prompt, and attended with much local irritation, is, according to the experience of Mr. Powell, surgeon at Bombay, a remedy of great powers in this affection. " The good effects," says Dr. Kennedy, " of this sudden and power- ful counter-irritation, were strikingly illustrated in the case of an European, who received immediate relief in the burning sensation at the stomach on the acid blister being applied; and who the next morning, being annoy- ed with spasms of the extremities, requested the same remedy might be applied; it was accordingly done and so great was the relief obtained to one leg, that he cried out for God's sake to apply it to the other, which was similarly affected.5' Another patient, he observes, was brought in, and supposed to be past recovery. His stools passed off involuntarily; the extremities were cold, and the pulse could not be felt. " The acid blister was applied to the stomach, and the patient got well." Two parts of the acid is to be diluted with one part of water; with this mixture the surface over the affected part is to be rubbed. As soon as the patient experiences pain from it the acid is to be neutralised by washing the sur- face with a solution of carbonate of potash. " The cu- ticle can now be easily detached, and leaves the cutis vera raw, upon which a common blister may be laid to keep up the irritation."* * Observations on the use of Nitrous Acid as a substitute for Blisters, by Dr. Kenedy, F. R. S. E. in the Edinburgh Medical and Surgical Journal, for Oct. 1820. EPISPASTICS. 211 TARTARIZED ANTIMONY. Although not a vesicating substance, tartar emetic deserves to be particularly mentioned in this place, as possessing the power of exciting a peculiar pustular eruption, frequently followed by highly salutary conse- quences. The best mode of using it for this purpose is to incorporate it with simple cerate or lard, in the proportion of a drachm of the former to about an ounce of the latter, and to apply it either by frictions or spread on leather and worn in the way of a plaster, on the skin. Dr. Jenner, who has recently published a most valua- ble essay on the influence of artificial eruptions on certain diseases,* recommends the tartar emetic oint- ment to be made according to the following formula.! The effects which arise from inunction with this oint- ment are, a sense of itching or prickling in the part rubbed, commonly appearing on the second or third day after the frictions have been commenced. " If the part so affected be rubbed or in any degree irritated (from which few can refrain at first) an eruption of small watery pustules takes place immediately." If the patient abstain from irritating the part, the eruption will appear somewhat later. " The pustules," says Dr. Bradley, " are uniformly compared by patients to vario- lous pustules; but they are much smaller, not so red at the base, nor so tense and white when fully suppurated." I have, however, seen them much larger than the vario- lous pustules, and they are generally very painful. In the essay already quoted, Dr. Jenner adduces a * American Medical Recorder, vol. v. p. 684. t Antim. tart, (subtil, pulv.) jii. Ung. cetacei, 5'ix. Sacch. albi. 3L* Hydr. sulph. rub. gr. v. M. fiat unguent. • The sugar prevents the ointment from becoming' rancid. 212 EPISPASTICS. number of cases in which this ointment was applied with the happiest effects He employed it with success in mania, phthisis, asthma, chronic hepatitis, chorea, epilepsy, and various other anomalous cases. This ap- plication has also been highly recommended as a remedy in hooping-cough. " Of all the remedies," says Dr. Bobinson, " I have found beneficial in hooping-cough, frictions upon the region of the stomach with the tartar- ized antimonial ointment have been the most remarka- bly and most undeviatingly useful. The eruption on the stomach is frequently accompanied with a slight degree of inflammation about the remote parts in females, with a spare eruption of minute pimples; and, on this occur- ring, the disease uniformly begins to abate. In cases where the patient is of a full habit and the inflammatory diathesis runs high, it may be proper to apply a few leeches to the feet previously to the use of the antimonial ointment. But I have used it with advantage, even in cases where the fever was attended with delirium at night. I have never seen the eruption produced in this way threaten the bad consequences from gangrene which not unfrequently supervene when the blisters are applied too early in hooping-cough, when the inflamma- tory diathesis runs high, and before blood has been abstracted. The effects of the ointment in other re- spects are also widely different. When it does produce an eruption, it almost always affords relief; whereas I have never seen an instance where the application of a blister has been of the smallest service in hooping-cough, except after blood-letting, when there have been mani- fest symptoms of inflammation."* This accords with the experience of Dr. Jenner: "With tartarized anti- mony," observes this distinguished physician, " we can not only create vesicles, but we can do more,—we have at our command an application which will at the same * London Medical Repository, January, 1821. epispastics. 213 time both vesicate and produce diseased action on the skin itself, by deeply deranging its structure beneath the surface. This is probably one cause why the sympa- thetic affection excited by the use of cantharides and those changes produced by tartar emetic are very differ- ent" The eruption should be kept up for some time, either by the re-application of small portions of the diluted tartar emetic ointment to the affected part, or by other gently stimulating ointments. If they become much irritated and very painful, a soft bread and milk poultice, or an ointment made with equal parts of sweet oil and wax, will in general afford relief, without interfering with the eruption. SETONS AND ISSUES. The effects of setons and issues are very analogous to those of thearticles already mentioned in this chapter. Being, however, very permanent in their operation, they are often peculiarly applicable in certain chronic affec- tions where it is generally necessary to keep up a long continued influence on the system. Among the Greek and Roman physicians, the use of caustic issues was frequently resorted to. Hippocrates employed them in gout, sciatica, chronic diseases of the liver, spleen, and lungs; and iEtius mentions their use in palsy and asthma. Celsus, also, employed them in affections of the joints, in epilepsy and in phthisis. Boerhaave and fie Haen, in modern times, recommended them in the treatment of the,scrophulous disease of the hip joint; and Mr. Pott speaks highly of their efficacy in diseased or incurvated spine. A caustic issue on each side of the diseased ver- tebras has been frequently known to give perfect relief in such affections. Dr. Rogers, professor of natural philo- vol. n.—e e . 214 EPISPASTICS. sophy and chemistry at Williamsburg, Virginia, has re- cently published some highly interesting observations on the employment of caustic issues. He relates several cases of phthisis pulmonalis which yielded entirely to their influence. In a case of this kind, which, from the strong hectic symptoms, the constrained state of the respiration, and the appearance of the matter expectorated, was con- sidered altogether hopeless, a caustic issue formed on the sternum inter mammas, performed a perfect cure in the space of about three months. " In chronic affections of the breast," says Dr. Rogers, " this remedy is less trou- blesome, less painful, gives more permanent caustic irri- tation, and appears^to me much more efficacious than blistering, however managed. So strongly am I impress- ed with this sentiment, that for several years I have trusted no case of the kind to any course of remedies without the aid of that under consideration. In chronic catarrh I have found it of siugular utility."* Dr. Rogers has employed them with perfect success to prevent abor- tion in habits prone to this accident, as well as in the treatment of leucorrhcea and menorrhagia. Issues have likewise been applied with much advantage in vertigo, gutta serena, chorea, and tetanus. Dr. Hartshorne of this city has employed them with success along the spine, in this latter affection;! and Dr. Lewis, of Pittsburg, has related a case of this disease which yielded to the appli- cation of caustic potass along the tract of the spine.| When setons or issues are employed for the removal of local affections, they should be applied as near the affected part as practicable. In general diseases, how- ever, they may be inserted on some convenient part of the extremities, as on the inside of the leg, just below the knee; or on the arm, near the insertion of the deltoid muscle. * American Medical Recorder, vol. iv. p. 222. t Eclectic Repertory, vol. vii. p. 245. \ American Medical Recorder, vol. iii. p. 176. EPISPASTICS. 215 Rubefacients. The articles which belong to this class do not vesi- cate, but simply produce a redness and inflammation of the part to which they are applied. Their modus ope- randi in the cure of diseases, depends probably on the same principles that have been mentioned above in rela- tion to the operation of epispastics. They concentrate the excitement, and produce a determination of the cir- culation to the part upon which they immediately act. Without, however, entering into any discussion upon this point, I pass on directly to the consideration of the individual articles of this class. SEMINA SINAPIS. Mustard is one of the most useful rubefacients we possess. Its action on the skin is prompt and power- ful, producing, when good, pain and inflammation in fifteen or twenty minutes. It contains fecula, mucilage, a bland fixed oil, " and an acrid volatile oil upon which its virtues depend, and which on standing deposits a quantity of sulphur and an ammoniacal salt" Water extracts nothing but tasteless mucilage from the unbruised seeds; when bruised they impart all their active princi- ples to water; but very sparingly to alcohol. The mode of using this article, as ^rubefacient, is to make a paste with the farina of the seeds and vinegar, and to apply it in the shape of a poultice to the skin. The pain which such an application produces is generally exceedingly severe, and if suffered to remain on too long it is apt to occasion troublesome sores. These sinapisms as they are technically called, are often of great service in the 216 EPISPASTICS. treatment of diseases. In apoplexy and comatose af- fections they are applied to the feet, in order to produce a revulsion from the engorged vessels of the brain. They are, also, very beneficial when applied to the abdomen in spasmodic affections of the stomach and bowels; as well as in all painful affections unattended by high arte- rial excitement. In the low states of fever, they will sometimes manifest very useful effects, by their general stimulant operation, and their tendency, when applied to the lower extremities, of lessening the cerebral con- gestion, which always exists more or less in the latter periods of typhous fevers. Mustard seed is also used internally as a medicine. The unbruised seeds are particularly recommended in paralysis, dyspepsia, chlo- rosis and chronic rheumatism. Powdered mustard mixed with warm water, in the proportion of a table spoonful of the former to a pint of the latter, acts prompt- ly as an emetic. CAPSICUM ANNUUM. This 4s an excellent rubefacient. It may be em= ployed for this purpose, either by mixing the powdered capsules in proof spirits, or in the shape of a saturated tincture. In paralysis or torpor of the extremities, and in the low states of fever, friction with either of these preparations is sometimes very serviceable. Wearing socks dusted with red pepper, is said to be very useful in diseases of the bowels attended with cold feet. The cataplasms of capsicum have also been recommended as good applications to the feet, in the delirium and coma of typhous fevers. The diluted juice of the pods has been employed with excellent effects in chronic ophthal- mia. EPISPASTICS. 217 ALIUM SATIVUM. Garlic is frequently employed to produce rubefacient effects. It is, however, apt to vesicate, and where mere inflammation or redness of the skin is desired, it is not so well suited as the two preceding articles. Sydenham speaks highly of the application of garlic to the soles of the feet, as a powerful means of producing revulsion from the head. The late professor Barton thought it an excellent application in deafness from atony or rheuma- tism. For this purpose he recommended a clove of the garlic to be surrounded with cotton and introduced into the ear; or wool or cotton moistened with the juice and applied in this way. It has also been employed with success, in the form of an ointment, to discuss indolent tumours.* OLEUM TEREBINTHIN.E. Turpentine is strongly rubefacient, and is one of our most common applications for purposes of this kind. There are some peculiar habits, however, in which it cannot be used on account of its occasioning violent smarting and erysipelatous inflammation. It is usually employed in the shape of a liniment, in union with alco- hol and other rubefacient articles. When applied to the skin in an undiluted state, it excites considerable pain, with redness, and generally a vesicular eruption. It is an excellent application to the throat in cynanche trachealis; and may, indeed, be applied with advantage in all instances where remedies of this kind are indi- * Thacher's Dispensatory. / 218 EPISPASTICS. cated. Of the use of this article in burns and scalds, I have already spoken under the head of Stimulants.* OLEUM MONARDjE PUNCTATA. The oil of the monarda punctata, a beautiful native plant of this country, is a most powerful rubefacient. Its powers in this respect were first noticed by Dr. E. A. Atlee of this city, in an interesting paper published in the second volume of the American Medical Recorder. It is exceedingly active, producing heat, redness, pain, •and vesication in a very short time, when applied to the skin. Dr. Atlee states, that he has used it with much advantage, as a rubefacient liniment, in chronic rheuma- tism, difficulty of hearing, periodical headach, paralytic affections, cholera infantum, and typhus. "During the prevalence of the epidemic typhus in our city a few years ago," says he, " I Was much pleased with its ef- fects in the remarkable sinking state, and coldness of the extremities, to which the patients were subject. The arms, breast, and legs were bathed with this lini- ment,! omitting the laudanum, and in a few minutes a comfortable glow succeeded." In the treatment of cholera infantum, I have myself employed it with great and prompt advantage. By bathing the abdomen and extremities with the oil properly diluted, it speedily pro- duces redness of the skin, and very generally relieves the gastric irritability. From my own experience with this oil I am satisfied * The following is an excellent rubefacient liniment: R, Ol. oliv. £x. ol. terebinth, ^iv. acidi. vitriol. 3iii. Misce. t Rj Ol. monard. punct. 5ss. Tinct. camph. 5ii. Tinct. opii. 3ii. M. EPISPASTICS. 219 that it is one of the most active rubefacients we possess, and that it will be found to answer exceedingly well in all cases where such remedies are indicated. AQUA AMMONL-E. This article is very frequently employed as a rubefa- cient. In union with sweet oil, it forms an excellent ap- plication in a variety of affections. Pringle thought it particularly useful in cynanche tonsillaris, and it is still much used as a liniment to the throat in this and other similar affections. Its rubefacient powers are, however, not very great, its application being seldom followed by much redness, unless in young subjects. CAMPHORA. Camphor dissolved in alcohol is one of our most com- mon rubefacients. The celebrated Steer's opodeldoc consists of soap §vii. alcohol §ii. camphor §ii. liquor ammon. 5iv. and oil of rosemary 3ss. This mixture is a very useful stimulating liniment in rheumatic affections. Dr. Ferriar recommends the following ointment as an efficacious application in lumbago* He speaks very highly also of frictions with camphor dissolved in vitri- olic aether. *' R Pulv. camph. 9ii. ung. basil. |i. sapo. common. 5ss. pulv. sem. sinap. $'1. Fiat unguentum. 220 epispastics. TlftCTURA CANTHARIDUM. The tincture of cantharides possesses but feeble ru- befacient powers; it does not, like most of the other ar- ticles that have been mentioned under this head, produce much burning heat in the part to which it is applied, and it is seldom even that it can be made to produce much redness of the skin. It has nevertheless been recom- mended as peculiarly serviceable in chronic rheumatism and paralytic affections, PIX BURGUNDICA. This resinous substance is obtained from the Norway spruce fir, (pinus abies,) by making incisions through its bark. Spread on leather, it is much employed as a rubefacient application, and its effects are, indeed, often highly useful. When applied to the skin, it generally begins to produce a prickling heat in the course of about twenty-four hours, followed commonly by numerous small red pimples exuding a serous fluid, and occasion- ally also by vesication. In lumbago a plaster of this substance worn over the loins often proves very service- able. Applied between the shoulders or to the breast, it is also frequently attended with very good effects in diseases of the lungs, particularly in chronic catarrh, hooping-cough, and spitting of blood. In chronic diar- rhoea and dysentery I have known very excellent effects to arise from a large burgundy pitch plaster worn on the abdomen. Enveloped in cotton and introduced into the ear, it has been found serviceable in difficulty of hearing depending on a rheumatic affection or atony of the ear. EPISPASTICS. 221 Errhines. These are medicines, which, when applied to the Schneiderian membrane, increase its natural secretions. In persons not habituated to their use, they generally pro- duce sneezing, and hence they are also called sternuta- tories. The practical application of these remedies is but very confined. Their use is restricted exclusively to the cure of some affections of the head. Their modus operandi is not difficult to understand. By irritating the Schneiderian membrane, they occasion an afflux to this organ, and an increase of its secretions, and consequently a derivation of the circulation from the surrounding or neighbouring parts. Hence, they have been found ser- viceable in rheumatic affections of the head, in pains of the ear, in ophthalmia, toothach, and various other affec- tions of these parts. I proceed to mention a few of the principal articles employed as errhines. NICOTIANA TABACUM. Tobacco, in the form of snuff, is extensively used as a luxury. In persons not habituated to its use, in this way, it acts as a pretty powerful errhine. By repetition, how- ever, it soon loses its power of increasing the discharge from the nose; and, on this account, it can seldom be employed with particular advantage in cases that require a pretty long use of such a remedy. It has been said, that when snuffing produces a considerable discharge from the nose, which is sometimes the case even in such as take it habitually, it cannot be laid aside without the risk of injurious consequences. " From my own expe- rience," says Dr. Cullen, "I am led to repeat here, that whenever the discharge has been considerable, the laying aside snuffing, and therefore suspending that discharge VOL. II.—f f 222 EPISPASTICS. may havevery bad effects." All artificial discharges be- come constitutional by long continuance, and can seldom be checked suddenly without producing injurious ef- fects. ASARUM EUROPIUM. The asarabacca, besides its emetic and purgative pro- perties, is powerfully errhine. When snuffed into the nose it produces violent sneezing and a copious discharge of mucus from the nostrils, and frequently also a plenti- ful secretion of saliva, continuing sometimes for several days. It must be employed in moderate doses, as its effects are often exceedingly violent when snuffed in large portions. A few grains of it snuffed once or twice a day has been known to produce excellent effects in toothach, ophthalmia, headach, and other affections of the head. helenium autumnale. This is a syngenesious plant, indigenous to the United States, in many parts of which it grows in great abun- dance. The whqle plant is intensely bitter, and may be usefully employed as a tonic. As an errhine, the pow- dered leaves are recommended by the late professor Bar- ton as safe and valuable. I have prescribed it in a few cases, and found it to produce profuse discharges of mu- cus from the nose. It is less violent in its effects as a sternutatory than the asarum, and produces quite as much discharge. EPISPASTICS. 223 TURBETHUM MINERALE. This is a very valuable errhine. It seldom fails, when snuffed up the nose, to produce very copious fluid dis- charges. When employed for this purpose, it is generally mixed with the powder of asarum, or with common snuff. In affections of the eyes and ears, this errhine has been found to produce valuable effects. Dr. Barton states, that he has employed it in cases of epilepsy, gutta serena, &c. and that he can confidently recommend it as a re- medy entitled to attention. In two instances in which he used it considerable salivation was produced. Various other errhines are mentioned by writers on the materia medica, but of which I consider it superflu- ous to give any particular account. It will be sufficient merely to mention their names, the principal of which are : beta, betonica, majorana, hedera terestris, euphor- hium, origanum, achillea, ptarmica, &c. CHAPTER XIV. II. Medicines that increase the action of the Urinary Organs. DIURETICS. Diuretics are such remedies as promote the discharge of urine. Some articles of this class appear to be ab- sorbed into the circulation, and act directly upon the se- cretory vessels of the kidneys; others produce their effects in a more indirect manner; they act, primarily, on the stomach, and propagate a sympathetic action to the kidneys. There are others also, that act by promoting absorption, augmenting thereby the quantity of serous fluid in the blood-vessels, in consequence of which the renal emunctories are excited into increased action.* That many articles of this class are absorbed into the circulation, and act directly upon the secretory vessels of the kidneys, is demonstrated by the re-appearance of these substances in the urine. I have, however, already dwelt particularly on this subject when speaking of the general modus operandi of medicines, and shall therefore not say any thing further on this point, in the present place. With regard to the latter mode of producing diuresis, that is, by exciting the action of the absorbents and inducing a repletion of serous fluid in the blood-ves- sels, it will be proper to be more explicit. The emunc- tories of the animal system, are outlets to the effete mat- ters, or the superabundant and imperfectly animalized * Murray's Materia Medica. DIURETICS. 225 fluids circulating in the blood-vessels. They are " the scavengers of the animal economy," whose activity is proportionate to the mass of materials which is to be thrown off. If the blood be deprived of its serous parts by dropsical effusion, the skin and kidneys, being less excited to active excretion, on account of the deficiency of the materials which they are destined to remove, be- come inactive, whilst the exhalants from which the drop- sical effusion takes place, continue by a sort of vicarious office to separate from the blood its watery portion. If in this state we prescribe a remedy whose effect is simply to excite the secretory vessels of the kidneys, as, for instance, squills, we will seldom produce any aug- mented secretion of urine, because, the necessary ma- terials for the secretion of the urine do not exist in suf- ficient abundance in the blood. If however we unite with this simple diuretic another article, possessing the power of exciting the re-absorption of the effused fluid, we at once stimulate the vessels of the kidneys, and furnish them with an augmented portion of the materials of secretion. It is on this account that we often derive so much advantage from the union of squills and calomel in dropsy; and it is upon the same principle that the action of diuretics is increased by copious draughts of mild diluents. The system appears to be equally inca- pable of bearing with impunity, either too small or too large a portion of serous fluid in the blood. As soon as this part of the circulating mass becomes more than ordinarily augmented, the kidneys or the skin are excited into action to reduce its quantity; and hence, we often excite the action of the kidneys, by indulging our patients in the free use of milk drinks. But although diluents are certainly useful, in cases of dropsy, to excite the action of the kidneys, yet when once this effect is pror duced, and the absorption of the effused fluid takes place, they ought to be less liberally used, since, by sup- plying the blood-vessels with a sufficient quantity of 226 DIURETICS. watery fluid, there will be a less demand made upon the absorbents, and consequently a slower reduction of the dropsical effusion. The action of diuretics is also promoted, in full and phlogistic habits, by whatever lessens arterial excitement, or diminishes the quantity of fluid circulating in the system. Thus, bleeding and cathartics sometimes do essential service, in this way. There is no contradic- tion, in this statement, to the one made above,—that copious draughts of diluents increase the efficacy of diu- retics, by furnishing the vessels with a more abundant share of watery fluids. In opposite states of the system these contrary means produce, indeed, precisely similar results. They both increase diuresis by favouring the absorption of watery fluid. The only difference that sub- sists between bleeding and plentiful dilution in this re- spect is, that the former increases the activity of the absorbents, and lessens the rapidity of serous effusion, whilst the latter acts simply by furnishing the absorbents of the alimentary canal with a greater quantity of fluid for absorption. It must also be observed that bleeding and catharsis can only be useful in this respect in cases where the blood-vessels are full and active; whilst, on the contrary, copious draughts of bland liquids are par- ticularly suitable, where the system is less plethoric, and the blood has already been much exhausted of its serum. It is not difficult to understand in what manner the discharge of urine is augmented, by the plentiful use of water; but how depletion, or the reduction of arterial excitement, acts in increasing the vigour of the absorb- ents we are not able to explain. The fact however is fully ascertained, not only by the effects of bleeding and purging in the treatment of dropsy, but also by the direct experiments of Magendie, who has recently demonstrat- ed, what indeed had been noticed before, that absorp- tion is accelerated or retarded in proportion as the DIURETICS. 227 quantity of fluid circulating in the blood-vessels is in- creased or diminished.* Much dispute existed formerly with regard to the pro- priety or impropriety of allowing dropsical patients to indulge freely in the use of mild and diluent drinks. Al- though copious draughts of water will in general increase the quantity of urine, I can, nevertheless, not believe that any essential advantage will often result from a very great indulgence in this way. For if the urine be in- ' creased, by the copious use of drink, it is to be observed, that the source of this increase is not so much in the absorption of the dropsical fluid deposited in the cavities of the body, as in the absorption of the water taken into the stomach and bowels from without. Hence it is, that, however copious the discharge of urine, dropsical swellings will often diminish but triflingly,or remain sta- tionary, or even increase. To torture the patient, how- ever, with excessive thirst, is not only useless, but abso- lutely pernicious. A pretty free use of mild drinks should always be allowed; thirst ought never to be suf- fered to become so intense as to produce general irrita- tion. How an increased secretion in the kidneys can re- duce dropsical accumulations, is difficult to perceive. It cannot be wholly from any direct action which diuretic remedies may exert on the absorbent system; since we have it from very high authority! that dropsies have been cured by the free use of diluent drinks alone; and it will hardly be contended that such a remedy could exercise any direct influence over the absorbents. I am inclined to believe that the explanation must be sought for in the following circumstances. When the discharge from the kidneys is much increased, in a case of dropsy, we not only determine the serous discharge to these emuncto- * Journal of Experimental Physiology, by M. Magendie, 1821. t Dr. Cullen. 228 DIURETICS. ries, but lessen the general mass of this portion of the blood, and consequently lessen the effusion from the ex- halants furnishing the dropsical fluid. Now if the ex- halation from these vessels be diminished, and the regu- lar discharge from the kidneys be re-established, the dropsical accumulations must gradually disappear, al- though the absorbents remain in the same condition, with regard to the degree of their activity. But independent of this effect of diuresis in diminishing accumulations of effused fluids, there are other results which we have reason to believe take place, concomitantly with those just mentioned, and which still further increase the effi- cacy of diuretics in dropsy. I have stated above that depletion favours, in a very decided way, the absorption of fluids; hence when the blood-vessels are suddenly de- prived of a portion of their serous fluid, by the action of a diuretic, nature, making an effort to sustain the neces- sary proportion of this component part of the circulatory mass, excites the absorbents into more vigorous action, in Order to supply the deficiency which the animal eco- nomy experiences. From the great and rapid reduction of strength, pro- duced by excessive discharges of urine, as in diabetes, it is evident that the general powers of the system are much under the control of diuretic remedies. They are accordingly often employed as depletory remedies in sthenic diseases. In gout, and rheumatism especially, they have been recommended as highly useful, when employed in conjunction with cathartics. Dr. Scuda- more, speaking of the treatment of this disease, says, " In imitation of nature's efforts to remove redundant matter by the medium of the kidneys—an action, the ex- istence of which I think myself entitled to infer from my experiments—we are to keep the corresponding treatment attentively in view; and I have invariably em- ployed, with the greatest advantage, purgative and diu- retic medicine conjointly, so that the exhalant vessels of DIURETICS. 229 the alimentary canal, and the secreting function of the kidneys are stimulated to increased action at the same time."* In the treatment of chronic dysentery too, diuretics have been prescribed, with a view of determining the discharge of fluids from the intestinal vessels to those of the kidneys.! Celsus, in his account of the treatment of dysentery, says, " Et ea, quae urinam movent, si ea consecuta sunt, in aliam partem humorem avertendo pro- sunt."| On the principle here mentioned by Celsus, diuretics are sometimes found to produce useful results in affections of the breast and head. I have known a case of gutta serena cured by the employment of cream of tartar and calomel, in large doses, the immediate and only sensible effect of which was constant and copious diuresis. Diuretics have also been known to produce beneficial effects in certain affections of the pulmonary organs. Upon this subject Dr. Armstrong makes the following interesting observations. " The apparent benefit which I have seen to result from sudorifics and diuretics in some cases of threatened consumption, would alone seem to indicate the applicability of medicines which act upon the kidneys and skin in certain examples; but as my own experience is defective on this point, I recommend it to the notice of others, as well from practical as pathologi- cal considerations." Again, he observes: "As the skin and kidneys both closely sympathize with the lungs, is it probable that diseases of the latter might be benefit- ed by certain articles of food which operate on the for- mer?" Diuretics are said to be a powerful auxiliary in the * Scudamore on Gout, p. 100. t Bampfield on Tropical Dysentery, p. 165. \ Celsus, de Medicina, Lib. iv. Cap. xv. de Dysenteria. VOL. II.—G g 230 DIURETICS, cure of ulcers situated on the lower extremities, and at- tended with oedema of the leg.* In various affections of the urinary organs, diuretic remedies are especially indicated, and often afford very decided advantages. In ulcers of the kidneys, or in- flammation of the mucous lining of the bladder and ure- thra balsamic diuretics, may in general be usefully em- ployed. These appear to act, in the cure of affections of this kind, by medicating the urine, which, coming into immediate contact with the diseased part, act upon it as a local remedy. It is in this way, no doubt, that balsam copaiva and turpentine cure gonorrhoea. They impreg- nate the urine with their peculiar medicinal qualities, which, being passed through the urethra, acts upon it in the same way that injections do. If we admit, as I am fully disposed to do, that diseases do occasionally depend on a deteriorated state of the blood, we must regard diuretic remedies as a most im- portant class of medicinal agents in the cure of such dis- eases. The kidneys, perhaps, more than any other emunctory of the animal economy, are an outlet to such portions of the circulatory mass as are effete, or foreign and inimical to the regular actions of the system. We find, too, that the solution of diseases is more frequently attended by a critical discharge of urine than by any other of the excretions. Diuretic remedies have ac- cordingly been recommended in a variety of chronic diseases, which appear to be accompanied by a morbid condition of the fluids; such as scurvy, elephantiasis, &c. In the beginning of this chapter it is stated that ca- thartics promote the operation of diuretics. It must be observed however that quite the contrary effect ensues from purging, when induced either by the diuretic me- dicine itself, as sometimes occurs when the dose is very large, or from the simultaneous exhibition of some ca- *Lond. Med. and Phys. Jour. No. 162. DIURETICS. 231 thartic medicine. When purging is thus produced, a check is put to the absorption of the diuretic remedy, in consequence of the rapidity with which it is hurried through the alimentary canal; and there is, moreover, a direction given to the discharge of the humours, by the intestinal exhalants. These observations are particu- larly applicable to the saline diuretics, having a vegetable acid as a constituent. " This super-tartrate of potass or cream of tartar acts in well regulated doses, as we all know, upon the kidneys; the tartaric acid being in this case abstracted, and assimilated by the digestive process, and the alkaline base at the same time elimi- nated and subsequently absorbed; but if we increase the solubility of the compound, by reducing it to the state of a neutral tartrate, (soluble tartar,) or by combining it with boracic acid, or some body that has a similar ^effect; or, what is equivalent to it, if we so increase the dose of the cream of tartar that catharsis follows its administra- tion, then diuresis will not ensue, since no decomposi- tion can take place under such circumstances; for it is a law of the animal economy, that the process of assimi- lation and absorption are arrested or very imperfectly performed during any alvine excitement."* DIGITALIS PURPUREA. Under the head of Narcotics, an account is given of the remediate effects of digitalis, so far as they seem to depend on its sedative virtues. In the present place, therefore, I have only to speak of it in relation to its property as a diuretic,—a property to which, indeed, it owes some of its most important medicinal effects.! * Paris's Pharmacologia. t The appearances of the urine were at one time regarded as 232 DIURETICS. The diuretic powers of this medicine, seem to be en- tirely independent of its narcotic effects. It is even stat- ed by some very eminent writers, that its diuretic and narcotic operations are incompatible. Dr. Ferriar ob- serves, " that when given in such quantities as to excite nausea, or to produce evident narcotic effects, it does not operate as a diuretic." Withering expresses the same opinion. Although it must be admitted that the sedative and diuretic powers of digitalis are very generally exerted in- dependently of each other, yet there can be no doubt, that though not necessarily connected, they are occasion- ally found to act concomitantly, and are at least not in- compatible.* Conceiving that the curative powers of of the utmost consequence, in forming a proper opinion of the character of diseases.—At present this excretion is unquestion- ably too much neglected; by an attention to it we will often be greatly aided, in our judgment of the nature of diseases. Dr. Prout, observes: "A diminished flow of urine accompanies active inflammation, and an inflammatory state of the system in general. The urine is invariably of a deep colour. ' " An increased flow of urine, or diuresis, very constantly acconr- panies those diseases connected with a peculiar state of nervous irritability, as hysteria. It may be also produced by certain pas- sions of the mind, as fear. Lastly, it may be induced by local ir- ritants acting on the urinary organs themselves. In those cases the urine is always of a pale colour. " Thus, generally speaking, nothing can be more opposite than the conditions of the system, and consequently the principles of practice, indicated by a diminished or increased flow of urine. Hence, they are symptoms of primary importance in all diseases in which the urine is^concerned; and, whatever may be the disease, seldom fail of furnishing us with a clue to the principles upon which it is to be treated."—An Inquiry into'the Nature and Treatment of Gravely Calculous, and other Diseases connected with a deranged operation of the Urinary Organs. Lond. 1821. ft. 35. • ' * Dr. Ferriar observes, " that the diuretic action of digitalis, though independent of its sedative powers, may sometimes take place in conjunction with the latter, and may even co-operate with DIURETICS. 233 digitalis in dropsy are dependent upon its sedative ef- fects, Blackall and Paris disapprove of the common prac- tice of prescribing this remedy in combination with ca- lomel, since this latter article always excites the action of the heart and arteries, and is therefore inconsistent with the sedative operation of digitalis. I feel persuad- ed, however, that this objection is rather hypothetical than founded on experience and correct observations. Were it a fact, that the diuretic powers of this medicine are dependent on its sedative effects, the impropriety of such a combination would be evident; but as no such dependence subsists between these powers, inasmuch as the diuretic effects of the medicine are generally conspi- cuously evinced, when the action of the heart and ar- teries is least reduced, and on the contrary sometimes entirely wanting when the sedative effects are most pow- erful, it does not seem reasonable to ascribe any unfa- vourable consequences to the mere stimulant effects of calomel upon the diuretic operation of digitalis, with which it is sometimes combined. Although digitalis oc- casionally acts very powerfully as a diuretic, it is not to be regarded as very certain in its operation. In gene- ral, where it produces any good effects in dropsy it does not require long before it manifests its diuretic powers. Dr. Ferriar observes, in relation to this point: " if no beneficial effects be perceivable, in the course of a few days, I exchange the digitalis for some other diuretic." I have myself repeatedly noticed this circumstance in my experience with this remedy; and I believe that it will seldom be proper to continue it more than seven or eight days, if no manifest diuretic effects ensue. Great diversity of opinion exists among writers con- cerning the remediate powers of this medicine in hydro- pic diseases. Some physicians of eminence, have ex- it, by its effect on the system as an evacuant."—Essay on Digita- lis. 234 DIURETICS. tolled its virtues in the most extravagant terms; whilst others have not been willing to concede to it any pro- perties in this respect whatever. The weight of good testimony is, however, in favour of the anti-hydropic vir- tues of this article, and almost all agree in opinion, at present, that, though not very commonly adequate to the cure of dropsy, it is nevertheless a remedy of valuable powers, and deserving of particular attention in the treat- ment of such affections. Dropsy is a disease by no means so uniform in its character and causes as is generally supposed. It arises in the most opposite states of the system, with regard to vascular action and repletion; it is dependent on various organic affections; appears as a consequence of different acute and chronic diseases; and is attended with distinct characters of urinary secretion. These circumstances point out some diversity in the character of the disease itself, and it is not reasonable to suppose that any one particular remedy is equally applicable to the disease under all these diversities of disposition. It appears, indeed, from the experience of physicians, that digitalis is peculiarly under the influence of circumstances of this kind, and hence, no doubt, have arisen the contradictory statements that have been made by writers concerning the anti-hydropic effects of this medicine. By Dr. Withering we are informed, that in his practice the di- gitalis seldom succeeded in curing ascites or anasarca, in persons of tense fibre and great general strength of system; on the contrary however it hardly ever failed to produce conspicuous diuresis in persons having a feeble or intermitting pulse, much laxity of fibre with a pale countenance and cold skin. Dr. Maclean, in his excel- lent work on hydrothorax, confirms these observations, and observes, in addition to what Withering has said, that he seldom derived any benefit from the medicine in per- sons of a fat corpulent habit, connected with a dull, slug- gish, irritable fibre, but that he generally succeeded well DIURETICS. 