LEMENTS OF THERAPEUTIC &J&~^rS AND * w ^ MATERIA MEDICA. TO WHICH ARE PREFIXED XWO DISCOURSES ON THÈ HISTORY AND IMPROVEMENT OF THE MATERIA MEDICA, ORIGINALLY DE1IVERED AS INTRODUCTORY LECTURES. BY N. CHAPMAN, M. D. PROFESSO» OF THE INSTITUTES AND PRACTICE OF PHYSIC AND CLINICA! PRACTICE IN THE UNIVERSITT OF PENNSYLVANIA. « To comniuiiicate what I have tried, and leave the rest to others for farther inquiry, is ali niy design in publishing these papera."—Newton. IN TWO VOLUMES VOL IL - %! '^Cfa KIFTH EDITION, ENLARGED AND REVISED- PHILADELPHIA : i-AREY, LEA, AND CAREY, CHESNUT STREET. 1 827. *t<\ 33o C4lo(od v.a1 l'asterai Disimi of Pennsylvania, to v>it : BE IT REMEMBEKED, Thiit on the fifteenth day of Stpteinber, hi the fiftielh year of the Independence of the United States of America, A. D. 1825, Nathaniel Chapman, M. D. of the said distrìct, hath deposiled in this office the title of a book, the right whereof he claims as author, in the words following, to wit : "Elementi of Therapeutics and Materia Medica. To wliich are prefixed two Discourses on the History and Improveraent of the Materia Medica, originali}" deliv«red as intro- ductory Lectures. By N. Chapman, M. D. Professor of the Institutes and Practice of Physic and clinical Practice in the University of Pennsylvania. ' To communicate what I have tried, and leave the rest to others for farther inquiry, is ali my design in publishing these papers.'—Newton. Fourth edition, enlarged and revised." • In conformity to the Act of the Congress of the United States, intituled " An Act for the encourag-ement of learning, by securing the copies of Maps, Charts, and Books, to the authors and proprietors of such copies, during the times therein mentioned." And also to the Act entitled, " An Act supplementary to an act, entitled, ' An Act for the encouragement of Iiarn'inp, by securing the copies of Maps, Charts, and Books, to the authors ami proprictot> of such copies, during the times therein mentioned,' and extending the benctìts thereof to the arts of dssigning, engraving, and etching historical and other prìnts." D. CALDWELL, C'erk >jf 'Ar Easte ni Distrìct of Pennsylvania. MJK'I.N Oli l-4KRV, l'l;iMBR«. WB * ' • CONTENTS OF THE SECOND VOL SECTION I. Anthelmintica, or Anthelmìntics Lumbricoides SECTION II. Of Particular Anthelmìntics Ilydrargyri-sub-Murias, olim Calomelas Spigelia Marilandica Ilelleborus Foctidu9 Melia Azedarach Chenopodium Anthelminticum Tanacetum Vulgare - Geoffraea Inermis - Allium Sativum Artemisia Satonica Camphora - Ferrum - - - - Ascarides Hydrargyri-sub-Murias, olim Calomelas Aloetic Preparations - Enemata Trichurit, or Tricoccphalus - Txnia .... Mercurial Preparations Drastic Purgatives CONTENTÒ. Polypodium Filix Mas - - .31 Dolichos Pruriens .... 3S Stannum - - - . - - ib. Terebinthina: Oleum 34 SECTION 111. Epispastica, or Epispastics - - • * - 3o Vesicatoria, or Blisters - *>9 SECTION IV. Of the Practical Application of Blisters - - -47 Meloe Vesicatorius, vel Lytta Vesicatoria - - 61 Cantharis Vittata, vel Lytta Vittata - - - 63 Meloe Niger ..... 64 Antimonium Tartarizatum - - - - 65 Acidum Nitricum - - - ^ Ranunculus Bulbosus - - - - 67 Fonticuli et Cetacea, or Setons and Issues 68 Rubefacientia, or Rnbefacients - - - - 70 Terebinthinse Oleum .... ib. Oleum Monardae Punctatse - - - - 71 Camphora ..... 72 Tinctura Cantharidis - - - - - 73 Tinctura Capsici ----- ib. Cataplasma Sinapis - - - - - ib. Emplas. Picis Burgund. .... 75 Cataplasm. Rad. Allii - - - - ib. Caustica et Escharotica, or Caustics and Escharotics «. - 76 Moxa - - - - . -77 Potassa Fusa - - - . - ■ ib. Causticum Lunare - - - - - 78 Alumen Ustum - 79 Acidum Nitricum - - - - - ib. Cupri Sulphas - ib. Cupri Sub-Acetis, olim iErugo - - - 80 Oxydum Arsenici Album .... jj,. Mercurial Preparations - - - - - 81 Hydrargyri Nitrico-Oxydum, olim Ilydrargyrus Nitratus Ruber ib. Ilydrargyrum Praecipitatum Album, olim Calx Hydrargyri Alba ib. Hydrargyri Oxymurius .... 82 Unguentum Hydrargyri Nitratis - - - ib. Unguentimi Picis Liquida: - - - 83 SECTION V. Diffusible Stirnuhi'29 Hydrargyri Sulphuretum Nigrum ... 332 Hydrargyri Oxymurias, vulgo Hydrargyrus Muriatus Corrosivus ib. Hydrargyri Sub-Murias, vulgo Hydrargyrus Muriatis Mitis - 339 SECTION XI. Tonica, or Tonics - - 341 SECTION XII. Particular Tonict - • 345 SECTION XIII. Medicinal Tonics ... 351 Cinchona Officinalis - - - - - ib. SECTION XIV. The JVatural and Pharmaceutical History of Cinchona, &c. - 378 Cinchona Caribica - 389 SerpentariaVirginiana - - . 390 Eupatorium Perfoliatum .... 392 Eupatorium Pilosum ... - 394 Chironia Angularis - - 395 Cornus Florida, et Cornus Sericea - ib. Prunus Virginiana ..... 395 Liriodendron Tulipifera - 398 Cusparia Febrifuga - 399# Columba ..... 400 Gentiana Lutea - 402 CONTENTS. Quassia Excelsa - Quassia Simarouba Swietcnia Febrifuga Croton Eleutheria Anthemis Nobilis Carbo Ligni Spongia Usta Fuligo Ligni lodine - Myrrha - - - SECTION XV. Minerai Tonics Fevrum - Ferri Ramenta et Fila Ferrum Squama; Oxidi Ferri Sub-Carbonas, vulgo Rubigo Ferri Ferri Sulphas, vulgo Sai Martis - Phosphas Ferri Ferrum Tartarizatum - Tinctura Ferri Muriatis Ferri Prussias Cuprum Cupri Sulphas, olim Vitriolum Cceruleum Cuprum Ammoniatum Zincum Zinci Oxydum, vulgo Flores Zinci Zinci Sulphas, vulgo Vitriolum Album Zinci Acetas Bismuthum - Bismuthi Sub-Nitras Argentum - Argenti Nitras - - - Aurum Arscnicum Album Sulphur SECTION XVI. ìslrimrentiti, or Astringents QuercusRobur fc Quercus Ccrris Kino - - • i Mimosa Catechu - \m UONTENTS. Punica Granatum ... - - 457 Haematoxylon Campechianum - - - 458 Viscum .----- 459 Geranium Maculatum ... - ib. Prìnos Verticillatus ----- 460 Rubus Procumbens et Rubus Villosus - - 46* Orobanche Virginiana ... - 462 SECTION XVII. Minerai Astringenti - 464 Plumbum - -ib> Plumbi Superacetas, olim Saccharum Saturni - - ib. Argilla .----- 473 Super-Sulphas Aluminx et Potassa;: vulgo Ahimen - ib. Barytes ... - - 476 Calx ..-.-- 477 Acidum Nitricum, olim Aqua Fortis - - 478 Acidum Muriaticum ... - - 484 Acidum Sulphuricum * 485 ELEMENTS, &c. SECTION I. Anthelmintica, or Anthelmìntics. By Anthelmintics we understand those remedies which destroy or expel worms situated in any part of the alimentary canal. This class is exceedingly exten- sive, and has been variously arranged. There is, in- deed, hardly any article of the materia medica, which has not, under certain circumstances, evinced more or less of a vermifuge property. The anthelmintics are endowed with very different powers, and operate in severa-! distinct modes. There is one set which may be considered as poisonous to these animals. There is a second, which are mere evacuants of them, as the purgatives. There is a third, which are mechanical irritants. There is a fourth, which operate indirectly, by changing that condition of the stomach and bowels on which the generation, and, per- haps, subsistence of worms depend. - By some writers, the preceding division has been made the basis of an arrangement of these medicines. I do not perceive any very serious objection to it, .hough, as each species of worm requires. in a certain voi.. IT.—2 10 ELEMLMS 01 degree, peculiar remedies, itwill, probably, in a practi- cal view, be more advantageous to«treat of them in this last relation.* Yet it is to be understood, that some of these articles are equally applicable to e very sort of worm, and are thus indiscriminately employed. The worms which infest the aìimentary canal of the human subject, may be divided into round and fiat, each of which forms, according to the strict rules of classification, a genus. The species of the round worm are the ascaris lumbricoides, the ascaris vermicularis, and the trichuris or tricocephalus.* The teres, or ascaris lumbricoides, as the first of these worms is technically called, resembles so nearly the common earth worm, that it has been considered as the same, or a variety of the same animai, f By closely inspecting the two, however, a very material differencc will be observable. The residence of the lumbricoides is chiefly in the duodenum, jejunum, and ilium. They are rarely detected either in the large intestines or sto- maci!. When in the one or the other of these places, they are, for the most part, endeavouring to escape out of the body, having been rendered previously uncom- fortable by disease, or some active medicine. The teretes are from five to ten or twelve inches long, of a cylindrical shape, except at the extremities, * By Professor Brera, of Pavia, v.ho has writtcn with great ability on the subject of worms, another species is added,r.ame- ly, the vermi-vesicularis. This he describes as having a head similar to'that of the tscnia, united to a vesicle full of water, and very curiously organized. It is found in the brain and various other parts of the body, including the primae vìe. t Linnaeus. THERAPEUTICS. 11 iibout the size, when fully grown, of a common quill, and are often found to exist in very great numbers. Two hundred of them are recorded to have come away from a child of eight years of age in the course of a week, and I have known nearly half this number to be voided in a younger child in less time. The ascarides are very diminutive, not being more than half an inch long, and resemble a fine white thread cut into pieces, and, by reason of this, are called thread worm. Commonly, they Dccupy the rectum, though in some instances they have been met with in the sto- mach, and hence denominated maw worm. They also, occasionally, occupy the vagina of women. Of the dif- ferent species of worm, these are by far the most nume- rous, sometimes existing to an extent almost incredible. The trichuris, or long thread worm, is about two ^nches long, with a tail twice the length of its body, having also a proboscis, which it can protrude or with- draw at pleasure. It is of rare occurrence, and has not been very accurately described.* I have seen it only twice—in two children of the sanie family. It is said to reside principally in the ilimn. Of the fiat worms, the tamia is the only one. This is a very extraordinary animai. It is of great length, * I have not met with Hooper's book, which is said to contain a very accurate delineation of it. We are told by Brera, " that one part of the body terminates in a filamentous elongation, as hne as a hair, and coiled round in a very surprising manner— the other part turning in a spirai form, most commonly termi- nates in a hook, broad and ottuse, and similar to the pistil of the ìiliaceous flowers. From this extremity the worm can put forth a sort of tube enveloped in a sheathe." 12 ELEMENTS OF being from ten to two hundred and thirty feet,—found sometimes curled up, or entangled like a bunch of tape, to which it has been compared. By late writers, two species of tamia are described.* The extensive chain in the first of these consists " of links, or joints, which occasionally fall apart, each one becoming a distinct worm, possessed, for a time, of independent life, and from their resemblance to the seed of the gourd, called cucurbitinae." Each species resides in the small in- testines.f The origin of worms would' constitute a subject of very curious and interesting speculation. It belongs not, however, to my province to indulge to any extent in inquiries of this description. I should at once be led into an intricate discussion relative to the genera- tion and modes of nourishment of the whole tribe of pa- rasitical animals, of which little is satisfactorily ascer-j tained. Though not much has been absoìutely deter- mined as to the origin of worms, we are pretty well acquainted with the circumstances which favour their production. In ali cases of diminished strength and emaciation of frame, however induced, and especially * Tsenia osculis marginalibus, and taenia osculis superficial-. ibus: t Of the tsenia, Professor Brera gives an account somewhat different. He divides this worm into two varieties, the afmed and unarmed tenia. The first is the tsenia cucurbitina, or soli- tary worm, and the other taenia ata, the chief difference between them consisting in the former, or armed taenia, having on its head two protuberant and pointed appendages, which serve as crotchets or fangs. Whether its chain separates into pieces, as I have stated, on the authority of some writers, does not appear. THERAPEUTICS. 13 if the bowels share in this debilitated state, we may, in a ehild, suspect either their existence or speedy gene- ration. Children, from the first to the fifth year, are said to . be more liable to worms than at any future period. Of this fact, there can scarcely be any doubt, though how to account for it is not so easy. It has been imputed to the circumstance of their having, at this early season, a larger quantity of mucus in the bowels, which is thought to serve as a nidus, or matrix, for the generation, de- velopment and support of these animals. This hypo- thesis unquestionably receives some support from the consideration, that a slim and penurious diet, consisting of crude vegetables and unripe fruit, is favourable to the production of worms, and hence they always abound in the low and poorer classes of society. But whence are derived the principia or rudiments of the animai ? * To this question a satisfactory answer has never been given. It is alleged, by some, that they are taken into-the stomach with food. But such a con- jecture is refuted, at once, by the fact, that these worms are peculiar to the human species, not being seen in any other animai, or in any other position—and more- over, they have sometimes been discovered in the sto- rnaci! of foetuses and very yoùng children, even within the month. Nevertheless, let it not be imagined for a moment, that I am disposed to lend any support to the antiquated notion of equivocai generation. By its adoption, we are not at ali helped out of our difiìculty, and certainly would depart very widely from a correcl philosophy.* * There are some facts which have lately come tomy know- 14 ELEMENTS OF It has long been a matter of controversy among prac- titioners, whether worms are in themselves noxious, or ever prove the originai or accessary cause of disease. This point was once warmly debated. While on the one hand it was maintained> that almost ali the com- plaints of children are influenced, in a greater or iess degree, by the irregular movements of these animals, it was, on the other, as strongly insisted, that they are entirely harmless, and therefore merit no sort of consi- deration. By some of the disputants, it was even de- clared, that worms are highly useful in executing the duties of scavengers, removing the indigested sordes, and preserving clean the stomach and bowels. Nothing is less correct, or would be more dangerous than this extravagant notion, if carried into practice. Whoever is conversant with the complaints of chil- dren, and has attended to them, without any of those ledge, that give a strong support to the theory of the external origin of worms. The second volume of the Transactions of the Dublin College of Physicians, contains a very interesting paper by Dr. Barry, in which he gives an account of a spring near Cork, replete with ascarides, so that persons using the water become most terribly affected with these worms. The inquiry in this case seems to have been so carefully conducted, and the whole of the statement so well authenticated, as to preclude, altogether, doubt or hesitation as to its accuracy. It appears, also, that one species of tacnia was found by the celebrated Pallas in the waters of Siberia, and we are told, that tke inhabitants of the fens of Lincolnshire are peculiarly liable to ascaridtts, and the Hollanders not less so to taenia, ascribable to the state of the waters. Clarke, a veterinary surgeon of great respectability, has, moreover, discovered that the bots in horses proceed from tho rggs of a fly, the Aestrus Equi. IHERAPEUTICS. 15 prejudices which pervert the judgment, must acquiesce in this sentiment. I have had again and again occasion to witness a variety of diseases, which either originated or were kept up and aggravated, by the irritation of worms. There is, indeed, scarcely a complaint which* the presence of these animals will not excite or imitate. Cases are recorded of their producing epilepsy, cata- lepsy, choita, tetanus, apoplexy, mania, hydrocephalus, ophthalmia, perverted vision, paralysis, especially of the muscles subservient to speeeh, syncope, palpitations of the heart, hiccup, dry cough, pleuritic pains, con- sumption, cynanche trachealis, rheumatic pains of the joints, dysentery, convulsions, &c. To these may be added a peculiar fever termed verminosa febris. This is a slow and irregular remittent. The exacerbations are attended with heavy drowsiness : the remissions with a morbid vigilance. There is pain in the bowels, and at the pit of the stomach, with occasionally purging. and a good deal of gastric distress. The head is much affected, sometimes painfully, though, for the most part, with stupor or delirium. The eye is wild, the pupil dilated, the alse of the nose con- tracted, the cheeks flushed, the forehead polished, as if glazed. The case, in short, presents so many of the appearances of hydrocephalus, that it is easily mistaken for that disease. Two symptoms, however, most com- monly attend, which are peculiar and distinctive. These are, a very strange alteraiion of voice, and, in some instances, a total loss of speeeh. But it is prò per to state, that by Butter, a name which holds a respectable place in theannals ofour science, it is positively denied. that this species of fever is at al] • 16 ELEMENTS OF occasioned by worms. It is contended by him, with no little plausibility, that it proceeds entirely from crude accumulations in the intestinal passages, and he recom- mends for its cure, purging. In a majority of cases I think he is right, though it is stili manifest to me, that he has laid down his position too generaliy, and without making those exceptions which are found sometimes to exist. Considering, therefore, worms as a cause, and a very serious cause too, of disease, I shall endeavour to point out the symptoms by which the different species may be distinguished, and to assign to each the appropriate set of anthelmintics. As occasioning most of the aftec- tions which I have noticed, I shall commence with some observations on the lumbricoides. LUMBRICOIDES. It has already been mentioned, that worms may be suspected in a child where there is emaciatioft, and especially weakness of the bowels, accompanied by discharges of slime or mucus. The reverse of this is said sometimes to happen, or the most robust and flo- rid children will have worms, and suffer much incon- venience from them, without any serious detriment to health. But cases of this sort are so rare, that I am not aware of ever having met with worms under such circumstances. Among the more uniform symptoms of worms of this sort, are those of intestinal irritation, pains in the bel- ly, alternations of diarrhcea and costiveness, great thirst, and yariable and often voracious appetite. Tlu • THERAPEUTICS. 