035 in relieving those of a " weak, delicate, irritable consti- tution, with a thin, soft, smooth skin, which in the ana- sarcous limb is transparent." Dr. Thomas states, that in cases where the urine does not coagulate by heat, he usually found digitalis unsuc- cessful; where the viscera were sound, however, or the habit not entirely depraved, he found it to succeed. He also observes, that when the digestive organs fail, and there is frequent sickness or diarrhoea, with a bad habit of body, the use of this remedy has appeared to be injurious. With regard to its relative value in hydrothorax, ascites, and anasarca, the evidence of practitioners is contradic- tory, and does not afford any conclusions worthy of con- fidence. Dr. Blackall, who has paid very great attention to the different varieties of dropsy, and especially to circumstances connected with the urinary secretion, ob- serves, that in dropsies consequent to scarlatina, in which he invariably found the urine to coagulate by heat, he derived the most important advantages from the use of digitalis, with blood-letting. As digitalis generally operates most beneficially in dropsy when united with other diuretic or hydragogue remedies, it is not commonly employed alone, but com- bined usually with calomel, squills, Dover's powder, cream of tartar, &c. Dr. Ferriar was in the habit of giving cream of tartar early in the morning, in doses suf- ficient to purge, and digitalis, with opium, in increasing doses, every evening. If there was naturally a tendency to purging, he gave the digitalis " in half-grain doses, at intervals of five, six, or eight hours, with the usual pre- cautions." I have seldom employed this medicine by itself in dropsy. My practice has almost invariably been to combine it with acetate of potass or squills, and fre- quently also with calomel and Dover's powder, as di- rected by Dr. Ferriar.* Squills and the saline diuretics * The formula which Dr. Ferriar generally used, contains pulv. 236 DIURETICS. appear to be particularly qualified to increase the diuretic properties of digitalis. The reason of this does not ap- pear to be very difficult to explain, if we adopt the opi- nion expressed by Dr. Maclean concerning the modus operandi of this medicine as a diuretic. He regards the beneficial effects of digitalis, in dropsy, as dependent mainly upon its powers of increasing the activity of the absorbents. This opinion derives very considerable sup- port from the fact, that this remedy very rarely produces any diuretic effects in persons unaffected by dropsical effusions, and in whom, consequently, no sudden reple- tion of the vessels, by absorption, can take place. The same circumstance takes place with regard to the ope- ration of calomel. In subjects where no effusions exists, this remedy hardly ever manifests any diuretic operation. In persons, however, labouring under dropsical collec- tions, the diuretic effects of this medicine are often very powerful and sudden. These effects can hardly be ex- plained upon any other principle than the absorption of the dropsical collections, in Consequence of which the vessels become suddenly overcharged with serous fluid, which is eliminated either by the bowels in the form of a diarrhoea, or by the salivary glands, or the kidneys. If these views be correct, and I am much inclined to put confidence in them, the fact that squills and some of the saline diuretics have a tendency to increase the diuretic operation of digitalis, would appear to be explicable upon the principle* mentioned in the preliminary observations to this chapter; namely, that whilst the absorption of the effused fluid is increased by the action of the digitalis, and consequently a greater portion of serum poured into the blood-vessels, the other remedies act more immedi- ately upon the kidneys, and increase their functions, by which the absorbed fluid is again eliminated. From this digitalis gr. §, calomel gr. i. pulv Doverigr. viii. made into pills. To be taken at bed-time, and repeated during the day according to circumstances. DIURETICS. 237 view of the subject we see, too, why calomel has a great- er tendency to increase the diuretic effects of squills than of digitalis; for with the former it produces the double and direct effect of absorption and renal action, whilst with the latter it can only produce increased ab- sorption, which may or may not excite the action of the kidneys. The best form for administering this medicine with a view to its diuretic operation is, an infusion of the leaves. The infusion of digitalis, directed by the London and Edinburgh Dispensatory, may be taken in the dose of from Sss. to 3i. twice a day, and gradually increased, until symptoms arise which require its suspension, such as slow pulse, accompanied with nausea, palpitations, faintness, purging, and great prostration. Dr. Blackall, in his excellent treatise on dropsies, mentions another symptom of the undue effects of this medicine, which it may be of importance to bear in mind; he slates that the continued use of the digitalis, or an over-dose of it, occasionally produces a tensive pain of the head, ex- tending sometimes over one eye, and attended with a disturbance of the brain, which precedes other bad symptoms, and which, if not attended to and speedily obviated, often terminates in convulsions or death. Its narcotic effects, when too violent, are best coun- teracted by stimulants, such as brandy and water, opium, and volatile alkali, &c. The sulphate of iron, and the infusion of cinchona, produce precipitates, when added to the infusion of digitalis. VOL. II.—h h 238 DIURETICS- SCILL.E RADIX.—SCILLA MARIT1MA.—SQUILL ROOT.* This is one of the most certain, efficacious, and va- luable diuretics we possess. Like digitalis, it is rendered much more active in its operation as a diuretic, by com- bining it with some other articles of this class, and par- ticularly by giving it in union with calomel. I have al- ready spoken of the propriety of uniting it with calomel, in cases where we wish to evacuate dropsical effusions. The squill seems to increase diuresis by stimulating the kidneys to invigorated action, and calomel, it is well known, has a powerful tendency to promote absorption. By uniting these articles together, therefore, we obtain a remedy which enables us at once to excite the action of the absorbents and the kidneys, and thus, in the most effectual manner, promote the removal of dropsical col- lections. The late Dr. Home of Edinburgh, supposed that the diuretic effects of this medicine were greatly enhanced by uniting it with such articles as are capable of promoting its emetic operation: or'by giving it in sufficient doses to produce decided impressions on the stomach and bowels. Directly the reverse of this opin- ion was strenuously advocated by Dr. Cullen, who maintained that the diuretic effects of the squill are ge- nerally much less conspicuous when it operates strongly on the stomach and intestines, than when it produces no sensible operation on these organs. The reason of this he conceived to be, that by such effects on the bow- els the medicine was " prevented entering the blood-ves- sels, and thereby reaching the kidneys." Whether we admit this explanation or not, the fact is, I believe, fully established that not only this, but every other arti- cle belonging to this class of remedies, is less apt to pro- * A particular account of the natural history of this root has already been given under the head of Emetics, DIURETICS. 239 duce diuresis when it either purges or vomits, than when no such effects are produced. Upon this subject Dr. Blackall observes, " it never operates so favourably as when it is given in the fullest quantity which the pa- tient can bear without sickness." This corresponds with the experience of other writers who speak of this reme- dy. It appears to be admitted on all hands, that the re- medy is, in general, more apt to afford relief in hydro- thorax than in any of the other varieties of dropsy.* " In the early stage of thfs disorder," says Dr. Blackall, " medical treatment does a great deal, principally by means of diureticts: and squills is by far the most pow- erful of them." " It is particularly useful," he says, " where, with an oppression of the chest, the urine is scanty, high-coloured, full of sediment, and without se- rum. Its use, however, is^not limited to this state; I have sometimes seen it render service where the urine is partially coagulable. But in proportion as that symp- tom becomes more marked by its extreme constitutional characters, inflammation, and a weakness of the diges- tive organs, it fails in its effect, or is even injurious." He recommends it to be given at first in the dose of thirty drops of the vinegar or tincture of squill, three times a day, and gradually increased to forty or fifty drops. When it does not act entirely as it could be wished, " the addition of a grain of calomel," says the same writer, "every night, is frequently followed by a great flow of urine at the same time that the salivary glands are affected." Dr. Maclean also speaks in very high terms of the efficacy of squills and calomel in hy- drothorax. I have myself uniformly obtained more ad- vantage in this disease, by these two articles in union with nitre, than from any other diuretic I have ever em- ployed. Such a combination is particularly efficacious when it produces inflammation of the gums and the * Blackall, Maclean, Van Swieten, &c. 240 DIURETICS. glands about the throat The reason why calomel and squills are more apt to afford relief in hydrothorax than in the other varieties of dropsy, may be owing to a three- fold operation: it promotes absorption, excites the urin- ary discharge, and, by determining the circulation par- ticularly to the glands of the mouth and throat, it causes a derivation from the exhalants of the pleura, and there- by lessens the dropsical exhalation. The exhalants of the cavity of the thorax would be more likely to be in- fluenced by such an afflux to the glands of the mouth and throat, than those situated more remotely, and hence, perhaps, arises the more speedy relief which is com- monly procured in hydrothorax by such a combination of remedies, than in ascites and anasarca. The expec- torant operation of squills, is also a circumstance which would seem to render it more suitable in dropsies of the chest than the other diuretics. The diuretic operation of squills is said to be assist- ed by the mistura ammoniaci and spiritus aetheris vitri- olici;* and Dr. Ferriar observes, that " in some habits the combination of tincture of squills with syrup of buckthorn proves very powerfully diuretic." Dose: from one to four grains, in substance. Tinc- ture and vinegar of squills, from thirty to sixty drops. COLCHICI RADIX.—COLCHICUM AUTUMNALE.—-THE BULB OF THE MEADOW SAFFRON. The colchicum autumnale is a perennial plant, grow- ing in abundance in the temperate climate of Europe, and may be conveniently cultivated in our gardens. " The root is a double succulent bulb. The flower is * Blackall DIURETICS. 241 large, of a purple colour, and comes directly from the root The leaves appear in spring, and are radical and spear-shaped. Corolla consisting of a simple petal di- vided into six lance-shaped erect segments. Capsule three-lobed, divided into three cells, containing globu- lar seeds, which are pot ripened until the ensuing spring, when the capsule rises above the ground upon a strong peduncle. It flowers in autumn, when the old bulb begins to decay, and a new one is formed. In the following May the new bulb is perfect, and the old one wasted and corrugated. The roots are dug for use in the beginning of summer."* When fresh, this root possesses extremely active powers, producing, according to the observations of Stcerk, when taken in a dose less than a grain, " a burning heat and pain in the stomach and bowels, stran- gury, tenesmus, thirst, total loss of appetite," and in larger doses, violent and even fatal effects. Its active principle resides in a milky fluid, and consists of an essential oil. It contains extractive matter, " which, when in solution, undergoes a chemical change." It has been ascertained by Sir E. Home, that the deposit which takes place in the vinous infusion produces nau- sea and griping, and that the efficacy of the medicine is notdestroyed by removing the deposit. It contains also an alkaline principle in combination with gallic acid;f which when snuffed into the nose produces vio- lent sneezing, and vomiting and purging when swallow- ed. When taken in a duly regulated dose, it generally acts upon the bowels and kidneys, producing commonly one or two brisk alvine evacuations, and a pretty copi- ous diuresis. Neither of these effects are however very constant results of its exhibition, nor does it appear that * Thornton's Family Herbal. t Annals de Chimie, torn. xiv. Mai, 182 k 242 DIURETICS. they are essential to its remediate influence, in many of the diseases for which it is prescribed. By the ancients colchicum was much employed as a remedy in arthritic and other diseases. It appears also from their writings, that they indiscriminately applied the names hermodactylus and colchicum to the same plant; though colchicum is the most ancient name, and it seems, too, that the name hermodactylus was appli- ed to several speciesA It is thought by many, that the colchicum autum- nale, which has of late become so important a remedy, is the hermodactylus of the ancients. This appears in- deed very probable, when we compare the description which Dioscorides gives of colchicum, with WTither- ing's account of the English meadow saffron. They agree perfectly in giving the very same distinguishing marks to the plant which they respectively describe. ]Now Serapion, in his description of hermodactylus, employs " the very words in which Dioscorides de- scribes colchicum." It is therefore quite evident that these writers must have had the same plant in view in their descriptions. It appears also, that in England, at no very remote period, colchicum was known by the name of hermodactylus. " In an English translation of Wirtzung's Praxis Medicinae Universalis, printed in the time of Queen Elizabeth, we have the following pas- sage: 'Hermodactylus, in Greek colchicum, in Latin ephemerum deleterium. Our common hermodactylus is the hermodactyle root and true colchicum, which Galen calleth ephemerum deleterium.' "f And Sir John Hill says, in his British Herbal, that " no one who has seen the hermodactylus of the east, and compared * Medical Sketches, B. G. Kerr. From this little work I have drawn the principal part of my historical account of this plant. t Medical Sketches. Diuretics. 243 it with the meadow saffron of England, can for a mo- ment doubt that they are the same plant." The colchicum was in high repute among the an- cients, and prescribed for the very diseases in which it is at present so much commended. It had, however, nearly sunk into total neglect, when Mr. Want of Lon- don, within a few years past, again brought it into no- tice, as forming the active principle of the eau medici- nale, D'Husson so much extolled for its remediate powers in gout. This opinion concerning the identity of the colchicum and the eau medicinale, is advocated by Sir Everard Home, in a paper published in the Phi- losophical Transactions;* but is strongly contested by Scudamore and others. Be this as it may, it seems to be conceded very ge- nerally, that the colchicum is a remedy of great powers in gout and rheumatism. It is not, however, allowed on all hands to be always a very safe remedy. It is stated, by very high authority, that although generally speedily effectual in removing the local symptoms of pain and inflammation in gout, it has a tt ^..ncy " to leave the disposition to the disease much stronger in the system, and lead to still more calamitous, because still more constant pains of the chronic form of the disease."! This writer, however, does, not disapprove of colchi- cum when properly administered, but speaks of it, on the contrary, in termsof confidence and praise. When given in the subjoined formula.J " it produces all the good effects," he says, "of which the medicine in its other forms is capable, and is not chargeable with any one ill consequence." * Part ii. 1816. t Scudamore on Gout, p. 108, Amer. edit. |R Magnes grs. xv. ad xx. raagnes sulphat 3'-*d 3"* aceti colchici 3i. ad ^\i. with distilled water most agreeable, and sweet- ened with syrup. To be taken at once, and repeated every four or six hours. 044 diuretics. From my own experience I can say nothing of its effects in gout; in chronic rheumatism, however, I have had unequivocal evidence of its efficacy. In a late work on the colchicum autumnale, it is stated to be equally efficacious in the chronic and in- flammatory forms of this disease. The author, Mr. Haden, asserts, that in his practice, " it has proved it- self a remedy of eminent power, in controlling the ac- tion of the heart and arteries, and in curing those states of the constitution which we are taught to name dis- eases of excitement."* In pure inflammations, he says, if given every four hours until it purges freely, the pulse will become nearly natural, from being either quick and hard, or slow and full. The form in which he employed this remedy is a powder, composed of one part of powdered colchicum, three of carbonate of potash, and five of sulphate of potash. Of this he gave one drachm three or four times a day, in half a pint of warm water, in the state of effervescence, with tartaric or citric acid. If this failed to move the bowels freely by the second or third day, he gave salts or the infusion of senna, to quicken its operation. As the strength of this preparation must depend much on the manner in which the colchicum is dried, and as, moreover, its active powers are much weakened by this process, it is evident, that the remedy must be liable to great varia- tions of strength. Within the last year, the seeds of the colchicum au- tumnale have been introduced to the attention of the profession, as a remedy of extraordinary powers in the cure of chronic rheumatism, and greatly superior in every respect to the root of this plant. Dr. W. H. Williams, of Ipswich, in England, to whom the credit * Practical Observations on the Colchicum Autumnale, as a general remedy of great power in the treatment of Inflammatory Diseases, both acute and chronic, &c. by Charles T. Haden, sur- geon. 1820. diuretics. 24>5 is due of having first brought before the profession the remediate properties of the seeds, says: " Much as the powers of the root of this plant have been extolled by different writers, I cannot omit this opportunity of de- claring my decided conviction, that, however success- fully different preparations of it may have been occa- sionally administered, its uncertain effects, the violence sometimes accompanying its operation, the little reli- ance to be placed upon the experiments hitherto made to ascertain the exact period of the perfection of the bulb, and the deterioration it frequently undergoes in keeping, are objections so weighty, that its value in the materia medica is insignificant, compared with the im- mense advantages attending the exhibition of the seeds." He states, that he exhibited the vinum seminum col- chici* to a great many patients, some of whom were severely afflicted with chronic rheumatism, and he de- clares that he was astonished by the rapidity with which the pains were removed and the use of the limbs re- stored. He directs it to be given two or three hours after breakfast, and repeated at bed-time. " With re- spect, more especially, to the vinum seminum colchici," he says, " of the safety of which I have experienced such abundant proof, I cannot contemplate an extensive use of it in many painful diseases, besides chronic rheu- matism, without entertaining the hope and belief that we have at length found the happy desideratum; a powerful, yet mild medicine, capable of substituting * B Sem. colch. autumn, siccat. §ii. Vini Hispanici (Sherry Angl.) Octan. i. Digere per dies octo vel decern, subinde agitando, dein per char- tam cola, et in vasi probe clauso usui serva. Dose %i. twice a day, gradually increased to 3'ii. Dr. Williams states, that " the acidum aceticum and the spiritus ammoniae aromaticus, imbibe the powers of the seeds in the same proportion as sherry; that an abundant aqueous extract may be obtained frcn the seeds, but no oil, and that water distilled from them appears totally inac- tive." VOL. II.—I i 246 diuretics. calmness, tranquillity, and balmy sleep, in the place of pain, weariness, and restless nights,—a renovation of long lost limbs, and comparatively robust health, in lieu of feebleness and emaciation."* I fear, however, that this flattering account of the sanative virtues of our re- medy will not be verified to the full extent. There can, nevertheless, be no doubt, from the statements we have had, that it possesses very active powers; and although it is not probably entitled to the high encomiums be- stowed upon it, there are just grounds to expect from it very important remediate results. With regard to the employment of colchicum with a view to its diuretic operation, late experience does not appear to speak much in its favour. By baron Slcerck, however, it was regarded as a very powerful diuretic, and exceedingly useful in dropsy. Having ascertained by experiments on himself that the oxymel of colchicum, taken in doses of a tea-spoonful, produced copious dis- charges of urine, he made trial of this remedy " in the hospital at Vienna, in desperate hydropic and other serous disorders, in which it was always found to act without disturbance as a most potent diuretic, after the common medicines employed with that intention had failed." He commenced with a drachm twice a day, and gradually increased the dose to an ounce, and oc- casionally an ounce and a half a day. I have seen it employed in one case of dropsy only, and in this instance it excited copious diuresis, without, however, effectually removing the disease. This remedy has also been recommended in humoral asthma; of its powers in this disease, however, there * Observations, with Cases illustrative of the salutary powers of the Seed of Colchicum Autumnale, &c*&c. by William Henry Williams, M. D. F. L. S. S c London Medical Repository for August, 1820, and June, 1821. DIURETICS. 247 is nothing extant, so far as I can ascertain which is cal- culated to attract the attention of the profession. Dr. Paris thinks "that acids and oxygenating sub- stances render the vinous infusion drastic; on the con- trary, alkalies render its principles more soluble, and its operation more mild, but not less efficacious." The saturated vinous tincture is given in the dose of from 3ss. to 3i. Mr. Bichard Battley, chemist, of London, who ap- pears to have paid very particular attention to the na- ture and properties of this root, and the best time for taking it, says, " that this root is deprived of its power, progressively, from the time of throwing out the new bulb until its final disappearance; and that, although very little change of appearance occurs during the winter months, it really undergoes a decided change during that period; that August before the new bulb is thrown out, is the proper season to procure the root; and that the various opinions, as to the medicinal properties of colchicum have proceeded from the various states in which it has been brought into use. " The root, when dug up in August, should be im- mediately cut into transverse slices, equal in thickness to a half crown; to be then exposed, in wicker baskets without placing the pieces in contact, to a temperature of 170° to 180°, and so to remain until dried, which will require from two to three hours."* NICOTIANA TABACUM. Tobacco possesses very considerable diuretic pro- perties, but on account of its extremely unpleasant and sickening effects, it is seldom employed as an internal remedy. Dr. Fowler, who has written a work on the * London Medical Repository, for July 1820. 248 DIURETICS, employment of this remedy in dropsy and dysury, speaks very highly of its' efficacy in these diseases. He recom- mends it to be used in the form of an infusion; and ob- serves that the best time for administering it is about two hours before dinner, and on going to bed. Dr. Ferriar also employed it in some cases with success; though he does not speak of it as deserving much confidence. He gave it, occasionally, in combination with other diuretics,* giving at the same time purging doses of cream of tartar in the morning. He states that he succeeded in several very unfavourable cases by this plan of treatment, and he thinks " that the action of the kidneys may in general be excited in this manner." I have employed the tinc- ture of tobacco in two cases of dropsy, and althongh considerable diuresis was produced, no permanent ad- vantage was gained. Tobacco has also been recom- mended in nephritis calculosa, and of late by Mr. Earle, in retention of urine from stricture. Under the head of Narcotics, I have already spoken of its employment in this way; to which the reader is referred for a particular account of its various remediate powers. LYTTA VESICATORIA. Under the head of Epispastics, I have given a par- ticular account of the chemical character, and of the external employment of cantharides, and shall therefore confine myself in the present place, to a consideration of its powers as an internal remedy. Cantharides are a very ancient article of the materia medica. Hippocrates * R Oxymel colchic. Oxymel scillae. Tinct. nicotian. Spi. aether, nitros aa p. ae. misce. capeat cochleare par vulum ex aquae pauxillo quater in die. DIURETICS. 249 speaks of their internal employment in dropsy and amenorrhcea, and they are particularly mentioned in the writings of Dioscorides, Galen, and £liny. When taken internally, in an excessive dose, can- tharides occasion a burning sensation in the fauces, throat, and stomach, producing inflammation of the in- testines, and frequently blisters of the mouth and oeso- phagus. The heart and arteries are greatly excited, the pulse becoming full and hard, and the skin hot, like in inflammatory fever; the thirst is excessive and un- quenchible; great anxiety is experienced, attended with retching, vomiting, diarrhoea, pains in the bowels, back and joints, itching of the skin, vertigo, syncope. But the most distressing and prominent operation of this article is its action upon the urinary organs. It pro- duces, when taken in an over-dose, inflammation of the neck of the bladder and urethra, occasioning thereby the most painful dysury; the urine comes off drop by drop, being generally mixed with blood and attended with ex- cruciating pain; sometimes an entire suppression of it takes place, accompanied with the most distressing efforts to micturate. These symptoms are generally accom- panied by the most tormenting erections. These are the effects of the medicine when exhibited in exorbitant doses; when employed in small ones, instead of produc- ing difficult and painful discharges of urine, or its total suppression, it excites a copious diuresis, and may often be very usefully employed where the evacuation is to be promoted. In cases of dropsy attended with a weak and languid circulation, cantharides will frequently produce very good effects. It appears to be more especially useful in those cases of anasarcous effusions which sometimes supervene in persons recovering from scarlatina and other acute fevers. Dr. Ferriar reports some cases of this kind which speedily yielded to the conjoint employ- ment of bark and tincture of cantharides. 250 DIURETICS. Cantharides have been recommended as particularly serviceable in hydrothorax, accompanied with a relaxed habit of body. They are also mentioned by some writers as serviceable in humoral asthma, and in other chronic affections of the breast Burdach says, that cantharides in union with bark, or opium, or aether, are very service- able in chin-cough, after it has already continued for a considerable time, and is attended with considerable atony of the general system. It should be given so as to ex- cite slight pain in passing urine. From what I have seen in my own practice, I am strongly inclined to believe that cantharides may be usefully employed in incipient phthisis, when it occurs in young females of relaxed habits of body and suffering from amenorrhcea. In the oedema which often accom- panies suppression of menses* in young chlorotic females, I have found the tincture of cantharides, with bark, a most useful remedy. By this remedy we at once iovigorate the general system, promote the action of the kidneys, and determine the circulation to the uterine vessels, and thereby frequently reinstate the catamenia, and with them, health. From their powerful tendency to act upon the urinary organs, cantharides have been much employed both for the cure of incontinence of urine, and suppression of this discharge from torpor or paralysis of the bladder. Nothing, indeed, has as yet been discovered which is so effectual in the former of these affections as this remedy. Where the incontinence arises from a paralysis of the sphincter of the bladder, we in general derive essential advantage from cantharides, given to the extent of pro- ducing slight strangury. It is equally serviceable for that species of incontinence of urine which many young people experience during sleep. We thus not only * See what is said of this remedy in the chapter of Emmena- gogues. DrURETICS. 251 strengthen the sphincter mnscles of the bladder, but * greatly increase the sensibility of the neck of this organ, as well as of the upper part of the urethra, in conse- quence of which these parts contract the moment the urine comes in contact and irritates them, and thereby prevent its escape. An excellent mode of employing cantharides for affections of this kind is, to apply them externally, in the form of plaster, to the sacrum.* Cantharides were formerly a good deal employed in gonorrhoea and gleet. Of late they have again been particularly recommended in the latter affection and in leucorrhcea. In the second volume of the Edinburgh Medical and Surgical Journal, Dr. Robertson has pub- lished an interesting paper on the employment of can- tharides in these diseases. In gleet I have derived the most satisfactory results from this remedy. It is neces- sary, however, to give it in doses sufficiently powerful to produce a considerable ardor urinae, and this, effect should be sustained for some time. I have been less successful with the remedy in fluor albus: though in some cases I have known it to produce unequivocal good effects. 'k There is no article of the materia medica," says Dr. Hosack, " used in any individual disease, the value of which ought to be estimated more highly than lytta in cases of seminal weakness and impotency." The in- troduction of this remedy in cases of this kind, in the United States, is due to Dr. Francis, of New-York. In a letter which I have lately received from him, he ob- serves: "My experience of the remediate powers of the cantharides, and its perfect safety and innocence, when given to a great extent, is such that I administer it in doses of two or three drachms a day, and on some oc- " Of the use of Blisters applied to the region of ihe Os Sacrum, in the cure of Incontinence of Urine, 8cc. by Thos. Dickson, M. D. Medical Observat. and Inquir. art. xxvii. vol. 2. 252 DIURETICS casions have given it to the amount of one, two, or three ounces in twenty-four hours. I have not yet failed in a single case of impotence, though I have had instances of this dreadful disease of four, five, or six years standing." Dr. Hosack mentions a remarkable case of this kind which came under the care of Dr. Francis and himself. It was induced by the mismanagement of a neglected syphilis, and the injudicious use of strong lead injections. The patient was reduced to such a state of mental an- guish as to induce him to seek a termination from his wretchedness by self-destruction. " With this view he took nearly six ounces of the tincture of cantharides during the night. Yet no dangerous symptoms occurred: he admitted he felt a degree of warmth throughout his body to which he had been a stranger, and that his mind was less depressed than before the commission of this act of folly." He was now induced to take two drachms and a half of the tincture of cantharides three times a day, in union with a dessert-spoonful of the tincture of amara, and to use a generous diet In the course of three weeks he was completely relieved; "his virile powers resumed their wonted vigour, nor has he to the slightest degree relapsed into his former state of weak- ness."* It appears from experience, says Dr. Robert- son, that the quantity of lytta requisite to keep up the irritation in the urinary organs is always proportionate to the " existing debility either of the general habit or of the generative organs." The use of cantharides in cases of this kind must not be soon relinquished if they should not immediately produce any obvious amendment. " Per- severance in the use of the remedy," says Dr. Hosack, " is a practical precept that must here be enforced. The extent to which it may be carried would, unaided by experience, seem incredible Cures have been ef- fected within a few days; at other times, from peculiarity * Appendix to Thomas's Practice, sixth edit. p. 1034. DIURETICS. 253 of condition, as many months or years have been requir- ed to accomplish the object in view." Cantharides have also been recommended in cutane- ous eruptions. Mr. Mead* and Dr. Carmichael men- tion their success in this respect. It does not appear, however, that the remedy possesses any particular pow- ers in cases of this kind. The strangury produced by cantharides is best obvi- ated by copious draughts of bland liquids, such as flax- seed tea, gum arabic water, decoctions of barley, melon seeds, &c. The dose of cantharides in substance is from one to two grains. It is best given with opium or extract of hyoscyamus. The tincture may be given from thirty to sixty drops. In cases of poisoning from cantharides, it has been recommended to exhibit large doses of sweet oil; but the experiments of Dr. Pallas, and Orfila prove that this is an exceedingly improper remedy in accidents of this kind. According to the experiments of the latter, cantharides macerated in cold oil, will, when exhibited to dogs, kill them in a few minutes. This depends on the property which oil possesses of dissolving the active principle of cantharides.f BALSAM COPAIBjE. The treej which affords this resinous liquid, grows spontaneously at Guiana, Brazil, in the country around Tolu, and in the Spanish West Indies. Deep incisions * Medica Sacra, p. 24. t Journal de Pharmacie, Nov. 1822. t Copaifera Officinalis, Linn. VOL. II.—K k 254 DIURETICS. are made in the trunk of the tree, from which the bal- sam flows in considerable abundance. When it first issues from the tree it is very liquid, and nearly colour- less. On being kept, however, it acquires the consist- ence of oil, and assumes a pale golden colour. Although susceptible of considerable inspissation, it never be- comes solid. Its taste is aromatfc, acrid and bitter; and its odour fragrant, and peculiar. It is always transparent, whatever be the degree of its consistency. By distillation with water it affords a very odorous pale coloured essential oil, leaving an insipid resinous substance. The action of alcohol on this balsam de- stroys its transparency, and gives it a very disagreeable odour.* In water it is quite insoluble; but alcohol, and the expressed and essential oils, dissolve it with facility. It forms white saponaceous compounds with the pure alkalies, soluble in water. Balsam copaivae is a stimulant diuretic, imparting to the urine a bitter taste and peculiar smell; in large doses it acts pretty powerfully as a cathartic, and in ex- orbitant doses, it sometimes produces " a sort of vibra- tory feeling in the brain, or causes a febrile anxiety, with a mental disturbance bordering on insanity."! The free use of this remedy is sometimes followed by an eruption like the nettle-rash, especially when it disor- ders the stomach. It has seldom been employed simply with a view to its diuretic operation, although in some diseases of the mucous linings of the urinary and geni- tal organs, it is a remedy of unquestionable utility. In the cure of gonorrhoea, the reputation of this sub- stance has long been very considerable, and it seems indeed to be very well founded. Many practitioners depend almost exclusively on its employment in this disease, and my own experience, independent of the •Alibert, Elemens de Therapeutique, torn. ii. p. 341. t Dr. J. Armstrong. DIURETICS. 255 authority of others, leads me to place very great confi- dence in its powers. Dr. Armstrong, in his work on scarlet fever, makes some excellent observations on the mode of administering this remedy in virulent go- norrhoea. This article, he says, " has been so gene- rally restricted to the advanced stages, that, so far as I know, there is only one writer who advises it, and that by a short paragraph, in the inflammatory state." He recommends it as generally a speedy and effectual re- medy " in the primary as well as in the last stage of go- norrhoea," and states that he derived his knowledge of the efficacy of its early use in this disease from Dr. Pearson Dawson, " who had prescribed it with great success for more than twelve years, in the very com- mencement of virulent gonorrhoea."* Dr. Armstrong gives it, at first, in doses of sixty drops, formed into an emulsion with sugar, mucilage and water, repeated every morning and evening. The dose must sometimes be increased to the amount of three, four, or fivedrachms in twenty-four hours. To be entirely effectual the use of the copaiva should always be continued for a week or ten days after the discharge ceases." When there exists much ardor urinae, the copaiva may be allowed to act pretty freely on the bowels To restrain its pur- gative operation where this becomes troublesome, some laudanum should be given with it The good effects of this remedy will be much pro- moted by an antiphlogistic regimen, rest, and cleanli- ness. These remarks on the use of copaiva in gonor- rhoea, are drawn from Dr. Armstrong's excellent ac- count of his experience with this remedy. For several years past I have pursued this plan of treatment, and I * Dr. Chapman in his Therapeutics recommends precisely the same practice. He seems, however, not to have read what Dr. Armstrong had said on this subject; for he speaks of the practice here recommended, as peculiar to himself, and does not refer to the work of Dr. Armstrong. g56 DIURETICS. am fully satisfied that it will in general be found much more effectual, and certainly less apt to produce injuri- ous consequences, than the common practice of em- ploying strong astringent injections. I have, however, frequently employed, conjointly with the copaiva, in- jections of very weak solutions of sugar of lead, espe- cially towards the end of the disease; and it has appear- ed to me that the cure has been expedited and confirmed thereby. In the gonorrhoea of females, the balsam copaiva is less useful than in males. This is easily accounted for, when we advert to the circumstance, that in the latter, the urine, which becomes strongly impregnated with the balsam, passes immediately over the diseased surface of the'urethra, and thus acts in a manner like an injection on the affected parts. In the female, however, no such immediate local impression can take place, inasmuch as the vagina, and not the urethra, is the part princi- pally affected. That the urine becomes medicated by the copaiva is beyond a doubt, both from the taste and odour which it acquires in persons who take it; nor do we see any reason to doubt that a medicated fluid pass- ing along the urethra from the bladder outwards, should not be as effectual as if it passed from a syringe in- wards. Balsam copaiva has also been recommended as a very useful remedy in chronic inflammation of the bronchia, and similar affections. Dr. Armstrong considers it among the best remedies we possess in affections of this kind. " It seems," he observes, " in many cases, to exert a specific influence over the mucous membrane of the trachea and its branches; it increases the flow of urine, it not unfrequently keeps the bowels regularly- open, and sometimes it acts upon the skin, causing an itching or an eruption." I have employed this article in a few cases of what I considered chronic inflamma- tion of the bronchia; but its effects wTere not such as to DIURETICS. 157 induce me to think a great deal of its powers in this way. Dr. Armstrong observes, that the copaiva some- times produces an itching or eruption of the skin, both of which frequently alleviate the cough very much. This remedy, combined with sulphur, was much em- ployed by Morgagni in chronic pulmonary diseases, and Dr. Armstrong states, that he has often exhibited such a combination with manifest advantage.