17 ehild sometimes becomes hungry, almost immediately after eating heartily—and, at other times, the appetite is feeble and depraved, soliciting strange and outré ar- ticles, as dirt, chalk, &c. There is, moreover, foatid breath early in the morning—the complexion is pale, or sallow, or leaden, with occasionai flushes—swellings of the lips, and especially of the upper lip—watery mouth, sometimes even copious discharges of saliva— enlargement of the nostrils—a livid circle round the eyes, dilatation or contraction of the pupil, with a fix- ed unmeaning expression, and tumidity or distention of the belly, particularly at night. The sleep is dis- turbed, the child often awaking with great terror, and is liable to startings—with grinding of the teeth. Du- ring the day he picks his nose—is tormented with temporary headach—sometimes has a dry cough, with a slow fever—the pulse being hard, tense, and corded, and there is a disposition to spasmodic or convulsive affections. Taken alone, no one of the preceding circumstances will be conclusive of the existence of worms.* But se- veral of them concurring, there can be little or no doubt of the fact, and we are accordingly to resort to the proper remedies. * " The ambiguity of every symptom," says an intelligent writer, " ascribed to worms, except that of voiding them, is well known. VOL. II.--3 18 ELEMENTS Oi SECTION IL Particular Anthelmintics. HYDRARGYRI-SUI3-MURIAS, OLIM CALOMELAS. Of these, one of the most efìicacious is calomel, which should be given in the largest dose over night, and worked off the succeeding morning, by castor oil, or some more active cathartic. If the first dose should not answer, the medicine is to be repeated several times, at the interval of two or three days. Ali the active purgatives, as jalap, scammony, gam- boge, colocynth, sulphur, aloes, croton oil, &c, seem to possess, in a greater or less degree, the power of re- moving worms. The treatment, indeed, in these cases, consisted, at one time, very much in the em- ployment of such articles. Whether they operate in any other mode than as mere evacuants is questionale. Even in this way, they often prove serviceable, and very much so as auxiliaries to the more determined vermifuge medicines. THERAPEUTHS ib SPIGELIA MARILAXDICA. The pink root is an indigenous vegetable, growing in the southern states, and especially in South Caroli- na. Every part of the plant is possessed, in some de- gree, of the vermifuge property, though the root is in- comparably the most active. This is a powerful me- dicine, sometimes inducing ali the effects of a narcotic poison. It is probable, that by virtue of this very pro- perty it proves so destructive to worms. But a difter- ent view of its modus operandi has been entertained by some, who, considering it merely a purgative, refer to its action on the bowels the whole of its anthelmintic efficacy. To this representation I cannot agree. Certainly, in my hands, the spigelia has several times proved use- ful without at ali purging, though I think it more ef- fectual when it does so copiously. This medicine may be given either in powder or decoction. Of the form- er, the dose for a child is from five to ten grains, and of the latter, half an ounce or more, to be repeated oc- easionally. But, whichever prescription " is adopted, some brisk purgative should be added, and the calomel or senna is to be selected, as the one or the other mode of exhibition is preferred. By this combination, we increase the power of the medicine, and entirely pre<- vent any unpleasant nervous affections. Of late, we have had a powder, prepared by an apothecary in this city, which has acquired no slender reputation. It is vended as a nostrum, the composi- fion of which is ascertained to consist of spigelia with *0 ELEMENTS 01 some other articles.* It is very efiicacious, and I do not know a better formula in most cases. Distinct from its vermifuge property, the pink root is thought to do good in irregular remittents. This opinion was early adopted by the southern physicians. Of its correctness to a certain extent, I am satisfied, and can hardly doubt, that every practitioner who has largely used the medicine, must have seen it do good in the febrile affections of children, though no worms were brought away. HELLEBORUS FCETIDUS. This is a native vegetable, common also to many parts of Europe. As might be expected from the title, the smeli of the recent plant is offensive, and with a bitter taste, remarkably acrid and nauseous. Though I never have used the hellebore, I do not distrust its powers. It is favourably spoken of by some of the ablest practitioners in this country and in Europe. There was formerly in this city a Dr. De- witt, who acquired great celebrity in the treatment of worms by a medicine, the composition of which he dis- guised. But ultimately it was discovered, by the late Dr. Kuhn, to consi^t of this species of hellebore, and a small portion of ev. TRICOCEPHALUS. S Of this worm I have little further to say. It is to be distinguished, so far as I know, by no peculiar symp- toms, and probably might be managed with equal suc- cess, by some of the means which are resorted to in ascarides, or lumbricoides. TJENIA. We have no symptoms which very clearly distinguish this worm. Its existence, perhaps, is more generally attended by a steady gnawing, or an irregular biting sensation at the pit of the stomach, and by an indescrib- able wretchedness, incident to the gastric affections. Emaciation of the body is said more rapidly to take place from it, than from the other worms, in some cases amounting even to atrophy. While this wasting is going on, the appetite is enormous. The belly becomes dis- tended, and there is sometimes a sense of coldness in it, attended by an irregular turning motion and weight on one side. The complexion is, in some instances, livid, or leaden, and the eyes wild and distracted, or sunken and suffused with tears, with pupils widely di- lated or much contracted. The head is often affected with acute pain or vertigo, and the whole nervous sys- tem becomes deranged, as is indicated by tremors, con- vulsive twitchings, inability to walk firmly, and, occa- 30 ELEMENTS OF sionally, by well marked symptoms of paralysis. An anomalous symptom of taenia, is a sense of extreme tension in the nose. Now and then, the existence of this worm may be positively determined, by a discharge of small substances resembling gourd seed, which we are now told are the marginai papillae of the worm, though hitherto considered as the links of its chain. MERCURIAL PREPARATIONS. In the treatment of taenia, the mercurial preparations have been tried, and, probably, on the whole, with as much success as any other class of remedies. They are, however, fallacious, having, indeed, in the few cases which have come under my notice, proved generally inefficient. Yet they have, undoubtedly, done more good in the hands of other practitioners. I have used calomel, ethiops minerai, and corrosive sublimate. The latter, which has recentiy acquired considerable repu- tation, should be given in solution, in the dose of a fourth or sixth of a grain. DRASTIC PURGATIVES. Most of the drastic purga ti ves have been used in taenia. This is the case with jalap, scammony, colo- cynth, elaterium, and, above ali, gamboge, which, in very large doses, is extolled as a sovereign remedy. Not less than twelve or fifteen grains of it will do, as the most active purging is necessary for the expulsion of the worm. Of this practice, my own experience will not enablc me to say much, though I think that TIIERAPEUTICS. 31 the active cathartics will be found to be among our best remedies under such circumstances.* The Cro- ton oil has recently been a good deal extolled for this purpose, and, I suspect, justly, silice it unquestiona- bly proves very efficient in the expulsion of other worms. POLYPODIUM FILIX MAS. The male fern has been prescribed in taenia since the time of Galen. Too much has been said of its efficacy, in these cases, to doubt it altogether, and yet, from my own observations, I should be induced to rate its powers very low. The dose of the fern is from one to three drachms, to be taken in syrup, or simply washed down with water. To promote its operation, a strong purga- tive is to be given after a few doses, and, if the worm be not expelled, the same course should be repeated. Cullen thought it very doubtful whether the fern has any anthelmintic property, he being inclined to suspect, that ali the effects imputed to it may be referred to the cathartic with which it is generally combined. This suspicion, however, does not seem to be well founded, as in Germany, where the medicine is much employed, * Gamboge enters largely into several of the nostrums for taenia. The famous specific of Herrenschwand, which, at one time, excited so much curiosity in Germany, was composed, according to his own declaration, " of from ten to fifteen grains of gamboge, with from fifteen to twenty of kali." But, on be- ing analysed, by order of Elizabeth of Russia, there were found in it, besides, both mercury and arsenic. The specific of Glossius has also gamboge for its basis. 32 ELEMENTS OF and highly celebrated, it is exhibited alone. Many cases might be adduced in support of its utility. There is one in particular related by Dr. Jones of New York, of a lady, who, after taking numerous worm medicines, with little or no effect, drank a decoction of fern, a pint daily, till some gallons were consumed, when a worm carne away measuring forty-five feet. It may be fur- ther remarked, in support of its efficacy, that the fern constitutes the basis of Madame Nouflleur's well-known remedy for tape-worm, the secret of which was pur- chased by Lewis XV. of France, at an exorbitant price.* The United States produce several species of fern, which probably possess the same powers as the Euro- pean, though this is mere conjecture, as none of them, I believe, have hitherto been subjected to experiment. The most common American species, is the Polypo- dium Virginianum, which grows in the neighbourhood of this city, as well as in many other districts of our country. * These are substantially the directions of Madame Nouf- fleur : " Three drachms of the root of the male fern, reduced to a fine powder, and mixed with any simple water, and swallowed at a dose. Two hours after taking the powder, twelve grains of calomel, as much resin of scammony, finely powdered, with five grains of gutta gamba, must be taken hi a bolus. If the pa- tient is of a strong constitution, or has been used to violent pur- gatives, this dose may be increased." The following is the once famous prescription of Stoerk, with which, he says, he has " destroyed ali sorts of worms. R. Sai. polycrest.—Pulv. jalap.—Valerian. àà ^j.—Oxymel scili. §v. m. exhibeatur adultis quater per diem gss. junioribus vero gj. aut^ij. THERAPEUTICS. 33 DOLICHOS PRURIENS. This is a plant of the West-Indies, and the parts used in medicine are the hairs or spiculae attached to the pod. The operation of this article is said to be purely mechanical, being supposed to prick the worms, and in this way to expel them out of the alimentary canal. It might be suspected that the same degree of irritation would be felt by the inner coat of the intes- tine, and that, therefore, the medicine might prove in- jurious. Experience, however, has taught the contra- ry. Taken in the quantity of a table-spoonful.mixed in syrup or mucilage, it is said to be both a safe and efficacious remedy. I have never employed it, though so highly extolled by many respectable practitioners.* STANNUM. The filings of tin, or the powder made by heating it nearly to the melting point, and shaking it briskly, may be employed. The dose is one or two drachms, mixed with syrup, to be taken for several mornings in succession, and then purged off by an active cathartic.f * By some recent experiments, we are taught, that the good effects of the Cowhage do not depend on any mechanical ope- ration. The spiculae, either macerated or comminuted, were found equally etlectual as in the originai state. t Alston, who first recommended tin filings i-i taenia, gave, in t-ome instances, an ounce al a dose. VOL. i.—.*> 34 ELEMENTS OF It was long supposed that the efficacy of tin, in these cases, is owing to the arsenic which it contains. But it has been found, that the purest metal answers as well, and its operation is now commonly referred to mechanical irritation. As, however, it is proved, that, when reduced even to an impalpable powder, tin is not less effectual, this hypothesis must also be abandoned. Of late, it is conjectured, that it acts merely by the hydrogen it generates in the alimentary canal, and this opinion is supported by the allegation, that its powers are increased by a mixture with sulphur, by which sulphuretted hydrogen is evolved. In addition to the preceding remedies, there is a va- riety of others which have been suggested at different times, for the cure of tape-worm, among which may be enumerated, sulphur, the blue and white vitriol, sai ammoniac, arsenic, very large doses of castor-oil, de- coction of the bark of pomegranate, the samphire, mare's milk, &c. The onlyarticle, however, the pow- ers of which have been sufficiently attested, to be enti- tled to particular attention, is the following.* TEREBINTHIWE OLEUM. This is given in the dose of from half an ounce to two ounces, in the morning, when the stomach is * It has been proposed, in cases where the worm protrudes at ali beyond the anus, that a drop or two of prussic acid should be applied to it, so as, at once, to terminate its exist- ence. That it would prove effectual, is highly probable and I cannot perceive any danger in the experiment. THERAPEUTICS. 35 empty. It commonly excites an agreeable warmth, without any sickness or other gastric distress. After a while, however, some patients are apt to complain of giddiness, slight pain in the head, and, sometimes, when taken in the largest dose, of thirst, and other febrile sensations. But these speedily pass away, leaving behind no serious consequences. It appears that the oil, which probably acts as a poison to worms, is most effectual when given by it- self,* and that strangury, and other unpleasant effects, are more likely to occur, if it be employed in the or- dinary small doses, than when exhibited so as to purge. My own experience does not enable me to say much of it in taenia. Twice I have prescribed it where I sus- pected the existence of this species of worm, and in one instance a very large number of lumbricoides was evacuated, while in the other, no such effect followed, though the symptoms which led me to its use were re- moved. Yet of the utility of the turpentine in taenia, there can be no doubt. The late periodical journals abound with proofs of it, proceeding from some of the most dis- tinguished of the English practitioners,f and it has been successfully used in this city. Bold as the practice seems to be, I do not think we have any thing to apprehend from it. In one of the cases to which I have alluded, I gave a wine-glassful of the turpentine for several days successively, and the * The liquid carbonate of ammonia, with turpentine, is said. however, to have proved a very effectual remedy in taenia. t Eclectip Repcrtory. voi. i. p. -i ! i« 3b UEMEXTS Ut man declared, he felt no more from it than from the same quantity of ardent spirits. Being so efficacious in taenia, it is reasonable to sup- pose that the turpentine will prove stili more so, in the less intractable species of worms. The fact stated, of its evacuating the lumbricoides, is sufficient, of itself, to encourage us to a further trial in sudi cases.* I have now completed the consideration of the best means for the destructioti or expulsion of worms. Little, however, would be accomplished in most cases, were we not to prevent their reproduction, which can only be done by the removal of the causes promotive of their generation and nourishment. Every species of worm seems to have its origin and support in a weak and depraved condition of the diges- tive organs. The indication, therefore, is to restore to them the proper degree of vigour, which may be efFect- ed by the exhibition of lime water, bitter tonics, the preparations of steel, and by a due regulation of diet, with whatever else conduces to the confirmation of health. We are told by Brera, that camphor is particularly scrviceable with this view, by counteracting the " pre- disposition to the further development of verminous seeds." How far this is true, I cannot say. But the carbonate of iron I have found highly useful in doing avvay that condition of the primae vise, which favours the production, or continuance of worms. Common salt, freely used, is also excellent under similar circum- I bave lately given a combination of turpentine with oil, very successfully, in several of these cases. THERAPEUT1CS. 37 sianccs. To this purport we have some very interest- ing facts. It is stated, in one of the reports of a com- mittee of the House of Commons, respecting the salt duties, that, by an old law of Holland, criminals were punished by being kept on bread without salt, and that, io use the language of the writer, " the effect was most horrible, these wretched creatures having been devour- ed by worms, engendered in their own stomachs." We learn from the same source, that the people of Ireland, who, on account of their extreme poverty, were unable to purchase salt, from the enormous duty on that arti- eie, became sickly, and especially with gastric and in- testinal complaints, and, as a consequence, much infest ed with worms. The importance of this article is further illustratcd by the eagerness with which it is sought after by ani- mais, and that, when deprived of it, they pine away, and become emaciated, probably from worms. By the >hepherds of England, a common expedient to cure sheep of wTorms, to which they are very liable, is to turn them to feed, for a few weeks, on the salt marsh- es, which is represented as very effectual. Aware of this fact, lord Somerville, who is, perhaps, the largest owner of sheep in the world, and the most successful in the prcscrvation of them, allows annually a ton of salt to every hundred. Taken ali together, these facts are very curious, as showing the necessity of this condiment to our well he ing, and its particular eflicaey in the case before us. 38 ELEMENTI Oi SECTION III. Epispastica, or Epispasties. The etymology of this term warrants a more exten- sive meaning than is commonly affixed to it. Literal- ly, it signifies to draw, and may be used in the same sense as attrahentia. But, as the epispastic substances generally excite a blister, the term is, at present, re- ceived as synonymous with vesicatoria, or vesicantia. By the ancients, ali external applications which redden or inflame the skin, were called epispastice, and desig- nated according to their several degrees of eftect : the siigli test being entitled phcenigmoi, the next sinapis- mi, the more active vesicatorii, and the strongest caustici.* In treating this subject, I shall arrange what I have to say, under the heads of rubefacients, blisters, se- tons, issues, and caustics. But, as blisters are the most important, and demand the largest share of atten- tion, it is right, perhaps, to commence with the histo- ry of these applications. I shall thus escape from many repetitions, which otherwise would be unavoidable. * Parr's Medicai Dictionarv THERAPEUTICS. 