* To render it more pleasant, and less apt to offend the stomach, it may be very conveniently formed into a mix- ture with the yolk of egg, or mucilage and water.f It is very frequently found in an adulterated state in the shops. M. Bucholz says, that it is impure if it do not dissolve in a mixture of four parts of pure alcohol and one of rectified aether. Rape oil, says Dr. Paris, is often mixed with it, " in whicli case, if dropped into the water, the drops will not retain their spherical form, as they invariably will, if pure." PIPER CUBEBA. This plant is a native of Java, the Philippine islands, of Guinea, and the Isle of France, and furnishes the cubebs of commerce, an article which has lately attracted considerable attention as a remedy in certain diseases. The cubebs, which are the berries of the plant, are of a light brown colour, wrinkled on the surface, about the size of black pepper, and furnished each with a slender pedicle. According to the analysis of Vau- quelin, they contain: 1. A volatile oil, which is nearly solid. 2. Resin resembling that of balsam copaiva. * Armstrong on Pulmonary Consumption, p. 274, 2d edit. t Bal. copaiv. ^ss. spt. lavend. comp. spt. nit. dulc. al 3ii laud. 3i. g. arab. 3ii. aq. font. |iv. M. Dose, a table-spoonful morning, noon, and night. 158 DIURETICS. 3. A portion of another and coloured resin. 4. A coloured gummy matter. 5. An extractive principle, similar to that contained in leguminous plants. 6. Sa- line substances.* The cubebs are a warm and aromatic stimulant. In some persons they are mildly aperient, but in others they produce a contrary effect. Taken in the dose of from one to two drachms, they are considerably diuretic, giv- ing a deeper tinge and peculiar odour to the urine. Within a few years past this article has been highly re- commended, by some practitioners, in the cure of go- norrhoea. Mr. Jeffreys, senior surgeon of St. George's and St. James' General Dispensary, London, has lately published the result of his experience with the cubebs in this disease, from which it appears that, out of twen- ty-seven cases which were treated with this remedy, eighteen were cured, six relieved, and three failed.f In only three of the cases cured did the disease conti- nue beyond the twelfth day. The majority of cases were well before the eighth day. Dr. Jeffreys thinks that this remedy is more decidedly beneficial in the more inflammatory form of the disease. He observes also, that the good effects of the medicine commonly begin to show themselves within forty-eight hours after the ex- hibition of the first dose; and that in those cases which yield only partially to its iufluence, the disease is put in such a state as to dispose it to yield more readily to the balsam copaiva. Several other writers of respectability have published favourable reports of the effects of cu- bebs in gonorrhoea. I have myself employed it in per- haps, a dozen cases; aud have found it decidedly bene- ficial in some instances. The general result of my ex- perience with it, however, does not lead me to regard it * Annals of Philosophy, for March, 1822. f Practical Observations on the use of Cubebs, p. 64. DIURETICS. 259 as superior, or even equal, to the pure balsam copaiva administered in large doses. The»cubebs have also been prescribed with advantage in leucorrhoea. Dr. Trail of Liverpool, states that he has employed it in this disease, and that, in every in- stance, he has found it to mitigate the violence of the complaint, and in several cases to remove it entirely. The cubebs may be given either in the form of powJ der or of tincture. The former is given in doses of from 3i. to 3iii. two or three times daily. From one to two or three drachms of the tincture* is given three or four times during twenty-four hours. APIUM PETROSELINUM. This, the common parsley of the gardens, possesses very considerable diuretic properties, and is much used, as such, in domestic practice. The root has an agree- able sweetish taste, and the whole plant is slightly pun- gent and aromatic. The root is considerably more di- uretic than the other parts of the plant, as I have frequently had occasion to observe in my practice. Given in the form of decoction, it seldom fails to pro- duce a very considerable increase of urine. I have em- ployed it very advantageously in suppressions of urine, and particularly in the strangury which sometimes supervenes on the use of cantharides and turpentine. I have also known it to give considerable relief in ne- phritic affections, attended with painful micturition. I have commonly prescribed it together with the nialva rotundifolia, or with water-melon seeds. ' These addi- * The tincture may be made according to this formula: R Bacc. piper, cubeb. f iii. Syiritus vin? tenu. O. i. Digere per dies septem, et cola. 360 DIURETICS. tions are especially suitable in cases of strangury. It in general lies easy on the stomach, and is by no means unpleasant to the taste. DAUCUS eAROTA.—WILD CARROT. The wild carrot grows in very great abundance in many parts of the United States. In the vicinity of this city, particularly, it is one of the most common plants. The seeds of this species of carrot have a warm and moderately pungent taste, and a very agreeable aromatic odour. They are considerably diuretic, and are much used by the country people in suppressions of urine and painful micturition. In my own practice I have derived the most unequivocal advantage from an infusion of these seeds in anasarcous swellings of the lower extremities. They have also been employed with success in the other varieties of dropsy. In a consultation letter which I re- ceived from the late Dr. Wistar, in the case of the late Judge Yeates of Lancaster, who laboured under hydro- thorax, the doctor observes: "The wild carrot seeds, in infusion, have also been sometimes successful in hydro- thorax." They hardly ever fail to produce pretty copious diuresis; and an infusion of them may be drunk to almost any extent, without nauseating the stomach. The common garden carrot is also applicable to useful medicinal purposes. When boiled and beaten into a pulp, it forms an excellent cataplasm to ill-condi- tioned ulcers. " A marmalade of carrots, on account of their strong antiseptic qualities, has been successfully used for preventing and curing the sea-scurvy. An in- fusion of these roots has also been found to afford con- siderable relief to persons afflicted with the stone and DIURETICS. 261 worms, but especially the tape worm. It may be given to the extent of a pint a day."* This plant is figured in Barton's Med. Bot vol. i. ERIGERON HETEROPHVLLUM. This plant is common to the United States and Eu- rope; and is found in very great abundance in almost every part of this country. It rises to the height of two or three feet; u the stems are roundish, striated, pubes- cent, and about the thickness, below, of a pipe stem, gradually tapering towards the top, where it is divided into numerous spreading branches." The radical leaves are ovate, acute, deeply toothed, and supported by broad winged petioles, half the length of the leaves. The stem-leaves are sessile, lanceolate, acute, deeply sinuated, or remotely serrate-toothed in the middle. The leaves of the branches are lanceolate, entire, and closely sessile. All the leaves, except those from the root, are ciliated at and ftear the base. The flowers, borne in terminal, rarely lateral, corymbs, are numerous, " and of the sun- flower shape. The disk or centre is bright yellow," and the rayflorets capillary, numerous, white, blue, and sometimes pale purple. It flowers from August to late in the fall.f This plant is well entitled to attention for its powers as a diuretic and antilithic. In this city it has been a good deal employed, within a few years past, in nephritic and gravelly affections. Dr. Physic employed it in a case of dysury, attended with great pain and irritability of the bladder, with much relief to the patient. Dr. Wistar, in a letter to me, some years ago, says, " I once * Thatcher's Dispensatory. t Barton's Vegetable Mat. Med. vol. i. p. 232. VOL. II.—*L 1 262 DIURETICS. attended a gentleman who suffered with gout and hydro- thorax; the squill produced great disturbance and pain of the stomach, and thus did more harm than good. This gentleman was greatly relieved by the infusion of scabious, which he took very freely." In another letter, already refefred to in the preceding article, he says, " The infusion of scabious, taken plentifully, once gave complete relief in a similar case, (hydrothorax, with gout,) but it has sometimes failed." I have been much in the habit of prescribing this plant in gravelly and hydropic diseases. It has seldom failed to produce pretty copious diuresis in my practice, and the advantages derived from it have been such as to give me a very high opinion of its remediate powers. It will, in general, lie easy on the stomach, and has no tendency to weaken the digestive powers. Some of my patients have even found an increase of appetite from its use, and I do not recollect an instance where it became injurious to the stomach, " My own experience," says Dr. W. P. C. Barton, " with this plant, enables me to bear tes- timony to its diuretic virtues. If it be not among the most powerful medicines of this class, it has the estima- ble property of being innocent to the stomach. I have used a strong decoction of this plant in a case of ne- phritis, at the Naval Hospital, and my success in this instance far exceeded my sanguine expectations, and emboldens me, with some degree of confidence, to re- commend the scabious in similar cases."* The plant should be collected when in flower. The best way of using it is in decoction, of which a pint or two may be taken in twenty four hours. For ex- cellent figures and descriptions of the Erigeron Hetero- phyllum and E. Philadelphicum, see Dr. W. P. C. Bar- ton's Vegetable Mat. Med. vol. i. * Vegetable Mat. Med. vol. i. p 23§. DIURETICS. 263 CHIMAPHILA UMBELLATA.--WINTER GREEN.—PIPSIS- SEWA. This plant is common throughout every part of the United States, growing in dry shady woods, and pre- serving its verdure during the winter season. The root is perennial, creeping, and of a yellowish colour. The stems are semi-procumbent, hard and woody at the base, from six to eight inches high, " and marked with the scars of the former leaves." The leaves generally grow in whorls, opposite or scattered, subsessile, lanceolate, somewhat wedge-shaped, acutely serrate, decurrent on the petiole, coriaceous, and of a deep shining green colour. The flowers appear in June and July, in a soft of umbel, variegated with purple and white. When chewed it imparts an aromatic pungency to the taste, and when bruised it has a strong and unpleasant smell. This vegetable has been but recently introduced into regular practice, and from the accounts which have al* ready been published of its efficacy in various diseases, it would appear to be entitled to much credit. Schoef speaks of it as " astringent and co-roborant," but says nothing of its diuretic qualities. During the American revolutionary war, it was employed as a tonic remedy in typhous fever. It was formerly a good deal used in some parts of the United States as a domestic remedy for rheumatism. Of late it has been introduced to the particular notice of the profession as a valuable diuretic medicine. Dr. Sommerville, of the British army, de- puty inspector of the military hospitals in Canada, in a paper published a few years ago, adduces some inter- esting facts demonstrative of its good effects in dropsi- cal diseases. He states that the diuretic effects of a strong infusion of this herb were always very consider- able, and that one patient to whom he gave it experi- 264 DIURETICS. enced an agreeable sensation in the stomach soon after taking the medicine, and a very considerable increase of appetite. He states, also, that Sir Walter Farquhar employed this remedy in the case of a lady labouring under abdominal dropsy, in which the diuretic effects of the medicine were very strikingly manifested. Dr. Marcet, in consequence of Dr. SommervihVs paper, tried the extract of this plant at Guy's Hospital, in doses of fifteen grains, with manifest advantage. Other wri- ters speak favourably of this remedy as a diuretic. In my own practice I have employed it in one case only; and, although it evidently produced a considerable increase of urine, it did not afford any decided advan- tage. The bruised leaves will sometimes produce red- ness, vesication and desquamation, when applied to (he skin.* The pipsissewa has also been successfully employed in the cure of intermittents. Dr Mitchellf relates se- veral cases of this complaint, which were effectually removed by the use of this remedy. It has also been recommended as an excellent antilithic. The late Dr. Barton says, that " all his trials and inquiries respecting this plant have convinced him that it is an important antilithic, not less so than the uva ursi." I have used it in some cases of this kind, but did not derive any particular advantage from it I suspect that its antilithic powers are entitled to very little attention. This vegetable has of late been a good deal employ- ed in cancerous affections, and some very remarkable cases are published in testimony of its good effects in this way. Although I am perfectly satisfied of its total inutility in cases of this kind, I have nevertheless in * Barton's Collection towards an Essay on the Materia Medica, third edit, part ii. p. 21. t Inaugural Dissertation on the Medical Properties of the Py- rola Umbellata. Phila. 1803. DIURETICS. 265 several instances known its internal employment to produce excellent effects, in the cure of ill-conditioned ulcers, and venereal eruptions. It may be given in the form of a strong decoction, to the extent of a pint in twenty-four hours. The watery extract of this plant has also been employed, to the extent of five scruples in twenty-four hours. SUB-CARBONAS POTASSiE.*--KALI PRiEPERATUM. Both the carbonate and sub-carbonate of potash, occasionally manifest considerable diuretic powers. Upon the subject of the modus operandi of the saline diuretics, Dr. Cullen observes, " With respect to the whole of them, it is to be observed, in the first place, that as it seems to be determined, by the nature of the animal economy, that all saline substances received into the mass of blood should soon pass out again by the ex- cretions, and particularly by that of urine, it will be obvious that, as all saline matters are more or less sti- mulant, they must all of them, in passing by the kid- neys, be more or less diuretic." From the reappear- ance of these salts in the urine, after having been taken into the stomach, there can hardly be a doubt of the correctness of explaining their modus operandi in pro- ducing diuresis. This is rendered still more probable by the fact, that when they prove laxative, and are thereby prevented from being absorbed, by the rapidity with which they are carried out of the body through the alimentary canal, they produce little or no diuretic effect. To obtain the full diuretic operation of the neutral salts, it is therefore necessary to exhibit them * The chemical history of this article has already been given in the chapter of Antacids. 266 DIURETICS. in such small doses, as to prevent them from acting on the bowels as a purgative, and they must be repeated at short and regular intervals. The diuretic effect of the fixed alkali is said to be enhanced by combining it with bitters, as was the cus- tom of Sir John Pringle. Dr. Cullen observes, that by giving the alkali in this way, he "commonly found it to prove diuretic." He also adds, that" alkalines may be often prevented, by purging, from reaching the kidneys; and that their diuretic effect may be often more certainly secured by giving an opiate at the same time." Dr. Mead was in the habit of using such a combina- tion, and he represents the practice as a very useful one. Formerly, the carbonate of potash was much employed in the cure of dropsy. We find it recom- mended in the works of Ettmuller, Willis, Sydenham, Monro, Mead, Mascagni, and other writers of the early and middle periods of the last century, as an efficaci- ous remedy in this disease. Monro speaks particularly in praise of it, when given in combination with rhu- barb. *' In the cure of those dropsical patients whose constitutions are so weak that they cannot bear purg- ing, it is to be attempted," says Sydenham, " by diu- retics: those are the best which are made of the lixivial salts." I have employed the carbonate of potash in combi- nation with squills, in persons labouring under hydro- thorax attended with indigestion and acid in the stomach; it is obvious that in cases of this kind such a combination is especially indicated, and in the few instances in which I have tried it, I have had much reason to be pleased with its effects. Dose from gr. x, to 3ss. DIURETICS. 261 ACETAS POTASSjE.--SAL DIURETICUS.--TERRA FOLIATA TARTARI. This salt is obtained in foliated laminar masses; it is extremely deliquescent, and possesses a sharp and pun- gent taste. One ounce of water at 60° dissolves four hundred and four grains. Four parts of alcohol, by weight, will dissolve one part of the salt. It consists of forty-five parts of potass and forty-eight of acetic acid. " It is decomposed by tamarinds and most sub- acid fruits; by almost every acid, as well as every variety of neutral salt, whether alkaline, acid, or me- tallic." This article was formerly much employed as a diuretic; though at present its reputation as such does not appear to be very great. In combination with other diuretics it is however, still frequently prescribed; and I have my- self, in some instances, used it with evident advantage in the way recommended by Dr. Maclean in his work on hydrothorax.* Alibert, however, speaks of it as a very efficacious diuretic in dropsy. " This remedy," says he, " is so well suited to the sensibility of the ab- sorbents that its administration is frequently followed by very salutary effects." He mentions a case of anasarca that was effectually cured by this remedy alone, after many other diuretics had been long tried in vain.f He observes that he might cite many other cases treated in the hospital Saint Louis, which show " the remediate powers of this valuable medicine." It cannot be given in powder or pills on account of its extreme deliquescence. The dose is from 3i. to * R Bacc. juniper, contus. 5ii. infunde in aq. ferv }fc. ii. per horas aliquot, dein cola, colatur. adde kali acetat. gss. spir. junip, e. §ii. M. This is to be used in draughts of about a gill, three times a day, as an adjuvant to a more active diuretic mixture composed of nitre, squills, and calomel. f Elemens de Therapeutique, vol. i. p. 327- 208 DIURETICS. 5i.; in the dose of from iii. to 3iv. it proves mildly cathartic. NITRAS POTASSiE.—NITRE.—SALTPETRE. In another place the chemical history of this salt is fully detailed, together with the various medicinal powers which it possesses independent of its diuretic operation. As a diuretic, nitre is not very powerful. It may never- theless be advantageously employed, either alone, or conjointly with other diuretics, in dropsical affections; particularly in cases attended by much arterial excite- ment, where it produces the two-fold advantage of diuresis and a reduction of the action of the heart and arteries. Alibert observes, that when given with a view to its diuretic effects it should be administered in copious draughts of some mild liquid. When exhibited in this way it is much more active as a diuretic, than when given in substance. The dose, as a diuretic, is from gr. x. to gr. xv. In exorbitant doses, it excites vomiting, spasms, convulsions, bloody-stools, and even death. SUPER-TARTRAS POTASS^.--CREAM OP TARTAR. I shall not repeat here what I have already said re- specting the chemical character of this remedy. Pos- sessing both hydragogue and diuretic properties, the cream of tartar would seem to be peculiarly suited to the treatment of hydropic diseases. By many, indeed, it is considered as one of our most efficacious remedies in such affections. When given in a large dose, it acts upon the bowels, producing copious watery stools; and, at the same time, excites the kidneys to an abundant secretion of urine. By this combined operation upon DIURETICS. 269 the kidneys and bowels, the remedy often evinces a powerful control over dropsical accumulations. To in- crease its diuretic effects it may be advantageously given in union with digitalis, as was practised b) Dr. Ferriar. This accomplished writer observes, in those cases in which he employed the cream of tartar successfully, it operated very early, w producing an increased flow of urine within twenty-four hours. It commonly dimin- ishes the swellings very speedily, and for the greater part, lessens the patient's size more quickly than the in- crease of urine would lead us to expect" It is quite evident, indeed, that the power of this remedy, in evacuating dropsical accumulations, does not depend ex- clusively on its property of exciting the renal emunc- tories, but in a considerable degree also, on its powers to increase the action of the intestinal exhalants. Cream of tartar is apt, by frequent repetition, to weaken the digestive organs; to obviate this effect, cordials and tonics ought«to be employed along with it. In doses of 3iv. to 3vi. it acts as a hydragogue: in smaller ones it acts simply as a diuretic. To increase its diuretic operation, it should be given in solution. 3L of the cream of tartar to a pint of boiling water, and flavoured with lemon peal and sugar, forms an excellent and cool- ing diuretic drink. SPIRITUS iETHERIS NITROSI. The dulcified spirits of nitre is a colourless fluid, ex- tremely fragrant, and of a pungent acidulous taste. It consists of a portion of nitric aether and nitric acid in union with alcohol. " With the green sulphate of iron it strikes a deep olive colour, and with the tinctures of guaiacum it produces a green or blue coagulum." Though by no means a very certain or active diuretic, vol. 11.—Mm 270 DIURETICS. the sweet spirits of nitre may sometimes be administered with much advantage, as an auxiliary remedy in dropsy.* It is not however often employed in dropsy, and is certainly, perhaps, never to be depended on as a princi- pal remedy in this disease. In the diseases of children, it is a very common remedy, and as it possesses consi- derable diaphoretic powers, it may be very usefully em- ployed, not only in diseases of the urinary organs, but also as a general remedy in febrile cases. From its plea-* sant taste it can in general be easily given to children. When administered as a diuretic it should be given in large doses, not less than three drachms at once to an adult In doses of ten to thirty drops it acts as a gen-? fcle diaphoretic. TINCTURA MURIATIS FERRI, The muriated tincture of iron possesses considerable diuretic powers. It has been especially recommended in suppressions of urine depending on spasm. Given in doses of ten or twelve drops every ten or fifteen mi- nutes, it sometimes procures prompt relief in the most obstinate cases of this kind. " To the good effects of this medicine," says Dr. Thomas, " I can myself bear testimony, having tried it in some cases of spasmodic suppression with success. After six doses the urine usually flows easily. In a case of chronic dysury, at- tended frequently with discharges of bloody urine, and a constant feeling of uneasiness or soreness about the neck of the bladder, I prescribed this remedy with de- cided and permanent advantage, after a very great vark * Dr. Paris gives this formula, as a highly stimulating diuretic. R Tinct. Lyttse M. x. Spirit. iEtheris Nitrici 3L Misturae Cam- phorese 3xii. Syrup Zingiberis 3i. Fiat Haustus ter in die su ipjendus,' DIURETICS. 271 ety of medicines and modes of treatment had been em- ployed with but temporary benefit In a letter which I lately received from my friend Dr. Francis of New York, he observes, " the muriated tincture of iron is acknowledged by all as a valuable diuretic. But in cases where there is much local irritation, as in some affections of the prostate gland, and in disorders about the neck of the bladder, its action is, at times, exces- sively painful. Under such circumstances," he conti- nues, " I have found the muriated tincture of gold pre-^ ferable. Indeed the gold deserves far more notice as a diuretic than as an antivenereal remedy." 4 CHAPTER XV. ///. Medicines that alter the state of the Urinary Secretion. LITHONTRIPTICS, OR ANTILITHICS. These are medicines capable of correcting the lithic diathesis, or of dissolving urinary calculi. The urine, even in a state of health, is by no means a simple ho- ✓ mogeneous fluid. It contains various substances, in such proportion as to be held in permanent solution. Some of these are liable, from particular causes, to be augmented beyond the proportion which the urine is capable of holding in solution, and they are therefore deposited, creating urinary sediments, gravel, and by further accretion, calculi. A disposition in the system to form such an excess of urinary sediments, is deno- minated the lithic diathesis, and constitutes a very inr- portant object of medical attention. It appears from the researches of chemists, that these urinary deposi- tions are of very various, and even opposite characters, as they occur in different individuals, or in the same in- dividual, at different times and under different circum- stances of health, diet, exercise, drinks, &c. AH the varieties of urinary deposits described by authors may, however, be regarded as composed of the four follow- ing elementary substances. 1. The lithic acid and its compounds. 2. The oxalate of lime. 3. The cystic oxide. 4. The earthy phosphates.* Almost all the * Prout on Calculous Affections, p. 110. LITHONTRIP TICS. 278 pulverulent and amosphous sediments consist either of the lithic acid and its compounds, or of the earthy phosphates. The yellowish, or nut-brown, reddish browa or lateritious, or pink sediments are of the for- mer kind. The white precipitate consists of the latter substances. The particular state of the system which favours the formation of the lithic acid or lithates, is call- ed the lithic acid diathesis, and that which gives rise to the phosphates, the phosphatic diathesis. What the essential characters of these diatheses are, it would be in vain to inquire. Observation and experience, how- ever, have given us some information with regard to the causes which favour their rise. Thus, it appears, that an excess of lithic acid is especially favoured by what- ever tends to weaken the digestive organs; and espe- cially by those causes, either dietetic or otherwise, which produce acidity in the primae viae. It is on this account that persons who live chiefly on vegetable food, are most subject to lithic acid sediments in the urine. Those circumstances which appear to favour the for- mation of phosphatic diathesis, are, injuries done to the back, and whatever produces a nervous state of the sys- tem, as fear and mental anxiety, and also, the long use of alkaline remedies.* With regard to the inffuence of *"A deposition of the earthy phosphates from the urine has been long observed to be attended by very distressing symptoms, though no one seems hitherto to have generalized them. They consist in great irritability of the system, and derangement of the chylopoietic viscera in general; such as flatulence and nau- sea, obstinate costiveness, or peculiarly debilitating diarrhoea, or both, frequently alternating; and the stools are extremely unna- tural, being either nearly black, or clay-coloured, or sometimes like yeast. These are always accompanied by more or less of a sensation of pain, uneasiness, or weakness in the back and loins. There is a sallow, haggard expression of countenance; and as the disease proceeds, symptoms somewhat analogous to those of diabetes begin to appear."—Prout's Inquiry into the Nature and Treatment of Calculous •djff'ections, p, 152. 274 LITHONTRIPTICS. the ingesta or urinary deposits, Dr. Wilson Philip draws the following conclusions from an interesting and long series of experiments which he performed on this sub- ject* " 1. That acid and acescent ingesta tend to in- crease the deposition of lithic acid from the urine, and to prevent that of the phosphates. 2. That a diet composed of a large proportion of animal food tends to lessen the deposition of lithic acid, and to increase that of the phosphates. 3. That every thing which pro- motes the action of the skin tends to prevent the depo- sition of lithic acid, and to occasion that of the phosphate. 4. That dyspepsia tends to increase the deposition of lithic acid, and to lessen that of the phos- phates, both by producing acidity of the primae viae, and by rendering the skin inactive. 5. That indolence has the same tendency, both by inducing dyspepsia and by lessening the activity of the skin in proportion as it impairs the vigour of the circulation. 6. That an acid passes by insensible as well as sensible perspiration." Dr. Prout observes, that " an unusually heavy meal, especially of animal food or of bread, is invariably fol- lowed by a deposition of the lithate of ammonia from the urine." From these observations it is evident that our most efficacious antilithic means, consist of such remedies as are calculated to invigorate the digestive organs, and to correct the morbid contents of the primae viae; and es- pecially a proper attention to the nature and quantity of the food. With regard to lithontriptics, or those articles which are supposed to have the power of dissolving urinary calculi, it is obvious that they can produce no solvent effect until they are brought into immediate contact with the calculi. Their modus operandi must therefore be * Medical Transactions of College of Physicians in London, vol. vi. 1820. UTHONTRIPTICS. 275 very different from that of the antilithic remedies. These appear to produce their remediate effects chiefly by favouring healthy digestion and chyiification, and by thus preventing the formation in the digestive and chylopoietic organs of an undue proportion of those materials from which the urinary deposits are formed by the kidneys. The former remedies, on the other hand, pass through the circulation, and being thrown into the urinary or- gans, exert a solvent power upon the lithic concretes, existing in the kidneys and bladder. When we reflect how great an influence diet and the state of the digestive organs have upon the nature and quantity of urinary deposits, it would appear highly probable that the ingredients out of which these depo- sits are formed by the kidneys, are prepared for them in the digestive and assimilative organs, and that they are not formed by the renal emunctories " from what- ever may be presented to them indiscriminately."* If this be the fact, it is clear that the remedies which check the formation of urinary sediments act before they reach the kidneys; and that in proportion as they are adapted to restore the healthy condition of the digestive and chylopoietic organs, so are they calculated to act beneficially in the lithic acid diathesis. It is very questionable, whether we possess any re- medies capable of dissolving calculi existing in the uri- nary organs. The attempts at removing calculous concretions by remedies of this kind having hitherto, with very few exceptions, proved abortive, is a fact which sufficiently warrants the scepticism which prevails on this subject. Still, as it is ascertained that some substances exert an evident solvent power upon calculi out of the bladder, and as it is moreover equally well established that these very substances, when taken in- * Prput 276 lithontriptics. ternally, are absorbed and carried to the bladder, there would appear some reason to expect advantages from the employment of remedies of this kind in calculous cases. Mascagni states, that after using the carbonate of potash, he found his urine so impregnated with it as to convert the yellow colour of turmeric to a brown, and to evince no slight solvent power upon a calculus put into it. It must, however, be observed, that the alkalescence of the urine, produced by the internal use of an alkali, is but very transient Mr. Brande states, that in the experiments he made on this subject, he found " that the effects of the alkali, in becoming pro- minent in the urine, was at its maximum probably in less than a quarter of an hour after it had been taken into the stomach; and in less than two hours the whole of the alkali had passed off." In speculating upon the lithontriptic power of certain substances, it must not be forgotten that well attested cases are on record, in which the internal employment of such remedies was followed by a complete cessation of all the symptoms indicating the presence of urinary calculus, and where, notwithstanding, the calculus still remained in the bladder, as was ascertained by the in- troduction of a catheter. Early in the last century a Mrs. Stephens received a large pecuniary reward from the British parliament for discovering a remedy which she used with signal success in calculous affections. It was found, however, that although her patients got rid of all their painful symptoms, the calculi were not dissolved. De Haen relates a remarkable case of this kind, in which he gave, from November, 1756, to June, 1757, seventeen pounds of Venetian soap, fifteen hundred pounds of lime-water, and the same quantity of milk. Under this treatment the patient gradually got better until all his calculous symptoms entirely vanished. Not- withstanding this apparent cure, the presence of a cal- .1.ITH0NTRIPTIC3. 211 cuius was still demonstrable by the sound.* Sir E. Home mentions two cases where the symptoms had sub- sided under the employment of alkaline medicines, but on dissection the calculi were found of great size, im- bedded in cysts. He moreover states, that in some in- stances the calculous concretions increased rapidly while the patients were taking these remedies regularly. One patient took alkaline medicines four or five years, and " at his death the bladder was found nearly filled with light spongy calculi of different sizes, not less than three hundred and fifty in number. Another who had taken soda, both mild and caustic, for some months, and then submitted to the operation on the symptoms in- creasing, was found to have a calculus, which was sur- rounded with a coat of triple phosphate one tenth of an inch thick, the rest being a mixture of uric acid and phosphates." Whytt supposes that, in cases where the symptoms disappear under the use of lithontriptics, the calculi, though not dissolved, have their asperities re- moved, and that they are coated by a mucilaginous crust by which they are prevented from doing injury to the ten- der parts with which they are in contact. " Exemplo no- bilissimi equitis H. Whalpole aliorumque, debuit conclu- des si calculi non solverentur, eis tamen asperitates demi, circumvolvique crustam mucilaginosam, quae ne noceat calculus, efficiat."f Dr. MarcetJ also contends, that although little or nothing can be expected from this class of remedies, in destroying calculi already formed, "yet in some instances the sharp edges of small calculi may be so blunted by the internal use of chemical solvents, * Calculi verus martyr sumptis libris 17, saponis Veneti, 1500 libris lactis, et 1500 libris aquae calcis, liberatus sic fuit, ab ejus symptomatibus, ac si ultra no adesset calculus; qui tamen et post curam, et elapso post eandem anno, prsesens demonstratus cathe- tere fuit.—Ratio Medendi, vol. i. p. 138. t I have not access to the works of Dr. Whytt, and therefore quote from De Haen's Ratio Medendi, vol. i. p. 136. J Marcet on Calculous Disorders. London, 1817. VOL. II.—N n 278 LITHONTMPTICS. as to allow them to be passed with less difficulty and in- convenience." Where therefore the symptoms of cal- culus disappear under the internal use of solvent reme- dies, we cannot conclude positively that the calculi have been dissolved and removed out of the system, espe- cially if they be located in the kidneys, in which case we can derive no information from examinations with the sound. Experience is therefore decidedly opposed to the opinion which ascribes any very particular solvent pow- er to this class of remedies. From the same source, however, we learn with equal assurance, that these re- medies are often of unequivocal advantage in certain gravelly affections, and especially in counteracting the tendency which often prevails in the system to form an excess of lithic matter with urine. I would, however, ascribe very little to the solvent power of these remedies, nor can I believe that they produce any very considera- ble effect by the power they may have of neutralizing the uric acid before it has time to form concretions, and thus prevent, as Mr. Brande supposes, the further in- crease of calculi.* The medicines which are most useful in this respect, tend to correct acidity in the pri- mae viae, and to favour the digestive process; circum- stances which I have already said have a very intimate relation with the generation of lithic matter by the re- nal emunctories. In treating of the particular articles of this class of remedies, I shall have occasion to speak more espe- cially on this point; to which, therefore, I now pro- ceed. * Philosophical Transactions, for 1810, Part I LITHONTRIPTICS, 279 CARBONAS SOD£i et POTASSiE. When we advert to what has already been stated, concerning the tendency of acid and acescent ingesta to increase the secretion of lithic acid and its compounds, by the kidneys; and of the influence of an acid condi- tion of the contents of the primae viae from indigestion, there can be no difficulty in perceiving that the fixed al- kalies may operate beneficially in urinary depositions composed of lithates or lithic acid. For, whether we admit their solvent power or not, it would appear quite reasonable to suppose that, as these urinary sediments are more copiously secreted by the kidneys when mor- bid accumulations of acid exist in the stomach and bow- els, the remedies in question would, by removing this exciting cause, tend to correct the renal secretions. I would not, however, ascribe every thing, in this respect, to the mere antacid properties of the alkalies. They are, undoubtedly, absorbed to a degree into the circula- tion, and again thrown into the urinary secretion, and may thus exert some remediate effect, not only by their immediate action upon the secretory vessels of the kid- neys, but also, in a small degree, perhaps, by their sol- vent properties. Be this as it may, there can at present be but little doubt of the utility of alkaline remedies in correcting the lithic acid diathesis, or of occasionally af- fording relief in nephritic and calculous affections. It is thought by some late writers* that the alkalies are inferior to magnesia, as antilithics; and Sir E. Home accounts for their inferiority, by supposing it to depend on the greater insolubility of the magnesia, and its con- sequent longer retention in the stomach, affording it thereby a greater opportunity of counteracting "the formation of uric acid." I am much more inclined, * Sir E. Home, Brande, Scudamore, Prout, &c. 280 UTHONTRIPTICS. however, to adopt the opinion of Scudamore on this subject He contends, " that although some advantage is afforded to the alimentary canal by its power of neu- tralizing acid matter, yet that its (magnesia) chief supe- riority over the alkalies depends on its purgative quali- ties; so much more easy is it to arrest the morbid process of digestion by a medicine which removes the cause, than by one which merely has the effect of temporary correction." When the lithic acid sediments prevail, we almost in- variably find the digestive process out of order, and much acidity in the alimentary canal; and from what I have already said concerning the connection between such a state of the digestive organs, and the secretion of uric acid by the kidneys, it is quite plain that the alkalies are the proper remedies. For although it does not appear that they reach the urinary passages in suf- ficient quantity to exert any particular solvent power upon the pre-existing calculous matters in these organs, still, however, the prevailing tendency of the system to form lithic matter may be checked, " by the beneficial changes which they produce during the first stages of assimilation, by neutralizing excess of acid, or otherwise disturbing those affinities, which, in the subsequent pro- cess of assimilation and secretion, give rise to calculous affections."* Independent of the effects which are here ascribed to the action of the alkalies, they appear to pos- sess very considerable power in allaying the morbid ir- ritability of the urinary passages. It is very different, however, with the white urinary sediments. These, as has been observed above, consist of earthy phosphates, forming a triple compound with ammonia, and are in general unconnected with indigestion, and acidity in the primae viae. In urinary sediments of this description the alkalies are not only useless, but absolutely perni * Marcct. LITH0NTR1PTICS, 281 cious. The white sediments," says Mr. Brande, " may always be abundantly formed by alkaline medicines, and persons who habitually drink soda water, or take mag- nesia, are frequently voiding it Its appearance, in the latter cases, has often led to serious errors. I have known soda water, exhibited in a case of a stone in the bladder, produce abundance of white sand, which the ignorance of the patient and his medical attendant led them to refer to the solvent power of the medicine upon the stone, which they thought was giving way, and being voided; whereas great mischief was doing by giving the urine more than its usual tendency to deposit the phos- phates, and consequently to augment the size of the calculus."* The alkaline corbonates are generally given in pre- ference to the pure alkalies. They appear to answer equally well, and are much less offensive to the stomach. " The stomach," says Dr. Paris, " appears to bear the protracted exhibition of the carbonate of potass and soda with more temper than it does any other alkaline com- bination. From twenty to fifty grains of carb. of soda or potass may be taken two or three times a day. The liquor potassae, or sodae, may be taken in solution in doses of from g" xv. to g1^ 1. two or three times a day, in veal broth or table beer," which latter is said to dis- guise its nauseous flavour completely. Whilst pursuing a course of alkaline remedies, it will be useful occasion- ally to interpose a purgative medicine. Upon this point Dr. Paris observes, "but we must not combine it (the purgative) with the lithontriptic, for it is a law, that ca- tharsis suspends the process of absorption." If it were true that the antilithic power of the alkalies depended on their being absorbed and conveyed to the urinary or- * Brande's Observations on the Medico-Chemical Treatment of Calculous Disorders. Quarterly Journal of Science and the Arts, No. 12. 282 LITHONTRIPTICS. gans, this caution would no doubt be very proper. But this is extremely doubtful; and it appears moreover that magnesia, whose powers in this way are superior to those of the alkalies, operate most beneficially when it pro- duces a purgative operation. Besides, the existence of such a law is by no means established. Every one must, indeed, admit that while purging is going on absorption must be diminished; but it is much to be doubted whether it is suspended. Bhu- barb impregnates the urine with its colour, notwithstand- ing its purgative operation;—here absorption is not sus- pended. From Mr. Brande's experiments, it appears very clearly that neither the carbonates nor sub carbo- nates of the fixed alkalies exert any sensible action on uric acid; and it seems equally clear, from what this able writer says, " that an alkali administered to a calculous patient stands no chance of reaching the uric concre- tion in a caustic state." If these facts be correct, and there can scarcely be a doubt on this point, we have a very plausible explanation of the inefficacy of the alka- line carbonates as solvents of urinary calculi. Alkaline solutions have been injected into the bladder through the urethra; I have not, however, learned that any de- cided advantage has been gained from such a practice. Fourcroy and Vauquelin paid particular attention to this mode of dissolving urinary calculus. Incompatible substances: "acids and acidulous salts, borax, muriate of ammonia, acetate of ammonia, alum, sulphate of magnesia, lime-water, nitrate of silver, am- moniated copper, muriate of iron, submuriate and oxy- muriate of mercury, acetate of lead, tartarized antimony, tartarized iron, the sulphates of zinc, copper, iron, &c." f.ITHONTRIPTICS, 283 MAGNESIA. The antilithic powers of magnesia are very consi- derable, and appear to be pretty generally acknowledg- ed by the practitioners of the present day. Mr. Brande, in an interesting paper published in the Philosophical Transactions, first directed the attention of physicians to the efficacy of this remedy in preventing the forma- tion of certain varieties of urinary depositions. Instead. of pursuing the hopeless inquiry after an efficient solvent for urinary calculi, physicians and chemists have of late endeavoured to ascertain the nature of urinary sedi- ments, and the causes which influence their increase and decrease, " with the view of administering such pre- ventive medicines as may indispose the system to pro- duce those concretions, or check their growth, without altering the tone of the constitution." From some trials made by Mr. Brande, he found that magnesia diminished the quantity of uric acid in the urine more promptly and conspicuously than any of the alkalies, however largely administered. He relates four cases in which the anthilithic powers of this remedy were unequivo- cally displayed* The first was a gentleman whose urine was constantly highly charged with uric acid, which was deposited in the form of red sand or crystals. He suc- cessively took the subcarbonates of soda and potass without any benefit from the former, and but little from the latter. He was finally directed to take fifteen grains of magnesia three times a day; in a week after com- mencing with this remedy the uric deposits were sen- sibly diminished. The medicine was continued for eight months, and the urinary deposit disappeared en- tirely. Another patient, suffering from a similar com- * On the efficacy of Magnesia in preventing an increased for- mation of Uric Acid, &c. by W. T. Brande, M. D. in the Philo- sophical Transactions, 1810, Part I. 284 LITHONTRIPTICS. plaint, after having tried the alkalies ineffectually, was wholly cured by taking twenty grains of magnesia, night and morning, for six weeks only. The third case is that of a person who succeeded in removing repeated attacks of uric acid, by the use of magnesia. The fourth case was a confirmed calculous tendency, which yielded almost completely to the free use of magnesia. Dr. Scudamore, whose opinion deserves great weight, does not admit the claims which are allowed to magnesia as a remedy in gravelly affections. " I condemn," says he, "any unlimited confidence in this medicine, as being, in most cases of complaint, a very inadequate remedy for the disease which is existing. The gravel and the gout are, as it were, but symptoms of the morbid action of other parts; and the primary disease and its true cause, is to be foupd in the digestive organs. But the gravel has a deeper foundation than the mere production of acid matter in the alimentary canal. In these cases we must look with vigilance to the state of the stomach, of the liver, and of the bowels, and to all the digestive assimilation, in connection with the wrong functions of the kindeys, in a manner less superficial than the rule of placing all our dependence on magnesia, or upon any alkaline medicine whatever, seems to imply. We shall learn that these remedies are^ useful, and even important, as auxiliary parts of treatment, but that they do not deserve any higher character, or stronger dependence."* It is scarcely necessary to observe, from what has already been said, that magnesia, like the alkalies, can only be properly administered in gravelly affections when the urinous precipitate is of the uric acid description; without an attention to this circumstance, the use of magnesia may become very pernicious in calculous com- plaints. I have lately employed this remedy in the case of a person much harassed by indigestion, and * Scudamore on Gout, p. 256. UTHONTRIPTICS. 2§5 whose urine was loaded with an uncommon quantity of uric acid. The vessel into which he discharged his urine was coated with a crust of this substance. I or- dered him twenty-five grains of magnesia three times a day, with infusion of gentian and orange peal. In less than three weeks the uric deposit had nearl) disappeared; but I could not succeed in removing it wholly, although he took it for upwards of four months. Magnesia has lately been strongly recommended as a remedy for diabetes. Dr. Trotter has published an account of five cases which were effectually cured by this remedy. He directed his patients to take from one drachm and a half to two drachms of the pure magnesia in twenty-four hours. The relief obtained from it was generally very prompt, and the cure in the course of a few weeks perfect* Since publishing the first edition of this work, I have had occasion to prescribe in two cases of diabetes.—In one case, which was of long standing, but not very violent, the magnesia proved effectual. In the other case, however, which was violent and rapid in its pro- gress, this remedy did not produce the slightest bene- ficial effect. AQUA CALCIS. ' Lime-waterj was formerly much employed in cal- culous affections; and there can be no doubt of its having sometimes manifested very useful powers in these com- plaints. Like the two former articles, it exerts but little or no solvent power upon urinary concretions, when taken in- ternally. It appears to act chiefly by correcting that * London Med. and Phys. Jour. vol. xxxix. p. 366, and vol. xlvii. p. 460. t Contains about ^-^ of lime VOL. II.—0 O • 286 LITHONTRIPTICS. state of the digestive organs upon which the lithic acid diathesis would seem to depend. Whytt, De Haen, Alston and others mention cases of its successful em- ployment for the removal of the symptoms of calculous complaints. It appears that, like the alkalies, it has been known to give effectual relief in calculous com- plaints, without, however, dissolving or removing the calculus. I have already quoted a case of this kind from De Haen, and similar ones are related by Whytt, Alston and others. In nephritic affections, depending on calculous concretions, or on too abundant a secre- tion of uric acid, the free use of lime-water will often afford great relief. Lime-water is generally directed to be given in milk to the extent of from a pint to a quart daily. Whytt gave it in combination with soap; but it does not appear to be more powerful in this way, and is much more un- pleasant to take, than when mixed with milk. Atten- tion must be paid to the nature of the urinary deposit; its exhibition, where the phosphates predominate, would prove not only of no avail, but very pernicious. Lime-water has been employed for various other re- mediate purposes. It has been much recommended for its good effects in diabetes. Dr. Ferriar constantly gave it as an auxiliary remedy with cinchona, opium and uva ursi. Shutz and Wilhelm, two German writers, detail cases of diabetes mellitus and insipidus, in which the use of lime-water alone proved successful.* It has also been employed with advantage in dysury depending on excess of lithic acid in the urine. In a case of this kind I prescribed it with the happiest effect. Pringle, Mar, and others recommend lime-water with milk in phthisis, and not a few cases have been reported in tes- timony of its efficacy. As gout is always connected with a lithic acid dia * Hufeland's Journal of Practical Medicine) yol. ii. p. 128- LITHONTRIPTlCS. 287 thesis, lime-water having a tendency to counteract such a disposition, may often be usefully employed in the chronic form of the complaint. It is very advantage- ously united with bitters in gouty complaints. In the cure of obstinate scorbutic ulcers, lime-water has been known to produce very excellent effects. There is a case of this kind related in the first volume of the Lon- don Medical Observations and Inquiries, which was effectually relieved by taking three pints of lime-water every day for five months, after a multiplicity of other means had been tried without any benefit. The ulcer was of several years standing, and situated on the left leg. Hoffman asserts that there is no remedy equal to lime-water in that variety of scurvy which proceeds from the continued use of salted diet. Baumbeck speaks well of lime-water as a remedy in cancer; but it is scarcly necessary to observe, that in this respect it is not entitled to the least attention.* It has also been found useful in chronic dysentery, leucorrhcea, and chlorosis. It may in general be usefully given, in all cases, attend- ed with a sluggish, phlegmatic habit of body, and an acid state of the contents of the alimentary canal. As an external remedy lime-water may be applied to very useful purposes. With olive oil it forms a most excellent liniment for burns and scalds; and with corro- sive sublimate, it constitutes the aqua phagedenica, a highly useful wash for foul and sluggish ulcers, particu- larly of the syphilitic kind. According to Hufeland and others, lime-water mixed with some mucilaginous decoction, forms an exceedingly useful injection for the removal of ascarides. If the internal use of lime-water occasions heat and thirst, the sweet spirits of nitre ought to be given two or three times a day, according to the advice of Whytt It * Vogel. Repos. Dissertatio de curationecancriocultiet aperti peraquamcalcis vivae potam prasstita. Gotting. 1769. 288 UTH0NTRIPT1CS. is, in general, useful to employ some bitter tonic infusion whilst taking the lime water. Acid drinks must be avoided during a course of lime-water. MINERAL ACIDS. The alkalies and alkaline earths, as is stated above, are the appropriate remedies in the lithic acid diathesis. They can only be employed with propriety, as antilithics, when the urinary deposits are of the red or lateritious kind, or, in other words, consist of calculous matter, in which the uric acid predominates. As might be sup- posed, quite the reverse obtains in relation to the employ- ment of the mineral acids in calculous affections. These are by no means fit remedies when the sediments are of the uric acid kind; but their antilithic power is generally unequivocally evinced in complaints in which the phos- phatic diathesis prevails, and where the calculous sedi- ments are white, or of that species in which the earthy phosphates predominate. " When from any cause," says Mr. Brande, " this white sediment appears, the internal use of acids will, in most cases, diminish or remove it." Jt is asserted by those who employ the alkalies and acids in calculous complaints, on chemical principles, that the urine "has a tendency to deposit white sand,whenever its natural acidity is diminished, as is shown by the ad- dition of a little alkali to recently voided urine, which immediately throws down a white powder." The modus operandi of acids in preventing such deposits would therefore appear to be easily explained; for as it is de- monstrable that acids taken into the alimentary canal show themselves again in the urine, it is evident that, to obviate the depositions of this white sediment, we need only to exhibit an acid internally, with a view of aug- menting the acidity of the urine, and thereby enabling LITHONTRIPTICS. 289 it better to hold its earthy phosphates in solution. Dr. Scudamore opposes the chemical theory on this subject, and maintains that the phosphates are deposited, not- withstanding the existence of a free acid in the urine. "I have now arrived at the end of an extensive exami- nation of specimens of urine depositing the phospates, and also holding them in solution, yet still having the power of reddening litmus in the usual manner."* He thinks that the mineral acids are useful in cases where the gravelly deposit consists of the earthy phosphates, simply by their tonic action on the stomach. That acids may prove advantageous in such complaints, by their tonic operation, can hardly be doubted. But if any con- siderable share of their good effects depended on a tonic influence, we ought, I think, to see them as efficacious in the lithic acid depositions as in those consisting of the earthy phosphates, since the former are generally even more conspicuously connected with a weakened state of the digestive organs tHlmihe latter. Still however, it is undeniable, that bark, exercise, bitters, and mineral to- nics, are often successfully employed in complaints at- tended with urinary deposits of this kind. " The febrile affections of children are very frequently attended by an apparently alarming deposit of white sand in the urine, and a dose of calomel will often carry off both the fever and sand." Whatever may be the modus operandi of mineral acids in diminishing the earthy phosphates of the urine, their utility in this way seems to be fully established. The nitric, the muriatic, and the sulphuric acids, have each been employed to check the formation of white uri- nary sediment. The nitric acid is thought by Mr. Brande to be more liable to occasion those symptoms of indigestion which are attended by flatulency and eruc- tations, than the other two acids, " and in a few particular * Scudamore on the Gout, p. 256. Amer. edit, 290 LITHONTRIPTICS. cases its long continued use has rendered the patient re- luctant to food; though many instances might be cited of its tonic effects, as a promoter of digestion and increaser of appetite." The sulphuric acid has a much more uniformly tonic effect, and may usually be persevered in much longer than the nitric and muriatic acids, without producing griping and other disagreeable gastric affections. The muriatic acid, though mostly agreeing very well with the stomach, is apt, by long use, to act upon the bowels, and to bring on a troublesome diarrhoea. " This cir- cumstance," observes Mr. Brande, " however, often re- commends it; for constipation very frequently attends the state of the body which favours the formation of white sand." " When the mineral acids agree," says this wri- ter, " they are usually very effective, and in a few days they diminish or entirely prevent the formation of the sabulous deposit; but where they disagree they rather increase the quantity, or they *tefld to the production of a mucous secretion, probably from the coats of the blad- der, which envelops and is voided with the sand, and which, in particular cases, may certanily tend to increase ihe risk of its agglutinations, and of the formation of a concretion in the bladder. The mineral acids, too, al- most always disagree with children, who are equally liable with adults to an increased secretion of the phos- phates, and in whom prompt and effectual treatment is equally requisite to prevent the formation of a stone in the bladder."* In cases of this kind recourse must be had to the vegetable acids. The tartaric acid may be given freely, either in a pure state or combination, as in cream of tartar. From five to twenty grains of the for- mer, and from twenty to sixty of the latter, may be ad- ministered two or three times a day. The citric acid is * Brande on the Medico-Chemical Treatment of Calculous Disorders. Quarterly Journal of Science and the arts, No. 12. LITHONTRIPTICS. 291 however, preferable to the tartaric, and may be admi- nistered in doses of from five to sixty grains; it rarely proves inconveniently purgative, and is very effectual in modifying the secretion of urine. Although the vegetable acids, when properly admi- nistered, will seldom increase the phosphatic diathesis, yet it appears from the observations of the writer I have just quoted, that cases do occur where a copious white deposit is attended with a peculiar irritability of the blad- der, and which are aggravated by any of the acids just mentioned. When a copious white sabulous deposit in the urine is connected with a biliary derangement, as is sometimes the case, it will be best to depend rather on an acescent regimen than on medicine; " and to obviate costiveness, if necessary, by an occasional dose of magnesia in a glass of sour lemonade."* CARBONIC ACID. This gaseous acid was at one time much in vogue as a solvent for urinary calculi. It appeared from the ex- periments of Hales, that water impregnated with carbo- nic acid, has the power of gradually dissolving urinary calculi; and it was demonstrated also that, when taken into the stomach, it soon makes its appearance in the urine. Hence it was concluded, that by means of this aerial fluid, we might readily dissolve " human calculi while yet in the bladder;" an opinion which was zea- lously advocated by Percival, Saunders, and others. Whether the opinion of these men be correct or not with regard to the modus operandi of carbonic acid, in gra- velly disorders, there appears to be no reason to doubt its occasional utility in preventing the white urinary de- * Brande 292 LITHONTRIPTICS. posit. Where, from peculiar circumstances, in cases of this kind, the other acids disagree with the patient, the carbonic acid, Mr. Brande observes, will often afford yery decided advantages. This acid may be very con- veniently taken, as it is dissolved in the artificial mineral waters, "or it may be administered in the form of a sa- line draught, in the state of effervescence; which is best done by dissolving thirty grains of carbonate of potash, and twenty grains of citric acid, in separate tea cups of water, and then mixing the solutions in a large tumbler, and drinking the whole during effervescence. This dose may be repeated two or three times a day, or oftener if expedient."* UV& URSI FOLIA.—BEAR BERRY. The uva ursi is an evergreen, creeping plant; with small oblong, oval leaves, resembling very closely those of the common garden box. It is indigenous both to Europe and the United States. The leaves have an odour bearing some resemblance to that of hyson tea, and are of a bitterish and sub-astringent taste. They contain, " tannin, mucilage, gallic acid, extractive, resin and traces of lime;" and yield their active principles both to alcohol and water. The virtues of this plant are variously represented by writers on the materia medica. Alibert says, "all that can be said of this remedy is, that its action is under certain circumstances, manifestly diuretic;" and he de- clares that its supposed specific power in nephritic and other diseases of the urinary passages has not the least foundation. The weight of testimony is however greatly in favour of its remediate powers in disorders of this kind. The * Brande, Pnilosoph. Trans. 1813, p. 213. LITHONTRIPTICS. 293 account given by De Haen of its efficacy in diseases of the urinary organs, is indeed exceedingly flattering, and although few other practitioners may have been equally successful with it, there is, notwithstanding, sufficient evidence extant to warrant us in regarding it as a useful remedy in such diseases. De Haen relates some very remarkable instances of the successful use of uva ursi in calculous and nephritic affections. He employed it with much success, also, in a case of ulceration of the penis and perineum from calculus in the bladder, and in peru- lent discharges from the urinary passages. He insists, however, that this remedy is wholly ineffectual in cases where there is much derangement of the internal uri- nary organs, whether from calculi, pus, or the too fre- quent and long retention of urine. "Magis confirmor," he says "magisque in eo quod in hoc opere toties monui, nullarum earn virium esse, ubi in systemate urinoso in- terno multa facta fuerit, sive a calculo, sive a pure, sive ab urina, saepius diutiusque retenta, degeneratio."* He states, that in several instances of urinary calcu- lus, this remedy afforded complete relief, "although the catheter showed that the calculus still remained." It does not appear from late experience, however, that any dependence is to be placed on this remedy in calculi of the bladder. In nephritic affections from gravel and other cases, we have abundant proof of its utility. Dr. Ferriar, whose testimony deserves the highest respect, says " I have given this remedy (uva ursi) in a consider- able number of nephritic cases, in very moderate doses, and always with manifest advantage." It must be con- fessed, however, that we are by no means warranted in ascribing all the good effects of the practice detailed by Dr. Ferriar to the uva ursi. He states, that " when the pain was very acute and the pulse quick, he began the cure with bleeding and a gentle purgative, composed of * Ratio Medendi, vol. iii. p. 117. VOL. II.—P p 294 LITHONTRIPTICS. manna and a neutral salt This purgative he repeated twice a week, and on the intermediate days directed the patient to take five grains of uva ursi, and half a grain of opium, three or four times a day."* Out of sixteen patients treated in this way he cured twelve. It is im- possible to say how much of the good effects of this treatment is to be attributed to the uva ursi. That how- ever some, perhaps a considerable share, of the success is to be ascribed to this remedy, may be inferred from its beneficial operation in diseases of this kind, when administered by itself, as I have myself witnessed in a few instances. Dr. Ferriar observes, that he never found it necessary to give it in larger doses than five grains, and that in doses of a scruple or half a drachm he found it to produce nausea, even when given with "^ opium. The same circumstance is mentioned by Lewis; " In all the cases," says he, " that have come to my knowledge, it produced great sickness and uneasiness."! In that variety of urinary disease which is attended with copious white sediment in the urine, especially in the last portions discharged, occasioning pain and irri- tation in the urethra, Dr. Prout states, that "he has often seen the greatest advantage from the combined use of muriatic acid, hyoscyamus, and uva ursi, together with the use of alterative purgatives." I have a patient under my care now, who has been for upwards of two years exceedingly afflicted with a pain in the region of the right kidney, attended with all the usual symptoms of renal calculus. He has been gradually getting better under the use of uva ursi and opium, in doses of twelve grains of the former with half of the latter, three times a day; and is at present almost entirely free from any symptom of his disease. The late professor Barton thought it particularly serviceable in nephritis depend- * Medical Histories, vol. i. p. 56. t Materia Medica. LITHONTRIPTICS. 295 ing on gout "In my own nephritic paroxysm," he observes, " alternating with attacks of gout in the feet, I have certainly found the medicine of much service: and I confidently and with much pleasure recommend it to the notice and trial of other sufferers from the same affection."* . Of the modus operandi of uva ursi in nephritic and calculous disorders, we are entirely uninformed; nor will I consume the reader's time by speculations upon a topic which has been so fruitlessly attempted by many of the ablest physicians. The remediate employment of uva ursi has, however, not been confined to affections of the urinary organs; it has been equally extolled in the cure^f other maladies, particularly in diabetes, consumption, leucorrhcea, haematuria, and gonorrhoea. . In the treatment of diabetes, Dr. Ferriar was in the habit of giving it in conjunction with cinchona, opium, and lime-water.f Dr. Bourne, professor, of the practice of physic in the University of Oxford, speaks very highly of the efficacy of uva ursi in the cure of pulmonary con- sumption. He states, that out of sixteen cases treated with this remedy, nine were cured, four relieved, and three died. This is certainly very extraordinary suc- cess; and is calculated to create the suspicion that some error in diagnosis may have occurred. He gave the medicine in ten-grain doses, with half a grain of opium, three times a day.J It is best administered in the form of powder. * he dose is from gr. x. to 3L * Barton's edition of Cullen's Materia Medica, vol. ii. p. 422. t R Pulveris uvae ursi, corticis Peruvian, aa Qi. opii gr. ss. quater in die sumend. bibat aquae calcis |ii. postsing. dos. pul- 1 Cases of Pulmonary Consumption, 8cc. healed by Uva Ursi, to which are added some Practical Observations. London, 1806, p. 393. 296 LITHONTRIPTICS. HUMULUS LUPULUS. The hop was at one time much recommended for its supposed lithontriptic properties. It has also been ac- cused of being favourable to the production of calculous affections. From my own experience I can say nothing in favour of its antilithic powers. Nor do I believe that it is entitled to any attention for its properties in this respect Several of the bitter astringent vegetable me- dicines have been commended for their good effects in cases of gravel and calculus. The gentiana lutea and quassia have been particularly mentioned as useful in affections of this kind. From the frequent connection of gravel and disordered function of the digistive organs, and the apparent dependence of the former on the lat- ter, it is not at all unlikely that these articles may often produce beneficial effects in nephritic and gravelly dis- orders. They may in general be very usefully given conjointly with the alkaline antilithics, as has already been stated when speaking of these remedies. CHAPTER XVI. IV. Medicines that promote the Secretory Action of the Salivary Glands. SIALAGOGUES. HYDRARGYRUS. It does not appear that the Greek and Roman physi- cians had any knowledge of the medicinal properties of mercury. They regarded it as a dangerous poison, and excluded it from the materia medica.* It was first em- ployed by the Arabians, as an external remedy in the itch and other cutaneous eruptions. The corrosive sub- limate and red precipitate, two of the most active pre- parations of this metal, are mentioned by Geber; and both Rhazes and Avincenna speak of the outward em- ployment of mercurial remedies. In Europe mercury was used externally in cutaneous disorders, as early as the twelfth century, by Gilbert, Theodoric, and others; but it was not employed as an internal remedy until early in the sixteenth century, when John de Vigo first gave it in the plague. About the same time Mathiolus used it internally in the cure of lues venerea; and Paracelsus adopted and advocated its employment with his charac- teristic zeal and enthusiasm. From this period the re- putation of this medicine gradually extended itself, t'»7®-.—Dioscorides, lib. v. cap. ex. 298 SIALAGOGUES. though not without great opposition: its powers became more correctly appreciated; and its application to the cure of diseases conducted upon more rational princi- ples. In its metallic form mercury does not appear to pos- sess any medicinal properties; but in the state of its va- rious preparations its influence on the animal economy is extensive, powerful, and important. Such, indeed, is the variety and extent of its remediate powers, that it may be most effectively employed in the form of its dif- ferent preparations, as a sialagogue, an errhine, a cathar- tic, a diuretic, a sudorific, an emmenagogue, an astrin- gent, a stimulant, an antispasmodic, and an anthelmintic; and hence we at once see how exceedingly various and important must be its therapeutic relations. Of all the sensible effects of mercury, salivation is the most re- markable, and, viewed as an evidence of its specific or general influence, undoubtedly the most important result of its operation. Mercury, it is observed by Cullen, " acts as a stimu- lus to every sensible and moving fibre of the body." What the peculiar^ character of the excitement which it produces may be, it would be in vain to inquire; but it appears to be more permanent and universal than that of any other medicinal agent with which we are acquainted. There are three modes in which mercury appears to act in producing its effects on the animal economy: 1. It is absorbed into the circulation and acts through the medium of the blood. 2. It produces a primary impres- sion in the part to which it is applied, which impression is propagated to other parts by means of the nerves. 3. It acts locally, by simply exciting an action in the parts to which it is directly applied.* * Dr. A-.! W. Ives, in the Appendix to Hamilton's Observa^ tions on the use and abuse of Mercurial Medicines. 9IALAG0GUES. 299 That mercury is carried into the circulation, and con- veyed with the blood, throughout every part of the sys- tem, is demonstrated by the fact of its presence having been detected in the solids and fluids of the body, and particularly in some of the secretions. Zeller states, that he found quicksilver in the bile; and Wepfer,* La- borde,f Brodbeltj and others mention instances in which this metal was found in the bones of persons who had died after severe and tedious mercurial courses. Dr. Hamilton detected globules of mercury in the milk of women in a state of salivation; and it is a fact well attested, that gold worn near the skin, by persons taking mercury, occasionally becomes covered with a white amalgam,—a circumstance which proves the presence of mercury in the cutaneous discharges. The absorp- . tion of mercury into the circulation, may also be infer- red from the pecoliar metallic taste of the tongue, and the well known mercurial odour of the breath and per- spiration of those who are under the specific influence of this metal. Dr. Ives, in the very excellent essay on the modus operandi of mercury to which I have already referred, observes: Where mercury produces its specific action on the constitution, it appears to be previously absorbed into the bloood-vessels. It there becomes 'a new and peculiar source of irritation to all the organs concerned in the circulation and the various secretions; it extends its influence through the medium of the blood to the nervous system, increasing its irritability, and thereby reacting upon the heart and arteries, and thus perpetuates the train of constitutional morbid associations which constitute mercurial fever." With regard to the sympathetic effects of mercury. « * Wepfer, Observationes Anatom. p. 303. t Journal de Medecine, torn. I. p. 27. t Samlung auserles. Abhandl. f. pr. Arte. B. xix. s.. 547. 300 SIALAGOGUES. also, I will quote the observations of Dr. Ives, because they express in clear and concise terms what I would wish to say on this subject " It has been shown, by the experiments of M. Bichat, and it is confirmed by daily observation, that the secretory action of the glands is increased by stimulating the mouths of their excretory ducts: it is in this way that mercurial preparations usually excite their deobstruent effects; but they appear also to have a sympathetic action, which is much more extensive. It is that which Mr. Hunter, in order to illustrate the spread of disease, has denominated con- tinuous sympathy, and which Bichat has pointed out as being maintained with peculiar vigour between mem- branes of the closest similarity of structure. In this way it seems that mercurial medicines, when taken into the stomach, extend their operation to other and distant portions of the mucous membrane, producing an in- creased discharge from the kidneys, lungs, skin, &c. Other medicines frequently exert their influence by this sympathetic action, particularly on the mucous mem- branes; astringents are often applied to one portion of this membrane, to check a hemorrhage in another por- tion." The local operation of mercury is manifested, by the purging and vomiting which some of its preparations produce; it is also evinced by the effects which very minute doses of calomel display in allaying morbid irritability, or inordinate peristaltic action of the ali- mentary canal, in cholera, diarrhoea, &c. When mercury is introduced into the system so as to excite its specific action, it at first increases the ac- tion of the heart and arteries; the pulse becomes quick, tense, and occasionally full; the gums become tender, accompanied with a peculiar metallic taste of the mouth and foetor of the breath. If the mercury be pushed further, the tongue, gums, and salivary glands, begin to swell; the teeth become painful and loose, the saliva SIALAGOGUES, 301 flows in great abundance, small ulcerations make their appearance on the tongue, gums, and roof of the mouth; the appetite fails; occasional pains are felt in the^stomach and bowels; the countenance acquires a peculiar ex- pression, indicative of a distressful morbid irritability of the system; aud much debility and emaciation commonly ensue. These are the ordinary phenomena of a regular mercurial course. Instances however occur, in which, owing to peculiar susceptibilities of the system, the ac- tion of mercury produces a train of symptoms which, so far from being salutary, are attended with much distress and danger, and permanent injury to the constitution. Palsy and epilepsy, and even death, have been known to supervene, in consequence of the action of mercury. Mr. Pearson has described these unfavourable effects of mercury under the name of erethismns. " This state," he says, '• is characterized by great depression of strength, a sense of anxiety about the praecordia, irregular action of the heart, frequent sighing, trembling, partial or uni- versal, a small, quick, and sometimes intermitting pulse, occasional vomiting, a pale contracted countenance, a sense of coldness; but the tongue is seldom furred, nor are the vital or natural functions much disordered." Fortunately, however, these distressing consequences of the action of mercury are but very rarely witnessed, and appear to depend either on idiosyncrasy of consti- tution, or on improper exposure and management during the mercurial influence. Every powerful article of the materia medica, indeed, may, under circumstances of idiosyncrasy or mismanagement, produce deleterious consequences. It is the abuse of such remedies that renders them dangerous: cautiously employed, they are the means which God has placed in the hands of man, to mitigate and remove pain and disease. We sometimes meet with persons so insusceptible to the action of mercury, as to make it extremely difficult, or even impossible to bring them under the specific in- vol. n.—q q 302 SIALAGOGUES. fluence of this remedy, unless measures be resorted to capable of doing away such resistance to its operation. In general a very feeble, and a very full and phlogistic habit of body are alike unfavourable to the action of mercury. When the former condition exists, opium, wine, and the Peruvian bark are indispensable; in the latter state of the body, bleeding and purging are to be employed. But there are states of the system which are neither connected with plethora nor debility, but in which notwithstanding there exists a powerful resist- ence to the operation of this remedy, and in which neither bleeding nor opium is of the least avail. Under circumstances of this kind, I know of no means more powerful in awakening the susceptibility of the system to the inffuence of mercury, than nauseating doses of antimony or ipecacuanha. My friend and preceptor, Dr. Joseph Klapp, of this city, from whom I learned the value of this practice, has been much in the habit of exhibiting these remedies in conjunction with mercury, with a view of accelerating its specific influence; and he informs me that he has seldom failed to establish the mercurial action in a short time, by these means, after the system had resisted the unaided operation of this re- medy for many weeks, and months. Upon this subject Dr. Paris remarks: " Reiterated practice has taught me, that the system, in a strong and healthy condition, fre- quently offers a resistance to the operation of mercury, which is overcome the moment the stomach becomes deranged, the circulation languid, or the general tone of the system impaired. I have frequently seen this during my hospital practice: if a patient who has been using mercurial friction, or taking the preparations of that metal without effect, be transferred into a close and unhealthy ward, his appetite soon fails, the tongue be- comes furred, and the system instantly yields to the in- fluence of the remedy. Nauseating doses of antimony frequently repeated, or the accidental supervention of SIALAGOGUES. 303 any disease of debility, will be attended with the same phenomena."* Of the efficacy of nauseating doses of antimony, in overcoming the resistance of the system to the action of mercury, I have lately had a remarkable example. After having tried ineffectually, for nearly two months, to bring a venereal patient under the specific influence of mercury, employed both internally and externally, I at length, by the suggestion of Dr. Elapp, gave him nauseating doses of tartar emetic, and by these means succeeded, in less than three days, in establishing a gentle salivation. Dr. Paris suggests that nausea, and other causes which derange the digestive organs, favour the salivant influence of mercury, by the power which they may possess of " overcoming the resistance which nature, in a state of health, makes to the admission of poisonous substances into the circulation." This explanation is, however, wholly hypothetical; since it is perfectly as- certained that a state of health is, in general, the most favourable condition of the system for the specific in- fluence of mercury. It is, moreover, predicated upon the supposition that remediate substances are more readily absorbed in a state of debility and disease than in the vigour of health,—a supposition by no means countenanced by experience. Dr. Klapp, in a conver- sation which I had with him on this subject, suggested that the effects of nausea in favouring the operation of mercury, may be referred to the obvious tendency which sickness of the stomach has to determine the circulation to the salivary glands, and to excite their secretory ac- tion, as is shown to be the case by the increased flow of saliva which commonly takes place during nausea. There is undoubtedly a very intimate connection be- tween the stomach and the glands of the mouth; and it is not improbable that, through this relationship between * Paris's Pharmacologia, p. 115. Lond. 3d edit. 304 SIALAGOGUES. these organs, nausea may produce the effects which arc here ascribed to it.* In relation to this subject It. A. W. Ives makes the following observations, which are worthy of much attention: " Cutaneous perspiration has such an intimate connection with, and dependence on. the circulation, that it is, perhaps, the best criterion of the susceptibility of the system to mercurial action. I have never known ptyalism produced in fever where the skin was perpetually dry, and even in diseases unattended with febrile excitement, have generally been able to form a correct prognosis of the effects of mercury from the state of this secretion. Hence the importance of com- bining antimonial preparations with calomel."f Whether, however, we can offer a satisfactory explanation of the fact in question or not, its practical consequence is not the less obvious and important; and from what I have myself seen, and learned from others on this subject, I am well satisfied that this practice will in general enable us, better than any other means with which we are now acquainted, to overcome the insusceptibility which we occasionally meet with in*patients to the specific action of mercury. Mercury may prove remediate:— 1. By producing a new and peculiar excitement in the system, and thereby overcoming the previous morbid excitement, on the principle suggested by Hunter,— * This practice of combining nauseating doses of emetic sub- stances with mercury, for the purpose of expediting its salivant operation, was employed by Dr. Klapp several years before Dr. Paris's observations on this subject were published. 