39 VESICATORIA, OR BLISTERS. By these we mean such external applications as cause the exhalants to pour out a serous fluid, separate the cuticle from the true skin, and produce vesication. The manner in which this is done admits of a plain and satisfactory explanation. By the irritating na- ture of the substance, the extremities of the arteries are excited to an increased exhalation or effusion, which is retained by the impervious cuticle. Of the precise mode in which blisters operate in the cure of diseases, we are stili uncertain, though this is a point which, at different periods, has occasion- ed numerous disquisitions, and eager controversies. It is fortunate that the cairn and attentive practi- tioner has pursued his path unmoved by these spe- culations, and, carefully observing the effects of the remedy, has ascertained, with, perhaps, sufficient precision, the time and circumstances when it becomes proper to recur it. Nevertheless, I can scarcely admit of any unusual obscurity in the modus operandi of the vesicating ap- plications. No one, I presume, at present, could be found to support the ridiculous hypothesis, which re- ferred the effects of blisters to the absorption of the acrid particles of which they are composed into the cir- ulation, and to the subsequent stimulation thereby im- 10 IÌJ.EMENTS Ol parted to the system. Many arguments might be ad- duced to show, that even strangury is never occasioned in this way, much less that we are to seek an explana- tion of the general action of blisters in the process of absorption. Not, however, to press a point which is of no great practical importance, I shall mention only one or two leadingobjeetions to this vulgar notion. It seems to me, that, if strangury do thus arise, it ought invariably to take place on the application of a blister. But, so far from this happening with uniform- ity, it is an incident of comparatively rare occurrence. Nor does it less follow, that this afleetion ought always to be in proportion to the size of the blister, and the time it is kept on. These circumstances, however, have little or no influence in the production of strangu- ry. It is moreover known, that the internai use of cantharides is seldom attended by any such effect, and, when it does "occur, it is more frequently from small than large doses of the article. These, perhaps, are reasons sufficient to refute the opinion to which I have alluded, without an appeal be- ing made to the general improbability of any article reaching the circulation unchanged. It would really appear in the case before us, that absorption is, in a great measure, suspended, since, were this process to go on as usuai, the fluid must be taken up as fast as it is eflused, and no accumulation could take place. The exact cause of this species of strangury is not determined, though it is well known that a great va- riety of articles besides cantharides, and some of these by no means of an acrid nature, excite it. Thus it is pretty constantly brought on by the solanum nigrum, THERAPEUTICS. 41 and I have seen it caused by camphor. Heberden mentions a case of this sort, and I once saw it induced in typhoid pneumonia, from the free use of the medi- cine. We have some cases recorded of its proceeding from the use of opium. Even the mildest diuretics, including nitre, often occasion it. Whatever, in short, is possessed of a peculiar relation to the urinary organs, has a tendency to induce strangury. May we not then account for it on the principle of extended action through the medium of sympathy? Cantharides are universally allowed to be one of the articles of the materia medica, which most conspicuous- ly display their affinity to the urinary organs. Ap- plied in the form of a blister to the surface of the body, they excite a locai impression, which, by virtue of the consent of parts, is propagated in the mode I have just mentioned. This, at least, is the solution of the difficulty which accords bcst with my medicai creed, and I think, too, with the existing state of our medieal intelligence. Contemplating the operation of a blister, more than one mode is presented in which it might be serviceable in the treatment of diseases. By the increased action it excites, the primary effect of the remedy is indubi- tably stimulant, though, from the quantity of fluid poured out, it appears also to be ultimately evacuant. But among experienced practitioners, little hesitation prevails as to which of these operations the best ef- fects of blisters are to be ascribed. Excepting some cases of dropsy, I ani not aware that any great ad- vantage is derived from such depletion. Certain it AOL. n.—6 42 ELEMEATS OF is, that the relief afTorded is not proportioned to the quantity of fluid evacuated, and often the most signal benefit accrues, where little or no discharge takes place. Demonstrated by the clearest evidence, it is now ad- mitted, with regard to the living body, that an exist- ing morbid action may be removed by inducing a new and different impression in the same part. It is on this principio that we can explain the extraordinary eflicacy of vesicatories in locai inflammations. Nor is it less a law of the animai economy, that, in many in- stances, a very strong impression made on a part, has the effect of soliciting or drawing towards it morbid action existing in some remote portion of the body. It is this we understand by the term revulsion, and which we habitually perceive illustrated in the operation of these and similar applications. Blisters, however, have a more pervading effect, and hence are useful in complaints of a general or constitutional nature. They act here, as in the former case, by their stimulating power, increasing the force of the circulation, and heightening excitement, as happens in typhous fever, and many other low diseases. That they are cordial and exhilarating is further proved, by their eflicacy in nervous affections, whether distinguished by a preponderance of mental or corpo- real infirmity and weakness. It is somewhere recorded of the celebrated Dunning, an eloquent barrister of the London bar, that on great occasions, when he was cal- led upon to make the fìnest displays of his powers, fo- rensic or parliamentary, he put on a blister, and found THERAPEUTICS. 43 that, while it elevated his mind, tone and vigour were imparted to his body. But it is not merely as a stimulant, that they ope- rate. While, under sudi circumstances, every part of the system is pervaded, it is on the cutaneous capil- laries that the impression is more specifically felt, in evidence of which we find perspiràtion as a common re- sult of their application, and which is very clearly shown in fevers, and other diseases, with a dry and un- relenting skin. In estimating these remedies, it will be prudent, as a guide in practice, to consider them as stimulants, sometimes acting by inviting morbid action from dis- tant parts—at other times by producing a locai im- pression which supplants the existing one,—and as calculated generally to sustain or revive the strength of the system, with a strong tendency to excite dia- phoresis. Yet it is not to be concealed, that a differ- ent view has been taken of their operation, and, among others, by Cullen, who, depreciating their stimulant and evacuant effect, is disposed to ascribe their utility chiefly to the property of relaxing spasm. That they are, to a certain extent, antispasmodic, is sufficiently proved by the great advantage derived from them in many of the spasmodic affections. But this they do by a mere modification of the stimulant power, in the same way that they tranquillize the sys- tem and compose to rest, under circumstances of ex- cessi ve mobility, either naturai or acquired. What I have said, refers to the primary effects of a blister. The originai irritation continucd by any aerid dressing eventuale* in a purulcnt sccreliun. or, in other 44 ELEMENTS OF words, the vessels assume a species of glandular action, establishing, in the language of the older pathologists, a drain, similar to that of an issue or seton, by which deep seated congestion, irritation, or inflammation, is diverted and overcome. I am next to make a practical application of blisters to the cure of diseases, and, considered in this light, they become exceedingly interesting and important. As preliminary to the main discussion, I shall suggest some few rules for their employment. 1. Let the blister remain on till it draws effectually. The ordinary time required for this purpose is ten or twelve hours : but on the head, at least doublé this period, or so long as to induce suppuration of the scalp, and in this case, to prevent strangury, the hair should be removed several hours previously to the application of the blister, if such a delay be admìssible. This is an interesting practical fact, first communicated to me by the late Dr. Kuhn, and which, I have since ascer- tained, is noticed by Heberden. Children, owing to delicacy of skin, are much more speedily blistered, and hence, in their cases, it may be earlier removed. Being continued too long, it sometimes induces gan- grene, as I have witnessed in two or three instances. 2. It will be right in locai affections, and in the whole of the phlegmasiae, to apply the blister as nearly as possible over the immediate seat of the complaint, its eflicacy thereby being much increased : but wish- ing to interrupt trains of morbid association, as in most of the diseases of periodical recurrence, to the extre- mities alternately will answer better. Let it also be as large as the nature of the part will allow. Large THERAPF.UTICS. 45 blisters give scarcely more pain than small ones, and are generally beneficiai in the ratio of their dimen- sions. 3. In those individuals liable to strangury, or where, from excessive irritability, much pain is excited, it will be proper to remove the blister after three or four hours, or as soon as the rubefacient effect is produced, to bathe the part with a mixture of olive oil and lau- danum, or fresh lard, and re-apply the blister. This sometimes succeeds in doing a way the inconvenienee. But, should it fail, a soft emollient poultice may be sub- stituted, which, so far as I have tried, soothes irrita- tion, and produces well filled vesications. As a pre- ventive, it will also be prudent to direct the free use of diluent beverages, as flaxseed tea, barley-water, or a solution of gum-arabic. To cure strangury, the same drinks are serviceable, though not so much so as the parsley or wild carrot tea. But, if the affection be violent, as sometimes happens, we must resort to more efficient remedies, such as fomentations to the pubes, or the warm bath, or camphor, balsam copaivac, turpentine, and, above ali, to opium, particularly in the form of an enema. 4. Never resort to blisters in diseases of the higher grades of action, till the system is reduced by vene- section and other depleting measures. Too early employed in such cases, they hardly ever fail painful- ly to increase irritation, and exacerbate morbid ex- citement. 5. In the very' advanced stage of disease, blisters should be applied to the thighs, shoulders, back, neek, breast, or head, and never to the anklcs or wrists, as 46 ELEMENTS OF here, on account of the lowness of temperature and feebleness of vital energy at the time, they either do not draw at ali, or if they do, it is imperfectly, occa- sioning a weak species of inflammation, which is apt to become gangrenous. Moreover, they never produce any general salutary impressions, owing to the sympa- thies that link the different parts of the system together being suspended or destroyed. 6. In putting on a blister, care should be taken to adjust it to the part, and so to apply the bandages, as to secure it against slipping, which gives unnecessary pain, and prevents it from drawing well. This may be done by strips of adhesive plaster, which are found exceedingly convenient in the application of blisters to portions of the body in which there is much motion, as to the sides, neck, &c. It is a common practice to bathe the part previously with warm brandy or vine- gar. In certain cases, however, where the drawing of the blister is doubtful, from a low state of system, it will be better to excite irritation by frictions with the spirit of turpentine, or by a sinapism. 7. The usuai dressing for a blister is simple cerate spread thinly on linen. If there be much irritation, lard perfectly fresh, by which I mean without rancidi- ty or salt, should be preferred. A mixture of lime water with olive-oil, or lard, as in burns, sometimes af- fords much relief. To keep a blister discharging, the weak epispastic or savine ointment is employed. THERAPEUTlCS. 47 SECTION IV. The Practical Application of Blisters. Conformino to the course hitherto pursued, I shall commence with some remarks on the application of blis- ters in the febrile affections. In intermittents, they are sometimes highly useful as a preventive of the paroxysm, when so managed as that the full impression shall be felt at the anticipated mo- ment of attack. Even where the effect is not so strik- ing or immediate, they are not without utility. Con- stantly kept up on the extremities, the irritation which they induce will, after a time, so interrupt the trains of morbid association, constituting this form of fever, as frequently to put an end to the wòrst cases of it, acting bere very much on the same principle as a mercurial salivation. Nor are they less demanded, in those cases of the disease attended by visceral congestion, or indu- ration of a painful and inflammatory nature. Little, indeed, will tonics avail, till such obstructions are re- moved, and, with this view, a succession of blisters over the affected part ought never to be neglected. In relation to continued fevers, there is a wider dif- ferenee of opinion, as to the propriety of the vesicating applications. By some writcrs they are altogether con- 48 ELEMENTS OF demned, and, among these, the most distinguished by weight of authority is the celebrated Fordyce. It was one of the notions of his great and originai practical mind, that blisters have not the slightest tendency to arrest the progress of fever, maintaining, on the con- trary, that the new irritation which they occasion, proves an accessory cause. Perhaps it is not difficult to reconcile the contrariety of sentiment on this point of practice. Nothing is more opposite than the effect of a blister, in the early stage of fever invariably doing harm, while there is much action, and as uniformly proving beneficiai in properly reduced states of the vascular system. The more ordinary continued fevers of this climate are the bilious, inflammatory, and typhous—the latter, however, occurring much more rarely, and for the most part in winter. My practice is to recur to blisters in the former of these fevers, whenever I find the disease con- tinue, after thorough evacuations of the alimentary canal and blood-vessels, and especially if there be displayed any typhoid disposition. Blisters, under such circum- stances, should be applied to the extremities, and, by the stimulation imparted, they are often productive of manifest advantage. But in yellow fever, a disease essentially dissimilar, though it has been maintained to be the same in a more aggravated shape, blisters may be earlier resorted to, and differently applied. Taught by dissection, as well as by the leading phenomena or symptoms, that the sto- mach is the seat of this pestilence, inducing a malignant gastritis, a prompt application of a large blister over the region of this viscus is obviously indicated, and expe- rience confirms its utilitv. FHERAPEUT1CS. 49 Às to typhous fever, a course somewhat different should be pursued. It seems now to be ascertained, that the brain is the part on which it mainly expends its force. We have, in every stage of the disease, evi- dence of undue determination to this organ, the removal of which is most effectually accomplished, after general measures—by cold applications, topical depletion by leeches or cups, and, finally, a blister of sufficient di- mensions to embrace the whole cranium. It is not unknown to me, that objections have been raised to the last of these remedies. But they rest on no solid foundation, and are contradicted by the tenor of medicai experience. Certain points of practice are so firmly settled, as no longer to be disturbed by cavil- lers or wild speculatists, and among these is the eflicacy of a blister properly timed, to relieve the head in ty- phous fever, and especially where stupor exists. As well, indeed, might a practitioner deny the power of bark in intermittent fever, or mercury in syphilis, as that of a blister in the case mentioned. Eccentricities of this sort are common in the history of the human mind, and we have no reason to hope that our science should escape them. Considering the immense influence that the spinai marrow indirectly exereises over ali the great l'unctions of the animai econoniy, which recent experiments have proved, it seems not at ali improbable, that much advantage might result from blisters and such like ap- plications, to portions, or perhaps, in very obstinate cases of fever, to the whole of the spine. Nor are we cntirely without facts to verify this conjecture, though \oi,. n.—7 50 ELEMENTS OF these are derived more from a trial of the remedy in the r.ervous and spasmodic, than the febrile affections. To sustain the system in the sinking condition of ty- phous fever, it is a practice with many to apply blisters to the extremities. That they occasionally do good can hardly be doubted, though they often fail to draw, and, even where we succeed in this respect, the effect seems not always to be a verysalutary one. The fact is, un- der such circumstances of depression, even if the blister draws well, the general sympathies are so broken and subverted, that action is not at ali extended, the system at large refusing to respond to the locai impression. As more certain means of stimulation, rubefacient enibro- cations over a considerable surface, at this conjuncture, will be found to answer best. Of the phlegmasiae, I know not a single case in which blisters are not employed. Butof the numerous affections coniprehended under this order, there are some in which they are more particularly demanded. Every practi- tioner is aware of their eflicacy in the whole of the acute pneumonic cases, though some discrepancy of opinion may be traced as to the time when they should be ap- plied. My mie, which I have reason to suppose issanc- tioned by good modem authority, is to postpone the blister, especially in pleurisy, till some considerable re- duction of vascular action is effected. At this precise period it proves unequivocally useful, by extinguishing the remnant of pain or oppression, and seems also to ar- rest the further march of the disease. Earlier than this, I have found that blisters scarcely fail to occasion great distress to the patient, and assuredly aggravate the symptoms which they are intended to relieve. THERAPEUTICS. 