1 have before me an account of four cases, transcribed from the case book of the Alms-house Infirmary of this city, in which Dr. Klapp ex- hibited small doses of ipecacuanha with calomel for the express purpose of facilitating its effects upon the salivary glands. These eases occurred in the year 1819. t Appendix to Hamilton's Observations on the use and abuse of Mercurial Medicines, p. 210. SIALAGOGUES. 305 that two different diseases cannot exist in the body at one and the same time, unless they exist in totally dif- ferent structures. It is in this way, probably, that mercury removes diseases, when exhibited in such doses as to produce no sensible evacuations or affections of the system. 2. By equalizing the circulation, and thereby re- moving local congestions. It is by an effect of this kind that mercury, in general, acts so beneficially in fevers of a congestive character. " The power which calomel has," says Dr. Armstrong, " in equalizing the circulation is no where more conspicuously displayed, than in dis- eases of a congestive character. Before its exhibition the skin will be cold, wan, and shrunk, the pulse feeble or oppressed, and the whole system apparently relaxed: but as soon as the mouth is made sore from its influence the skin becomes warm, reddish, and distended with vigorous circulation, while the pulse is full, soft, and strong, and the general energy in a great measure re- stored." 3. By establishing an afflux to the inflamed glands of the mouth, from the neighbouring parts. It is in this way, in part at least, that salivation proves serviceable in hydrocephalus, diseases of the breast, &c. 4. By exciting discharges from the bowels, and the various excretory glands of the body. Hence its utility in dropsy, dysentery, hepatitis, &c. Having premised these general observations on the employment of mercury, I shall next proceed to a par- ticular consideration of its therapeutic application; and in the last place give an accounnt of its various prepa- rations, and the peculiar remediate purposes to which they are applicable. Mercury was for a long time almost entirely confined to the treatment of chronic diseases. About the mid- dle of the last century it was introduced by some of the New-England practitioners as a remedy in acute inflam- 306 SIALAGOGUES. matory fevers; and soon afterwards Dr. Robert Hamil- ton, of Lyn Regis, in England, published his valuable observations on the efficacy of calomel and opium in in- flammatory diseases. Latterly mercury has become a very common remedy in acute disorders; but even at present its powers in these affections are perhaps too little attended to by the profession in general. Dr. Armstrong, upon whose judgment much reliance is to be placed, observes, in re- lation to this subject, " calomel is a medicine far too much given in chronic, and far too little in acute diseases; for while, when administered with due discrimination, I have never known it prejudicial in acute diseases, many instances have been presented to me where it seemed to have broken up the health in chronic diseases." The result of his experience with this remedy is very strong- ly in favour of its powers in diseases of high arterial ex- citement or venous congestions; and the testimony of many other practitioners of great celebrity might be ad- duced in behalf of this practice. It appears to be admitted, pretty generally, that mer- cury is most efficacious in fevers attended with disorder of the biliary organs, and hence we find it most com- monly recommended in the autumnal fevers, or those arising from marsh exhalations. A great deal has been said both in praise and con- demnation of the employment of mercury in yellow fe- ver. From my own experience 1 can say nothing con- cerning its powers in this disease; but much respecta- ble testimony is decidedly in favour of its utility in this ■ endemic scourge of hot climates. It was very early em- ployed by some West India practitioners in this disease. The credit however of having first extensively used this remedy in yellow fever, and raised its reputation in this respect, is Undoubtedly due to Dr. Chisholm. Soon after the mercurial practice was brought into particular notice in the yellow fever of the West Indies, it was SIALAGOGUES. 307 adopted and zealously advocated by Dr. Rush and others, in the treatment of this disease as it occurred among ourselves in the year 1793. It appears to be the opi- nion of those who speak most in favour of the mercurial practice in this disease, that it acts most efficaciously when given in very large aud frequently repeated doses, so as to bring the system under its specific influence as speedily as possible. By exhibiting large doses of ca- lomel, at short intervals, the combined advantage of its cathartic and early specific operation will be gained; and experience would seem to demonstrate that this practice, if promptly and decisively employed, will some- times arrest the disease in its commencement, and re- cover patients that would, perhaps, under a more gentle treatment be lost Dr. Bancroft, however, considers the inffuence of mercury of very doubtful efficacy. He thinks, " that where persons have recovered from the yellow fever, after having been salivated, their recovery was not occasioned by salivation, but was the conse- quence of such a condition of the powers of life, and of the functions connected therewith, as induced a mi- tigation of the disorder." In the treatment of our autumnal bilious fevers, mer- cury, carefully employed, is a remedy of much impor- tance. I have often observed, that as soon as a tender- ness of the gums came on from the employment of mercurial purges in this disease, the symptoms began to decline, and convalescence was speedily induced. I have seldom, however, administered calomel in any other way in bilious remittent fevers, than in purging doses; nor does it appear to me proper, to push its constitutional operation further than merely to give evidence of its in- fluence by a slight soreness of the mouth. In obstinate intermittents mercury is a remedy of very great power. I have succeeded in curing cases of this disease in a short time, by the use of calomel so as to affect the the mouth, after bark, arsenic, together 308 - SIALAGOGUES. with bleeding and blistering, had been vigorously and very perseveringly employed without the least advantage. Mercury is particularly applicable to those cases of .n- termittent fever that are connected with obvious symp- toms of visceral disorder, especially obstructions of the liver, spleen, &c. Calomel has also been much praised by some writers in the cure of typhus fever. Dr. Rush found the pulse becoming full and slow, aud succeeded by evident amendment, in typhus mitior, on the supervention of sa- livation. Dr. Warren, also, observes, that in cases of typhus where the debility had become very great, and in which wine and bark had been ineffectually used, " a few doses of calomel excited the system to action, and the patient began immediately to recover."* But the efficacy of this remedy appears to me more conspicuous in that variety of typhus which Dr. Armstrong calls the congestive form of the disease. This writer states that he generally gave it in a scruple dose at first, in its early stages, so as to procure full alvine evacuations, and ob- tain the alterative effects of the medicine as early as pos- sible. It appears, indeed, from the testimony of Chis- holm, Johnson, Armstrong, and others, that the specific influence of mercury is peculiarly beneficial in every species of congestive fever. " For a long time," says the latter writer, " I overlooked one of the principal effects of calomel in congestive fevers; and at last it was only forced upon me by patients almost invariably recovering with rapidity, when ptyalism was excited. The power which calomel has in equalizing the circu- lation, is no where more conspicuously displayed than in diseases of a congestive character. Before its exhi- bition, the skin will be cold, wan, and shrunk, the pulse feeble or oppressed, and the whole system apparently relaxed, but as soon as the mouth is made sore from its * A View of the Mercurial Practice in Febrile Diseases, p. 97. SIALAGOGUES. 309 influence, the skin becomes warm, reddish, and dis- tended with the vigorous circulation, while the pulse is full, soft, and strong, and the general energy in a great measure restored. The liver is intimately concerned in the pathology of congestive fevers, and for the first day or two the alvine evacuations (from calomel) will commonly be found either as dark as tar, or whitish and slimy; but they speedily become natural when ptyalism takes place, and a copious secretion of bile al- most invariably augurs a favourable issue."* In the ty- phoid fever which prevailed among the blacks in the suburbs of this city during the preceding two summers, I have seen the good effects of calomel strongly illustrat- ed. In several cases of this fever, evincing a highly congestive condition of the internal organs, I obtained the most decided advantages from large and frequent doses of calomel. As soon as the gums become sore, the tenderness in the epigastrium, of which they inva- riably complained, began to decline, and the other symp- toms gradually receded. In the acute phlegmasia! fevers, mercury is also a remedy of very considerable importance. It must be observed, however, that it can rarely be given with ad- vantage, or even propriety, in affections of this kind, without the previous or concomitant use of the lancet or other antiphlogistic and depletory measures. With such precautions, it may be resorted to in some of the phlegmasia with very great advantage. In these diseases the calomel should, in general, be given in such doses as to procure its purgative and specific operation, at the same time. " In such affections," says Dr. Armstrong, " the shortest and most certain way of procuring the specific, is through the purgative operation of calomel, for the high excitement resists the agency of calomel, and the intestines are usually so lined with morbid mucus * Armstrong on Typhus, Am. edit. p. 167. vol. ii.—R r 310 SIALAGOGUES. as to prevent its absorption, unless this mucus be brush- ed away, by purging, from the mouths of the absorbent vessels. One large, or two tolerably free doses of calo- mel, therefore, may be administered in the day, followed up by some other aperients, to induce plentiful evacua- tions before bed-time, while to accelerate its more com- plete absorption during the night, it may be given in divided doses, combined with opium, where there is pain in the chest or belly, or much general irritation." It must also be observed, that ptyalism is excited with much difficulty during the unabated violence of fever; and that while the skin is hot and dry, and the pulse quick or tense, calomel may be given with freedom, without the fear of producing inordinate affection of the mouth. When, however, the fever is somewhat mode- rated, calomel must be much more cautiously given, "because, as the system is then verging towards its natural state, its specific action will be more readily in- duced: and where, during the continuance of the fever it either acts freely on the skin or kidneys, while it keeps the bowels soluble, the practitioner need not be impatient about the appearance of ptyalism; for the mo- dus operandi of calomel is to equalize the distribution of blood, to restore the natural balance of the circulation by communicating a power to the capillary system of vessels which enables them to resume their secretory offices as before."* Of the great efficacy of mercury in hepatitis, there can now no longer be any doubt. Its employment in this disease originated in the East Indies, and was in- troduced into England about the year 1764, by Dr. Robert Hamilton of Lyn Regis.f In the beginning of the acute form of this disease calomel should be given * Armstrong on Typhus, p. 338. t Letter from Dr. Hamilton to Dr. Duncan, in the medical Commentaries for the year 1783-84, vol. ix. p. 191. SIALAGOGUES. 311 in large doses, with a view principally to its purgative effect, and ought always to be premised and accompanied by bleeding, both general and topical, and epispastics over the region of the liver. When the more violent symptoms of inflammatory excitement are subdued it will, in general, be highly useful to produce a gentle mercurial action in the system. In the chronic form of this complaint there is no treatment equal to a proper mercurial course. In this, however, as well as in all other chronic affections in which it may be thought pro- per to give mercury, it should be administered in minute doses, so as to affect the system very gradually. Dr. Ay re and Dr. Armstrong dwell particularly on the im- portance of attending to this mode of administering mercury in chronic diseases. In this respect the former of these authors has introduced a very valuable improve- ment in the use of calomel in chronic affections of the liver. Mercury has also been much commended for its powers in pulmonary inflammation. Dr. Robert Hamil- ton, whose paper I have already quoted, states that he employed calomel and opium in peripneumony with asto- nishing good effect This combination, he observes, eased the perspiration, promoted the discharge of bron- chial mucus, and acted like a charm in allaying the cough and general irritation. He also gave calomel and opium with great advantage in pleuritis, rheumatism, and other inflammatory affections. Dr. John Warren, professor of anatomy and surgery in the University of Cambridge, relates cases of pneumony in which calomel with opium were employed with exceedingly good effects.* From my own experience, I can say nothing of this practice; it is not at all unlikely, however, that after the violence of the inflammatory symptoms have * A View of the Mercurial Practice in Febrile Diseases, p. 152. 312 SIALAGOGUES. been moderated, opium and calomel in small doses, may be very serviceable The employment of calomel in cynanche trachealis originated, I believe, with the phy- sicians of this country. We are informed by Dr. John Archer of Maryland, that, in conjunction with polygala seneka, he used calomel very freely in this disease. Dr. Rush also placed considerable reliance on the efficacy of this medicine in that species of cynanche trachealis which he denominated the humid. He directs it to be given in large doses in the very commencement of the disease, and afterwards in smaller doses until the symp- toms disappear. When given in this way, he observes, that the bark is hardly a more certain remedy in inter- mittents than calomel in this form of croup. Two Scotch physicians, Dr. James Anderson, and Dr. Hamilton, both of Edinburgh, have published accounts of their success with this remedy in croup. The former gave calomel to the extent of eighteen grains in twenty-four hours, in doses of two or three grains every hour to children three years old; and he affirms that out of seven cases thus treated, not one died. Some years ago Dr. Stearns of Albany published an interesting paper on the use of very large doses of calomel in this disease. Instructed by the observations of Dr Stearns, I have since employed a similar practice with much success. Instead of the ordinary emetics, I give from fifteen to twenty grains of calomel to a chikl from two to five years old, at once; this hardly ever fails to excite copious emesis, and acts at the same time briskly as a cathartic. The nausea and relaxation produced by the calomel, is of much longer continuance, than that which attends the usual emetics. After the inflammatory symptoms of this disease have abated, it sometimes assumes a somewhat chronic cha- racter, attended with a dry hoarse cough, and difficult respiration. When the disease acquires this disposition calomel and ipecacuanha in small doses, repeated every three or four hours, is of essential service. It must be SIALAGOGUES. 313 confessed, however, that it would be wrong to place any great reliance on this, or any other medicine, in this rapid and dangerous affection, without the concomitant em- ployment of other means, and above all venesection, even to deliquium in very violent cases, as directed by Dr. Ferriar. The quantity of calomel recommended by Dr. Stearns and myself, in this disease, is however nothing when compared to that administered by Dr. Hamilton of Edinburgh. He states that he gave above a hundred grains in twenty-four hours, to a child only two years old; and by this practice he " completely succeeded both in curing the disease and in preventing any shock to the child's constitution, and in every case where it was employed previous to the occurrence of the lividness of the lips and other mortal symptoms." I would not how- ever recommend so bold a practice as this; but on the contrary regard it as rash and hazardous. Mercury has also been given, in cynanche maligna. Dr. Warren describes a putrid sore-throat prevalent at Boston in 1735, in which calomel was freely employed by some practitioners and it is stated with very good effect. " When the disease did not prove fatal on the second or third day, it was almost universally attended with great erosion and excoriation about the fauces, in- side of the mouth, lips and chin, and wherever the sali- va lodged; and these parts became covered with a white aphthous slough, painful and corrosive. In these cases calomel given freely and liberally was the only medicine which could be depended on to stop the progress of the erosion." In subsequent epidemics, however, this prac- tice was not found equally serviceable. In the scarlatina anginosa, which prevailed in this city in 1783, Dr. Rush, gave calomel in small doses, in every stage of the dis- ease. In chronic inflammation of the bronchia, calomel and opium are often of much service. Dr. R. Hamilton greatly extols the powers of this remedy in this affection. 314 SIALAGOGUES. Dr. Armstrong, though satisfied of the occasional utility of opium and calomel in chronic bronchitis, speaks, however, with more distrust of its powers in affections of this kind. " Cordially," he says, " as I join in the general and strong commendation of these two agents, preceded by evacuants, in acute inflammations, it is only justice to confess that they have not unfrequently disap- pointed my expectations in chronic ones; yet where the ordinary measures fail, they certainly deserve a fair trial even in simple inflammation of the bronchia; though the opium should be moderately administered, and most- ly along with camphor and antimony."* Much was at one time said concerning the efficacy of mercury in pulmonary consumption; and a considerable number of cases are reported in the periodical journals both of Europe and this country, in testimony of its utility in this almost hopeless malady. Dr. Samuel Akerly of New-York, in a letter to Dr. Rush, gives an account of four cases of pulmonary consumption which were cured by salivation;! and Dr. Rush himself men- tions his success with mercury in this disease. In the fifth volume of the American Medical Recorder, there are three cases related by Dr. John Gloninger of Le- banon, in which this remedy was successfully resorted to. For my own part, however, I am much inclined to doubt whether mercury has ever been of any real ser- vice in genuine tubercular consumption; and it is not improbable, I think, that the cases which have been men- tioned as having been cured by this remedy were of that variety of the disease which has of late attracted consi- derable attention, and described by Dr. Wilson Philip and others, under the name of ** dyspeptic phthisis." This form of consumption is generally preceded by symptoms of indigestion, but particularly those which * Practical Observations on Scarlet Fever, &c. p. 276. t Coxe's Medical Museum, vol. iii. p. 198. SIALAGOGUES. $15 indicate a disordered state of the hepatic system. " Con- trary to what is usual in other species of the disease, the spirits from the beginning are generally more or less depressed, and the countenance sallow."* The cough is first dry, and comes on in violent fits, commonly after a full meal or on lying down. The matter is generally thrown up in astonishing quantities. There is for the most part but little or no pain felt: if there is any expe- rienced it is usually " a dull pain in the pit of the sto- mach, or pretty low down in the left side of the chest." The diagnosis of dyspeptic phthisis, says Dr. Philip, does not, however, rest merely on the modification of the symptoms common to all the forms of this disease. There are other symptoms present by which we may generally with little difficulty distinguish this variety of consumption. These symptoms are, flatulence, acidity, furred tongue, impaired appetite, and irregular bowels. In this variety of the disease, mercury, with mild tonic remedies, is of primary consequence. It must not, however, be given so as to excite salivation; on the con- trary it ought to be introduced into the system very gra- dually, and pushed no further than merely to produce a slight tenderness of the gums. One or two grains of the blue pill, with some tonic bitter, may be given once or twice in twenty-four hours. " There is no disease," says Dr. Philip, " in which the advantages of minute doses of mercury are more conspicuous than in this; as the tenderness of the epigastrium abates, and the state of the alvine discharges improve, in by far the majority of cases, the pulmonary symptoms gradually disappear." There can hardly be any doubt of the utility of mer- cury in incipient phthisis depending upon a syphilitic taint But even here it is only in the early stage of the complaint, that this remedy can be employed with any prospects of success. * A Treatise on indigestion, by A. P. W. Philip, M.D. p. 500. 316 SIALAGOGUES Mercury has also been much recommended by some, in the cure of rheumatism both chronic and acute. In the latter form of the disease, Dr. R. Hamilton employ- ed calomel and opium with much success. The use of calomel in acute rheumatism is, however, certainly a practice of very doubtful efficacy; and unless as a pur- gative, or in cases occurring in the miasmatic districts, and attended with symptoms of biliary disorder, is but seldom employed in the present practice. In chronic rhumatism mercury is a remedy of acknowledged effi- cacy. Dr. John Ott», a very intelligent practitioner of this city, in an excellent paper on the cure of chronic rhumatism, published in the Eclectic Repertory,* says, " The result of my experience in the Pennsylvania Hos- pital is, that every form of chronic rheumatism in almost every instance is removed during the ptyalism, if it be carried to a considerable extent ;*that the exceptions are very few where there is not permanant relief obtained; and that, in a vast majority of cases, a complete cure is effected, if the salivation has been continued actively three or four weeks." Opium is an excellant auxilary to calomel in this disease; it allays irritation and pain; and prevents it from acting too violently on the bowels, a copious discharge from which is generally injurious in cases of this kind. In that variety of rheumatim which is brought on by imprudent exposure to cold, while under the influence of mercury, our best remedy will, in general, be a second mercurial course. " I have in every case of this kind," says Dr. Scudamore, " seen that all the ordinary methods of treatment are of no avail, or afford only palliative, and very temporary relief; but I have invariably had the satisfaction of witnessing the cure to be effected by resuming a well conducted course of mercury."! In some varieties of opthalmia murcury is a remedy * Vol. ix. p. 530. f Scudamore on Gout and Rheumatism, p. 316. SIALAGOGUES. 3J7 •f great powers. Mr. Travers observes, that in certain habits simple ophthalmic inflammation, whether local or constitutional, " becomes worse under the usual deple- t ory measures, the irritability increasing as the strengh fails. When this is the case, calomel, opium, and anti- mony are our best remedies."* Where there is opacity of the cornea, in strumous ophthalmia, " calomel," says the same writer, " or the blue pill, or the oxymuriate of mercury, should be exhibited in combination with opium so as slightly to affect the system. The efficacy of the mercurial remedy mainly depends on its combination with opium." Mercury is no less useful in sclerotitis; but in no form of ophthalmia is this medicine more decidedly beneficial than in choroid and iritic inflammation. After dwelling on the employment and action of mercury in inflammatory diseases of the ey% Mr. Travers observes: " But if any two facts are well established in modern practice, I apprehend they are these:—first, the power of mercury to arrest acute membranous inflammation, both prior to and after the effusion of adhesive matter; and secondly, its power rapidly to remove, by an excite- ment of the absorbent system peculiar to itself, the newly adhesive matter. If these facts be admitted, then the propriety of its use is indicated in iritis, as in carditis, pleuritis, peritonitis, and the only practical question that can arise respecting it is, how far the patient's strength is equal to support the remedy. There are, I admit, states of the organ as well as of the constitution in which it cannot be borne, and no sooner is its influence felt than the inflammation threatens disorganization, and if the plan be persevered in, quickly runs on to it." By the writers on the diseases of hot climates, mer- cury has been much recommended as a remedy in dys entery. Cleghorn gave calomel and opium combined in the evening, and a purgative draught in the morning. * A Synopsis of the Diseases of the Eye, &c. p. 253. VOL. II.—S S 318 SIALAGOGUES. This, he observed, hardly ever failed to bring off" a prodigious quantity of round, hard, foetid lumps, to the great relief of the patient." It does not appear* how- ever, that he employed mercury in this disease with a view to its salivant operation. By some of the late wri- ters on the diseases of the East Indies, calomel is more exclusively and confidently recommended in this disease. Dr. James Johnson gave it in " scruple doses," two, three, or four times a day, and although he admits that " the first stage of dysentery cannot be treated on prin- ciples too strictly antiphlogistic, he contends that when the second stage has commenced, or, in other words, when the previous increased action has ended in conges- tion, nothing can be more useful than to saturate the sys- tem with mercury. This mineral does more to resolve irritative fever, to equalize the circulation, disgorge the capillary vessels, restore the balance of the nervous pow- er, and open the sluices of the various healthy secretions and excretions, than any other remedy with which I am acquainted."* This practice, Dr. Robertson observes, is, however, only adapted to tropical climates, " for there the human frame is much less susceptible of the action of mercury, and consequently will bear much larger doses of that metal than it would be prudent to prescribe in the cli- mate of England." Dr. Bampfield,f thdugh averse to such Herculean doses of this medicine, speaks never- theless decidedly in favour of mercurial remedies in this disease, as it occurs in tropical climates. xt In my note- book," he observes, " it is stated, that more than fifteen months had elapsed after my arrival in the East Indies, before one fatal case occurred in the course of which ptya- lism had been fully induced and supported." In the in- flammatory form of this disease, calomel should not be given with a view to its specific effects, until the high fe- * Johnson on the Influence of Tropical Climates, 3d edit. p. 22Q t On Tropical or Scorbutic Dysentery, p. 135. SIALAGOGUES. 319 brile excitement be previously moderated by bleeding, purging, and other antiphlogistic measures. When this has been effected, calomel, Dr. Bampfield observes, may be resorted to with various and very important intentions: —" as a cathartic to empty the intestines of their faeces, and to excite an increased secretion from the healthy portions of the mucous membrane; to emulge the portal circle; to excite the salivary glands; and, which is the most important as a general stimulus to the system, to excite increased secretions generally, and a mercurial fever or irritation that supersedes inflammatory actions." There are other writers besides those already mentioned, who speak equally strong in favour of very largo doses of mercury in tropical dysentery. In the dysenteries of the middle latitudes, mercury requires a much more cautious use. After the inflammatory excitement is moderated, and there exists much intestinal irritation, with a dry and hot skin, there is no remedy better cal- culated to afford relief than calomel, ipecacuanha, and opium. Except, however, in the chronic form of the disease, I have seldom found it necessary to excite ptyalism. A slight affection of the mouth has, in ge- neral, been sufficient in my practice to afford relief. In diarrhoea calomel, judiciously managed, is a remedy of great efficacy. In minute doses it allays morbid intestinal irritation, more readily than any remedy we possess. Dr. Ayre of Hull, in his very ex- cellent treatise on marasmus, has fully set forth the value of small doses of calomel in this and other similar in- testinal affections. I can myself speak with much con- fidence of this practice. Within the last three years I have relied almost exclusively on minute doses of calo- mel, in the treatment of this complaint, and I do not remember of having been disappointed, in a single in- stance, in putting a stop to it. I commonly give one- fifth or fourth of a grain of calomel with an equal quan- tity of opium, every two, three or four hours, according 220 SIALAGOGUES, to the urgency of the symptoms. The use of minute doses of calomel is very strongly recommended by Dr. Ayre, in cholera. In that variety of this complaint which is peculiar to infants, I have been for several seasons past much in the habit of giving small doses of this remedy; and I have had reason to be pleased with its effects. I usually give from one-eighth to one-fourth of a grain with three or four grains of prepared chalk, every hour or two; I do not, however, rely exclusively on this remedy, but always direct the occasional use of the warm bath and rubefacient remedies to the surface. The late Dr. Miller of New-York, mentioned the efficacy of this practice in cholera long before the appearance of Dr. Ayres' book, to whom the credit of having first em- ployed the remedy in this way is now commonly as- cribed. To Dr. Ayre, however, we are indebted for a very ample and interesting view of the usefulness of this practice. In the cholera of adults he gave from one- sixth to one-third of a grain of calomel every half hour; and he relates a number of cases which were speedily relieved by this treatment Colica pictonum is another disease in which the efficacy of mercury appears to be well established. So thoroughly, indeed, am I satisfied of. the utility of this practice, that I rely entirely on large doses of calomel and opium, together with bleeding, where the arterial excitement is vehement I do not remember a single instance in which the bowels did not readily give way to the action of an ordinary cathartic, as soon as the mouth became affected by the mercury. For the more chronic effects of the poison of lead which show themselves in paralysis of the wrists, shooting pains through the ab- domen, pale and haggard countenance, &c. there is cer- tainly no remedy equal to mercury, given to the extent of exciting salivation. Dr. Clutterbuck, in his excellent work on the deleterious effects of lead, places the utility of this practice in a very strong light SIALAGOGUES. 321 In dyspepsia, when, from long continuance, functional disorder of the liver is induced, mercury, judiciously administered, is a remedy of very great consequence. The blue pill, in doses of four or five grains in the even- ing, and aided by occasional mild laxatives, tonic bjtters, and a proper diet, will, in general, act very beneficially. Here, however, salivation is to be carefully avoided; the slightest affeetion of the mouth, so as to give evidence of the alterative influence of the medicine, is all that is requisite from mercury in this complaint.* Being closely connected with indigestion, hypochon- driasis may here be mentioned as a disease sometimes considerably benefited by mercurial remedies. Given as a purgative in conjunction with other cathartic remedies, it does much good in this disease by exciting the healthy action of the liver, invigorating the portal circulation, and emulging the biliary vessels. With these intentions, the following pill may be used to much advantage.! This cathartic generally produces large bilious evacuations, frequently of the consistence and colour of tar, and which are almost invariably followed by great relief to the distressing hypochondriac symp- toms. A good deal has been said both in Europe and in this country concerning the efficacy of mercury in the cure of mania. Dr. Rush frequently employed saliva- tion in mental diseases in the Pennsylvania Hospital, and occasionally with much advantage. " Too much," he observes, " cannot be said in its favour in general madness." At present mercury is much less resorted to in mania than it wasformly. It is however a remedy well worthy of attention in the treatment of this disease; * Wilson Philip on Indigestion. t Extract colocynth comp. $\. calomel gr. xv. antim. tart. gr. ii. ol. carui g". v. M. ft. In pil. xxiv. dividend, cap. ii. vel. iii. quaque nocte. This pill is much praised by Drs. Johnson and Scudamore, in hepatic disorders 322 SIALAGOGUES. more especially in those cases which depend on, or at least are intimately connected with, deranged function of the hepatic system* or alimentary canal. Mercury has also been successfully used in tetanus. Dr. Rush cured a case of this disease in the Pennsyl- vania Hospital, by salivation, aided by bark and wine. Walthers, a German writer, says a great deal in favour of salivation in this disease.! Munro also gave mercury successfully in tetanus; and Dr. Joseph Klapp of this city has reported a case of this disease in which saliva- tion with the cold bath effected a cure. Mercury has often been given in conjunction with opium in this dis- ease. Dr. Odier of Geneva, says, that he has known these agents given in very large doses to produce very good effects in tetanus.| Mercury is supposed to be more efficacious in idiopathic tetanus, than in that variety which proceeds from mechanical injuries. It is doubtful, however, whether any real distinction exists in the essential character of idiopathic or symptomatic tetanus, and I am inclined to believe, with Dr. Morrison. who has lately published a treatise on tetanus, that the general treatment, in these varieties of the disease, can- not be distinct. Dr. Morrison observes, that spontaneous salivation has not unfrequently been noticed rt in tetanic patients, where cases terminated favourably, and hence probably the first idea of using mercury."§ " I have undoubtedly had many examples," says this writer, (t of the good effects of mercury in the cure of this dis- ease. Four grains of calomel given two or three times a day, with three or four drachms of the ointment well rubbed on the neck and spine night and morning, I be- * Kaempff, Hufeland, Prost, Burrows, Pinel, &c. f Walthers' Observations on the curative powers of mercury in tetanus. Abhandlungen aus dem gebiete der Pr. Med. B. i. 9. 166. t Manuel de Medecine Pratique, p. 189. § Johnson on the Influence of Tropical Climates, p. 474. SIALAGOGUES. 323 lieve to be an excellent practice. A much larger quan- tity of ointment may be used on different parts of the body: indeed the more continued the friction, the better." Dr. Clark advises a slight mercurial salivation, after wounds in hot climates, as a means of preventing the occurrence of this disease. Of the remediate powers of mercury in hydrophobia, nothing can be said calculated to excite any well grounded hopes. It is true, it has been confidently re- commended by many writers of great eminence in the profession.* Bonerf even states that he cured five hun- dred hydrophobic patients by mercury. This is quite equal to the reports that have been recently published concerning the powers of Scutellaria in this disease, and deserves not the least credit. Unfortunately we know as yet of no remedy or course of treatment which holds out even a ray of hope in this dreadful malady. The immediate excision of the part bitten by the rabid animal is undoubtedly the most promising mode of preventing the occurrence of the disease. But to be effectual it should be done directly after the bite is inflicted; by this means we may prevent the absorption of the virus, and the consequent evolution of the disease. Dr. Chapman says: "I am thoroughly persuaded that the extirpation of the part, at any period prior to the accession of the attack, would prove as effectual as if it had been done when the bite was originally inflicted." This persuasion however does not appear to be founded upon any expe- rience, but derived solely from his speculative views con- cerning the modus operandi of the hydrophobic virus, which according to his notions, is by the poison exciting a train of "associated motions, the primary link of which commences at the original seat of irritation." By * Portal, Johnson, Astruc, Desault, Sauvages, Haag, Cheyne, Walthers, Kaltschmidt, and others. t Burdach's Arzneymittellehre, B. ii. p. 268. 3^4 SIALAGOGUES. breaking this train of morbid actions, at any time ante- rior to the full development of the disease, he thinks we shall be able to prevent its full formation. It may be observed, however, that although the primary link of such a train of morbid actions be destroyed, yet the con- secutive ones being already formed, would still remain and progress to their ultimate point. But speculation apart, we know from direct experiment that the extir- pation of the bitten part has failed in preventing the ac- cession of the disease. Dr. Hosack mentions a case of this kind.* In dysphagia mercury has been known to produce very good effects. Dr. Munkley! relates a remarkable case of dysphagia in which the remedy was successfully employed. The patient, a woman about forty years old, complained of an inability to swallow; whatever she attempted to swallow, after staying some time in her throat, was thrown up again, by what appeared from her description a kind of convulsive motion of the oeso- phagus. She could swallow nothing but very liquid diet, and this only in very small quantity. A gentle sa- livation continued for about six weeks, cured her effec- tually. The writer alludes to other cases of this kind, in which mercury was successfully used. " The only medicine," he says, " from the use of which I have ever found any service in this complaint is mercury; and in cases which are recent, and where the symptoms have not risen to any great height, small doses of mercury given every night, and prevented by purgative medicines from affecting the mouth, have accomplished the cure; but where the complaint has been of long standing, and the symptom has come on of the food's being returned into the mouth, in the manner above described, a more * Thatcher on Hydrophobia. t Medical Transactions of the London College of Physicians, vol. i. p. 172. SIALAGOGUES. 325 powerful method of treatment becomes necessary. In this case I have never found any thing of the least avail in removing any of the symptoms, but mercury used in such a manner as to raise a gentle but constant spit- ting." Dr. Thomas Percival also relates a case of difficult deglutition, in which mercury, together with bark and antispasmodics effected a cure.* There are other writers who speak of their success with this remedy in dysphagia.! Many authors speak very highly of the powers of mercury in gutta serena. It is said to be particularly serviceable in those cases which are connected with in- ternal ophthalmic inflammation, and in which, therefore, the pupil is in a very contracted state. Mr. Ware strongly recommends mercury in cases of this kind; and Mi. Stevenson observes, that it may be exhibited with much advantage during the active stage of the disease; "so as to produce an early constitutional effect, for it will tend not only to alter the morbid action of the ves- sels, but will serve likewise, after the inflammatory symptoms have subsided, to promote the absorption of any lymph that may have been effused during the preceding violent vascular excitement"{ In the chro- nic form of this disease, mercury may be useful by re- moving visceral obstructions, which are not unfrequently the primary source of this affection. In dropsy mercury is a remedy of acknowledged effi- cacy. 1 have already spoken of the modus operandi of this remedy in hydropic diseases, when treating of the Diuretics, and shall not therefore in this place say any thing further on this point. In union with squills, calo- mel given so as slightly to affect the rnouth, generally * Medical Transactions of the London College of Physicians, vol. ii. p. 90. t Bisbane, Kock, &c. j Stevenson on Amaurosis, p. 208. VOL. II.—T t 326 SIALAGOGUES, acts with great efficacy in hydrothorax. When squills are inactive as a diuretic, as is sometimes the case, the addition of a grain of calomel every night until the sa- livary glands become affected, very commonly determines it to produce a copious diuresis.* In exhibiting mercury in dropsy, it is of much consequence to attend to those circumstances which experience has pointed out as being favourable or opposed to its remediate operation.' Thus it is stated by Maclean, Blackall and others, that " some firmness of the general habit," is to be regarded as a fa- vourable circumstance to the action of mercury in drop- sical affections. Ou the contrary, as Dr. Blackall ob- serves, " if the habit is so depraved that the coagulable part of the blood already passes off by the kidneys, the operation of this mineral is obviously very equivocal and hazardous." This corresponds with the observation of other writers, and my own practice has furnished me with several very striking instances of the injurious ef- fects of mercurial remedies in dropsy attended with a depraved and scorbutic habit of body. In cases of drop- sy attended with visceral obstructions, particularly those of the liver, mercury will in general prove very servicea- ble. In dropsies of this kind the urine is commonly very thick, and highly charged with bile and uric acid. The utility of mercury in hydrocephalus is often very considerable. Percival, Dobson, Rush, Cheyne, and other writers mention cases of this disease which were successfully treated by this remedy. " When the ex- istence of the complaint becomes probable," says Cheyne, " there ought to be no other delay than that occasioned by our endeavour to subdue the disorder in the bowels, in commencing the mercurial course, which it must be allowed has cured hydrocephalus even when far advanc- ed."! He gives an account of two cases in which the * Blackall on Dropsies, p. 44. + Cheyne on Hydrocephalus, p. 96. SIALAGOGUES. 327 efficacy of mercury is put in a very strong light. It is to be observed, however, that bleeding, both local and general, with purging and blistering ought never to be omitted as collateral and very important resources. Calomel may at first be given as freely as the stomach will bear, with a view to its purgative effects; when the bowels are once thoroughly evacuated, it ought to be given in small and frequent doses, and employed at the same time externally by frictions. By a course of this kind I have in a few instances succeeded in recovering patients from what I conceived to be hydrocephalus, after they appeared to be in almost a hopeless state. It must be confessed however that there is some reason to sus- pect, that other diseases of children, particularly the in- fantile remittent fever, and mere cephalic congestion from abdominal irritation, connected with fever, are not unfrequently mistaken for genuine, hydrocephalic disease; and it may thus be, that some of the cases of this disease which are stated to have been cured by this and other remedies, were in reality not hydrocephalus, but other affections connected with inordinate deter- minations to the vessels of the brain.* Dr. Underwood and Dr. Blackall say nothing in favour of this remedy in the treatment of hydrocephalus. The weight of testimony is however decidedly in favour of its good effects in this disease. The first employment of mercury as a remedy, was as an external application in cutaneous diseases, and it remains to this day one of our most efficacious means in many of these complaints. It is particularly useful in some of the varieties of scabies, prurigo, and porrigo. Internally given, it is seldom of any service in these diseases, but some of them yield very readily to its * Dr. Coindet has directed the attention of the profession to a particular aspect of the urine, especially to a micaceous deposition like crystals of boracic acid, and which he believes to be urea. The appearance, he says, is almost peculiar to dydrocephalus, and takes place in the second stage. 328 SIALAGOGUES. external employment The itch is commonly cured without difficulty by mercurial ointment; and in the prurigo podicis, an affection attacking the anus and scrotum, and attended with intolerable itching and stinging, the nnguentum hydrargyri nitratis diluted, is the most efficacious remedy we possess In another variety of local prurigo, the prurigo pudendi muliebris, affecting the pudenda of women, and occasioning an ex- cessive and insufferable itching about these parts, there is no application more effectual than a solution of mu- riate of mercury in lime-water, in the proportion of two grains to an ounce of the latter.* Mercury has also been recommended in leprosy and elephantiasis, but it does not appear that its efficacy in these complaints is entitled to much attention. Scrophula is a disease in which the powers of mer- cury have beep very variously represented. That this remedy is capable of doing much good in the present disease, when judiciously administered, is pretty gene- rally admitted; but its imprudent employment, in the advanced stages of the complaint, is often followed by very bad effects. As a general remedy to correct dis- order <>f the chylopoietic organs, mercury, given in alterative doses, generally acts with decided advantage in the early stages of this disease. " The means," says Dr. Lloyd,! " that I would make use of for the accom- plishment of this point are the following: if the patient be an adult, and the bowels obstinately confined, I would give him five grains of the blue pill every night, and half a pint of decoct, sarsa. comp. twice a day." Copious purging, observes this writer, ought to be care- fully avoided; " we should," he says, " particularly avoid large purgative doses of calomel, as I am convinced they * Bateman's Practical Synopsis on Cutaneous Diseases. t A Treatise on the Nature and Treatment of Scrophula. Lond" 1821, p. 29. SIALAGOGUES. 329 often produce more general irritation than the evacua- tion they occasion from the bowels is able to relieve." He recommends the exhibition of alterative doses of this remedy until the symptoms of hepatic and intestinal disorder, if any exist, be removed. I have seen very good effects from the employment of muriate of mercury and cicuta, given conjointly in this disease. In several instances, however, where this remedy had removed extensive scrophulous ulcerations, I have known, after some time, the local disease to re- appear, and to go on with greater rapidity than at any time previously. Mr. Abernethy, in his invaluable work on the con- stitutional treatment of local affections, has given much interesting information concerning the remediate powers of alterative doses of mercury in diseases of this kind. Various diseases, too, of an anomalous character, de- pending on functional disorder of the hepatic system, are often entirely under the control of mercurial reme- dies. For much interesting and important instruction on this subject, the reader is referred to the works of Drs. Abernethy, Ayre, and Wilson Philip. I come now, in the last place, to say something con- cerning the use of mercury in venereal affections. Soon after this disease was known in Europe, mer- cury was employed as a remedy for its cure; and although it had at various periods to encounter much opposition, the experience of the most eminent of the profession in different parts of the world, gradually established its reputation in this respect, and it became at last almost exclusively relied on in the treatment of this disease. Within the last ten or twelve years, however, its re- mediate powers in this disease have been again called into question, and we are told, that both the primary and secondary symptoms of venereal affections disappear under the employment of simple dressings and vegetable decoctions, without the use of mercurial remedies. 330 SIALAGOGUES. Dr. Ferguson, one of the medical officers of the British army, during the late war on the continent, ob- served that the surgeons of the Portuguese and German regiments treated their venereal patients without mer- cury, and that the disease got well under the employ- ment of the simplest remedies. Mr. Guthrie and Mr. Rose, too, in the year 1815, made a number of experi- ments on this subject in the military hospitals of England, and in 1816, Dr. Hennen, deputy inspector of hospitals, and professor Thompson of Edinburgh, instituted a course of experimental inquiries on the same subject From these experiments it would appear, " that all sores on the sexual parts may be healed without mercury in any form whatever; that were that medicine has not been used, secondary symptoms do not appear in a larger pro- portion than one in ten; that such symptoms are of a milder nature than similar ones occurring after the use of mercury, and that those secondary symptoms gra- dually cease, under the very simple treatment of con- finement in bed, quiet, and a vegetable diet." Some indeed allege, that mercury is not only unne- cessary in the majority of venereal complants, but ex- tremely injurious in its effects, being apt, as it is said, to bring on tedious and dangerous constitutional afTec* tions,—swellings and caries of the bones, cutaneous eruptions, ulcerations, pain, debility, emaciation, &c. That mercury incautiously given, or the imprudent con- duct of patients with regard to diet, drink, exposure, &c. while under the influence of this remedy, will often pro- duce very serious consequences, is quite certain; but, it should be always recollected, that the abuse of a thing is no argument against the utility of its cautious and seasonable use; and that the most valuable remedies are readily converted into dangerous poisons by improper management. " I am ready to grant," says Dr. Curry, " that like antimony, opium, and every other active re- medy, mercury would do little good if it were not also SIALAGOGUES. 331 capable of doing some harm. The knife and the caustic are unquestionably powerful, and in so far may they be made dangerous instruments; but who ever blames the surgeon for employing a sharp knife or an active caustic, seeing that both the one and the other are to be directed by his eye, and guided by his hand?"* It would indeed appear extremely probable, that the cutaneous eruptions, ulcers, caries, nodes, &c. supposed by some to be so often the result of the use of mercury in venereal cases, do in fact depend on a different cause, since it must be confessed, that in other diseases, as for instance hepatitis, &c. no such consequences follow the use of this remedy, however long continued or largely given. " I beg leave to observe," says Mr. Carmichael, " that I have not, nor do I believe that any other per- ' son has, witnessed ulcers on the skin and throat, and nodes on the bones, from the exhibition of the most ex- tensive courses of mercury in any other than venereal diseases, nor even an eruption, except the well known mercurial eczema."! We have, too, the concurrent testimony of some of the ablest physicians, and who have been most exten- sively engaged in the treatment of this disease, in favour, not only of the superior remediate powers of mercury in syphilitic affections, but of the perfect safety of its employment under prudent management "My op- portunities of administering mercury," says Dr. Pear- son, " have extended to no less than twenty thousand cases, and I feel myself fully authorized to assert, that it is a remedy always to be confided in under every form of lues venerea; and when we have only this one disease to contend with, that it is a certain antidote, and as safe in its operation as any other active medicine drawn from the vegetable or mineral king- * Curry's Examination of the Popular Prejudices against Mercury, p. 40. t Edinburgh Medical and Surgical Journal, vol. xi. p. 436. 332 SIALAGOGUES. dom."* Dr. Ballingall, in a most excellent little work on syphilis, observes: " When I reflect upon some thou- sand cases, both of syphilis and liver disease, in which I have employed mercury, with a hand perhaps too un- sparing, and when I think of the health which many of my patients have afterwards enjoyed, I cannot believe that there is any great proportion of human constitutions upon which this medicine exerts the deleterious effects which have been lately ascribed to it" Even Mathias, who has written expressly on the diseases produced by mercury, observes, " when this mineral is administered with prudential reserve, and with discreet knowledge, its effects are blessed, safe, efficacious and permanent"! My own limited experience in this disease does not permit me to speak very confidently as to the comparative merits of the mercurial and non-mercurial practice. I have, however, never omitted using mercury in auy case, whether of local or constitutional syphilis, and in very few instances have I known constitutional symptoms to come on after the employment of this remedy. It is not my intention, however, to enter into any particular account of the mercurial treatment of syphi- lis. Those who wish to gain proper information on this subject will not seek it in works on the materia me- dica. It will nevertheless be proper, in this place, to mention the means that ought to be adopted as precau- tionary measures, against the morbid effects of mercury when exhibited in this and other diseases. With this view I shall quote the following rules from Dr. Hamil- ton's work on the use and abuse of mercurial remedies, as they appear to me to be highly important, and by far too much neglected by practitioners generally. " The first precaution to be adopted in this climate, * On the effects of various articles of the cure of Lues Venerea, p. 114. t Mathias on the Mercurial Disease. SIALAGOGUES. 333 during a course of mercury, is confinement within doors, with a regulated temperature of the apartment.' " Secondly.—The diet ought to consist of the mildest possible food, such as preparations of milk and farina- ceous matters with weak animal mucilages. In short all stimulant food, or drink of every description, ought to be most scrupulously refrained from/' "Thirdly.—If the individual be robust, sixteen or twenty ounces of blood should be drawn from the arm before any preparation of mercury be exhibited. Where, from the delicacy of the paiient, blood letting cannot be advised, confinement within doors, and low diet, should be persevered in for at least a week previous to begin- ning the mercury, and during that time one or more doses of cooling physic ought to be taken." " Fourthly.—The mercury ought not to be given in such quantity, or with such activity, as to produce a sudden effect upon the system. This is certainly one of the most important practical improvements, suggested by Abernethy and others, and confirmed by the late expe- riments; for irreparable mischief was often committed b) the hurry with which the system was loaded with mercury. If the other precautions be implicitly adopted, the more slowly the mercury is administered, the mere certainly, and perhaps speedily will the primary sores heal." " Fifthly.—Salivation is to be guarded against, by les- sening the dose or suspending the medicine, wherever the brassy taste in the mouth is perceived. The same measures are to be pursued, if any irrigation of the bowels threaten." " Sixthly.—Some vegetable diluent ought to be drank in large quantities. The decoctions of sarsaparilla, guaiac, sassafras, &c. answer this purpose." " Seventhly.—The daily use v( the warm bath, where that can be conveniently commanded, is found particu- larly serviceable." vol. 11.—u u 334 SIALAGOGUES. "Eighthly.—If any irritable feelings occur while under the influence of mercury, the use of the medicine should be instantly suspended, and the most active measures for checking the progress of such complaints ought to be carefully employed. Preparations of camphor, of the spiritus ammonias aromaticus, of opium, of cicuta, &c. are severally useful, according to the circumstances of such cases." " Ninthly.—After the mercurial course is finished, the patient ought to remain within doors for at least a fort- night, improving the diet (though still abstaining from wine and stimulating liquors,) and taking gentle exercise, progressively increasing it according to the return of strength." It must be confessed, indeed, that thousands have been treated successfully with mercury, without the ob- servance of, perhaps, any of the above precautionary measures. It can, however, hardly be doubted that the neglect of these rules has often been the occasion of much mischief, and that if they were more commonly attended to than they appear to be, we should hear much less of the disastrous consequences of the employment of this remedy than we at present do. Of the Mercurial Preparations. Mercury as has already been stated, does not ap- pear to posset any medicinal properties in its metallic state. Taken into the stomach, however, it readily passes through the intestinal canal, by its gravity; and is on this account sometimes given to force a passage in obstinate obstructions of the bowels. It is very frequently found adulterated, either by lead, bismuth, tin, or zinc. " Its impurity is at once indicat- SIALAGOGUES. 335 ed by its dull aspect; by its tarnishing and becoming co- vered with a grey film; by its diminished mobility, in consequence of which its globules are unable to retain the spherical form, and therefore tail, as it is technically expressed. Lead is discovered by dissolving it in nitric acid, and adding to the solution water impregnated with sulphuretted hydrogen, when, if lead be present, a dark brown precipitate will ensue; bismuth, by pouring the nitric solution into distilled water, when it will appear as a white precipitate; zinc, by exposing the mercury to heat; tin is detected by a dilute solution of nitro-muriate of gold, which throws down a purple precipitate."* Mercury is susceptible of a very great variety of phar- maceutical and chemical preparations, the mildest and simplest of which are those which are formed by tritu- rating this metal with mucilaginous, oily, or farinaceous substances. By this process it is divided into exceedingly minute particles, a small portion of which become oxy- dized, and thus rendered active as a remedy. PILULE HYDRARGVRI.—BLUE PILL. These pills are made by rubbing mercury with viscid substances, until the globules disappear, and the metal assumes the state of a black oxide. The conserve of roses is commonly employed for'this purpose, but objec- tions have been made against it on account of its astrin- gency, which Swediaur thinks weakens the powers of the mercury. Mr. Abernethy observes, that the blue pill is uncertain in- its operation, and he seems to think that this may depend on the sulphuric acid, which, it appears, is not unfrequently found to exist in the conserve of roses. "It is not improbable," observes Dr. Paris, * Paris's Pharmacologia 336 SIALAGOGUES. "that, in making the conserve for sale, some of this acid may be added to brighten the colour; and if so, the mercurial pill which is made from it may contain, in va- rying portions, some of that highly deleterious compound, the subsulphate of mercury." Four grains of the pill, made according to the London and Dublin Pharmaco- poeia, contain one grain of quicksilver. When we wish to exhibit mercury in this way, and the form of pill is objectionable, it may be very conveniently given in the form of Plenck's mercurial mixture, which consists of a suspension of the quicksilver in a solution of gum ara- ble. Plenck's directions for making this mixture are, to triturate together in a stone mortar one drachm of pure mercury and two drachms of the gum, gradually adding water till the globules are entirely extinguished, half an ounce of syrup and eight ounces of water is then to be added to it. The dose of this^is two table-spoonfulls, every morning and evening. A part of the quicksilver falls to the bottom, but readily unites again with the water by shaking. The blue pill is the mildest preparation of mercury we possess; and, in certain diseases or states of the sys- tem, is preferable to any of the other mercurial reme- dies. In general, where we wish to produce a very gra- dual and gentle mercurial impression, and where the bowels are easily excited into action, the blue pill is an excellent form of employing mercury. There are pe- culiar constitutions, however, in which this pill is so op- pressive that it cannot be taken without great distur- bance. " It is remarkable," observes Dr. Wilson Philip, " that the blue pill is so offensive to some constitutions, that I have seen several instances in which it disordered the secretion of bile, even when it was healthy at the time of its exhibition; and in such cases, as far as I have observed, the disordered state of the bile continues as SIALAGOGUES. 337 long as it is used."* This, however, is of very rare oc- currence; and, as a gene^jal rule, we have no remedy which is preferable to, or perhaps even so suitable as, the blue pill, wherever it is our intention to rectify the functions of the liver or chylopoietic organs. As an alternative, too, in the treatment of local diseases, kept up by constitutional causes, this pill, as directed by Abernethy, is in general the best form of employing mercury. WThen it is exhibited as an alterative, it may be given in jdoses of from four to six grains once or twice a day. Administered in doses of from gr. x. to 9i. it commonly acts as a gentle laxative. UNGUENTUM HYDRARGYRI. The mercurial ointment is a most important remedi- ate article, and as it requires much time and labour to prepare it by the ordinary processes in use, pharmaceu- tists have resorted to a great variety of expedients to faciliate its preparations. In an excellent paper on the preparation of mercurial ointment, by Dr. P. K. Bogers, professor of chemistry at William and Mary's College, Virginia,! he gives the following expeditious process, among several others, for preparing this ointment: " Take an ounce of raw linseed oil, which has been long exposed to the air, and half an ounce of tallow, to every pound of metal. First, divide the mercury by triturating it with the oil for one minute; then add the tallow, and triturate for one minute more; lastly, add the proper proportion of suet aud lard to make an ointment, and rub the whole for three minutes. A mercurial oint- ment, inodorous, of a fine deep blue colour, and perfectly * Treatise on Indigestion, p. 204. t American Medical Recorder, vol. ii. p. 235. 338 SIALAGOGUES. bland, yet active, may thus be prepared in five minutes.'' Mr. Planche* recommends t|jie oil of eggs, as the most useful substance to abridge the labour of making the mercurial ointment. " When mercury is triturated with oil of eggs," say the editors of the London Medical Be- pository, " which has been kept for some months, al- though it have no disagreeable odour, the metal in a few minutes spreads over the sides of the mortar in a thin layer resembling the amalgam on a looking-glass; in a few minutes longer all the globules disappear, and af- ter adding the lard and suet, the whole operation, which requires the labour of several days by the usual method, is completed in an hour."! Turpentine is very com- monly employed to expedite the preparation of this oint- ment, but it is very objectionable, on account of its rendering the ointment irritating, and apt, when rubbed on the skin, to produce, "either painful excoriations, or a fiery efflorescence, or a crop of small corymbose tubercles, which require the remedy to be discontinued." It appears from the researches of Mr. Donavan,| that the mercury exists in two different conditions in the of- ficinal ointment; in its metallic state, mechanically mixed, and in the state of an oxide, combined chemically with the lard, "and that the medicinal activity of the oint- ment resides exclusively in this latter portion, the pre- sence of metallic mercury not only being useless, but * Journal de Pharmacie, for 1815. t " The oil of eggs can be mos* readily procured by the fol- lowing method: 'Let any quantity of the yolks of fresh eggs be put into a silver or glass vessel, and dried by the heat of a water bath until the oil can be expressed from the mass in the hand. Put this into a cloth bag, and press it strongly between two plates of pewter warmed in boiling water. The oil, thrown upon a filter, in a funnel heated by steam, will then pass through perfectly clear.' The analysis of one hundred parts of oil of eggs, according to M. Planche, yielded ninety-one parts of pure animal oil and nine of suet.—Dykeman's Dysfiensatory,\i.7\\- \ Thompson's Annals of Philosophy, for October, 1819. SIALAGOGUES. 339 injurious, by obstructing the absorption of the active corn- compound of the oxide." This gentleman has accord- ingly introduced a very important improvement in the preparation of mercurial ointment, by directing it to be made with the black oxide of mercury and lard, and combining- them chemically, by agitating them together for two hours, at the temperature of about 350° Fah- renheit* . Every ounce of lard, when thus prepared, contains twenty-one grains of the black oxide. Mr. Donavan .tried the effects of this ointment on several persons, and found it as efficient as the officinal oint- ment, which contains nearly twelve times as much mer- cury; and it can be rubbed in completely, in less than one-third the time required for this purpose whin using the common ointment. The use of this new ointment is neat and cleanly, soiling the skin but very little; and where privacy is an object this is of great consequence. It is also much more economical, and may be prepared with much less labour than is requisite for the prepara- tion of the common mercurial ointment. •'' I consider this discovery," says Dr. Mease,! " w'tn that of dissolv- ing magnesia in aeriated water, as two of the most use- ful modern additions to our previous stock of pharma- ceutic knowledge." * " The oxide may be procured by decomposing calomel by a solution of pure potass, or by pouring a solution of the nitrate of mercury into a caustic alkaline solution: this oxide should be at first triturated with a little lard, in the cold, to make the penetration complete, taking care that the lard be quite free from common salt, or else calomel will be the ultimate result; the mix- ture is now to be submitted to the action of heat, and it is very important to attend to the necessary temperature, for at 212° the oxide and lard will not unite; at 600° the oxide will be decom- posed and the mercury vola ilized ; at 500° and 400° the oxide is partially decomposed, some red oxide being formed and mercury reduced; the proper temperature is between 300° and 320°, at which it should be maintained for an hour, and the ointment should be stirred until cold."—Paris's Pharmacologia. t In the Medical Recorder, vol. iii. p. 512. 340 SIALAGOGUES. This ointment, applied by friction to the surface of the body, produces the same general effects as when mercury is given internally. It in general, however, more promptly excites salivation than any other mode of administering this remedy; and it is also much less apt to weaken the alimentary canal than the other mer- curial preparations usually employed internally. In very irritable and weakly persons, however, I have known mercurial frictions to produce colic and diarrhoea, and much disturbance of the digestive organs. According to Mr. John Hunter, mercurial inunction is alwajs to be preferred to the internal employment of this remedy, inasmuch as the skin is much less essential to life than the stoftiach, and is therefore capable of bearing much stronger impressions than this latter organ. Be this as it may, it is very certain that all the purposes for which a general mercurial influence may be requisite, are to be well answered by this ointment. Inunction is com- monly performed by rubbing in from two to three ounces on the inner surface of the thighs, or on some other part where the cuticle is delicate. Where a prompt and efficient impression is repuired, the quantity of the oint- ment rubbed in, as well as the extent of the surface to which it is applied, may, however, be greatly augmented. Besides the diseases, in which mercurial ointment is serviceable, in common with the other mercurial pre- parations, there are some affections in which its reme- diate powers appear to be particularly useful. In the treatment of erysipelas, it would appear to be a very valuable remedy. Dr. Dean, of Chambersburg, in this state, was the first who made its virtues in this respect, publicly known. It appears from the testimony of this gentleman, and of Dr. Lyttle, that the efficacy of this oint* ment in erysipelas is very considerable. In conj'inction with depletory measures, the application of the ointment to the affected part, generally in a short time relieves the burning pain, heat and itching of the inflammation / SIALAGOGUES. 341 " Among the various local remedies," says Dr. Dean, " that have been recommended in this disease, and which I have had an opportunity of trying, there are none, I am inclined to think, superior to the strong mercurial ointment. The trials which have been made with it in this part of the country, have also obtained for the oint- ment the confidence of some of our most respectable physicians."* Dr. Dean also speaks of " an obstinate and trouble* some disease of the ears," for which he found the mer- curial ointment an excellent remedy. It consists of a severe and painful itching in the meatus auditorius, and is attended with continual "beating and ringing in the ears, and at times with a thin acrid discharge, which excoriates and inflames the parts over which it flows." The ointment must be applied to a cotton or woollen tent and introduced into the ear. For the reduction of venereal buboes, it is the most useful remedy we possess. Lentin observes, that both in acute and chronic rheumatic pains, mercurial oint- ment, mixed with an equal portion of camphor ointment, is a very valuable local application. HVDRARGYRI OXY-MURIAS.--CORROSIVE SUBLIMATE. This is a white crystalline mass, diaphanous when recently prepared, without odour, and of an exceedingly acrid and stiptic taste. According to some chemists, it is composed of eighty- two parts of oxyde of quicksilver, and eighteen of mu- riatic acid. Agreeably to the latest views, however, it consists of one proportional of mercury, and two of chlo- rine, constituting a bi-chloride of mercury. It dissolves * American Medical Recorder, vol. iii. 503. VOL. II.—X X 342 SIALAGOGUES. in eleven parts of cold, and in three of boiling water. It is also readily soluble in alcohol and aether. This latter liquid "has the curious property of abstracting it from its solution in water, when agitated with it" The addition of a few drops of rectified spirit or of muriatic acid greatly facilitates its solution in water.* Given in small doses, one-fourth of a grain for in- stance, its effects are those of mercury in general. It is, however, much less apt to excite salivation than most of the other mercurial preparations, and has a tendency rather to increase the perspiration and urine. It is said to be more mild iw its operation in cold than in warm latitudes.! If it be taken in larger doses, as from a half to a whole grain, its immediate effects are more violent, producing pain in the stomach, nausea, vomiting, anxiety and palpitation. In still larger doses, it produces burn- ing heat and blisters in the mouth, throat and stomach. excruciating colic pains, a continued violent vomiting of frothy mucus, mixed with blood, purging, intolerable thirst, and internal heat, tremors, tetanus, paralysis, cold sweat, syncope, swelling of the face, mania, and finally death. It sometimes produces violent strangury and aphonia. On opening the bodies of such as have died from the effects of this substance, the mucous coat of the stomach and bowels is found extensively inflamed, abraded, and covered with gangrenous spots. According to Orfila, corrosive sublimate, on being mixed with albumen, gluten, milk, animal broth, or bile, forms a precipitate, which consists of oxymuriate of mercury and animal matter. He accordingly recommends these substances, particularly the white of eggs, as the most effectual remedies we have, in cases of poisoning from corrosive sublimate. The vegetable gluten of wheat flour is said to be equally efficacious with the white of * Paris's Pharmacologia. t Burdach, Arzneymittellehre, Band. ii. s. 360. SIALAGOGUES. 343 eggs. The flour is to be administered in substance mixed with water. Corrosive sublimate, by cautious management, is a very valuable remedy in a variety of diseases. It is particularly applicable, however, in the secondary symp- toms of syphilis, in which it is extolled above all the other mercurial preparations by some physicians, whilst others condemn it, as ineffectual and injurious in its ul- timate consequences. Boerhaave, Van Swieten, De Haen, Pringle, Locher, and others, speak greatly in fa- vour of the powers of this remedy in syphilis. Van Swieten directs it to be given dissolved in proof spirits, in the proportion of one grain of the sublimate to two ounces of French brandy. Of this from one to two ta- ble spoonfuls is to be given twice a day. * Among the principal advantages," says Dr. Francis, " which the corrosive sublimate possesses over every other preparation of mercury are, that judiciously admin- istered it is particularly mild and safe in its operation, will admit of a more extensive use in all the various forms of lues venerea, and subject the patient to fewer inconveniences; that it readily enters into the general circulation, becomes miscible with the several fluids of the body, the soonest arrests the progress of the com- plaint, and eliminates the morbid matter through those emunctories best calculated for that purpose; that it su- persedes the necessity of salivation, by its action on all the secretions, and by promoting especially the cuticular discharges, and the evacuations from the kidneys; that it is the only preparation to be depended on in those peculiar habits of body so susceptible to become salivat- ed by every other form of mercury now in use; that, in its ultimate effects upon the constitution, it is attended with comparatively no injury. These facts are indeed truly important, and many of them are granted by those who altogether reject the use of this preparation.'* * Observations on Mercury, by Dr. Francis, in the 4th vol. of the Medical and Philosophical Register. 344. SIALAGOGUES. Dr. Locher, of the Vienna Hospital, on the recom- mendation of Van Swieten, employed this remedy very extensively in syphilitic affections, and we are told that from the year 1754 to 1762, he cured not less than four thousand eight hundred and eighty persons with it, with- out producing salivation; and that "no persons died, or experienced the least painful and dangerous symptoms, in consequence of this remedy." " That the corrosive sublimate," says Dr. Francis, "of all mercurial prepara- tions, soonest affects the system and arrests the action of the venereal virus, is a truth grounded upon the con- curring experience of the most distinguished practition- ers." " It is but proper to state, that the preparation of mercury now recommended, has been employed for the last twenty years in the private practice of Dr. Hosack, and during his attendance at the New-York State Prison, New-York Hospital, and the Alms-house of this city, as physician of those institutions. It has invariably been found to be the remedy best calculated for the removal of lues venerea, both in its primary and secondary stages; and not a single case is recollected in which the cure has not been permanent. Those injurious effects upon the stomach and bowels, which are so much ap- prehended, were avoided by a cautious employment of the medicine, and by a due consideration of the peculi- arities in the constitution and state of the patient. From this form of mercury, salivation scarcely ever was in- duced, and while under its influence, the employment of the decoct guaiac. et sarsaparil. was found to be an ex- cellent auxiliary in recent cases; and in the secondary stage of the disease, where the patient had been ne- glected, or where improprieties in the cure had been committed, it was almost indispensable."* It must be * Vide An Inaugural Dissertation on Mercury, embracing its Medical History, Curative Action and Abuse in certain Diseases. JSfew-York, 1811. SIALAGOGUES. 345 confessed, however, that much respectable testimony is opposed to the employment of corrosive sublimate in venereal affections. Mr. Pearson particularly speaks unfavourably of its powers. " The result of my obser- vations," says he, ' is, that simple mercury, calomel or calcined mercury, are preparations more to be confided in for the cure of primary symptoms than corrosive sub- limate. The latter will often check the progress of secondary symptoms, very conveniently, and I think it is peculiarly efficacious in relieving venereal pains, in heal- ing ulcers of the throat, and in promoting the desqua- mation of eruption. Yet, even in these cases it never confers permanent benefit, as new symptoms will appear during the use of it: and on many occasions, it will fail of affording the least advantage to the patient from first to last"* My own experience with this remedy, though not very extensive, is entirely in favour of its powers in lues velierea. I have, for twelve years past, been in the habit of employing the preparation almost exclusively in every stage of syphilis, and I have never known any ill consequences to follow, which could be fairly ascribed to its influence. In ulcers of the nose and gums, caries of the bones, exostoses nodes, and cutaneous eruptions from a syphilitic taint, corrosive sublimate, with opium or cicuta, is a remedy of unquestionable efficacy; and my own practice furnishes me with instances that yielded to this remedy after the milder mercurial preparations had been long, though ineffectually, employed. Corrosive sublimate is said to be less useful in this disease, when it is principally seated in the lymphatic and glandular systems.! It is also less applicable, in eases connected with/ much muscular debility and scir- rhosities, than some of the milder preparations of this * On Various Articles of the Materia Medica in Lues Venerea. t Burdach. 346 SIALAGOGUES. metal. I have hardly ever given it in any other way, than in union with the extract of cicuta. This com- bination has appeared to me to be particularly useful in the secondary stage of syphilis occurring in persons of a strumous habit; and it is also much less apt to produce disagreeable effects on the stomach and bowels, than when administered by itself. In employing this remedy, however, it ought to be continued for some time after the symptoms of the disease have disappeared. This indeed should always be done, whatever be the prepa- ration of mercury employed; but I am inclined to think, that this precaution is more especially to be attended to in the use of the corrosive sublimate. Mr. Burckhardt considers corrosive sublimate as al- most a specific against the swellings which occur about the joints of rheumatic persons.* Corrosive sublimate has been recommended as an useful escharotic application to venereal and cancerous ulcerations. Justamond says, that a powder composed of equal portions of sublimate and arsenic, is an ex- ceedingly active escharotic, producing less pain than either of these articles by themselves. It is, however, beyond a doubt, that the corrosive sublimate produces much more pain when applied as an escharotic, than many other articles we possess; nor does it appear, that its usefulness in this respect is such as to compensate for the superior pain it creates. Dissolved in lime-water, however, (constituting the aquaphagedenica) in the pro- portion of two grains of sublimate to one ounce of the lime-water, it forms a lotion much recommended, in ill- conditioned ulcers of every kind. A weaker solution of this kind, consisting of from two to three grains of the former to eight ounces of the latter, forms one of the most useful injections for gleet, leucorrhcea, and gonor- * De usu Hydrargyri muriatici corrosivi in tumore pro arthri- tico habito. 1808. SIALAGOGUES. 347 rhcea after the inflammation- has been reduced. This injection is particularly recommended by Mr. Carmi- chael. The aqua phagedenica is also the most effica- cious application we have for the cure of that vesicular inflammation produced by the poisonous vine, (rhus radicans.)* In the treatment of cutaneous affections, corrosive sublimate is by many regarded as the most efficacious of all the mercurial preparations, whether applied exter- nally, or used internally. Hegewish, a German writer of note, observes, that a solution of corrosive sublimate is the best remedy we possess in the prurigo podicis; and Willan, Bateman, and others confirm this statement In erysipelas, this solution is also a most excellent re- medy. Applied to the inflamed parts, it often arrests the disease in a speedy manner, as I have myself wit- nessed in several instances. This practice, so far as I can learn, originated with Dr. Schott, of this city, and is, I am well convined, entitled to much attention.' The dose of this article is from one-eighth to one- fourth of a grain, repeated twice or thrice daily. It is always best to begin with the smallest dose, and gradu- ally to increase it to as much as can be borne by the patient without feeling any particular uneasiness in the stomach and bowels. It may also be very conveniently given in solution in aether or proof spirits. The former of these solutions is particularly recommended by Hufe- land. He directs it to be made by dissolving one grain of the sublimate in a drachm of sulphuric sether, the dose of which is ten drops in a cup of luke-warm milk three or four times a day. The incompatible substances are: the carbonates of the fixed alkalies, which precipitate it of a yellow colour- ammonia, which forms with it a white triple compound; tartarized antimony, nitrate of silver, acetate of lead^ * Dr. Barton. 