51 Yet an opposite course is pursued by some of the ablest practitioners of this country and of Europe, with alleged success—to which I can only reply, that the counter-evidence decidedly preponderates, and that my own experience, which I slowly give up to any one, tells me that I am right. The preceding remarks have reference only to con- firmed ordinary pleurisy. Either in thefonning state of this disease, or where it occurs in a debilitated sys- tem, or in the spurious pneumonies of aged people, a blister may sometimes be applied at once, without any preliminary depletion. To the anginose affections, blisters are well suited, and particularly to cynanche tonsillaris, trachitis, and la- ryngitis, though their application should be preceded by general evacuations, and also by topical bleeding with leeches or cups. Of the inflammatory affections of the alimentary ca- nal, there is no one in which blisters are more useful than gastritis itself. Excepting, indeed, venesection and locai bleeding, they are the m ms entitled to great- est confidence in this case, and the same may be said of enteritis, &c. Dysentery, though not thus located by the nosolo- gists, does, indisputably, when it assumes the inflam- matory shape, belong to this order. Most writers agree as to the utility of blistering in it, differing, how- ever, in relation to the part where the application is to be made. Influenced by the apprehension of excessive pain when made to the abdomen, the extremities are often preferred. This is an instance of mischievous lenity, proceeding;. I am persuaded, from an erroneoius X± j'.LEMENTS Ot impression. Delayed, which it ought always to be. till the foiee of inflammatory action is abated, a blister is then productive of comparatively little distress while drawing, and, sometimes, by the ease and comfort which it affords, even composes to sleep. Applied to the extremities, blisters, on the contrary, are more painful, and of no avail unless the case be so far reduced or protractcd as to partake of the nature of diarrhcea, or is blended with intermittent fever,—or to sustain the system in a low condition. Cholera morbus is another case in which blisters are employed. To check vomiting, they are applied over the stomach, or to the extremities. Either position will do very well : in exhausted states of the system, 'sinapisms are to be preferred. These remarks are equally applicable to cholera infantimi, with this differ- ence only, that such applications are more rarely, and never so urgently required. Not less to overcome the spasm, which causes the obstruction, than to obviate or remove inflammation, blisfeers are auiong our most effectual resources in colie, and on no occasion, perhaps, more conspicuously mani- fest tìieir antispasmodic power. It w'ould be superfluous to go through in detail the several visceral inflammations, such as hepatitis, sple- nitis, hysteritis, peritonitis, nephritis, and cystitis, since, in the use of the remedy, we are governed by one common mie, ninnely, to withhold its application till the force of the case is broken by previous depletion. As some practitioners, however, distrust the propriety of blistering in the affections of the urinary organs, from the fear of inducing strangury, or othcrwisc tttld- IHERAPEUTICS. 53 ing to the existing irritation, it may be useful to ob- scrve, that actual experience has shown the fallacy of these speculative objections, and fully attested the safe- ty and eflicacy of the practice. Of the utility of blisters in rheumatism, no one doubts. Yet even bere they are productive of harm, if prema- ture! y applied, and, where it can be conveniently done, should be preceded by general evacuations and locai detractions of blood. My conviction is, that they are much better adapted to chronic than acute rheuma- tism, almost always proving serviceable in the former instance, and especially when they induce the suppura- tive process. By some writers it is recommended to vesicate the affected part in regular gotit, and, as it proves so bene- ficiai in some analogous cases, we might imagine that it would be attended with the sanie results : on trial, however, I bave been disappointed, and no longer em- ploy applications of this nature. It has, indeed, been alleged, that they have the effect of repelling the dis- ease on some internai part of more value to life,*and hence are hazardous measures. But such applications are the very best means to invite and fasten down, if I may use the expression, gotit on the extremities, and I can have no idea of a remedy blowing hot and cold in this way. Neverthelcss, in misplaced or retrocedent gotit, vvhether it attaeks the alimentary canal, the lungs. brain, kidneys, or any other portion of the body, applied over the immediate seat of the complaint they are highly serviceable, and. sometimes,'eveu indispensablv neces- s;irr. 54 ELEMENTS OF Blisters are much used in phrenitis, and in ali the affections of the brain, partaking in any degree of in- flammation or congestion. No one disputes their u ili- ty in apoplexy, though doubts are entertained whe- ther they should be put on the head or lo ver extremi- ties. My own impression is in favour of the former position, derived from comparative trials on a scale sufficiently extensive to determine the poiut. Of their use in paralysis, I have before said so much as to re- quire no further notice.* As a remedy in mania, they have been generally extolled. To be serviceable, however, they require to be used with great discrimination. Directed too early, or while much vascular action exists, they inva- riably do harm. But the system being reduced by co- pious evacuations, they are well calculated to subdue turbulence, and equalize excitement. It is common to place them on the head, and here perhaps they are most effectual, though, while drawing, I have uniform- ly found that they increase the disease. If, therefore, such an exacerbation is to be deprecated, it will be prudent to make the application to the limbs, and this position should also be selected in melancholia, and other weak forms of the disease, where it is desirable to arouse the system out of its torpor by vigorous stimu- lation. Elsewhere I have presented my views of the na- ture of hydrocephalus.* As a part of the treatment of this case, blisters to the head are greatly relied on, * Vid. Cathartics. THERAPEUT1CS. 55 and deservedly. But we are to bear in mind, that they prove effectual very much in proportion to the time thev ar j kept on, and most so when suppuration of the scalp takes place. They should never be applied till action is much reduced by the detraction of blood, and by purging, nor removed in less than twenty-four hours—unitss strangury takes place. Of the treatment of ophthalmia, and some other af- fections of the eyes, blisters constitute an essential part. It is customary to apply them behind the ears, or to the temples, or back of the neck. They afford most relief in the last named position, where the attack is obstinate. On the brow they are sometimes very successful, and may be put in certain cases over the orbit of the eye itself, by previously closing the lids with a thin strip of adhesive plaster. In more than one of the profluvia, or diseases attended by increased discharges, blisters are occasionally direct- ed. Applied alternately to the ankles and wrists, they frequently relieve cases of protracted diarrhoea, which have resisted every other means. Much advantage have I also derived from them in leucorrhcea. They are sometimes beneficiai on the lower extremities, though incomparably more so when put over the lumbar verte- brae or sacrum, and in the same position are scarcely less serviceable in cystirrhcea. Of their use in gonor- rhcea and gleet, I have learnt little from my own obser- vations. The practice, however, is commended by some of my medicai acquaintance, and seems entitled to a share of confidence. Even stili less do I know of their powers in diabetes. Ali the cases of it which have rome under my notice could be traced distinctly to gas- 56 ELEMENTS OF tric derangement. Nevertheless, the kidneys, though secondarily, are always affected, and, for the purpose of calming the irritation of these organs, blisters seem to promise well. We are fully aware of their utility in other cases of preternatural discharge, as well as of incontinency of urine, and there seems to be no good reason why they should not prove serviceable in dia- betes. It has become a practice of late, perhaps more in this city than elsewhere, to treat some of the cases of hemorrhage by the vesicating applications. After ar- terial action is reduced by venesection, they are unques- tionably serviceable in hsemoptysis :, and, worn on the back of the neck, I have seen them suppress, in several instances, very troublesome bleedings from the nose. As respeets uterine hemorrhages, I am not able to say much, though in that irregular species of menorrhagia, which occurs about the period of the cessation of the menses, I have known some good result from them, ha- bitually kept on the ankles. The exanthematous affections, in certain shapes at least, deinand the use of blisters. To sustain the system in typhoid or confluent small-pox, they have been found advantageous, and also, where the eruption suddenlv recedes. Exactly with the same views are they direct- ed in measles, and moreover to relievethe violent catar- rhal affection which often attends or follows this disease. The utility of blisters in arresting the malignant forms of erysipelas is established by the amplest experience. To the late Dr. Pfeiffer, of this city, the credit of this valuable discovery has been generally accorded. But THERAPEUTICS. 57 the practice is of an older date, and, I think, inay be found in some of the writings of M'Bride. With nearly the same advantage, they are prescribed in scarlatina, to support the system when approaching the typhoid state, and, should the throat be affected, they are stili more important as a topical application earlier made. Of the class of neuroses, in which are included both the nervous and spasmodic affections, there is a great variety of cases where they are more or less employed. To vesicate the head in epilepsy, when the disease is supposed to originate from some morbid condition of the brain, is a common practice. Cases of this sort, however, are rarely curable by any course of practice, and blisters consequently are of little service. But epilepsy seems also to depend, in many instances, on a certain mobility of the system, somehow connected with a disordered stomach or bowels, which observes the law of periodical recurrence. It is in such cases that, worn on the extremities, they now and then dissever the trains of morbid association, and thus suppress the disease. What would be the effect of vesicating the spine in epilepsy ? Of the use of blisters in tetanus I have no experience. Nearly half a century ago a case was recorded by a West India surgeon,* of a cure having been accomplish- ed of this disease, by the application of a strip of blister plaster along the whole extent of the vertebral column —and this practice, I have heard, has recently been * Mr. Carter. VOL. II.--8 58 ELEMENTS OF imitated, and with sufficient success to claim our atten- tion. Certain spasmodic affections of the chest are some- times benefited by the use of blisters, among which may be mentioned pertussis, asthma, and angina pectoris. Perhaps it may not be entirely out of place to mention here, that they are prescribed with advantage in some of the spasmodic complaints of the stomach, and parti- cularly in gastrodynia with or without pyrosis. In several of the cachectic cases, blisters are greatly employed. To repress inflammatory action of the lungs in phthisis pulmonalis, they admirably co-operate with general and topical bleeding, and should be so repeated as to keep up a discharge from the surface. After the suppurative process in the lungs has commenced, how- ever, unless there is a fresh attack of inflammation, they prove nugatory, and often increase the mischief by aggravating the degree of irritation. Nevertheless, as expectorants, they are occasionally productive of relief by invigorating the lungs in the protracted catarrh of debilitated persons, and, perhaps, too, in some instances of consumption of this species. Much as blisters have been used in dropsy, I cannot help suspecting that they are an equivocai, if not a hazardous, remedy. My allusion is to their use in anasarca and ascites. To evacuate the water in the former case, they are applied to the lower extremities, and, though occasionally with success, they much more frequently fail, and sometimes, as I have myself seen, induce gangrene. From their application to the abdomen, not a great deal can be expected. Yet I have had one case of as- THERAPEUTICS. 59 cites, and know of another well authenticated, where the water was completely removed, and in a very short time, by this means. Of the eflicacy of blisters in hydrothorax there is not the slightest doubt. The disease, in the commencement, is generally of an inflammatory nature, and demands very active depletion, with the aid of Constant irritation on the surface of the chest. Even in the advanced stages, a temporary initigation of the more distressing symptoms is sometimes derived from the same measures. To their employment in erysipelatous inflammation I have aìready alluded. Led by analogy, Dr. Physick, some years ago, made trial of them in gangrene, and the success which he then stated, has been so fully confirm- ed by the concurrent testimony of a large number of practitioners, as to place this very high among the great practical improvements. It would seem that they are advantageous in gangrene arising from opposite causes, and differing essentially in character and cir- cumstances. I have known them to arrest the affection, when resulting from active inflammation, and not less promptly in one case, at least, in an cedematous limb, connected with a cachectic and exhausted state of sys- tem. Cases, however, of gangrene occur, such as are occasioned by mechanical interruption to the circulation, in which they can be of no service, and these, I suspect, will be found to constitute the chief exceptions to the general use of the remedy. As our object is to check the progress of gangrenous action, the blister should be applied so as to embrace the whole of the healthy margin, and bc managed aftcrwards in the ordinary manner. 60 ELEMENTS OF In another place* I have noticed the utility of blisters in amenorrhcea. But this is not the only case of sup- pression in which they are serviceable. Wherever, indeed, a naturai discharge is checked, either by tor- por of the secretory organ, or restrained by spasm, they will generally afford relief. Thisjs especially true in regard to retention of urine. Not a few of the locai affections are advantageously managed by blisters. As a discutient application, their power is acknowledged in bubos, in mammary swell- ings, in enlargements of the testicles, and in scrophulous and other indolent tumours. Of ali the means which I have ever tried, they are the most successful in re- lieving paronychia, if resorted to in the early stage of the case. Behind the ears, they are sometimes useful in deaf- ness, whether of an acute or chronic nature, and not less so in the painful affections of the ear, proceeding from an inflamed state of the membranous lining. On the cheek, they are confessedly one of the most effectual of our remedies in odontalgia—and I have known them to suspend the pain when put on the arm. Even a sinapism will sometimes be productive of the same effects. As a remedy in tinea capitis, in obdurate tetter, and in many other similar cases of a locai nature, when not attended by inflammation, the use of blisters is familiar to most practitioners. Much has been said of late years in their favour by Mr. Crowther and other surgeons, in the acute and * Vid. Emmenagogues. THERAPEUTICS. 61 chronic inflammations of the joints, and, from what I have seen of the practice, I cannot doubt of its great and decisive utility. To be successful, however, the discharge must be kept up, either by a repetition of the blister, or by dressings with savin ointment. Of the numerous improvements in surgery which have been suggested by Dr. Physick, there is scarcely any one of more unequivocal utility, than the management, by blisters, of inflamed veins from the operation of bleed- ing. In most cases, a single one will prove adequate to the cure, though, occasionally, where the arm is very stiff and tumid, a succession of them is demanded. The mode of application is, to confine a strip of the plaster along the whole course of the inflamed vein, making an opening for the pus or sanies to escape. To the cases which I have enumerated, many more might be added, in which blisters are employed. Enough, however, has been said to serve as a guide in their application, and to illustrate the great value of them as a means of combating disease. It remains to give some account of the substances used for the purpose of effecting vcsication. These are animai, minerai, and vegetable. MELOE VESICATOR1US, VEL LYTTA VESICATORIA. Of the genus Cantharis there are several species, but the one bere introdueed is most highly csteemed, 62 ELEMENTS OF and has long since supplanted ali the rest in practice. As a vesicating substance, the My labrum Cichorei was employed by the ancient physicians, and, we are told, is continued, for the same purpose, by the Chinese. Cantharides are to be met with in Germany, France, Italy, and most of the countries of Europe. Being, how- ever, procured chiefly from Spain, they are called Spanish flies, though the largest and best are brought from Italy. Cantharides are insects of the beetle kind, having a lively tinge of blue and green, interspersed with a golden hue, appearing at stated seasons in large swarms on trees, the foliage of which they ravage and destroy. They are caught by shaking them off the trees into a cloth held underneath—and are then immersed in vine- gar, or exposed to its vapour—and next dried, by being placed in the sun. Cantharides do not lose their virtue by age, or by keeping them in powder. Even these acrid insects are soon reduced, by others feeding on them, to dust, which, however, is found to be active as the recent fly, since only the inert parenchymatous portion is selected as food. Of the manner of preparing a blister plaster, little need be said, so familiar to almost every one is the pro- cess. It is commonly done by spreading a piece of soft leather, or new strong linen, of the proper form and dimensions, with basilicon ointment, and then working into it as large a portion of the "powdered flies as can be conveniently done. But, as the flies are apt to fall off, whatever care be taken in forming the plaster, it will always be prudent, and particularly if the blister is to be applied near the cye, to have it made of the epis- THERAPEUTICS. 