348 SIALAGOGUES. sulphur, sulphuret of potass, and soaps, all of which de- compose it; iron, lead, copper, bismuth, and zinc, in their metallic state, precipitate it, forming an amalgam on the metal employed. The infusions of chamomile, horse- radish root, colomba root, catechu, cinchona, rhubarb, senna, simarouba, oak bark, and almond emulsion, pre- cipitate it* HYDRARGYRI SUBMURIAS.—CALOMEL. According to the chlorine doctrine, calomel consists of one proportional of chlorine with one proportional of quicksilver, forming therefore a chlorite of mercury.! The name which is given to it in the British and Ame- rican pharmacopoeias, though sanctioned by general custom, is considered by chemists as very objectionable. For, " if we regard it as a compound of muriatic acid and oxyd of mercury, it is not a submuriate, but as much amuriate as the corrosive sublimate; the only difference depending upon the degree of oxidizement of the mer- cury, which is at a minimum in calomel, and a maximum in sublimate." Calomel, as it is found in the shops, consists of an ivory-white, inodorous and insipid powder, almost en- tirely insoluble in water, requiring, according to Rouelle, four hundred and fifty-two parts of boiling water to dis- solve one part of the calomel. Whether we consider calomel as a sialagogue, an alterant, or a purgative, it is undoutedly the most impor- tant of the mercurial preparations. Being very mild * Paris's Pharmacologia. t Calomel was formerly described under a variery of fanciful names; as draco mitigatus, aquila alba, aquila mitagata, manna metallorum, panchymagogum minerale, panchymagogus querce- tanus, sublimatus dulce, Sec. . SIALAGOGUES. 349 and safe in its operation, and admitting, from its various powers, an exceedingly extensive application as a re- medy, it is more generally employed in practice tfyan, perhaps, all the other preparations of this metal put together. Calomel is particularly useful in all diseases in which we wish to produce a general mercurial impression, and at ^he same time correct the action of the biliary organs, and evacuate irritating and noxious matter fro ii the intestinal canal. Hence, in febrile diseases, and more es- pecially in those of a bilious character, this preparation is almost exclusively employed where mercury is thought necessary; and even where its general influence is not wanted, its mildness and efficacy as a purgative renders it one of our most valuable remedies in diseases of this kind. It is particularly useful in the diseases of children, on account of the ease with which it may be given to them, from its want of taste. When given in very minute doses, as from one-eighth to one-sixth of a grain, it allays irritability of the stomach and bowels, and restrains purging and vomiting; and hence, it is an excellent re- medy in cholera and diarrhoea. I have already spoken of the anti-inflammatory powers of calomel and opium, given according to the plan of Dr. Robert Hamilton; and I need only add, that the more I see of this practice the more do I become persuaded of its efficacy. * When mixed with lime-water, in the proportion of one drachm of calomel to eight ounces of lime-water it forms the aqua mereurialis nigra. This is an excellent lotion for ill-conditioned primary and secondary venereal ulcers. It is particularly useful as a gargle in venereal ulcerations of the tonsils and palate. As an alterative it is given in the dose of from one- fourth to one grain; as a purgative, from gr. v. to 9i. Calomel is decomposed by the alkalies, lime-water, soaps, sulphurets of potass and antimony, iron, lead and copper. These substances are therefore medicinally incompa- vol. il—y y 350 SIALAGOGUES. tible with it. " There is reason," says Dr. Paris " for supposing that this preparation may undergo decom- position in transitu, and that therefore some substances may be chemically, and yet not medicinally incompa- tible with it." It sometimes contains a small portion of corrosive sublimate, which renders its operation harsh, and even dangerous in delicate habits. The corrosive sublimate may be readily detected by boiling the calomel with a small quantity of muriate of ammonia, and adding car- bonate of potass to the solution; if a precipitate take place, it is a proof of the presence of corrosive subli- mate. HYDRARGYRI NITRICO-OXYDUM.—RED PRECIPITATE. This preparation consists of small bright red scales, of an acrid and corrosive taste. It, is not a nitrate, as some will have it, but a subnitrate of mercury. It is insoluble in water; but in nitric acid it dissolves, with the evolution of heat, but without effervescence. This preparation is sometimes adulterated with red lead " and this may be detected by digesting it in acetic acid, and adding sulphuret of ammonia, which will produce a dark coloured precipitate."* Red precipitate is now but seldom employed as an in- ternal remedy. The preparations already mentioned are both milder and more efficacious, where a general mercurial impression is necessary. . Some late German writers, however, have spoken favourably of its internal use in old and obstinate venereal ulcers, rheumatisms, enlargement of the bones and herpetic eruptions. It is particularly recommended in cases of this kind by * Paris's Pharmacologia. SIALAGOGUES. 351 Berg, Horn, and Hufeland * Berg gave it in the dose of one-eighth of a grain with fifteen grains of sulphu- retted antimony, and gradually increased it up to a grain.! As an escharotic it will be particularly mentioned in another place. It may not be improper, however, to say something in this place concerning its external em- ploy ment in the form of an ointment—the unguentum hydrargyri rubrum. This ointment is much employed as a stimulating application to indolent and fungous ul- cers; and is particularly useful in glandular or scrophu- lous ulcerations. Externally applied it is of considerable efficacy in herpetic and scrophulous eruptions. It must, however, be cautiously applied, and not upon too large a surface at once, since it has been known, in common with many other external applications, to produce dangerous effects, by suddenly repelling the eruption for which it was em- ployed. This ointment is also an exceedingly good re medy in chronic psorophthahnia, especially if the ulcer- ation of the meibomian glands is of a scrophulous nature. For this purpose it is advantageously united with opium or camphor. In opacity of cornea, Morenheim and Mur- dina recommend this ointment as very useful. Falk extols its powers in haemorrhoidal tumors, of which he says, it speedily lessens the paiu and swelling, and grad- ually removes them altogether.]: Ackerman recommends a salve made of 9i red precipitate, gr. vi. camphor, and 3ii. of fresh unsalted butter, as an excellent application in chronic and obstinate ophthalmia. * Hufeland on the internal use of Red Precipitate in obstinate Venereal Affections and other Diseases. Journal der Prack- tischen Heilkunde. B. xxvii. st. 4, No. 5. f J. F. Berg de Hydrargyri Oxydati Rubri usu interno. Fran- cof. 1808. Vide Burdach, Mat. Med. vol. ii. p. 330. $ Burdach. 352 SIALAGOGUES. HYDRARGYRUM PRJECIPITATUM ALBUM.—WHITE PRE- CIPITATE. This preparation consists of a fine snow-white pow- der, possessing neither odour nor taste. It is composed of eight}-one parts of mercury, sixteen of muriatic acid, and three of ammonia; and is neither soluble in vvater nor alcohol, it may be readily distinguished from cal- omel by its not turning black, like this latter prepara- tion, on being triturated with lime-water. Boerhaave was much in the habit of employing this preparation in- ternally, and he recommends it particularly as being very efficacious, and as seldom, if ever, exciting copious salivation. At present, however, its internal employment is entirely neglected, and it is now only used as an ex- ternal application, in cutaneous affections, &c. It is one of our most efficacious remedies for the itch; it is said to be particularly useful, and almost indispensable, in that variety of itch which is attended with large and thick scabs, scattered over the surface of the body. The unguentum Werlhofii, which has been much extolled in cutaneous eruptions, consists of white precipitate and carbonate of potass, made into an ointment HYDRARGYRUM SULPHURETUM RUBRUM.--CINNABAR. Cinnabar is a red substance, of a crystalline appear- ance, possessing neither smell nor taste. It is insoluble in water, alcohol, and acids; the alkalies decompose it when melted with it. " It is composed of two atoms of sulphur, and one of quicksilver, and is therefore a bi- sulphuret of mercury. It is sometimes mixed with red lead, which may be detected by digesting it in acetic acid, and by adding sulphuret of ammonia, which will SIALAGOGUES. 353 produce a black precipitate."* If dragon's blood is mixed with it, it will impart a red colour to alcohol. Taken internally cinnabar has but w rv little action on the system. Cartheuser says, it often passes off by the bowels, without producing any general inpression on the animal economy. Lewis, however, states that he saw an instance of profuse and unexpected salivation excited by this preparation. At present it is altogether neglected as an internal remedy, being employed exclu- sively for the purpose of mercurial fumigations. Aber- nethy mentions its use in this way very favourably, and alleges that the system mav be brought under the mer- curial influence, by fumigations with this article, when the usual preparations of mercury are entirely inefficient Mr. Pearson, however, whose opportunities of observa- tion on this subject have been very extensive, does not speak very favourably of cinnabar" as a remedy in lues venerea. He at least does not think it sufficient to eradicate the disease, without the concomitant employ- ment of other mercurial remedies, although he admits that it may be resorted to with much advantage in cases of venereal sores in the mouth, fauces, nose, or on other parts of the body. The fumigation is made, by throwing 3SS. of the cin- nabar on red-hot iron, and in holding the fumes, or letting them pass upon the affected parts as they rise. When inhaled, these fumes generally very soon excite copious salivation. HYDRARGYRUM SULPHURETUM NIGRUM.--jETHIOPS MINERAL. This preparation is in the form of a black powder, without any particular taste or odour. It consists of * Paris's Pharmacologia. 354 SIALAGOGUES. one proportional of sulphur, and one proportional of quicksilver, being therefore a sulphuret of mercury; on being heated it becomes a bi-sulphuret In a solution of pure potash it is entirely dissolved, from which it may be again precipitated unchanged by adding any of the mineral acids.* In water,,alcohol, and the acids it is wholly insoluble. The aethiops mineral is supposed by some to have a more-powerful influence on the vessels of the cuticular surface than any of the other preparations of mercury. Others, on the contrary, deny it any superiority in this respect, and some even regard it as comparatively an inert remedy. Its remediate application appears now to be almost entirely confined to the treatment of cutaneous affections. Dr. G. Armstrong recommends it parti- cularly in scabby eruptions of venereal origin. It has ajso been recommended in chronic rheumatism, and glandular swellings. It does not, however, appear to be worthy of much attention; and it is now indeed but very seldom prescribed in any disease.! * Paris's Pharmacologia. t The turfiith mineral has already been noticed under the head of Mercurial Emetics, to which the reader is referred for all that is worthy of attention concerning its remediate powers. EXPECTORANTS. 355 CHAPTER XVII. G. MEDICINES THAT ACT UPON THE RESPIRATORY ORGANS. /. Medicines calculated to increase the Mucous Secre- tion in the Bronchia, and to promote its discharge. EXPECTORANTS. These are medicines which promote the bronchial secretions, and facilitate their discharge by expectora- tion. In order to understand the modus operandi of these remedies, it is necessary to consider the particular conditions of the pulmonary organs, upon which diffi- culty or deficiency of expectoration may depend. In many instances, it appears to depend directly on an in- flammatory state of the mucous membrane of the bron- chial tubes, as is the case in catarrhal and pneumonic affections. Whatever, therefore, is calculated to lessen the inflamed condition of the bronchial lining, gives rise to a more abundant secretion of the mucus, and con- sequently to a more copious expectoration. Hence we find that such remedies as determine to the surface, are always the most useful expectorants in acute cases; and hence, too, a blister to the breast frequently brings on free expectoration under such circumstances. When, on the contrary, the inflammation has been subdued by depletion, the secretion of bronchial mucus is often so 356 EXPECTORANTS. great that the debilitated powers of the system are in- adequate to throw it off. In instances of this kind, we may bring on a free discharge from the lungs by such articles as excite the vital energies. Again, suppressed expectoration may arise from a torpid or spasmodic con- dition of the bronchial glands, as would appear to be the case in spasmodic asthma. Here expectoration is promoted by thestimulatiug antispasmodics, and by some of the balsamics, which, possessing a peculiar tendency to pass off by the mucous tissues after having been ab- sorbed into the circulation, are thereby brought to act directly upon the secretory vessels of the bronchia, and to excite them into action. When there is a fixed source of irritation seated in the lungs, as, for instance, tuber- cles, the cough is very frequent, and the mucus being therefore discharged almost as soon as it is secreted, sufficient time is not allowed for its accumulation, and a consequent appearance of deficient expectoration ex- ists. In cases of this kind, we derive most advantage from remedies that allay irritation, as opium, prussic acid, &c. By these means the cough is rendered less frequent, and time being thereby given for the accumu- lation of the mucous secretion in the lungs, a more abundant expectoration ensues on the recurrence of the cough. It frequently happens also, that an irritation in the fauces and glottis keeps up, by continuous sympathy, almost constant coughing. When this is the case, the cough is most readily allayed by such articles as are of a mild mucilaginous nature, which, being swallowed, sooth the irritation of the fauces, and consequently that of the pulmonary system. But even where the irritation which keeps up a cough is primarily and exclusively seated in the mucous membrane of the bronchial tubes, demulcents probably do good by their soothing impres- sions upon the fauces alone. For, if an irritation in the fauces can be propagated to the lungs, and produce cough, a fact which is unquestionable, there is every EXPECTORANTS. 357 reason to believe that an opposite impression, may be likewise conveyed from the former part to the latter, and thus counteract, in a degree, the irritation in this part, and thereby relieve cough. There is still another mode, and to which I have already alluded, in which medicines may produce expectorant effects. It is a fact, fully established by observation and experiment, that certain substances, when received into the system, have specific tendencies to act upon certain organs or struc- tures. Thus cantharides affect the neck of the bladder, mercury the salivary glands, ergot the gravid uterus, &c. It is therefore not improbable, that some remedies may have a specific tendency to act upon the pulmonary system when received into the stomach; and this opinion would appear to be demonstrated by the fact, that several of our expectorants are known to be absorbed, and to be again eliminated by the pulmonary emunc- tories. Thus asafoetida, whether injected into the ab- domen of animals, or thrown into the stomach or rec- tum, is very soon discovered by its peculiar odour in the mucous surfaces, and especially in the mucous membrane lining the bronchiae. So also onions, when taken into the stomach, impart an exceedingly strong and offensive odour to the breath. From all this it is evident, that in prescribing expec- torants, attention should be paid to the particular cha- racter of the symptoms which render them necessary; for a remedy that may be advantageous in this respect, in one case, may be useless, or even pernicious in an- other, requiring a medicine of this kind. Thus, when cough and deficiency of expectoration arise from an acute inflammation of a bronchial lining, stimulating expectorants must be avoided. Where, however, these symptoms depend on a debilitated and spastic condition of the lungs, the stimulating articles of this class are those from which the greatest advantage is to be gained. Of the various diseases in which expectorants may be VOL. II.—Z Z 358 EXPECTORANTS. usefully employed, nothing need be said in this place, as these will necessarily come under notice when treating of the particular articles of this class. RADIX POLYGALiE SENECA. The diuretic and emmenagogue virtues of this ar- ticle, have already been noticed; and to complete its medical history, it only remains to speak of its virtues as an expectorant. In this respect it is entitled to very great attention, being undoubtedly one of the most active and useful articles of this class. Possessing, however, very considerable stimulant along with its other proper- ties, it cannot be used with safety in cases attended with high inflammatory excitement. In the latter stages of pneumonia, after the general as well as local inflamma- tory action has been moderated by depletory measures, there sometimes remains a troublesome cough, attended with imperfect expectoration, which is in general greatly relieved by the use of a decoction of this root. It also acts very beneficially in cough excited by an irritation in the fauces and larynx from cold, and which is usually attended with hoarseness. In no disease, however, has this article been more extravagantly praised as an ex- pectorant, than in cynanche trachealis. Dr. Archer, who first noticed its virtues in this disease, represents itg powers as often adequate, without the aid of any other means, to remove this alarming malady. Although very seldom sufficient, by itself, to the performance of a cure in this disease, it is unquestionably a very useful remedy in its management. As an emetic, it has been used in the beginning of the disease, and there can be no doubt of its often manifesting very beneficial effects when employed with this intention. Its stimulating pro- perties, however, render it objectionable in the early EXPECTORANTS. 359 stages of the complaint; and it is besides not equal to the tartar emetic in this respect, which is at once prompt, relaxing, and antiphlogistic in its effects. If, after the inflammatory symptoms have been reduced, a dry and hoarse cough, with oppressed respiration re- mains, we possess no remedy equal in efficacy to the polygala. To children from two to six years of age, we may give one or two tea spoonfuls of a decoction made by boiling half an ounce of the root in a pint of water down to three gills, with an equal quantity of honey, every one or two hours, until vomiting comes on. It is also an exceedingly good remedy in the hoarseness which is apt to affect children on taking cold, and which, if neglected, sometimes terminates in croup. SCILLA MARITIMA. The squill is very frequently prescribed as an ex- pectorant, and may be considered as one of the most valuable articles of this class of remedies. In the pec- toral affections of children, the oxymel of squill is a very convenient and useful remedy. Possessing emetic, along with its expectorant properties, it is peculiarly service- able when given to the extent of producing vomiting in very young subjects affected with cough, and attended with an accumulation of viscid mucus in the bronchia; in hooping-cough also, it frequently affords much relief. Being, however, considerably stimulant in its operation, it can only be employed with propriety in cases unat- tended with inflammation and fever. In conjunction with the camphorated tincture of opium, it forms an excel- lent medicine in slight catarrhal affections. From its active diuretic properties, in connection with its virtues as an expectorant, it is particularly adapted to the treat- ment of hydrothorax. It may be given either in sub- 360 EXPECTORANTS. stance, or in the form of the vinegar or oxymel of squills. The dose of the powder is from one to four grains; that of the vinegar and oxymel from one to two tea-spoon- fills. The following are excellent expectorant formulae.* ALLIUM SATIVUM. The peculiar odour and acrimony of garlic are ex- tracted by infusion in water; but by boiling they are almost entirely dissipated. In point of medicinal proper- ties it bears considerable analogy to the squill; being however inferior to it in its powers. As an expectorant it has been frequently prescribed in catarrhal complaints, and it would appear to be more especially indicated from its diuretic virtues in such cases as are attended with a hydropic state of the system. Being however much more unpleasant, and less active than many other articles of this class, especially the squill, it is at present but seldom employed as an internal remedy in regular practice. It is usually given in the form of a syrup, or oxymel, which is made by infusing the root in vinegar, and afterwards adding honey to it, until it acquires the consistence of a syrup. The onion also is employed, particularly in domestic practice, as an expectorant; and its effects in this way are very useful. ARUM TRIPHYLLUM.—INDIAN TURNIP. This plant is found both in North and South America. The root, which is the part employed for medicinal * R,. G. Ammoniac. 3ss. Scillae pulv. gr. x. Syrup tolutan q. s. Ft. massa in pit gr. v. Dividenda. Take two every morning and evening. EXPECTORANTS. 361 purposes, is bulbous, fleshy, giving off a circle of numer- ous radicles from its upper part. The lower half of the bulb is covered with a blackish, loose and wrinkled skin. When fresh it is exceedingly acrid, producing very vio- lent smarting pain when taken into the mouth, which leaves a soreness for many hours on the tongue. Ap- plied to the skin, however, it very seldom produces any rubefacient effects whatever. " The acrid property which resides in this and other species of arum," says Dr. Bigelow, " appears to depend upon a distinct vegetable principle, at present but little understood. It is ex- tremely volatile, and disappears almost entirely by heat, drying, or simple exposure to the air." This principle appears to possess "no affinity for water, alcohol or oil, being volatile, and, in a state of gas, inflammable."* The dried root possesses but very little acrimony. It is, however, not destitute of active properties even in this state, and may be very usefully employed in pec- toral affections, as well as in various other complaints connected with a cold and cachectic habit of body. It is by no means incapable, as is stated by some writers, of affecting the general circulation. Of the contrary of this I have more than once had satisfactory evidence. In the chronic asthmatic affections of old people, it is a remedy of very considerable value. I have also seen it do good in chronic catarrhs, and in phthisis pulmonalis. In these complaints it is indeed one of the most common remedies in domestic practice. It has also been pre- scribed with advantage in rheumatism, and in apthous sore-throat In this latter affection, Dr. Thacher says, it is a remedy of approved efficacy. It has been re- commended in the form of an ointment made of the fresh root, in tinea capitis, and tetter. Dr. Burson states, R Oxymel scillae 5iss. Misturse ammoniac, ^iii. Tinct. opii, eamph. 3;i. M. Dose, a dessert-spoonful morning and evening. * Bigelow's American Medical Botany, vol. i. p. 55. 362 EXPECTORANTS. that the berry of the arum is more retentive of its pecu- liar acrimony than any other part of the plant. The arum root is usually directed to be given in the form of a decoction, in milk; but Dr. Bigelow observes, that it imparts none of its acrimony to milk on boiling. The best mode of administering it would appear to be in the form of an emulsion with gum arabic and sugar. It may be given in doses of from twelve to sixty grains two or three times a day. Besides the articles already men- tioned, there are a great many others from the vegetable kingdom, that possess expectorant properties; of which the following are the principal: Inula helenium, iris flor- entina, tussilago petasites, pulmonaria officinalis, borago officinalis, hedera terrestris. G. ^MMONIACUM. This article has already been noticed under the head of Antispasmodics. As an expectorant its powers are very considerable. In the latter stages of pneumo- nia, after the fever and inflammation have been moderat- ed, and in chronic catarrhal affections, attended with accumulations of mucus in the lungs, ammoniac in uni- on with muriate of ammonia, oxymel of squills, anti- monials, laudanum or nitric acid, &c. will in general afford much benefit. It may also be employed with pe- culiar advantage in chronic complaints connected with inordinate mucous secretions in the bronchia?, and more especially, when these affections are attended with a cold and sluggish condition of the general system. It is also very useful in humoral asthma; and in the ca- tarrhal affections of old people, a combination of gum ammoniac and squill, forms one of our most valuable expectorants. It is particularly serviceable in those EXPECTORANTS. 363 cases where the expectoration is deficient from a want of power to throw up this viscid bronchial mucus, and where the skin is cold and the pulse weak and sluggish. In its general operation it is considerably stimulant It is therefore inadmissible in cases attended with active inflammation or high arterial excitement. In chronic cough, accompanied with a torpor of the alimentary canal, I have known large doses qf this medicine taken in the form of pills to afford much relief. For the doses, and modes of prescribing ammoniac, the reader is referred to the account of this article under the head of Antispasmodics. The following are excellent ex- pectorant formulae, into which this substance enters as a principal part.* ASAF02TIDA. Besides its antispasmodic properties, asafoetida pos- sesses also very useful expectorant powers. Employed in the form of an emulsion, its effects are often highly beneficial in coughs, connected with a weak and cold habit of body, and particularly in pertussis, provided no inflammatory symptoms be present. In chronic cough attended with oppressed respiration and a copious secre- tion of bronchial mucus, asafoetida generally affords considerable relief. Its stimulating quality renders it * R Acidi nitric. £i\. Aq. fontanae ^viii. Misce et terre ammon. 3ii. Donee solutio fit, et emulsio evadit. Dosis coch. unum. me- diocri ex liquore aliquo demulcenti. R Misturae ammoniae ^i. Syrupi. tolut. 5ss. Aq. cinnam. §iss. Tinct. opii camp. Iss. M. Fiat mistura. Dose a table-spoonful three or four times a day. The following is particularly recommended by Stoll. ^ G. ammon. vitello ovi soluti aa 3ii- Aq. pulegii %v\. Syrup. hysopi. Ii. Misce et exhibe cochleatim,alterius horis. 364 EXPECTORANTS. improper in cases connected with fever or inflammation. It may be administered according to the following form- ula.* CAMPHORA. Although camphor has not generally been mentioned as an expectorant, it is nevertheless well entitled to notice in this place. In protracted catarrhal affections, unac- companied by fever, it may be advantageously exhibited in union with squills, asafoetida, opium, &c. It is said to be especially useful in cases of cough connected with a rheumatic habit, or depending on repelled cutaneous diseases, when given in combination with sulphur and antimony. Combined with the vinegar of squill^ it forms a valuable expectorant in humoral asthma. The following is an excellent formula for exhibiting it as an expectorantf The tinctura opii camphorata, is also a very useful mediciue in this respect. CARBONAS POTASS^E ET SOD2E. The carbonates of potass and soda have been long known to produce excellent effects in certain pulmonary affections attended with cough and accumulations of viscid mucus in the bronchia. According to Mascagni * R Asafoetid. 9ii. Solve in Aquae menthae £iii. Acet. scillae 3ii. Syrup tolu. §i. M. Dose, a table-spoonful every third or fourth hour. t R Pulv. camph. 9iss. Pulv. g. arab. 3'iss. Pulv. sacch. alb. Ji. Tere simul cum aquae purae 5v»i- Vin. antim. 3iss Oxy. scillae |iss. M. Dose, a table-spoonful three or four times a day. EXPECTORANTS. 365 it is very efficacious, when given in large doses, in pneu- monia accompanied with an oppressive collection of slime on the lungs. It is also very highly spoken of by Dr. Pearson, as a remedy in hooping-cough, a disease in which it has very deservedly become a popular medicine. I have frequently prescribed it with much advantage in this affection, and never have known it to give rise to any unpleasant symptoms. The following is the formula recommended by Dr. Pearson.* In catarrhal affections attended with irritation of the general system, I have repeatedly used the following expectorant mixture with decided benefitf BALSAMUM TOLUTANUM. This substance is obtained from the toluifera bal- samum, a native tree of South America, by making in- cisions through its bark, from which it exudes in con- siderable abundance during the hot season. It is a thick tenacious substance, becoming hard by age, and of a yellowish brown colour. It has a warm and sweetish taste, and possesses a fragrant odour, very similar to that of lemons. It contains a volatile oil, benzoic acid, and resin. Alcohol dissolves it readily. " When dis- solved in the smallest quantity of a solution of potass its odour is changed into one that resembles clove pink." The balsam of tolu possesses no inconsiderable ex- pectorant properties, and may be employed with benefit * R. Carbon, sod. gr. iii. Vin. ipecac. gn. v. Tinct. theb. g*5 i. Aq. font. 3i. This is a dose for a child a year old, which may be repeat, d every three or four hours. f R. Potassae carb. gr. x. Tinct. opii. gl5 xx. Vin. antim. g". xv« Syrup, symp. 3ii. Aq. fontanae |i. M. To be taken on going to bed. VOL. II.—3 A 366 EXPECTORANTS. in chronic catarrhal affections, and especially in coughs connected with general debility and a cold phlegmatic habit of body. It is usually given in union with other articles of this class. The following formulae, into which it enters, are excellent expectorant preparations.* BALSAMUM PERUVIANUM. This balsamic substance is obtained from the myroxy- lum peruiferum, a native forest tree of South America. It is a viscid liquid, of a dark brown colour. I has an agreeable aromatic and penetrating odour. Its taste, which is at first rather mild, soon becomes very acrid, somewhat bitter, and hot. It contains an essential oil, a peculiar resin, and benzoic acid. It is perfectly solu- ble in pure alcohol; sulphuric aether dissolves nearly the Whole of it, but boiling water takes up only a part of the benzoic acid. This article was formerly much employ- ed as a remedy in chronic pulmonary affections. By the authority of Dr. Fothergill, however, this balsam, in common with the other articles of this kind, was, until late, almost entirely rejected as a remedy in pectoral diseases. The chief objection that has been urged against the employment of the balsams in affections of this kind is, their stimulating character; a quality which they undoubtedly possess in a very considerable degree; and which certainly also renders them inadmissible in all cases attended with acute inflammatory symptoms. There are, however, instances of pulmonary disease, * R Cetacei 3ii. Vitel. ovi q. s. ad solut. et adde. Aq fontanae 3vi. Syrup, tolutan. giss. Tinct. opii camph. 5ss. M. Dose, a table-spoonful every four hours. R. Mistura ammoniae 5iv. Syrup, tolut. 5i. aq. pulegii 5iii. Tinct. opii gtt. 1. M. Take a table-spoonful three or four times a day. INHALATIONS. 367 which simulate genuine phthisis, being attended with purulent expectoration, cough, emaciation, with slight hectic fever, &c, and which depend on a chronic in- flammation of the mucous membrane of the bronchia, in which the balsamic remedies often display the most salutary operation. In the chronic catarrhal affections of old people, and in asthma attended with a cold and torpid state ot the system, the balsam peru has been employed with excellent effect. It has also been praised as a remedy in gonorrhoea, and in various other diseases connected with a leucophlegmatic habit of body. Dr. Kollock of Savannah, states, that he has seen several cases of tetanus from wounds cured, as he believes, by the external and internal use of this balsam. The in- fluence of this medicine, he says, " has in several instances almost immediately controlled the spasms, and of itself restored the patient when rapidly sinking under the very liberal use of opium, bark, and wine. Two drachms in twelve or twenty-four hours is the largest quantity I have ever found it necessary to give."* The balsam peru is given in doses of from twenty to thirty drops, upon a bit of sugar, two or three times a day. It is also given in the form of tincture, from forty to sixty drops. INHALATIONS. The inhalation of aeriform fluids may be employed to great advantage in the treatment of pulmonic affec- tions. In this way we are enabled to make direct im- pressions on the respiratory organs, a circumstance which experience has shown to be of much consequence in many of the diseases to which these organs are liable. * Thacher's Dispensatory. 368 ' INHALATIONS. For the sake of distinctness, I shall arrange what I have to say upon this subject under the four following heads: Aqueous vapours; astherial vapours; fumes of burning substances, and gases. Aqueous vapours—In catarrhal affections, attended with painful and difficult expectoration, much benefit may generally be obtained from the inhalation of the steam of hot water, or of vinegar and water. This acts as an emolient and soothing application to the tender and inflamed vessels of the internal surface of the bronchial tubes. In pneumonia also, after the violence of the arterial excitement has been reduced by depletory mea- sures, the inhalation of steams of hot water, or decoc- tions of emollient herbs, will often contribute much to the support of an easy and regular expectoration. In no affections, however, are inhalations of this kind more decidedly beneficial than in the paroxysms of asthma. " To moderate the severity of the paroxysms in asthma," says Dr. Thomas, " we cannot employ a more powerful and efficacious mean of relief than the inhalation of warm steam frequently from an inhaler, or the spout of a tea-pot. An infusion of chamomile flowers, with the addition of a little aether, may be used on the occasion." Inhalations of warm vvater and vinegar, are also often very serviceable in cynanche ton- sillaris, and trachealis. JEtherial vapours.—The inhalation of astherial va- pours is a remedy of very considerable value in certain affections of the respiratory organs. In dyspnoea, de- pending on a spasmodic condition of the pulmonary sys- tem, I have frequently derived very great benefit from the inhalation of the vapours of sulphuric aether. Dr. Pearson, who speaks very highly of the employment of the sulphuric aether in this way, affirms that its efficacy is considerably enhanced by dissolving in it some of the extract of cicuta. Mr. Alibert states, on the authority of an author whose name he does not mention, that the INHALATIONS. 369 inhalation of sulphuric aether was found quite useful in a case of catarrhal phthisis, complicated with hysteria. The effects which arise from the inhalation of the va- pours of this aether from a bladder are exceedingly re- markable and resemble entirely those which are known to proceed from the inhalation of the nitrous oxyd gas. The sensations experienced during the temporary mad- ness it produces, is said to be indiscribably pleasant; but the shock given to the brain by the experiment is violent, and has been known to bring on convulsions, and other alarming symptoms. Q,uite recently, Dr. Bodtcher, of Copenhagen, has published some observations on the efficacy of the va- pours of camphor in complaints affecting the cavities of the nose, the throat, and the chest He states, that in the worst cases of stoppage of the nose from cold, a piece of camphor need only be kept for a few minutes before it, to obtain great relief. In cynanche tonsillaris, camphor kept before the mouth or nose, is said frequently to produce much good. It has also been found very ser- viceable in spasmodic coughs, in croup, and in asthma.* I have never seen camphor employed in this way, and can say nothing concerning the value of this practice. Dr. Bodtcher, however, speaks with great confidence of its usefulness. * Fumes of burning substances.—The inhalation of the fumes of tar and of resin, was very early considered be- neficial in diseases of the lungs. The following obser- vations of Pliny, (Hist Nat. lib. xxiii. cap. 6.) have a reference to this subject, and are, I think, very interest- ing. "Silvaseas duntaxat quae picis resinaeque gratia raduntur, utilissimus esse phthiscisaut qui longa aegritu- dine non recolligent vires, satis constat; et ilium cceli aera plus ita quam navigationum iEgyptiani proficere, plus quam lactes herbedos per montium aestiva potus." * Hufeland's Journal for June, 1822. 370 INHALATIONS. Dr. Mudge, of Plymouth, above thirty-five years ago, re- lated a case of pulmonary consumption, attended with purulent expectoration, which was entirely cured by re- sidence in the country, and the inhalation of the fumes of common resin twice a day. But the attention of the profession was more particularly directed to this prac- tice, about six years ago, by a publication of Dr. Alexan- der Crichton, physician to the court of St. Petersburgh.* He gives an account of several consumptive patients, who were perfectly cured by the employment of the tar fumes. He states, that the best mode of fumigation is to put the tar into an open vessel, over a lamp or hot iron, so as to produce a slow volatilization, until the air of the chamber is well impregnated. In this atmosphere the patient may remain from one to two hours together, two or three times a day. He observes also, that when the cough and hectic has been considerably subdued, the fumigation should not be persisted in, as it is apt to pro- duce a troublesome dry cough, " and prevents the en- joyment of what is then fit for the patient,-—common air. In the treatment of hooping-cough, the inhalation of tar fumes are often highly beneficial. Mr. Wans- brough, of Fulhani, in England, has related some very remarkable instances of the efficacy of this remedy, in this, as well as in several other diseases, attended with difficulty of respiration. An infant, three months old, from an accidental exposure to cold, became affected with catarrh, and difficulty of breathing, attended with evident accumulation of mucus in the bronchial cells, which the child was not able to expectorate. The symptoms increased rapidly; leeches, emetics, and ex- pectorants were unavailingly Used, and death appeared to be inevitable. In this situation he had recourse to An account of some experiments made with the Vapour of Boiling Tar in the cure of Pulmonary Consumption. Edinburg, 181'- INHALATIONS. 371 tar vapour. "I applied it at a distance/' he says, " whilst the child lay in its mother's arms, breathing quick and short, with frequent interruption, from what appeared to be accumulation in the bronchiae. The little creature seemed revived the instant she inhaled the vapour, and made an effort to cough." The fumes were brought nearer to her nostrils, which soon occa- sioned cough and vomiting. The patient was greatly benefited by this, and by repeating the fumigation twice a day for about a week, she was perfectly restored. In two cases of hooping-cough, that had been mismanaged during the early periods of the disease, and in which the expectoration had assumed a purulent appearance, I have derived decided benefit from tar fumigations. This remedy has also been found very useful in asth- matic affections. In acute inflammatory affections of the lungs, however, it cannot be employed without doing mischief. " It appears," says Mr. Wansbrough, " in cases where the lungs are under the influence of an inflammatory diathesis, the exhibition of the tar fumes is improper; but in chronic pulmonary affections, and also subsequent to the existence of increased arterial action, I have no doubt of the superior efficacy of this remedy." Mr. Wansbrough employed the vapour of the Barbadoes tar. The inhalation of the tar fumes appears to be particularly beneficial in chronic bron- chitis; or in that form of pulmonary consumption which depends on a chronic inflammation of the mucous mem- brane of the bronchiae. The inhalation of nitrous vapours has also been em- ployed, with much advantage, in certain affections of the respiratory organs. It is stated to be particularly effi- cacious in hooping-cough. Sev eral cases of this disease are related by Mr. Patterson, in which these fumigations 312 INHALATIONS. produced the happiest effects* Dr. John Thomas, of this city, has also related an instance of the excellent effects of this remedy in the present disease.f The most convenient mode of applying nitrous vapours is, to put an ounce of sulphuric acid into a tea-cup placed in a sand bath, and to add to the acid, from time to time, small portions of the nitrate of potash. The practice of smoking the roots of stramonium in asthma, and other pulmonary affections, does not appear to be entitled to much attention. 