63 pastic ointment, the formula for which may be seen in any of the Dispensatories. To increase the vesicating power of cantharides, va- rious means have been suggested, the best of which is, undoubtedly, that proposed by Dr. Hartshorne, of this city, consisting of a strong decoction made by boiling the flies with the spirit of turpentine. Dossils of lint soaked in this, and applied to any part of the body, hardly fail, under any circumstances, to excite a blister. CANTHARIS VITTATA, VEL LYTTA VITTATA. This is an American insect, having been met with, I believe, in no other section of the world. During the autumnal months it appears, in some seasons, in pro- digious numbers, covering the leaves of several different kinds of plants, which they devour, though they are found most abundantly on the potato vine, and hence are called potato fìy. In its general configuration and appearance, this in- sect bears some resemblance to cantharides. It is, how- ever, smaller, and of a different colour, having a mix- ture of red, black, and yellow, variously distributed. To Dr. Isaac Chapman, of the neighbourhood of this city, the credit is due of discovering its vesicating pro- perty. tytore than twenty years ago, he proved, by a series of trials, that in this respect it is equal, if not su- pcrior, to cantharides, which has since been confirmed 64 ELEMENTS OF by many of the most distinguished practitioners in every part of the United States. Experiments satisfactorily show, that whether used as an external application, or an internai medicine, they are productive of the same effects, with this difference only, that our native fly is much more prompt as a vesi- catory. As in the case of cantharides, they are killed by be- ing subjected to the vapour of vinegar, and afterwards carefully dried, so as to resist the process of putrefac- tion. Neither time nor pulverization impairs, in any degree, their activity. The fine dust to which they are reduced, after a few years, by the ravages of other insects, retains ali the powers of the fresh fly. No reason, in short, exists for the preference stili given to cantharides, except, perhaps, the irregularity with which practitioners are supplied with the Ameri- can insect. MELOE NIGER. Of the medicai properties of this insect I have no knowledge myself. It was originally recommended as a vesicatory by the late Professor Woodhouse of our University, who considered it as not less efficacious than either of the two preceding flies, and with this superiority, that it never excites strangury. Whe- ther this statement be correct has not been sufficiently determined. The fly does not abound with us, though in the New-England states it is said to be met with in very large numbers. It is not more than hatf the size of the other American insect—is of a dark black va- THEitAPEUTICS. 65 lour, and feeds chiefly on the stick weed* and potatoe vines. ANTIMONIUM TARTARIZATUM. Confined on the skin for a certain time, this salt pro- duces a peculiar species of pustular eruption, difficilit to heal, and hence, as affording a permanent irritation, is thought by some practitioners, to be singularly useful in protracted catarrhs, consumption, asthma, pertussis, angina pectoris, hepatitis, epilepsy, chorea, mania, chro- nic rheumatism, white swellings, and in ali such cases. Butitis doubtful whether it has any superiority over the common blister, and I am stili ignorant of the complaint in which it should be preferred. Besides the irritation it produces is most distressingly painful. The best mode of making the application is, to dust a piece of adhesive plaster, of the proper size, with emetic tar- tar, leaving the margin clean, that it may more firmly adhere.f * Ambrosia Trifida. t The celebrated Jenner has printed a very interesting pa- per on " the influence of aranciai eruptions on certain dis- eases," in which he strongly recommends the tfttar emelir ointment, prepared according to the followiug formula : R. Antim. Tart. Subtil. pulv. gij. Ung. Cetacei, jix. Sacch. Alb. gj. Hydrarg. Sulph. rub. gr. v. M. ft. ung. The application of this ointment by friction produces, at first, a sense of prickling and itching, and on rcpelition for a day or two an eruption of watery pustul»;. which sometimes voi., ii.—9 66 ELEMENTS OF ACIDUM NITRICUM. Nitric acid has lately been employed for the purpose of vesication. The practice originated in India, and was first applied in the epidemie cholera, which, within the last few years, has devastated that region. Being found exceedingly successful in that disease, it was sub- sequentlyextended to a variety of other cases, where prompt counter-irritation is demanded. It seems parti- cularly suited to the low states of fever,—to the comatose affections—to tetanus, and hydrophobia, as well as to mania, and other instances, where the ordinary process of blistering is resisted. Two parts of the acid, with one of water, are direct- assume the appearance of small pox. The use of this oint- ment he extols in the diseases enumerated above, and cites many instances in proof of its efficacy. Without doubting any part of his statement, I am persuaded, that just as much may be accomplished by the usuai vesicatories, and with less suf- fering. To the permanency of the irritation of emetic tartar, so greatly i^sisted on, as giving to it a superiority, I attach no sort of import mce. My experience, on the contrary, satisfies me, that !:.li-re:s permitted to heal and renewed, are generally mote effectual than when a single one is permanently kept open zxìÙ cHschai-ging. As a rubefacient, emetic tartar had long before been known, and was used with this v.ew. 1 wenty grains of it, dissohed in tv/o ounce? oi" "' ater, witìi one ounce of the tincture of cau- tha-ides, form the famous lininent or lotica of Stiuvc, in hoopin^-c righ, and is ec-sentially the same as Rocha's Royal Emò--o^zikny for tnis disease. The region of the stomach is directed, bv Stn:vf, to be well bathed with this every night, from which, he says, the best effects may be expected. THERAPEUTICS. 67 ed to be spread over the part with a feather, or the surface may be rubbed with the mixture till some sharp pain is induced, when the acid is to be neutralized by a solution of salt of tartar. The cuticle can now be easily detached, and leaves the cutis raw, which may be continued in this state by irritating dressings, &c. It is said, that the pain of this application is not greater than that from the fly blister, and much more speedily subsides. It is par- ticularly recommended by quickness of action, the ef- fect being attained in two minutes, in this respect re- sembling the actual cautery. In various degrees, many plants are possessed of the property of vesication, as the euphorbium, the meze- reon, the persicaria, the ranunculus bulbosus, &c. They have, however, given way in practice to the productions of the animai kingdom, of which I have treated. It, nevertheless, appears to me, that the last of the plants mentioned is, in this view, entitled to some further notice. RANUNCULUS BULBOSUS. This plant, better known by the title of crow-foot, or butter-cups, is every where spread over our mea- dows and moist fields. It is the bruised root which is used, and most promptly and powerfully does it ope- rate. Except in veterinary practice, I have never seen it resorted to, though it is occasionally done, as I understand, by country people, in their own com- plaints. Of this there is little doubt, that in the horse it will vesicate more effectually than cantharides. 68 ELEMENTS OF I Considering its great activity, I am inclined to sus- pect, that we might make some beneficiai application of it, though on this account alone it should not super- sede the animai vesicatories. Like ali other agents which act on the living system, epispastics are distin- guished by peculiarities of action, and some of them cause impressions infinitely more salutary than others. By many means we can raise a blister, and by some in much less time than with cantharides,—yet, there is none which precisely imitate their mode of action, or will do equal good in the cure of disease. It is pro- bable that the ranunculus will be found to answer bet- ter as a sinapism, to arouse the system in its low or le- thargic states, than for the purpose for which it has hitherto been employed. Fonticuli et Cetacea, or Setons and Issues. As sometimes substituted for blisters, I shall here say a few words relative to setons and issues. These ope rate very much like a permanent vesicatory, each oc- casioning an external irritation, attended by a purulent discharge, and hence are applicable to nearly the same description of cases. Yet they are not equal to a blis- ter, and should never be employed, to the exclusion of it, except from considerations of convenience to the pa- tient. The seton I would reject altogether, as more painful and disagreeable than either, and not so effec- tual. TIIERAPEUT1CS. 69 Generally, issues are applied in the complaints of the head and nervous system, such as vertigo, hemi crania, habitual stupor—and in gutta serena, incipient cataract—deafness—as well as in palsy, epilepsy, cho- rea—and recently in tetanus. Two cures of this last disease have been made by Dr. Hartshorne of this city, !>y caustic issues on the back of the neck. To some of the phlegmasiae, in a chronic state, at least, they are also thought to be well suited, and particularly to pneumonia, running into consumption—hepatitis,—in- flammation of the joints from rheumatism and other causes,—suppressed eruptions, or sanguineous or other discharges—dried up ulcers—to which may be added, diseased vertebrae. The latter application seems of late to be considered as one of very doubtful eflicacy. and is expressly condemned by some distinguished sur. geons. The ordinary mie is, to establish the issue dose to the seat of the disease. Yet, where there is no locai aflection, this is not always necessary. Near the in- sertion of the deltoid muscle of the left arm may be se- lected as a proper place. An issue can be made by incision or by caustic. The former mode being adopt- ed, a pea, or bean, or some hard substance, must be kept in the wound to promote the discharge, and to prevent cicatrization. But the latter is now prefer- red, and the approved mode of doing it, is previously to blister the part, and then to apply caustic to the raw surface for a few minutes. The best dressing is savin ointment. 70 ELEMENTS OF Rubefacientia, or Rubefacients. These are such means as redden or inflame the skin without producing vesications, acting very much on the principle of blisters, though with less power and effect. They are usually employed as liniments, or lo- tions, or embrocations. It seems that superficial in- flammation, in most cases, relieves that which is deep seated, and it is in this way that such applications are probably of service. To many of the diseases enumerated under the head of blisters, some one of the rubefacients is appropri- ate—and though the whole agree in their general or leading properties, stili to a certain extent they differ, and are not so well suited to the same description of cases. It therefore may be best to discuss the practi- cal application of each article separately. TEREBINTHIN.E OLEUM. The oil of turpentine alone, or mixed with olive oil, is much prescribed in rheumatism, in sprains, and swellings of the joints, in the anginose affections, as cynanche tonsillaris, and trachealis,—in pleurodine, and even in some of the deeper seated inflammations. It is commonly rubbed on the affected part—but, where a stronger impression is desirable, it is better to appiy flannel soaked in the oil itself, which excitee THERAPEUTICS. 71 a vesicular eruption that is more permanent in its ef- fects.* Though turpentine is thus irritant to the healthy skin, it constitutes one of the most lenitive and effectual applications to burns. On this point some difference of opinion continues to prevail among practitioners, owing, I suspect, to the mode in which the application is made. If, by carelessness or otherwise, it extends to the sound skin, great irritation and pain is always felt, and hence we should never use it except in the form of an unguent spread on linen, and so adjusted as merely to cover the burn.f OLEUM MONARDJE PUNCTATJE. This is very active, and has been employed advan- tageously in chronic rheumatism, in periodical pains of the head, in deafness, in paralysis, and in the low states of disease generally.| * The Guestonian embrocation, for rheumatism, is compos- ta as follows : R. Ol. Terebinth. giss. 01. Oliv. 3 iss. Acid, sulph. dilut. ^iij. t The oiutment of Kentish, who first prescribed the article in burns, which consists of turpentine worked up with basili- con ointment, is the very best mode of using it. t Dr. Atlee, of this city, to whom I am indebted for much of my information respecting the use of the oil, recommends the following liniment : R. 01. monard. punct. 3SS. Tinct. camph. i-ij. Tinct. opii, sij. M. 72 ELEMENTS OF CAMPHORA. Dissolved in rectified spirits of wine, or olive oil. alone, or mixed with other ingredients, camphor is a useful rubefacient and discutient, in sprains, bruises, indolent swellings, rheumatic affections, &c* * The annexed are probably the best formulae : lÀnimenlum Camphorae, L. R. Camph. §j. Oleum oliv. giv. M. Linimentum Camphoras Comp. L. R. Camph. gij. Liquor ammoni ae, ,^vi. Sp. lavend. 3*xvi. M. The following is particularly extolled by Dr. Ferriar in luro- bago. R. Pulv. camph. ^j. Ung. basii, gj. Sàpo Hispan.Jjss. Pulv. semiti, sinap. 9j. M. ft. ung. Not very different from the above, is Steer's Opodeldoc. It ronsists of R. Sap. Alb. gj. Sp. rect.gviij. Camph. giiiss. Liquor ammon. Jvj. Ol. Kosmar. gss. 01. origan. gj. M. Jlmbrocatio Cajeputi. R. 01. cajeputi, Camph. àà 3'1'ij. Sapo mollis, §ij. Alcohol, Ibj. Liquor ammon. gij M. THERAPEUTICS. 73 TINCTURA CANTHARIDES. By itself, or added to some of the preceding lini- menti, the tincture of Spanish flies forms one of the most active of these preparations, and is thought to be well suited to chronic swellings of the joints, from rheumatism, and other causes. as well as to the paraly- tic affections. TINCTURA CAPSICI. Either the officinal tincture or the powdered capsi- cum mixed with a small portion of any ardent spirits, is, in some cases, the very best of the rubefacients. By steadily irritating the surface with it, I have wit- nessed most striking effects in low states of disease— and I know nothing which affords more prompt relief in lumbago, sciataca, not to mention other forms of rheumatism, attacking suddenlv and without fever. In various diseases, and more especially those of the alimentary canal and head, attended with cold feet, great benefit has been experienced by constantly wear ing socks dusted with Cayenne pepper. CATAPLASMA SINAPIS. No article is, probably, so much used as the flower of mustard to stimulate the surface. Made into a paste with vinegar, and applied on linen to the affected part, it will sometimes speedily relieve superficial rheumatitì VOL. II.—-IO 74 ELEMENTS OF pains. It is also used to arouse the system in the apo- plectic and comatose affections, and in the ultimate stages of low fevers. The utility of sinapisms, how- ever, in the latter cases, appears to me very questiona- ble. They rarely produce any effect, and where they do, it is locai, a weak species of erysipelatous inflam- mation, very apt to become gangrenous. No general excitement is raised, owing to the destruction of those sympathies, which connecting the various portions of the system, an impression made on one part is extended to the whole. As a preventive of the return of convul- sions in adults or children, sinapisms should not be ne- glected. It is hardly necessary further to remark, that they are among the remedies in which we mostly confide, to attract and fix gout on the extremities. In these cases, they are applied to the soles of the feet, or above the ancles, and, while they sustain the gene- ral excitement, they seem to do good on the principlc of revulsion. Now and then, from excessive action, sinapisms, if permitted to remain on too long, will so completely de- stroy the vitality of the part, as to occasion gangrene. It is, therefore, prudent, where they give much pain, speedily to remove them, and resort to such means as may abate inflammation. Except in very torpid con- ditions of the system, half an hour will be sufficient time for the continuance of the application. To mitigate the action of mustard, it is distornar) with some practitioners to mix with it an equal portion of flour : but this is proper only in the cases of chil- dren, or adults with delicacy of skin.* * Wiitc/iead's Esscnce of Mussarti. This consists of oil et THERAPEUTICS. 75 EMPLAS : PICIS BURGUND : The concrete, obtained from the juice of a species of Norway Spruce, Pinus Abìes, spread on leather forms an excellent rubefacient, occasioning slight irritation and some exudation, rarely amounting to vesication. Applied to the breast, or between the shoulders, it is useful in protracted catarrh, pertussis, asthma, and is not without service in rheumatic and other painful af- fections, placed over the seat of the complaint. It is also preventive of catarrh. CATAPLASM. RAD. ALL1I. The bruised root of garlic, applied to the extremi- ties, has long been celebrated, in most of the cases in which, mustard is employed. It is particularly extol- led by Sydenham as a revellent in affections of the head. Being, however, a less active article, it is, for many purposes, certainly not so effectual, though as a poultice in paronychia, and some other deep seated in- flammations, it is highly useful. The juice of garlic, rubbed on the spine, has been thought very service- able in the second stage of hooping-cough. To the garlic, we might add nearly ali the alliaciai turpentine, camphor, and a portion of the spirit of rosemary— to which is added a sniall quantity of the flour of mustard. Whitehead's Essence of Mustard Pills. These consist of bal- sam Tolu with resili. Paris's Pharmacologìa. 76 ELEMENTS OF and siliquosse, as having, in some degree, the same prò perties. Caustica et Escharotica, or Caustics and Escharotics. These are such substances as erode or dissolve the animai solids, and between which there is no essential difference, except as regards the degree of power. Two modes have been suggested, by which they produce their effects : either by excessive action, destroying the vitality of the part, and thus occasioning a slough, or by chemical agency, " causing the elements of the soft solids to enter into new combinations, whence their co- hesion is subverted, and their composition changed." Caustics, or cauteries, for they are the same, are di- vided into acttial and potential: the first consisting of fire itself, or a heated iron—the second, of those articles whose mode of operation has just been mentioned. In the very infancy of our science, the actual cautery seems to have been resorted to, and its use was for a long time continued, to destroy fungous flesh, to burn out tumours, and to suppress hsemorrhage from divided vessels. But the introduction of the ligature, and the more general recurrence to the knife, and to escharo- tics, have nearly banished it from the practice of sur- gery, and altogether from that of medicine.* * It is stili used, I believe, by surgeons, in some of the hae- rnorrhages of the mouth, where the vessels are so situated as not to be commanded by a ligature: and much has lately been said of its vast utility by some of the French writers, in various diseases, chiefly of the class of neuroses. THERAFEUTICS. 77 MOXA. This is a soft spongy substance prepared in Japan, from the tender leaves of the artemisia vulgaris, by beating them when thoroughly dried, which are then forraed into small cones. As a substitute for the actual cautery, the burning of moxa on the affected part has been immemorially employed in the eastern countries, and lately the practice is much extolled in France, par- ticularly by Baron Larrey, in nearly ali the cases to which caustics are applicable. To apply the moxa well, he says, " we must first mark with a little ink the point where the application is to be made. The surrounding parts should be co- vered with a wet cloth, leaving the designated point alone exposed, so as to protect the neighbouring surface from the sparks : having ignited the apex of the moxa, it is then to be fixed on the point traced out, and by means of the porte moxa* retained in its situation. while with the blow-pipe the combustion is kept up till the whole is consumed. To prevent deep inflammation and excessive suppuration, which might be the results, it is proper to apply immediately afterwards the volatile alkali." POTASSA FUSA. The pure vegetable alkali, or potash, the causticum commune acerrimum, is the most powerful of its class. * A metallic ring with a handle resting on four ebony balls as bad conductors of beat, to protect the skin. 78 ELEMENTS OF But by mixing it with lime, its activity is lessened, and then it is called causticum commune mitius. As the applications of this caustic are chiefly surgical, it is not to be expected that I should enter into any mi- nute details relative to its use. I shall content myself, therefore, with a very few remarks. On account of its exceedingly deliquescent and pene- trating nature, it acts more deeply than any other caus- tic, so that care should be taken not to leave it on too long, and especially if its application be in the vicinity of large blood-vessels. The properties mentioned, render it very effectual in removing the callous edges of old and indolent ul- cers, and for this reason it is not admissible in recent sores, or such as are attended with much inflammation. Its employment is now chiefly restricted, besides the case just noticed, to the opening of abscesses, the form- ing of issues, and to some of the affections of the mouth and fauces—having this advantage under such circum- stances, that it may be neutralised by touching it with vinegar, and its extension thereby at once arrested. CAUSTICUM LUNARE. Of ali the caustics this is the one most used, and is applicable to the greatest number of purposes. Having the power of coagulating animai matter, it does not spread to any extent, and is, therefore, convenient where a large eschar is to be avoided. To common ulcers it is well adapted, stimulating them to the formation of healthy granulations, and disposing them to cicatrization. THERAPEUTICS. 79 But I doubt its applicability to venereal chancre, or, indeed, to any sores of the genitals. Why it should operate unfavourably in such cases, I do not know— though of the fact I am convinced. ALUMEN USTUM. Burnt alum, in domestic practice particularly, is much resorted to as an escharotic. In weak and relaxed sores, I have seen it serviceable, and sometimes it an- swers well in the venereal chancre, and other ulcers, so frequently met with on the same parts. ACIDUM NITRICUM. No one of the minerai acids is without caustic pro- perties, though the nitric is preferable. The only case in which I have used it, is in irregular, fungous, scrophulous sores. Here, as an escharotic, it is in- comparably the best which I have tried. Diluted, it is directed as a lòtion, in extensive ulcers, occurring in hot weather, breeding worms, which it speedily tle- stroys.* CUPRI SULPHAS. The blue vitriol, in a state of saturated solution, is a useful escharotic. I have found it particularly adaptcd to the early stage of chancre, and scareely less so, when more diluted, as a lotion, to ill-conditioned Vid. Blisters. 80 ELEMENTS OF sores of the genitals. It seems very promptly to change or subvert their mode of action, disposing them to take on the healing process. The powers of the remedy in these cases I learnt from my friend Dr. Washington, of the navy, who had ampie opportuni- ties, from his public station, of testing its eflicacy. CUPRI SUB-ACETIS, OLIM jERUGO. Dissolved in water, verdigris is used to cleanse foul ulcers—and a solution of it, in vinegar mixed with honey, forms the oxymel seruginis, so strongly recom- mended by some writers in aphthae. Blended with basilicon, it makes a stimulating ointment, useful for some purposes, as inflamed or ulcerated tarsi, &c. OXYDUM ARSENICA ALBUM. As an external application, the white oxid of arsenic was, at one time, in high repute in cancerous cases. It was originally an empirical remedy, prepared as a paste, which, applied to the ulcer, speedily formed an eschar, on the removal of which, by poultices, the dis- eased surface was found to be changed. Of late a dif- ferent formula has been adopted, consisting of a solu- tion of the arsenic, in the proportion of ten grains to an ounce of water, with which the sore is delicately touched by means of a pencil. THERAPEUTICS. 81 Cases are recorded of cancers essentially improved under this treatment, and, indeed, of cures being ef- fected. Yet our confidence in it has certainly abated, and we are not without evidence of its inducing so much irritation, as to compel an early discontinuance of the remedy. My own experience with respect to it is exceedingly imperfect. Mercurial Preparations. More than one of these are escharotic, and not a little employed. The first which I shall notice is, the HYDRARGYRI NITRICO-OXYDUM, OLIM HYDRARGYRUS NITRATUS RUBER. The red precipitate is a sub-nitrate of quicksilver, and is directed either in the shape of an unguent, or in powder, sprinkled on the surface of fungous or languid sores, to erode or stimulate, as the case may be. IIVDRARGYRUM PRAECIPITATUM ALBUM, OLIM CALX HYDRARGYRI ALBA. Contradistinguished from the preceding article, this is called the white precipitate, and is an ammoniated VOL. II.—11 82 ELEMENTS OF sub-muriate of inercury. Mixed with lard, in the proportion of a draehm to an ounce, it forms the un- guentum calcis hydrargyri albi of the Dispensatories,* which is much esteemed in some of the chronic erup- tions. It is unquestionably serviceable in such cases, and is recommended by its neatness. But the formula annexed is very superior to it.f This unguent has maintained in this city the highest reputation for more than half a century, in tetter, ring worm, tinea capitis, &c. It was originally con- trived by one of our most distinguished practitioners— though it ultimately carne to be sold as a nostrum by an unlettered woman, who, carefully concealing its composition, acquired a good deal of money, and stili more notoriety, by the many cures which she effected with it. HYDRARGYRI OXYMURIAS. Two or three grains of corrosive sublimate, dis- solved in an ounce of water, make a useful lotion in venereal ulcers, and also in some of the locai erup- tions. UXGUENTUM HYDRARGYRI N1TRATIS. Every practitioner is conversant with the virtues of itrine ointment. It is much prescribed in tinea capi- * Now, the Ung. Hydrarg. praecipit. albi. t R. Mere, precip. alb. gr. xv.—Sai. nit. dr.ss. Fior.__sulph. dr. i. Bene terantur, adde Axung. Porcenae, oz. ij. et fìat ung. THERAPEUTICS. 83 tis, in tetter, and other such cases, and forms an ex- cellent dressing in recent sores, disposed to spread by the acridness of their discharges, as well as in old ul- cers, requiring to be stimulated, or to have their fun- gous surfaces repressed. It is also directed in chronic inflammation of the tarsi, reduced by a mixture with lard or olive oil. UNGUENTUM PICIS LlQUIDJE. Tar ointment may be used in many of the cases in which the preceding article is directed. It is servicea- ble in tinea capitis, tetter, and similar affections, occa- sionally succeeds in healing languid sores, and consti- tutes an excellent application to the tarsi in the state before mentioned, as well as to hsemorrhoidal tumors, after the reduction of inflammation. I have, more- over, known very obstinate gleets cured by the daily introduction of a bougie, smeared with it, into the ure- thra. In the three last cases, it should be mixed with lard or any bland oil, so as to convert it into a soft lini- ment.* These are ali the escharotics I think worthy of par- ticular notice, though there stili remain some which * The following ointment I have found efficacious in some cases of prurigo and analogous affections : R. Picis liquidx, Sulph. sublim. Axung. Porcen. uà Ibss. Terra Cretis, oz. iv. Hydrosulph. aminoti, dr. ij. M. fiat ung. 84 ELEMENTS OF are occasionally resorted to, such as the muriate of an- timony, the powder and ointment of savin, &c. Enough, however, has been said on a subject, which, urged further, would lead us into details not very im- portane As regards the use of the whole of these ap- plications, to tetter, tinea capitis, and similar affections, I have to remark, in conclusion, that they are only ap- propriate to such cases, after the previous reduction of inflammation, by leeches, poultices, or other emollient means. THERAPEUTICS. 35 SECTION V. Diffusible Stimulants. My attention has hitherto been directed chiefly to the investigation of those classes of remedies, which, though locally stimulant, in their general effect, reduce excitement by evacuations, and are, hence, more par- ticularly adapted to diseases of increased action. These having been disposed of, I am next to turn to the con- sideration of the second di vision of my subject, or to the history of such remedies as are calculated to meet very opposite indications. Let me, at this early stage of the inquiry, again re- peat, that while I maintain so far the uniformity of the operation of the various agents on the living system, as that in one sense most of them are stimulant, I am stili not among those, who, deluded by theory, or in the ardour of generalization, have insisted that they are en- dowed with the same properties, differing only in de- gree of force, permanency, and diffusibility. Consist- enti y with my own conviction, there are no two arti- cles which produce precisely the same effects. The impression created varies both as to the force and na- ture of it, and cannot, by any variation in the dose, or manner of administration. be assimilated. 86 ELEMENTS OF Could we, by any process, bring this about, we might truly retrench the materia medica, and intro- duce that kind of simplicity into the practice of our art, which, though sometimes projected, sound expe- rience has taught to be vain and illusory. In relation to general stimulants, there is a distinc- tion too important to be overlooked. As formerly re- marked we have a set distinguished by great diffusibi- lity, which, nearly as soon as exhibited, occasion uni- versal excitement over the body : and a second sec- tion, by which tone is imparted, though very slowly, and only by a long continued administration. The diffusible are very transient in their effects, while such as are more graduai in their operation produce permanent, or enduring impressions, and are called tonics. In some arrangements, adopting Anodyna as the ge- neric title of the former division, these substances are subdivided into Paragorica, or such as alleviate pain, Hypnotica, or such as afford relief by procuring sleep, and Narcotica, or such as are productive of the same ef- fect by inducing stupefaction. But we have bere an instance of false refinement, while a distinction is insti- tuted, without any essential, or very obvious differ- ence. It is usuai of late to treat of these articles under the two heads of narcotics and antispasmodics. The latter term, however, is exceedingly vague, and one to which it is not easy to attach any definite idea. By spasm, we understand an irregular contraction of the muscular fibre, which may take place under the most opposite circumstances, and is susceptible of an infinite variety of modifications. TIIERAPEUTICS. 87 It occurs in an extreme condition of weakness, as m many of the nervous affections, and is also incident to a highly excited system, as is illustrated in colie, and stili more strikingly in some of the diseases pro- duced by the active poisons. Contemplated, therefore, in one view, we should place under the head of antispasmodics, ali the stimu- lating and tonic remedies, and in another, those eva- cuant and depletory. Though, we have no descrip- tion of articles which can be considered as peculiarly antispasmodic, it must be confessed, that there are cer- tain medicines, closely allied to the narcotics, with some distinct properties. The difference to which I allude has been explained on the supposition, that, as stimulants, they have less diffusibility, causing thereby greater permanency of impression, and, on this ac- count, constituting an intermediate link between the narcotics and tonics. The reverse of this, however, seems to be trae. No articles are so diffusive or eva- nescent in their effects, as some of the most decided antispasmodics, as ether, opium, &c. It is more pro- bable that they exercise a sort of specific control over the muscular fibre, allaying irritability, by which the irregular movements of spasm are overcome,and at the same time, in relation to some of them, assuaging pain, by lessening sensibility. Concerning the modus operandi of narcotics, no shght difference of opinion has prevailed. Towards the dose of the last century especially, the keenest controversy was maintained on the subject, between the disciples of Brown and Cullen. It is impossible for me to enter into a detail of the facts and reasoning. 88 ELEMENTS OF employed by the conflicting parties, in this memorable discussion, which was more characterised by adroit- ness of argument than philosophical courtesy. Nor do I deem it necessary. The decision of practitioners is pretty well made up, as to the particular circumstances of disease in which we are to resort to this assortment of medicines—and such is the species of intelligence most desirable. Yet, it may stili be the wish of some, to be made acquainted with the more prominent points of difference in the views of these two great and dis- tinguished theorists. This may be done in a very few words. Conformably to the notions of Cullen, a narcotic is a substance, which, in its primary operation, diminishes the actions and powers of the system, without any sen- sible evacuation, or, in other words, is a sedative. Noxious, however, in their nature, he supposed, the conservative principle of the constitution makes an ef- fort to correct the impression of these articles, and that the stimulant effect ascribed to them is, in reality, occasioned by the action thus induced. Exhibited, however, in too large a dose, the Vis Medicatrix is incapable of resistance, and the system becomes depres- sed, with the vital energies greatly impaired, or, as it may happen, entirely extinguished. Narcotics, there- fore, according to him, are dircctly sedative, and indi- rectly stimulant. His opponent, on the contrary, considered these sub- stances as direct stimulants, surpassing ali others in energy and diffusibility, and that the debility which ensues from an overdose is of an indirect kind, the con- THEUAPEUTICS. 89 sequence of the expenditure of excitability from exces- sive stimulation. Let us now trace the action of narcotics, and by do- ing so, perhaps, we may find that the opinions I have mentioned, however they may differ in speculation, are not wholly irreconcileable in a practical view. Given in a moderate dose, the purer narcotics ex- cite action both of body and mind. The force, fre- quency, and fulness of the pulse are increased—muscu- lar action is rendered more vigorous—the temperature of the surface becomes higher—some of the secretions are promoted—and hilarity and animation induced and temporarily maintained. But these effects, having continued for a short period, are succeeded by very unequivocal signs of diminished action, and subdued sensibility. The pulse becomes slower, and more full than naturai—the secretions, except of the skin, are abated—there is less susceptibility to impressions—pain is alleviated, and inordinate motions repressed—mus- cular power is abridged, and the mind, partaking of this general languor, becomes dull and inactive. This state either terminates in, or produces a tendency to, sleep. By a large dose, debility, without any previous ex- citement, takes place, or if there be excitement, it is so evanescent as not to be perceived—leaving ultimate- ly, as its effects, tremors, sickness, headach. andoppres- sion. Taken in excess, the system at once sinks under the impression, and the eonsequences are wild delirium, vol. n.—l'i 90 ELEMENTS OF or heavy stupor—deep, difncult, and stertorous respi- ration—convulsions, apoplexy, or paralysis, and death. Such would seem to be the ordinary effects of nar- cotics, in a moderate, large, and excessive dose, which, however, are not a little diversified by peculiarities of constitution, or the various morbid states of the system, and other circumstances, known to modify the action of ali medicines. No inconsiderable diversity also occurs from peculiarity of power in the different articles ap- pertaining to this very extensive class. Digitalis and opium, ether and tobacco, camphor and nux vomica, the prussic acid, &c. not to cite other examples, are ali in- cluded in it—though surely the analogy is very remote, both as regards their properties and practical applica- tions. In the new Italian doctrine of counter-stimulus, so ingeniously sustained by Rasori and Tommasini, we have a very different explanation of the modus operandi of the two sets of articles comprehended in the general class of narcotics. Contrary to the Brunonian hypo- thesis, it is alleged, that not a few of these substances produce an effect entirely opposite to that of stimula- tion, or, in other words, directiy reduce excitement, and among which are digitalis, prussic acid, &c. That part of the doctrine which relates to this subject is contained in the following summary by Tommasini : "1. That many substances act on the living fibre, in a manner directly opposed to that of stimulation— and that those effects which Brown attributed to a nega- tion of stimuli, are to be ascribed to the positive action of contra-stimulants. ** 2. That contra-stimulants have the power of sub- TIIERAPF.UTICS. 91 duing, even without any evacuatimi whatever, the ef- fects of an excessive excitement—and that when too liberally applied, diseases are produced, which the ad- ministration of stimuli alone can relieve. " 3. That we have, in the class of contra-stimulants, a set of remedies adapted to the cure of every morbid condition resulting from excessive stimulation,—and which may be used like blood-letting or purgatives. '•' 4. That the capability of the fibre to support large doses of contra-stimulants, or of stiinulants, is in pro- portion to the increased degree of diathesis present, whether occasioned by sthenic or asthenic powers. " .5. The discovery that this capability of supporting contra-stimulants, affords a juster measure of the inten- sity of the diathesis, than any that can be collected from the symptoms themselves.'v These views have very strong claims to attention, and seem to me, with due limitation, to be just. Can it be denied, that the prussic acid, as well. perhaps, as some articles of other classes of medicines, operate by a positive and obvious reduction of action, and that in their use we are regulated accordingly ? It has been demon- strated by experiment,* independently of the evidence of the general phenomena, that some of these articles act immediately on the brain and its dependencies, and assuming this as a fact, we are conducted to a satisfactory explanation. Ali vital movement is the rcsult of an influence ema- nating from these sources, and it being impaired or in- terra pted, the former must be weakened or destroyed. * Brodif. 