1 have prescribed it in several instances, but never with the slightest advan- tage. I have nevertheless seen some asthmatic persons who assured me that they generally derive benefit from it. Gases.—Soon after the discovery of oxygen gas, many physicians directed their attention to its employment in the treatment of diseases, and the reports which were at first published of its effects were highly promising. A more enlarged experience, however, has not confirm- ed the expectations which were once entertained of its powers, and it is now as much too little attended to as it was formly too highly extolled. The respiration of this gas was at first prescribed by Fourcroy in pulmonary consumption, and although its immediate effects appeared to be salutary, it was soon found to be one of the most certain means of hastening the progress of this disease to a fatal termination. Beddoes, believing that phthisis is essentially connected with a superabundant absorption of oxygen in the lungs, conceived the idea of placing consumptive patients in an atmosphere containing a smaller proportion of oxygen than the common air; or causing them to respire occasionally from a proper ap- paratus, air with a reduced portion of this gas. Hence he recommends consumptive patients to live in low and * The effects of Nitrous Vapour in preventing and destroying Contagion, by James Carmichael Smith, M. D.. p. 117. t American Medical Recorder, vol. v. p. 660. INHALATIONS 373 miasmatic districts, to sleep in cow stables, or in other places containing a deteriorated atmosphere Expe- rience, however, did not realize the hopes which were entertained of this practice, although there are not want- ing some well authenticated examples of its having pro- cured advantage. Little as is to be expected from the respiration of oxygen, in phthisis pulmonalis, it is never- theless a rjemedy of considerable value in a variety of other affections. In asthma it has been frequently em- ployed with unequivocal benefit. Beddoes speaks with great confidence of the usefulness of oxygen gas in this disease. He affirms that as soon as it is respired the laborious breathing ceases; the livid colour of the coun- tenance disappears, and respiration goes on freely and regularly. Dr. Thornton speaks highly of this practice. The respiration of atmospheric air, containing an aug- mented portion of oxygen, has also been found very beneficial in chronic cough depending on atony of the pulmonary organs. Various other gases have been em- ployed in medicine, particularly hydrogene and nitrogene. Those who wish to be particularly informed relative to the employment of pneumatic remedies, may consult the works of Beddoes and Thornton on this subject VOL. ii.—3 r CHAPTER XVIII. II. MEDICINES WHOSE ACTION IS PURELY TOPICAL. DEMULCENTS. Demulcents are medicines calculated to obviate or les- sen the effects of irritating matters, and that, " not by correcting or changing their acrimony, but by involving it in a mild and viscid matter, which prevents it from acting upon the sensible parts of our bodies, or by co- vering the surface exposed to their action." The mode in which this class of substances prove remediate is, therefore, very simple, being nothing more than an interposition of a bland fluid between the irri- tating matter and the parts exposed to their influence. As inflammation frequently exists in parts from which it is impossible to exclude substances of an irritating na- ture, and to which we may nevertheless make direct ap- plications, it is a matter of very great consequence to be able to apply such substances as afford some protection to the sensible and inflamed parts. Thus in inflamma- tion of the bowels, we derive advantage from mild mu- cilaginous drinks, by protecting the bowels from their ir- ritating contents; so also in ophthalmia much relief is obtained by a few drops of mucilage, as, for instance, thai of the pith of sassafras dropped into the eye, by which the inflamed conjunctiva is less irritated by the tears anc atmospheric air. It is not so easy to perceive, however, in what way demulcent remedies prove beneficial in parts to which demulcents. 375 they must reach through the medium of the circulation, as, for instance, in the diseases of the urinary passages. It is probable, as has been supposed, that they prove beneficial in the disorders of these parts, only by the large quantity of water which is usually taken with them, and by which the urine is rendered less irritating. GLYCYRRHIZA GLABRA. The liquorice is a perennial plant, indigenous to the south of Europe, and naturalized in the United States. The root which is the only part used in medicine has a peculiar sweet and mucilaginous taste. It contains, ac- cording to the analysis of M. Robiquet, some amylaceous faecula, a peculiar saccharine matter (glycion) different from common sugar in not being fermentable, a new chrystalline substance, possessing the appearance, but not the chemical character, of a salt, and a resinous oil.* The acetate of lead, muriate of tin, and nitrate of mer- cury, form a copious and more or less light brown pre- cipitate, with the concentrated aqueous infusion of this root.f Its saccharine matter, but none of its other principles, is extracted by alcohol. Water is its proper menstruum. By successive infusions it yields different extracts. That which is obtained by the first is yellow- ish, and of an agreeable sweetish taste; that obtained by infusing it a second time, is darker and less agreeable; the matter extracted by a subsequent infusion has scarcely any sweetness; but on the contrary is bitterish and acrid.| When employed in decoction it should therefore be boiled but a very short time, otherwise it * Alibert, Elem. de Therap. t Plaff's Materia Med. B. i. s. 193. | Ibid. 376 DEMULCENTS. will acquire a bitterish and unpleasant taste. The root yields a very large portion of a black extract, which is moulded into round pieces, well known by the familiar name of liquorice stick. The liquorice root is seldom employed by itself, being commonly prescribed in combination with other sub- stances, either to correct their taste or to improve their expectorant properties. As an expectorant demulcent it is, indeed, a very excellent remedy. Being mild and unirritating in its effects, it may be employed in the acute as well as in the chronic forms of catarrhal affections. The extract dissolved, and taken either by itself or in conjunction with other expectorants, is very frequently used in disorders of this kind. The. following are ex- pectorant formulae.* ULMUS FULVA.--SLIPPERY ELM. There are four species of ulmus indigenous to the United States. The present species seldom rises above thirty feet in height, with a slender trunk, dividing into numerous branches, and invested with a rough light- coloured bark. The leaves are oval-oblong, with a very long point, pubescent on both sides, serrated on their edges, and unequal at the base; the buds are tomentose, with a thick tawny wool; the flowers sessile; succeeded by membranous seed-vessels of a compressed and oval shape, containing one oval seed. The inner bark of this species of elm contains a very * 1J, Extract, glycyrrh. 3"« Aq. font. ferv. |iii. M. ft. solut. deinde adde. Vin. antim. 3ii- Tinct. thebaic. gl5 xl. M. Dose, a table-spoonful every two or three hours. R Extract, glycyrrh. 3>i- Solve, in aq. fceniculi j^iii. Aq. am- monias 3'- Aq. fontanag 5v. M. Dose, a table-spoonful three times a day, DEMULCENTS. 377 large portion of mucilage, which is readily extracted by infusion or gentle decoction. In the treatment of ca- tarrhal affections, in pneumonia, and in consumption, the infusion of this bark may be very usefully employed. It is also an excellent demulcent in affections of the urinary passages, and particularly in some of the diseases of the alimentary canal. In dysentery, its beneficial effects have been abundantly testified. I have very fre- quently used it in this disease, from the very commence- ment through its whole course, in conjunction with other remedies: and so well satisfied am I of its utility, that I seldom now prescribe in the complaint without ordering copious draughts of this excellent demulcent Dr. Maxwell Sharp, of Tennessee, relates two cases of this disease in children, attended with excruciating tormina in the umbilical region. A great variety of remediate means had been used without advantage, and the two little patients appeared to be sinking fast. He was finally induced to try the elm bark decoction, on the authority of Dr. Mease, whose paper he had read in Dr. Coxe's Medical Museum; and "the effect," he says, " was so immediate that it appeared to act like a charm on the disease."* Dr. Mease has informed me that the infu- sion of this bark is a common drink among women, when near their confinement, from a prejudice in favour of its powers to procure easy labours. This supposed virtue, he thinks, is probably derived from the aborigines of our country, among whom it is known that this drink is constanly taken upon similar occasions. It does not seem probable to me, that its efficacy in dysentery de- pends entirely upon its demulcent quality; for other vege- table demulcents, such as flaxseed tea, solution of gum arabic, &c. are not equal to it in this respect It cer- tainly possesses some active properties, as its beneficial effects in certain diseases evince, and which cannot be * Coxe's Medical Museum, vol. ii. p. 123, 378 DEMULCENTS ascribed to its demulcent powers. Thus the internal use of the decoction of this bark, has been found very efficacious in lepra vulgaris, and in other varieties of cutaneous diseases.* It is seldom found to show its good effects in these complaints, before its use has been continued for several months. The more diuresis it produces, the more certain is its beneficial operation. It is said frequently, at first, to increase the eruption, and this is considered an evidence of its ultimate good effects. For this purpose, two ounces of the bark are to be boiled in three pints of water down to one pint, and this is to be drunk in the course of a day. Quite re- cently the elm bark has been recommended by Mr. Henry Jeffreys, as a valuable substitute for sarsaparilla.f He employed it with decided advantage, in those cases for which sarsaparilla is usually prescribed. He used it, according to the following formula.| The elm bark may also be used with very good effects, as an external application, in ulcers, cutaneous eruptions, gun-shot wounds, chilblains, &c. For this purpose the bark must be bruised and boiled in water, and applied in the shape of a poultice. The mucilage which this bark con- tains affords very considerable nutriment Dr. Strong states that a soldier, who lost his way, supported himself for ten days on this mucilage and sassafras. * Lettsom, Med. Memoirs of the Gen. Dispensary, sect. iii. p. 152. Lyoans, in the Medical Transactions, vol. ii. Banau, in Abh. fur pract. Aerzte, B. ix. p. 195. Richter, Specielle Therapie, B vi. p. 95. t Cases of Surgery, by Henry Jeffreys, 8vo. p. 237. t R Decoct ulmi. (Ph. L.) Oc viii. Sassafras rad. concisae. Guaici ligni rasi sing ^i. Mezer. rad. corticis 3iii. Glycyrrhisae rad. contusse $i. Decoque per horam et cola. The dose is from half a pint to one pint a day. ._&/■* DEMULCENTS. 579 ACACIA GUMMI.--GUM ARABIC. The greater part of pure gum arabic is furnished by the acacia vera of Willdenow, a tree which grows in the sandy deserts of Arabia Petraea, Africa, and Egypt It is obtained by exudation from ii.cisions made into its bark. There are, however, a number of other trees from which a gum, similar to that furnished by the aca- cia vera, is obtained, and which is commonly mixed and sold with the genuine acaciae gummi.* Dr. Duncan observes, that " it is remarkable that the barks of all the trees which furnish this bland mucilaginous substance are highly astringent; that of the mimosa nilotica (acacia vera) itself is used in India for tanning; and in our own country the cherry and plum-trees, which sometimes yield a little gum, have very astringent barks. Two kinds of gum are met with in the shops, which are usually sold indiscriminately under the name of gum arabic. The genuine gum arabic consists of small ir- regular and roundish pieces, colourless, or of a very pale yellow colour, breaking with a shining conchoidal fracture, without smell, and a faintly sweet and muci- laginous taste. The other variety, which is brought from Senegal, consists of much larger, globular masses, of a yellowish brown, or dark brown colour, having a rough or wrinkled surface. Gum arabic is soluble in every proportion in water. It is also dissolved by the pure alkalies, lime water, the vegetable acids, but not by al- cohol, aether and oils. The nitrate of mercury converts the solution of gum arabic into a beautiful peach blos- som colour, a circumstance which may be considered characteristic of this gum. The gum Senegal assumes * All the species of the mimosa, the swietenia febrifuga, melia azadirachta, and the various species of the genus terminalia. 380 DEMULCENTS. a more bright red and becomes slightly turbid on stand- ing some time.* Chlorine, passed through a solution of gum arabic, converts it into citric acid.f A very diluted solution of the nitrate of iron converts its solution into a yellowish colour, becoming slightly turbid, and depo- siting a white sediment which is insoluble in nitric acid. " Neither the strong acids nor alcohol, when consider- ably diluted, occasion any disturbance in it; but sul- phuric aether, and its compound spirit, the tincture of mu- riated iron, and sub-acetate of lead, produce very dense precipitates; the acetate of lead only occasions decom- position when an alkaline salt is present in the formula: the volatile alkali curdles the mucilage, and hard calca- reous waters render the mixture difficult and often im- practicable."! When dissolved in water in the propor- tion of one part of the gum to six parts of the water, it forms a mucilage about the consistence of a syrup; with two parts of water it forms a very thick mucilage. Gum arabic is one of our most useful and pleasant demulcent remedies, and is much employed in affections of the lungs, bowels and urinary passages. In the treat- ment of dysentery, the free use of this mucilage is often productive of very salutary consequences. In the chro- nic bowel complaints of children, it is peculiarly benefi- cial; I have prescribed it with complete success in such cases, after a variety of other remedies had been tried ineffectually. As it is highly nutritious, children labour- ing under such affections may take it freely as a nour- ishment; indeed, I have sometimes confined them almost exclusively to it for several weeks; and in one instance I have seen a little patient restored to health by this treatment alone, after the case appeared to be hopeles. In catarrhal complaints, and particularly in coughs de- *Pfaff's System der Materia Medici, B. i. p. 111. t Annates de Chimie, vi. p. 178. | Paris's Pharmacologia. DEMULCENTS. 381 pending on irritation in the fauces or glottis, considera- ble relief may sometimes be obtained by allowing the gum to dissolve slowly in the mouth. Its solution is also much used as a demulcent drink in strangury, ardor urinaf;, and gonorrhoea. In pharmacy the mucilage of this gum is much employed in forming emulsions with oils, resins, balsams, &c. and to suspend heavy and in- soluble substances in water. GUM MI TRAGACANTHA. This gum is obtained by exudation from the astragu- lus creticus, a thorny shrub growing on the island of Candia, and other parts in the Levant It comes to us in the form of long, crooked, and somewhat flattened pieces, and occasionally also in irregular lumps. The colour of the best sort is whiter: that which is of inferior quality is generally of a pale red or yellowish brown. It is translucent, and has no lustre. When put into water, it swells up very much, but does not dissolve so as to form an entirely transparent solution. The acids, particularly concentrated nitric acid and the caustic alkalies, render the aqueous solution of this gum more transparent. The solution ofgum tragaqanth exceeds that of all other substances in viscidity. Eighty grains of the gum form a mucilage with thirty-two ounces of water of the consistence of a syrup. It is used like gum arabic, as a demulcent in catarrhal affections, &c. and for pharma- ceutic purposes. It is not, however, equal to gum arabic for making emulsions with oily or resinous sub- stances; nor should it be employed for making pills, un- less they are to be taken soon after being made; as it becomes exceedingly hard and difficult of solution on becoming dry. vol. ii.—3 c 382 DEMULCENTS SEMEN LINI. Flaxseed contains a very large portion of mucilage, which is readily extracted by infusion. The mucilage resides chiefly in the cuticle of the seed. Their paren- chymatous substance contains, besides a mucilage, a large portion of a bland oil, some albumen, and a very small quantity of saccharine matter.* An ounce of the unbruised seeds infused in a pint of boiling water, forms a moderately thick, ropy, colourless mucilage, possess- ing no odour, and a sweetish mucilaginous taste. Cold water does not extract any mucilage from the unbruised seeds. The infusion of flaxseed is frequently prescribed as a demulcent in diseases of the lungs, bowels, and urinary organs. The bruised seeds are much employed in con- junction with other substances, for emolient cataplasms. MUCILAGO SEMINUM CYDONIORUM. The seeds of the quince afford a very large quantity of a fine, colourless-mucilage, which, as in the flaxseed, resides principally in their external or cortical portion. It is readily extracted from the unbruised seeds even by cold water. One part of quince seeds, with three parts of cold water, will form a mucilage as thick as that which is formed by equal parts of gum arabic and water. This mucilage forms a copious flocculent precipitate, of a clear white colour, with the acetate of lead, and the chlorite of tin. The mucilage obtained from the bruised seeds, is not pure; it is mixed with a portion of albumen, which is very abundant in the kernel of the seed, and also with a small quantity of farina. In boiling water, * Pfaff's Materia Medica. B. i. S. 123. DEMULCENTS. 383 they give out an exceedingly large quantity of mucilage, one part of the seeds being sufficient to impart to forty- eight parts of water, the consistence and appearance of the albumen of an egg.* This mucilage is almost exclusively used as an exter- nal remedy. In acute ophthalmia, it is a very excellent application. It is sometimes employed in cases of this kind, in union with sugar of lead; but such a combina- tion does not appear to be a proper one, as it forms a pretty copious precipitate with this salt Besides the substances already mentioned under this head, there are a variety of other articles which are employed for their demulcent properties. Amongst these the following are the principal: Radix althaea, semen psyllii, herba et flores malvae, malyse fotundifolia, a plant exceedingly common in the United States, and medulla sassafras. This latter, the pith of the young branches of the sassafras, forms a beautiful, colourless, and pure mucilage by decoction, which has been much recommended as an application to the eye in acute ophthalmia. * Pfaff's Mat. Med. B. i. S. 122. 3U ESCHAROTIC S. CHAPTER XIX Escharotics. These are substances capable of destroying the texture of animal matter. They are employed to remove ex- cresoences; to open abscesses; to form artificial ulcers; and to change the condition of ulcerated surfaces. They are usually divided into eroding escharotics, and caustic escharotics. But the only foundation for this division appears to be the difference in the degree of their ac- tivity. POTASSA FUSA.--COMMON CAUSTIC. This is the most powerful escharotic with which we are acquainted. As it is usually met with in the shops, it consists of small cylindrical pieces, of a white colour externally, and a pale purple colour internally. It is deliquescent, and dissolves readily both in water and alcohol. It is a hydrated protoxide of potas- sium. This caustic is chiefly employed in forming issues, opening abscesses, and in destroying the callous edges of ulcers. Being rapid and powerful in its effects, and very deliquescent, considerable care is required in its application, lest it destroy the parts to a greater extent than is necessary or proper. The action of caustic potash may, however, be readily arrested by ESCHAROTICS. 385 applying vinegar to the part upon which it is rubbed, a"d thus neutralizing and destroying its properties. The formation of a superficial eschar by means of this caustic, is attended with particular advantage in several affections. In paronychia, before suppuration has taken place, it is an excellent application to put a stop to the further progress of the disease. For this purpose, the caustic is to be applied so as to form a thin eschar immediately over the spot where the pain is felt most severely. This practice originated with Dr. Per- km of this city. A similar practice may also be used with much advantage in bubos of an indolent character. Of the use of caustic issues in diseases of the spine, phthisis, tetanus, &c. I have already spoken, when treat- ing of issues and setons, in the chapter on Epispastics. NITRAS ARGENTI.--LUNAR CAUSTIC This metallic preparation has already been described under the head of Tonics;* and it only remains in this place to notice more particularly its powers as an es- charotic. The nitrate of silver is much less powerful as a caustic than the preceding article; but in the majo- rity of cases where such applications are indicated, it is decidedly preferable to the potash, both on account of its greater mildness, and its being less apt, from the pro- perty it possesses of coagulating animal matter, to spread and form extensive eschars. Where the surface of an ulcer requires an application of this kind, the lunar caustic is by far the best, as it is more apt than any other articles of this class to give a disposition to the new granulations to heal. A weak solution of this substance forms an excellent lotion to excite the weak granula- * Vol. i. p. 242 386 ESCHAROTICS. tions of fungous ulcers; it may also be employed with much advantage as an injection in gonorrhoea; and in puriform discharges from the ear. In the latter of these affections, a solution of this substance injected into the ear, is said to be particularly useful; it was, 1 believe, first recommended by Mr. Saunders, and lately Mr. Curtis, surgeon-aurist to the Prince Regent, has pub- lished several cases in which it was successfully employ- ed* In one of the cases which he reports, he states, that " the patient began by using ten grains in four ounces of water, and I increased it to the extent of thirty-five grains, which completely healed the parts: and I had the further satisfaction, at the same time, to find her hearing restored. It may be necessary, perhaps, to mention, that it took nine months to complete a cure." arsenici oxydum. The white oxide of arsenic is a very powerful escha- rotic. Its employment in this respect has been chiefly confined to the treatment of cancers, and for which pur- pose it seems to be the best escharotic we possess. When applied to an ulcerated surface of this kind, it often destroys the diseased parts very deeply, and seldom extends its destructive effects to those which are healthy. Richter states, that he employed the arsenic as an escha- rotic in cancerous ulcerations of the face, with decided benefit It is, however, much too powerful to be em- ployed for purposes of this kind without being mixed with other articles of a mild character. Various sub- stances have been used for this purpose, such as sulphur,f hemlock, orobanche virginiana, sanguis dragonis, &c. * London Medical and Phys. Journal for May, 1819. t See formula for Bernard's mixture, vol. i. p. 259. ESCHAROTICS. 387 The paste arsenicale was formerly much employed by the French surgeons as an escharotic for cancer. This mixture consists of seventy parts of cinnabar, twenty two of sanguis drachonis, and eight of white oxide of arsenic, formed into a paste with saliva at the time it is applied. It has also been used in the form of solution, which is an excellent mode of applying it when we wish merely to destroy the surface of the ulcer. If it create very great pain, we need only wash the part with a so- lution of opium. In phagedaena gangraenosa, which, according to the observations, of Mr. Blackadder, is always primarily a local disease, produced by a specific morbid poison, a so- lution of arsenic applied to the affected part has been found to produce the happiest effects."* alumen exsiccatum. When alum is exposed to heat, it yields its water of crystallization, enters into a sort of fusion, and finally dries into a white, spongy, and very light substance, which possesses considerable escharotic powers. When prepared for this purpose the heat employed to fuse it must not be too intense or very long continued, lest the alum be deprived of too much of its acid, upon an ex- cess of which its escharotic powers depend.f This substance may be used with very good effect in venereal chancres, as well as in other ulcers having weak and spongy granulations. It is very frequently employed to destroy fungous excrescences, &c. * Observations on Phagedaena Gangraenosa, by Home Black- adder. Lond. 1818. ,t Paris. 388 escharotics. hydrargyri nitrico-oxydum. The subnitrate of mercury, or red precipitate, is much employed as an escharotic in weak and fungous ulcers. It is not very powerful in this way, and seldom occasions much pain on being applied to an ulcer. It is used either by itself, sprinkled on the surface of the sore, or in the form of an ointment, in which way it is an excel- lent stimulating application to weak and spongy granula- tions. HYDRARGYRI OXYMURIAS. The corrosive sublimate is powerfully escharotic, but as its action in this way is exceedingly painful, it is very seldom employed for this purpose. A solution of it in lime-water, the aqua phagedenica already mentioned in a former part of this volume, forms a very useful lotion in foul and indolent ulcers, venereal sores, cutaneous af- fections of a local character, &c. Justamond recom- mends a powder composed of equal portions of subli- mate and arsenic as one of the best escharotic applica- tions to venereal and cancerous ulcerations. When thus combined, he says, they produce less pain than either of t these articles by themselves. sulphas cupri. The sulphate of copper possesses pretty active escha- rotic properties, and may be employed with very good ESCHAROTICS. 389 effect in venereal chancres, as well as in other sores hav- ing weak and spongy granulations. It may be used either in substance or in solution. A crystal of it cut into a pointed shape and applied to a chanc're for a few moments, will, in general, answer every purpose that can be expected from such applications. A weak solution, consisting of about three grains to an ounce, forms an excellent stimulating application to foul and languid ulcers. MURIATIC ACID. I do not know that this acid has ever been used as atf escharotic. In indolent ulcers, however, it occasionally proves an excellent stimulant; and in the slow caries of some of the spongy bones it may be employed with great advantage. I owe this latter idea to my friend Dr. McClellan, who has lately been induced, from speculative views, to prescribe the diluted muriatic acid in several cases of this kind, at the Philadelphia Alms-house and efsewhere. In one instance, he informs me, a very troublesome caries of the os calcis was speedily and effectually cured by the daily repetition of injections of the diluted muriatic acid; and in several other cases im- portant, though not equal, relief was obtained from the same remedy. Indeed, it will not prove difficult to con- ceive that this acid may be introduced into a fistulous ulcer, in so weak a state of dilution as not to injure the healthy surfaces, and yet prove sufficiently strong to dis- solve the dead bony spiculae, and to excite the morbid parts to granulation and cicatrization. VOL. ii—3 D 390 ESCHAROTICS. NITRIC ACID. This acid has frequently been employed by empirics for the destruction of tumours, and perhaps it may be considered as the most useful, as well as the most pow- erful of ail the escharotics, whenever an immediate de- struction of diseased parts is required. By the sudden and powerful excitement which it creates, it produces the advantageous effect of subverting the morbid train of action in the surrounding vessels, more extensively and permanently than any other of this class of remedies. Mr. Welford, in the eleventh number of the Medico- Chirurgical Transactions, speaks very highly of it as an escharotic, in a species of sloughing ulcer which occur- red among the prostitutes of London. Dr. McClellan of this city, has also resorted to it in consequence of Mr. Wellbank's representations, with the most decided ad- vantage, in three different cases. In one of Dr. McClel- lan's patients, who came under my notice last summer, a very large sloughing ulcer of the penis, which had been making a rapid and destructive progress, was immedi- ately arrested, and a speedy cicatrization effected, with- out the aid of any constitutional treatment. In the Philadelphia Mms-house a similar case, which alternately put on a phagedenic and sloughing appearance, and which had long resisted every other mode of treatment, was effectually subdued by the same remedy, under the care of Dr. McClellan. The method of using the nitric acid in such cases is, to smear all the sound parts in the immediate vicinity of the ulcer with basilicon ointment. and then to apply pledgets of lint dipped in the strong acid over the morbid surface. The acid should not be diluted. Bv pressing the lint firmly upon the ulcer a few seconds, the whole surface will be deadened, and a deep slough remain, underneath which healthy suppura- tion and granulations will ensue. INDEX. The Numerals refer to the Volume, the Figures to the Pages ,■ where the Figure* stand alone the First Volume is always intended. ABORTIVA, 324. Absorption of medicines, 2. Accasia gummi, ii 379. Acetas potass*, ii. 267. Acetate of lead, 134. Acid, carbonic, antilithic, ii. 291. muriatic, ii. 389. nitric, ii. 390. Acids, mineral, antilithic, ii. 288. Acidum nitricum, astringent, 299. sulphuricum, astringent, 303. Aconitum JVapellus, ii. 64. ASther, sulphuric, antispasmodic, ii. 119. AZthiops mineral, ii. 353. Alcohol, ii. 142. Allium sativum, rubefacient, ii. 217. antispasmodic, ii. 114. expectorant, ii. 360. Aloes extractum, 114 emmenagogue, 306. its chemical composition, 115. used in habitual costiveness, 116. Alum, 292. , used in colica pictonum, 293. exsiccatum, ii. 387. Amber, oil of, ii. 122. Ammonite aqua, ii. 219. Ammonia, an antidote of prussic acid, ii. 99 carbonas, stimulant, ii. 127. diaphoretic, ii. 172. Ammoniacvm, ii. 107. expectorant, ii. 362. Ammoniated copper, 236. Angustura bark, 214. Antacids, 170. Anthelmintics, 147. Anthemis Nobilis, 223. Antilithics, ii. 272. Antimony, as an emetic, 56. denounced by the medical fa- culty of Paris, ib. crude, 57. used in cutaneous disorders, ib. in scrophulous diseases, 58. Antimonii sulphuretvm prxcipitat. ib. useful in rheumatism, 59. tartarizatum, 60. Antispasmodics, ii. 101. Antimonial preparations, diaphoretic, ii. 162. Antimonium tartarizatum, epispastic, ii. 211. Apoplexy, emetics used in, 32. cathartics used in, 93. Aqua calcis, 174. . Argenti nitras, tonic, 242. Aristolochia serpentaria, tonic, 202. Arsenicum, tonic, 249. its effects, 250 inert when applied to a nerve, 251. used in intermittents, 253-5. in typhus, 255. in rheumatism, 256. in hooping-cough, ib. in hemicrania, 257. in sick headach, ib. in ulcer of the tongue, 258. in cutaneous disorders, 259. * mode of administering it, ib. its antidotes, 260. 392 INDEX. Arsenicum, escharotic, ii. 386. Artemesia san'iuica, !59. Arum triphyllum, ii. 360. Asafoetida, ii 102. used in c-«ries, ii. 104. expectorant, ii. 363. Asarabacca, ii. 222. Asarum, errhine, ii. ib. Ascatis vermicularis, described, 148. Asclejnas tuberosa, ii. 176. Asthma, cinchona used in, 198. Utility of emetics in, 31. spider's web, used in, ii. 90. prussic acid, used in, ii. 98. Astringents, 262. used in dysentery, 263. in leucorrhoea, 64. injections in gonorrhoea, 265. Atropa belladonna, ii. 54. used in hooping-cough, ii. 56. in tic doloureux, ii. 57. Aurum, tonic, 245. B. Backer's Pills, 313. Balsam copaiva. ii. 253. useful'in chronic bronchitis, ii. 256. tolntomtm, ii. 365. Peruvian, ii 366. Barlow's solution for tinea capitis, 137. Barytes, 297. Beach-drop, 274. Bear-berry, lithontriptic, ii. 292. Bernard's arsenical caustic, 259. Bismuthi Oxidum, 241. Bi-tartrate of Potash, 144. Biter-sweet, ii. 69. Black Hellebore, 124. pepper, ii. 149. Blackberry-root, c277. Black-drop, ii. 12. Blood, difficulty of detecting foreign substances in, explained, 3. Blood-root, 319. Bisters, ii. 192. Blue vitriol, 234. mercurial pill, ii. 335. Bonplandia trifoliata, 214.- Boneset, ii. 173. Bree't antispasmodic formula, ii. 47. Brodvm's nervous cordial, 219. Bubon galbanum, ii. 105, Burgundite pix, ii. 226, Bntterfiy-weed, ii. 176. Butter-nut, 111. C. Cabbage-tree, 157. Calcarix lapides, antacid, 17~. Calcis aqua, antacid, 174. lithontriptic, ii. 285. Callicocca ipecacuanha, 37. Calomel, 128. sialagogue, ii. 348. Calx, astringent, 295. Cambogia, 111. Camomile flowers, 223. Camphora, anthelmintic, 162. narcotic, ii. 36. its effects, ii. 38. rubefacient, ii. 219. expectorant, ii. if 4. used in typhus, ii. 39. in puerperal fever, ii. ib. in remittent fever, ii. 40. in intermittents, ii. ib. in rheumatism, ii 41. in epilepsy, ii. ib. in mania, ii. 42. in nymphomonia, ii. ib. in chorea, ii. ib. in eclamsia, ii. 43. in strangury, ii. ib. in dysmenorrhea, ii 44. Cantharides, emmenagogue, 321, epispastic, ii. 204. rubefacient, ii. 220. diuretic, ii. 248. used in dropsy, ii. 249. in phthisis, ii. 250. in incontinence of urine, ii. ib. in gonorrhoea, ii 251. in impotency, ii. ib. in cutaneous eruptions, ii. 253. Cantharadin, ii. 205. Capsicum, rubefacient, ii. 216. annuum, ii 145. Carbonas ammonix, stimulant, ii. 127. sodx et potasses, lithontriptic, ii. 279. potassx, expectorant, ii. 364. et sodx, expectorant, ii. ib. Carbonic acid, lithontriptic, ii. 291 Caries, asafoetida used in, ii. 104 INDEX. 393 Carrot, wild, ii. 360. CaryophilU aromat. ii. 14". Cascarilla, 222. Cassia senna. 106. lanceolatum, ib. Marilandica, 109. Castor, ii. 112. Catarrh, opium used in, ii. 19. Catechu extractum, 281. Cathartics, 77. differ in their operation, ib. diminish the action of the heart and arteries, 79 promote absorption, ib.' excite the portal circulation, 81. equalize the circulation, ib. used in typhus fever, 83-86. in the exanthemata, 86. in scarlatina, 87. in dysentery, ib. in puerperal fever, 88. in acute rheumatism, 90. in gout, 91. in hydrocephalus, ib. in apoplexy, 93. in hypochondriasis, 94. in hysteria, 95. in chorea, 96. in tetanus, 97. in marasmus, 98. in chlorosis, 99. in dropsy, 100. Cayenne pepper, ii. 145. Centaury, 210. Chenopodium Anthelminticum, 156. Chironia Angularis, 210. Chimaphila umbellata, ii. 263. Chirac's experiments on the mecha- nism of vomiting, 13. f Ching's worm lozenges, 168. Cholera, opium used in, ii. 23. Chorea, treated by opium, ii. 31. Cinchona, 179. pale, or condaminea, 180. yellow, or ovalifolia, 181. red, or magnifolia, ib. caribaea, 182. floribunda, ib. chemical composition, 183-187. pharmaceutical preparat. 187. used in intermittents, 189. in remittents, 192. in typhus, ib. in rheumatism and gout, 193, Cinchona, used in erysipelas, 195. in measles, ib. in scarlatina anginosa, 196. in dysentery, 197. in pertussis, 198. in asthma, ib. in pulmonary consumption, ib. in dyspeptic phthisis, 199. in scrophula, 200. in dropsy, 201. in hemicrania, ib. mode of exhibiting it, ib. Cinnabar, ii. 352. Citrate of morphia, ii. 12. Classification, synopsis of, ix. Cloves, ii. 147. Clutterbuck's mode of obtaining ela- terium, 121. Colcothar of vitriol, 231 Colica pictonum, cured by alum, 293. opium in, ii 18. Co lo cynt hides pidpa, 119. Colchicum, diuretic, ii. 240. Columbo, 216. Common caustic, ii. 384. Consumption, cured by inhaling oak bark, 268. Constipation, cured by emetics, 36. Convolvulus jalapx, 101. scammonia, 117. Conium maculatum, ii. 48. extract, how prepared, ii. 54. Copperas, 231. Cornus florida, 209. Corrosive sublimate, sialagogue, ii, 341. Cortex querci, 266. Cowage, !58. Crancsbill, 272. Cream of tartar, ii. 268. Cremor tartar, 144. Creta prceparata, 171. Croton Eleutheria, 222. tiglium, 125. Croup, emetics used in, 21. Cubebs, ii. 257. Cucumis colocynthus, 119. Cupri sidphas, emetic, 73. tonic, 234. escharotic, ii. 388. Cuprum, 234. Cuprum Ammoniacum, 236. Cusparia febrifvga, 214. 394 INDEX. Cynanche laryngea, cured by eme- tics, 22. Cynanchum Olemfolium, 106. Daphne mezereum, ii. 181. Darwin's opinion of the modus ope- randi .of emetics, 14. Datura Stramonium, ii 59. Daucus Carota, ii. 260. Deadly nightshade, ii. 54. Demulcents, ii. 374. Diabetes, treated by emetics, 35. opium used in, ii. 25. Diaphoretics, ii. 151. used in fevers, ii. 155. in pneumonia, ii. 156. in gout, ii. 157. in bowel affections, ii. ib. in dropsy, ii. 160. rules for administering them, ii. 161. Digitalis purpurea, narcotic, ii. 72. its effects, ii. ib. used in phthisis, ii. 74. in epilepsy, ii. 77. in mania, n. 78. in spasmodic asthma, ii. 77. diuretic, ii. 231. Diuretics, ii. 224. their operation in dropsy, ii 227. their action promoted by bleed- ing, ii. 226. used in gout, ii. 228. in chronic dysentery, ii. 229. in pulmonary affections, ii. . ib. in ulcers of the legs, ii. ib. in diseases of the urinary organs, ii. 230. Dogwood, 209. Dolichos pruriens, 158. Dropsy, treated by emetics, 35. cathartics used in, 100. cinchona used in, 201. opium used in, ii. 24. cantharides used in, ii. 249. Dysentery, treated by emetics, 27. cathartics used in, 87 cinchona used in, 197. astringents used in, 263. opium used in, ii. 21. Dyspepsia, the utility of emetics in, 34. Dyspeptic phthisis, cinchona used in, 199. Dysmenorrhea, camphor useful in, ii. 44 Dysury, cured by tobacco, ii. 82. E. Eclampsia, camphor used in, ii. 43. Elaterium- 121. used in dropsy by Ferriar, 122. Ellagic acid, 270. Emetics, 13 16. their modus operandi, 16. diminish the energies of the brain, 18. useful in hypochondriasis, ib. their use in tpyhus, 19. in malignant fever, ib. in intermittents, 20. . in scarlatina, ib. in erysipelas, ib. in puerperal fever, 21. in-croup, ib. in cynanche laryngea, 22. in peripneumonia notha, 23. in pneumonia biliosa, ib. in acute rheumatism, 64. in gout, 25. in acute ophthalmia, ib. in gutta serena, ib. in haemoptysis, 26. in menorrhagia, 27. in dysentery, ib. in mania a potu, 28. in hysteria, 30. in asthma, 31. in hooping-cough, 32. in apoplexy, ib. in epilepsy, 33. in indigestion, 34. in dropsy, 35. in diabetes, ib. in jaundice, 36. in hernia; humoralis, ib. in constipation, ib. Emetic tartar, 60. epispastic, ii. 211. Emetin, contained in ipecac. 36. mode of obtaining it, ib. Emmenagogues, 306. their modus operandi, ib. Enteritis, opium used in, ii. 16. . Epilepsy, cured by digitalis, ii. 77. cured by the sugar of lead, 288. INDEX. 395 Epilepsy, treated by opium, ii. 31. treated by camphor, ii. 41. Epispastics, ii. 192. their effects, ii. ib. used in mortification, ii. 201. in spasmodic affections, ii. 202. in epistaxis, ii. 201. in erysipelas, ii. 200. in dysentery and cholera, ii. ib. Epsom salts, 142. Erigeron heterophyllum, ii. 261. Errhines, ii. 221. Erysipelas, cinchona used in, 195. Escharotics, ii. 384. Eupatorium perfoliatum, ii. 173. Euphorbia ipecacuanha, 50. an excellent emetic, ib. Expectorants, ii. 355. F. Fern, male, 160. Ferri phosphus 233. sulphas, 231. Femur's mode of using elaterium. 123. Ferrum, 226. „ used in anaemia, 229. Ferrum ammoniatum, 231. tartarizatum, 232 Fevers, diaphoretics used in, ii. 151. Flaxseed, ii. 382. Flores martialis, 231. Flowers of zinc, 237. Folia sennce, 106. Foxglove, purple, narcotic, ii. 72. diuretic, ii. 238. G. Galbanum, ii. 105. Gall*, 270. Gall ointment for piles, 272. Gamboge, 111. used in dropsy by Ferriar, 112. Gangrene, cinchona used in, 201. Garlic, antispasmodic, ii. 114. expectorant, ii. 360. Gastritis, opium used in, ii. 16. Gentiana lutea, 218. Geoffrea inermis, 157. Geranium maculatum, 272. Ginger, ii. 148. Giauber*9 salts, 142. Glycyrrhiza glabra, ii. 379. Gold, tonic, 245. used in syphilis, 246. mode of employing it, 248. Gonorrhoea, astringent injections used in, 265. and gleet, cantharides used in, ii. .51. Gooch's anodyne in mania, ii. 47. Gout, treated by emetics, 25. cathartics used in, 91. diaphoretics used in, ii. 157,228. Guaiacum officinale, ii. 178. Gum ammoniacum, ii. 107, 362. arabic, destroys the taste of ipe- cacuanha, 45. asafoetida, ii. 102. ammoniac, ii. 362. Gummi acacia, ii. 379. Gutta serena, emetics used in, 25. Guy's powder of ethiopia, 166. H. Hxmatoxylum campechianum, 276. Hemoptysis, emetics employed in, 26. Hemorrhages, opium in, ii. 27. Hartman's emmenagogue pill, 316. Heleborus niger, 124. emmenagogue, 309. Heleborinum, 310. Helenium autumnale, errhine, ii. 222. Hematin, 276. Hemicrania, cinchona used in, 201. Heracleum gummiferum, ii. 107. Hernia humoralis, treated by emetica, 36. Herpetic eruptions, dulcamara used in, ii. 70. Hooping-cough, emetics used in, 32. cured by belladonna, ii. 56. prussic acid, ii. 98. Hop, 225. Hydrargyrus, an anthelmintic, 168. ii. 297. sub-murias, sialagogue, ii. 348. nitrico-oxyd, sialagogue, ii. 350. Hydrargyrumpr * *:* ^^||i mm,k ■*^":" .c 'Sfe X>w, /■ .$ ' ^ »»v'.. ^ ,->., '*»-*»»--,£^- -*J .*-; .7 4\ V ^-v- .^m.;- ^