92 EUEMENTS OF Certain agents, among which prussic acid is the most conspicuous, operating directly on the cerebral and nervous systems, have this effect, and hence proportion- ed to the dose, the depression, or absolute cessation of action. On a modification of the same principle, is the operation of the rest of the narcotics explicable. Exhi- bited moderately, they prove a stimulus to the brain and nerves, eliciting a larger supply of their energy— as is evinced by the high excitement of mind and body —in an increased quantity, torpor and insensibility fol- low—and in an over dose, the streams of the vital aura becoming interrupted, or vitiated, or defective, action is overwhelined, death suddenly ensues, or the economy of the system is disturbed and deranged in various modes and degrees. The narcotics being capable of producing either a sti- mulant or sedative effect, by their positive qualities, or the mode of administration, they may be employed to meet very opposite indications. To command their stimulant power, they ought to be prescribed in small doses, frequently repeated, and gradually increased, and the excitement raised is thus sustained. The design, however, being to mitigate pain, to procure sleep—to relieve irritation, or deaden sensi- bility, they should be exhibited in a full dose, and at more distant intervals. That the purer narcotics are endowed with the power which I have assigned them, is clearly proved, as we shall hereafter see, by the operation of opium, the arti- cle which, as most commonly resorted to, is best under- stood. It may be deduced from the preccding account of THERAPEUT1CS. 93 narcotics, that they constitutean important class of me- dicines, susceptible" of a very diversified application. But, to render them serviceable, much caution and dis- crimination are necessary. It is to be remembered, that the chief indications they are capable of fulfilling, are to excite and support the actions of the system—or the reverse,—to assuage pain, and allay irritation—to re- lieve spasmodic affections—to induce sleep, and to check most of the morbidly increased secretions and ex- cretions. We have, however, a large number of articles which, without possessing the narcotic property in any or a great degree, are more unequivocally stimulant, and which we recur to, in very many instances, with mani- fest effect, where excitement is to be created or sus- tained. These I shall treat of under the head of in- citants. Nothing, perhaps, in the exercise of our profession, is more difiicult than to fix the period, in the progress of a disease, or to ascertain the circumstances, in which it becomes proper to prescribe stimulants. As relates to the use of depleting remedies, it is far more easy to come to a just decision. Not to descend to details, which. probably, would not shed any very distinct light, I shall merely observe that in making up our minds on this point, we must, in the first place, be guided by the state of the system. Mcaning, in the administration of stimulants, to over- come an existing action, by exciting a new and a strong- er one, it is obvious that they can only be resorted to with any hope of advantage in the feeble shapes of dis- ease, or in more violent forms reduced by previous 94 ELEMEN'TS OF evacuations. In determining the exact point at which to commence the use of them, we may also be aided by watching their operation. Being ill-timed, they pro- duce pain in the head, or delirious wanderings, or mor- bid vigilance, or stricture of the breast, or restlessness and anxiety, with a hot dry skin, parched tongue, and a quick, corded, and irregular pulse. As it is of great importance that this set of articles should be correctly prescribed, I shall now endeavour to suggest some precise rules on the subject. 1. It will generally be found best to begin with small doses, though we are to recollect that the action of these medicines is more rapidly lessened by repetition, than any other, so that, in a short time, the quantity requires to be considerably augmented. Exceptions, however, exist, to the precept I have inculcated. Cases of typhous fever, and some of the neuroses, are marked by such a loss of susceptibility to impression, that we are called upon, even in the early stages of the latter disorders particularly, to exhibit stimulants freely. 2. It is wrong to combine many of these articles in one prescription, or to use any number of them at the same time. By directing them separately, or nearly so, we economise our resources in protracted diseases, and, probably, also, make a more distinct and powerful impression. Where it is expedient to deviate from this course, we should be careful to select such articles as are calculated to co-operate to the same end. Much is sometimes gained by harmony in the action of medi- cines. Thus, we shall find the carbonate of ammonia and wine whey, generally, consentaneous—and pure wine or diluted ardent spirits. not less so with articles of higher properties. THERAPEUTICS. 95 3. It is advisable to change occasionally the part of the body to which we apply stimulants, as sensibility may be left in one place to a remedy, when exhausted in another. This is a principle of very extensive ap- plication. The excitability of the stomach being worn out, we should resort to the bowels or skin. The pro- priety of this course is exemplified in the use of opium. Numerous are the cases, where, after it cannot be any longer given with advantage by the stomach, it will act very efficaciously, injected into the rectum. 4. In the administration of stimuli, as indeed of ali medicines, we should endeavour to graduate the article to the state of excitability. This is a point of much greater importance than is commonly imagined. Be- tween certain conditions of the system and medicines there would seem to be an aftiiiity or relation, which, when consulted, often leads to decisive advantages. It is not always that the most active article produces the greatest effects. 96 ELE.MENTS OF SECTION VI. Particular Stimulants. In arranging the diffusible stimulants I have not been a little embarrassed, differing as they do so essentially in their properties and uses. But perhaps practical convenience will be sufficiently attained by bringing them under the three heads of incitants, narcotics, and an t ispasmodics. Incitantia, or Incitants. AMMONIJE CARBONAS.* The importance of this article entitles it to a much fuller notice than it has hitherto received from me.f In some one state of every variety of febrile affec- tion, it is employed, though chiefly in the low or ty- phous fevers. Notwithstanding most writers seem to confide in its powers in these cases, and even strongly * In the London Pharmacopoeia, this is stated to be a sub carbonate. t Vid. Diaphorctics and Expecloranls. TIIERAPEUT1CS. 97 recommend it, the cxact circumstances in which we should recur to it, have not been definitely laid down. It was on a former occasion remarked, that in the early stage even of genuine typhus, there is some de- gree of congestive or inflammatory action, during the continuance of which it is wholly inadmissible, the treat- ment here consisting of emetics, purgatives, sometimes bleeding, cold applications to the surface, and subse- quently of the milder diaphoretics. But in the more advanced stages, the indications of increasing debility coming on, this, alone, or with opium and wine whey, is, of ali the remedies which I have ever tried, one of the most decidedly useful. To every other forni of continued fever, however inflammatory in the commencement, it is not less suited when a typhoid tendency supervenes. In the feebler shapes of intermittents it is sometimes prescribed, with bark, and has been advised by itself, previously to the accession of the paroxysm, which it is said to prevent, or failing to do so, to moderate the force, and shorten the duration of it. Disregarding its stimulant properties, some have considered it appropriate to certain of the phlegmasiae. By several of the British practitioners I saw it much employed, especially in acute rheumatism, and without any or with very little previous depletion. The idle ap- prehension of metastasis, seems, with them, to have been the operative motive against evacuations, and particu- larly venesection. This mode of treating the disease will not answer among us. Every where in the United States, it is, in the first stages, ifnota purely inflamma- tory affection, one at least of high action, to be managed vol. n.—13 98 ELEMENTS OK only by thorough reduction. Even in chronic rheuma- tism I am not aware that I ever did more with it than by large doses of the volatile tincture of gum guaiacum, into which it enters as a constituent part. What I know indeed of the two medicines leads me to prefer the lat- ter, as I think that in combination it displays better powers. The guaiacum, however, proving offensive to the stomach, the former alone may be substituted. Consulting some of the older writers, it will be found that it has also been much extolled in the several vari- eties of pneumonia. The late Dr. Kuhn informed me, that when he commenced his professional career, it was the established practice in this city, to treat pleurisy, and other acute affections of the chest, in the early stage, by very moderate bleeding, and next with the ammonia and seneka snake root, exhibited with a view to their expectorant effects. These diseases have un- dergone an essential change of character, or such prac- tice must have proved very destructive. No one, at least at present, would think of recurring to this medi- r ine in cases so entirely inflammatory. Yet there are several forms of pneumonia in which it may be used, at an early stage, with considerable advantage. To miasmatic districts, a species of pleurisy is inci- dent, which, seizing on the emaciated frames of the wretched inhabitants, is comparatively a feeble state of disease. Bleeding here, to any extent, cannot be borne, and soon after the carbonate of ammonia and other sti- mulants become necessary. The pneumonia of persons advanced in life, or of delicate and debilitated constitu- tions, affords a second example where it may be early employed. To deplete freely under such circumstances, THERAPEUT1CS. 99 would be fatai. Exercising a considerable influence over the irritated and inflamed states of the mucous tis- sue of the puhnonary organs, it is found exceedingly useful in that variety of spurious peripneumony, deno- tninated catarrhus suffocativus, as well as in ali the mo- difications of bronchitis where action is originally fee- ble, or has been properly subdued. Though, in the primary stages of genuine pneumonia^ this medicine is improper, stili, towards the dose of an attack, when there is a hard cough, with deficient ex- pectoration, hot skin, dry tongue, weak pulse, occa- sionai flushes, with other signs of prostration of strength, it will be productive of advantage. In this, which not unfrequently is the prelude to chronic pleurisy or pneu- monitis, as well as in some of the subsequent and final stages of these diseases, it is likewise beneficially em- ployed. Towards the conclusion of the case, it mani- festly sustains strength, invigorates the powers of ex- pectoration, relieves diflicult breathing, and in this way, where it does not cure, palliates symptoms, and renders somewhat less painful the ultimate scenes of ex- istence. Nor is its use thus limited. There are some who stili retain a higher appreciation of its powers, and prescribe it with the delusive hope, as I apprehend, of overcoming the diathesis which indisposes ulcers of the lungs to heal in genuine consumption. To the utility of this medicine in the winter epi- demie of our country, and especially when it assumes the pneumonic forni,* I have already had occasion to ;illude. It is, moreover, prescribed in asthma, per * Pneumonia typhoides. 100 ELEMENTS OF tussis, and in the hoarseness and cough consequent on ili-managed measles. Of its power in the two former diseases I have little or no experience. As an expec- torant it might be serviceable, and also, perhaps, by correcting the depraved state of the stomach, which if it be not the real, certainly in some instances proves an aggravating cause. Nor is my knowledge extensive as respects the latter case. Now and then, however, I have tried it, and not entirely without effect. It is here much extolled by several respectable writers. In some of the complaints of the alimentary canal, the carbonate of ammonia is much used. It is said to have done good in pyrosis, which I can readily be- lieve. Extreme debility of stomach, attended with vomiting and spasms, as in drunkards, is often allevi- ated by it. I have also used it beneficially in cardial- gia, and more so when occurring in pregnant women.* In that gastric affection, familiarly denominated ner- vous, or sick headach, to which the valetudinary of both sexes are liable, a dose of it will, in some in- stances, afford almost instantaneous relief. Gout in its more feeble forms is prone to retrocede from the extremities, and to wander irregularly about * It may be given in pili, or watery solution, or a few drops of the liquor ammoniae in water will sometimes answer. But the neatest and, perhaps, the most tìncient preparation, is the one annexed : R. Aq. ammoniae—Magnes. cale, aa gi.—Aq. cinnam. gii.—Aq. font. gvi. M. Of this, a table-spoonful may be taken whenever uneasiness is felt. But, used immediate- ly after each meal, it generally prevents the recurrence of the attacks, by probably neutralizing the acid evolved in this depraved condition of the digestive process. THERAPEUTICS. 101 vhe system, or to fasten on the stomach, or some other important internai part. Either alone, or in conjunc- tion with opium, it constitutes one of our best means of combating the former case. By imparting tone to the stomach, it expels the disease, and fixes it again in its proper situation. Gout, however, will make its ap- proaches to the alimentary canal in the more insiduous guise of periodical colics, or flatulence, cardialgia, and other symptoms of indigestion, which are relieved by this medicine alone, or with guaiacum. Carbonate of ammonia has acquired some repute in dysentery. In small and repeated doses, it is said to relieve tormina and tenesmus, to correct the bloody discharges, and, by producing a considerable deter- mination to the surface, to accomplish even more. No part of this statement has come under my own observa- tion, though it seems not at ali improbable, or incon- sistent with the acknowledged properties of the medi- cine. My own experience with it is limited to the sinking states of ordinary dysentery, and the originai typhoid forms of the disease—in both of which it i.v useful as a general stimulant. Diarrhoea, connected with protracted debility of the bowels, and acrid or otherwise morbid secretions, I have removed by a combination of it with opium,—and which is stili more beneficiai, where this state has been brought on by habits of debauchery. Lately it has been used in diabetes, and we have ont case, at least, reported of its success.* The intimate • By Dr. Net* man of Berlin, Philadelphia Medicai Journal, Voi. VI. 102 ELEMENTb OF connexion of the disease with derangement of the chy- lopoietic viscera, and particularly the stomach, might lead us to suspect, independently of any positive evi- dence, its occasionai utility. Numerous as are the diseases of the class of neu- roses, there is not one probably in which this medicine was not at one time employed. It has been tried in epi- lepsy, chorea, hysteria, apoplexy, palsy, tetanus, and hydrophobia. Excepting one form of palsy, and as a palliative in the hysterical paroxysm, I know not that it is of much importance in any of these cases. This, how- ever, is not the language commonly heldon the subject. Of late, I find, on the continent of Europe, and espe- cially in France, the carbonate of ammonia is by some commended in apoplexy. The writers who have made these reports, aver, that recoveries frequently take place by the copious exhibition of it, wholly unaided by venesection or other evacuations. Coming with such authority, it is certainly worthy of trial, though I confess I do not repose much confidence in these representations. Con- sidering its properties, if it do good in apoplexy, it is probably when induced by gastric impressions : in which view I am strengthened by having witnessed its eflicacy in the heavy soporose states of drunkenness, closely imitative of the real apoplectic affection. In this case much must be ascribed to its specific property of counteracting the effects of spirituous liquors, a fact now well ascertained. Of palsy there is one variety, the offspring of rheu- matism, in which it is unquestionably useful. Be- ing long affected by this disease, the muscles lose the THERAPEUTICS. 103 power of contraction, and the extremities, if they be the seat of the attack, of motion. Cases of this descrip- tion have repeatedly come under my care, which so nearly resembled genuine palsy, as not easily to be dis- criminated, though they may be generally known by more or less of pain or uneasiness, and particularly in damp or cloudy weather. They are to be managed as rheumatism, and in the selection of remedies, I have found the more stimulating diaphoretics to answer best, among which is the carbonate of ammonia. Of the utility of this medicine in mania, I have lit- tle to offer from my own knowledge, though its efli- cacy is well attested. As a cordial stimulant, it may be serviceable in melancholia, and in the low shapes of the other form of the disease. But I cannot perceive distinctly, the indications it is calculated to meet as ma- nia ordinarily appears. Much more, in my opinion, is it suited to the cases brought on by inebriety—and un- der such circumstances, I have sometimes afforded re- lief by uniting it with musk, when opium and camphor had proved unavailing. Among other purposes, the carbonate of ammonia has been applied to the treatment of cancerous and scrofu lous ulcers. Martini, an Italian writer, gave an ac- count some years ago, of several cases of cancer, which he had cured by the internai and external use of this article. Not long afterwards, Professor Hufeland in part confirmed this statement, by proclaiming its deci- ded eflicacy in scrofulous ulcers approaching to the na- ture of cancer.* These reports, however, not being * Whether they employed the caustic alkali or the carbonate is doubtful. 104 ELEMENTS of corroborated on further trial by other persons, the me- dicine lost ali its reputation, and has sunk, in this re- spect, nearly into forgetfulness. Yet, in scrofulous sores, and in the phagedenic ulcer of the penis, I have done great good with it, as a lotion, and in the form of fumes. Of its use as an internai remedy, in syphilis, though, at one time, so much commended, I need not say a word, the reputation which it formerly possessed hav- ing been entirely destroyed by the results of the expe- rience of Mr. Pearson and others. On the extent of its eflicacy in the bite of venomous reptiles, it is not easy to determine, as there exists not a little contradiction on the subject. By several writers of the East Indies it is asserted, that it coun- teracts the effects of the poison of the serpents of that country, and the same account is given of it in the West Indies. We have more than one case of its successful appli- cation in the United States, recorded by respectable practitioners,* though its utility is denied by others of not less weight of authority.f It is employed in- ternally, in considerable doses, while the bitten part is at the same time bathed with a solution of the caustic alkali. No opportunity has occured to me of testing its pow- ers in such cases. The experiments of the Abbe Fon- tana show, that it is useless in the bite of the viper, and I suspect that it is equally so in relation to other serpents. Yet I have employed it advantageously to * Dr. Ramsay, Scc. t Dr. Barton, Scc. THERAPEUTICS. 105 allay the pain and inflammation from the sting of the bee, the wasp, and other insects. The liquid ammo- nia* is the prepara tion used for this purpose, and also as a styptic, in which latter case, freely diluted, it is very effectual, according to Lapira, who tells us, that in his experiments he even arrested by it the hsemorrhage from the crural artery of the dog and sheep. The leading diseases in which this medicine is pre- scribed, have now been enumerated. But there is a variety of other indications not noticed, which it is ca- pable of fulfilling, that will not fail to occur to those engaged in the practice of physic. It is certainly one of the most important articles of the materia medica, and applicable to a large number of cases. Not long before his death, the late Dr. Kuhn, who was one of the most sagacious and discrimi- nating practitioners of this country, told me with some emphasis of manner, that after an experience of nearly half a century, if he were called upon to say with what single remedy he had done most good, he would with- out hesitation name the carbonate of ammonia, aided by wine whey. With such praise, from such authority, it surely would be superfluous to press it on medicai at- tention. In one respect it differs from every article of the class to which it is attached, and it would seem from most other medicines. The peculiarity to which I al- lude is this, that the excitement it raises approaches more nearly to that of healthy action, and hence it may * Liquor ammonice of the London College. voi., ir.-—J4 106 ELEMENTS OF be resorted to earlier than stimulants generally, in the fnflammatory affections, and with greater safety in mix- ed cases, so equivocai or obscure as to render uncer- tain the propriety of stimulation. Much of its remediai effect is probably to be ascribed to its power of pro- moting healthy or correcting morbid secretory action, particularly of the mucous and dermoid tissues. The carbonate of ammonia may be given in the shape of pili or julep, in the dose of five or ten grains, every hour or two, according to circumstances. The best form, however, is the latter, which may be made agree- ably to the annexed pr escripti on.* As the effects of this medicine are evanescent, per- haps more so than any other, except the etherial pre- parations, I prefer giving it in small doses, at short in- tervals, to the opposite mode, and I am persuaded, that in consequence I derive advantages from it, which I should not otherwise experience. f CAMPHORA. Camphor, though long considered as a gum, is a pe- culiar principle of vegetable composition. Chemical inquiries have rendered it probable that this is an es- sential oil combined with some acid, or perhaps a * R Ammon. carb.3ij.-Gum. arab., Sacch. alb. aadr. j.— Ol. cinnam. gtt. v.—Aq. font. oz. iv. M. The dose, a table- spoonful. t Incomfiatible substances.—Ali acids, the fixed alkalies and their carbonates, lime, magnesia, alum, sulphate of magnesia, acetate, sub-muriate, oxy-muriate of mercury, super-acetate of lead, tartarized iron, and the sulphates of iron and zinc. TUERAPEUTICS. 107 combination of the same elements with a larger propor- tion of carbon. In many of its habitudes it possesses a striking analogy to these oils, and some of them depo- sit it on standing. It is contained in small quantity in the rosemary, the sage, thyme, lavender, the star- wort, the common sassafras of our country, and in a va- riety of other plants. But as an article of commerce it is procured exclusively from the laurus camphora, which grows in the forests of Japan, existing in distinct grains in the wood of the root, of the trunk, and of the branches of this tree.* It is obtained by merely scraping it out, and is subsequently purified in Europe, and at present in this country, by the process of subli- mation. Camphor is imported in large cakes, colourless and semi-transparent, and is somewhat unctuous, with an odour highly aromatic, and a taste pungent and mode- rately bitter. Doubts were long entertained as to the precise me- dicinal properties of this substance. By most writers, at one period, it was considered as a sedative, exceed- ingly cooling in its effects. But how such a notion could have been adopted by any one who had ever at- tended to its operation, seems extraordinary, as few * It has been said, that the camphor imported from Suma- tra is the product of the Dryobobans Camphora. Camphor may be artificially formed by driving a stream of muriatic gas throughoil of turpentine. This factitious product, however, is to be distinguished from native camphor in not be- ing soluble in weak nitric acid, and, also, in not being precipi- tated by water from its solution in strong nitric acid. Parù'e Pharmacologia. 108 ELEMENTS OF medicines more clearly display their stimulant powers. Experiments, very diversified in their character, on plants, the inferior animals, and on the human system, demonstrate this point incontestably. Exhibited in a small dose, it increases excitement, and, if pushed to a great extent, induces delirium, vertigo, convulsions, and sometimes death, resembling, in this respect, the articles with which it is usually as- sorted. No medicine, perhaps, has been prescribed for a greater variety of purposes than camphor, though of late its employment is much restricted, and I think particularly so in the practice of this city. Yet it is a valuable article, and ought not to be neglected from the caprices of medicai fashion. To avert the parox- ysm of an intermittent, it frequently proves very suc- cessali, and has been thought useful with the Peru- vian bark in the apyrexia, where the addition of a dia- phoretic stimulant is required. It is, however, in con- tinued fevers, approaching the typhoid state, and in genuine typhus, that its reputation is best established. Combined with opium and ipecacuanha, or antimony, it is one of the chief remedies in the low, or what were formerly denominated putrid fevers. By some practi- tioners, on account of its supposed antiseptic proper- ties, it is here even preferred to the carbonate of am- monia. No doubt both are well adapted, though I confess I have succeeded better with the former. Yet, in these cases, when protracted, I bave sometimes alter- nated the medicines, so that the system might not lose its susceptibility by too long a use of the same article. This rule will be found salutary in practice. THERAPEUTICS. 109 Directed for the twofold purpose of promoting the eruption, when it imperfectly appears, and restoring it to the surface, if it suddenly recedes, camphor is much celebrated in the exanthematous fevers, and especially in confluent small-pox, and also as well to advance the maturation of the pustules, as to change generally the character and condition of the disease. Connected with this subject, there is a fact, which, perhaps, has not attracted sufficient attention. It is confidently stated by Rosentien, that if the skin be smeared over with camphorated ointment, the erup- tion will not appear on that part. To preserve the eyes, he advises, that a bag filled with camphor be kept before them—and to prevent the variolous sore throat, the free use of a camphorated gargle. These observa- tions, so far as I know, have not been corroborated, though, as coming from a respectable source, they should not be disregarded. Much has been written on the eflicacy of camphor in puerperal fever, and it is recommended by some in ali the stages of this complaint, with very little discrimina- tion or judgment. Having, on a preceding occasion, stated my views of the nature and treatment of this case, I shall now only observe, that, evacuations being premised to a consi- derable extent, camphor may be prescribed to allay ir- ritation, or sustain excitement, and, in combination with some other articles, to promote perspiration. Even in the purely inflammatory affections, camphor was formerly directed, and such was the practice of Hoffman and his contemporaries, who adopted the idea of its being sedative, and highly refrigerating in its uo ELEMENTS OF effects. Entertaining a contrary opinion, I must, of course, suppose, that the practice in these cases proved as mischievous, as the theory from which it was deduc- ed is erroneous. Nevertheless, after vascular action has been considerably reduced, it will, combined with opium and ipecacuanha, or what, perhaps, is stili pre- ferable, nitre and antimony, by exciting perspiration, operate beneficially in pneumonia and rheumatism. Equal parts of camphor and nitre form, indeed, a pre- paration exceedingly serviceable in some of the subdued forms of the latter disease. To ali the nervous and spasmodic affections, perhaps, without an exception, this medicine has been applied, and particularly to epilepsy. Cullen, who is very par- simonious of his commendation of the articles of the materia medica, speaks favourably of it in this com- plaint. The same opinion is expressed by Richter, who, however, limits its use to cases brought onbysup- pressed eruptions, onanism, and inordinate venereal de- sires. Yet it is the general opinion, that its powers in epilepsy are heightened by uniting with it the prepa- rations of copper or zinc—and it is reasonable to sup- pose, that such a combination might prove more active than camphor alone—since these are among the most efficacious of the tonic or stimulant remedies, in this disease. Nor have we less testimony to its utility in chorea. But, though several cases are recorded as cured by it, it must be confessed its reputation has declined, and at present is so low, that it is very rarely employed. Camphor was formerly much relied upon in tetanus. That it occasionally proved serviceable in this disease THERAPEUTICS. Ili is abundantly afnrmed—though, as in chorea, it has ceased to be prescribed, except in combination with opium. Of the treatment of hydrophobia by it, nothing need be said. Like every other means, it has failed to cure, or even to mitigate essentially this disease, leav- ing it among the most conspicuous of the reproaches of our art. Notwithstanding, therefore, the very high repute in which camphor has been held, as a remedy in the neu- roses, it appears, that its powers are by no means con- siderable. I think, indeed, that it is entitled to little or no confidence in any one of the cases of this class which I have enumerated. It is certain, that in epi- lepsy, the disease in which it has received most atten- tion, though it may sometimes mitigate symptoms, it is utterly inadequate, alone, to produce any permanent impression. Yet, in some of the more irregular spas- modic affections, its utility is confessed. Thus, in dys- menorrhcea, as formerly mentioned, dependent on spasm, it undoubtedly is of much service, though the cases in which perhaps it displays its best powers, are puerperal convulsions. It is not my intention to enter either into the history, or the details of the treatment of this terrible affection. I have not seen a great many cases of it, and I believe that it is comparatively of rare occurrence in this city. In the few instances which have come under my care, I used, with much effect, copious blood-letting. To this remedy I resorted, not less from certain indica- tions which seemed most urgently to cali for it, than from the success attending it, which I had witnessed in the European hospitals. To be effectual, it must be H2 ELEMENTS OF freely employed. No disease, probably, in certain in- stances, requires a more liberal use of the lancet—and as auxiliary to the same design, topical depletion from the head should be practised. I can speak also with great confidenee of the advantage of active evacuations of the bowels by cathartics and enemata. Camphor, however, has been strenuously recom- mended by Professor Hamilton, of Edinburgh, whose experience is exceedingly enlarged on this subject. But to be appropriate, it should be preceded by much depletion, and is probably calculated only to allay the nervous irritation which is generally very predominant in the disease. In the various forms of mania, it has, for a long time, been also a favourite remedy, though the cases to which it is more particularly applicable have not been indicated with precision, or the general practice regulated by any nicety of discrimination. Being so powerfully stimulant, we of course would avoid its exhibition in those states of the disease marked by high excitement. I have fre- quently observed, however, after proper reduction, that, either alone, or with opium in pretty considerable doses, it had a good effect in calming the commotions of the system, and in inducing sleep. Cases, however, exist, in which we may, at once, re- sort to it, without any depletion. Not unfrequently we find insanity to be simply a mental affection, in which the corporeal machine does not apparentiy participate to any extent. It is here usually brought on by the graduai operation of grief, or by the sombre contempla- tions of a false religion. There is, in such cases, little or no febrile action, and the mind settles down into me- THERAPEUTICS. 11^ Iancholy, and is ultimately depressed into a state of im- becility. During the twenty-four hours, some exacerbation takes place, and throughout an uncommon degree of morbid vigilance exists. Camphor and opium, with the alternation of the hot and cold baths, and blisters to the extremities, constitute the best mode of managing these particular cases. In puerperal insanity, I do not know that we are call- ed upon, by any peculiarity in the disease, to deviate very widely from the rules applicable to the treatment of mania generally. Yet it would seem to be more fre- quently attended with extreme nervous irritation than inflammatory action. In the former state, I have seen advantage from large and repeated doses of the tincture of hop, or the camphorated emulsion, where opium aggravated the symptoms. But the latter state existing, we should bleed and purge while there is increased excitement. Blisters to the head, or to the extremities, in either state, will be beneficiai. They alike allay nervous irritation, or subdue inflammatory action, and thus produce calmness and ease. Applied in a proper condition of the system, or, in other words, where ex- citement is sufficiently reduced, blisters sometimes prove the best of our anodynes. Nymphomania is said to be successfully treated by camphor. This strange affection proceeds from morbid sensibility of the uterus and its appendages. Camphor, I have observed, evinces in its operation a strong afti- nity to this organ, and hence is useful in many of its dis- eases. The testimony of Alibert is strong to this point. But the cases of furor uterinus, which have come under voi., n.—15 114 ELEMENTS OF my notice, were, in the beginning, connected with great fulness of system, and very high excitement of mind. The use of it, under such circumstances, should be preceded by copious evacuations. It, moreover, is associated, so far as I have seen, with amenorrhcea— and the cures, in every instance, were effected by re- storing the menstrual discharge. Without entering into any disquisition relative to the nature of that species of mania excited by intemper- ance, I shall remark, that the approved pian of manag- ing it, consists in the occasionai use of emetics, and in the steady exhibition of the most powerful stimuli. Even though it may seem to be forbidden by contra- indications, we ought rarely to depart from this course. The symptoms of vigorous and inflammatory action are too often illusive, and the system, for the most part, very speedily sinks into a dangerous degree of debility by the slightest depletion. Combinations of camphor and opium are exceedingly effectual. My rule is to give these medicines in large doses till the patient becomes composed, and then to sustain his strength by a generous diet, and cordial drinks. The preceding remarks refer more particularly to cases occurring in habitual drunkards, and where the constitution is shattered and broken down.* Under other circumstances, and where the pulse is really ac- tive and full, with congestions of the brain, general and * In treating of emetics, I noticed a very different mode of treatment in this case. But though it comes to us well support- cd, I have found the above pian so succcssful, that I have hitherto been unwilling to depart from it in any instance. THERAPEUT1CS. 115 locai bleeding may be advantageously brought into co- operation. Camphor may be exhibited in different forms. It ic sometimes prescribed in substance, as a bolus, which is objectionable from the bulk, and as being more apt to excite nausea. It may be diffused in water by tritura- tion, with sugar, or mueilage, or almonds, adding, in order to facilitate the process, a few drops of the spirit of wine. The camphorated julep of the Dispensatories ìs a neat preparation, though the annexed formula is, perhaps, to be preferred.* The mixture thus made is very palatable. Of late, however, the solution, or ra- ther suspension of camphor in milk, has nearly super- seded ali other preparations of the medicine in practice. It is made by simple trituration. Dissolved in seltzer water, it makes a very pleasant and cordial beverage. The dose of camphor is from five to ten grains, to be repeated once in two, four, or six hours, according to circumstances. In great emergencies, as much as two or three drachms may be given in the twenty-four hours. ft§ * R. Camph. 3'-—Myrrh. gr. xx.x.—Sacch. alb. 3ii-—Aq.font. t Incomfiatible substances.—It is affected by no salt with which we can combine it. \ Vid. Diaphoretics—Emmenagogues—- Rubefacients. § An odontalgie remedy in great repute, consists of a solution of camphor in oil of turpentine, a fluid ounce of which will dis- solve two drachms. 116 ELEMENTS OF TEBEBINTIIINJE OLEUM. Of the preparations of turpentine, I have repeat- edly spoken.* Distinct, however, from the uses which have been mentioned, it is appropriated, in the management of diseases, to purposes stili more impor- tane Exhibited internally, the spirit of turpentine is one of the most active and diffusible stimulants, pervading the whole system, though directed with greater force to certain parts. Its effect on most of the emunctories is well known, and is scarcely less manifested in the cor- rection of vitiated secretions, particularly of the mu- cous tissue of the primse vise, and pulmonary appara- tus. As a means of preventing the paroxysm of an in- termittent, given in immediate anticipa tion of it, as well as a stimulant, throughout the apyrexia, doing away the tendency to a recurrence, my own experi- ence, strengthened by that of others of greater authori- ty, convinces me that it merits attention. During the late unexampled prevalence of this dis- ease in the United States, it was much employed to meet these indications, and I have no slender evidence of its eflicacy. In continued low fevers, when other diffusible stimu- li are called for, much may be expected from turpen- tine. It was a common remedy with me in our late * Vid. Enemata, Diuretics, Emmenagogues, Anthelmintics, and Rubefacients. THERAPEUTICS. 117 winter epidemie, and I rely greatly on it in our sum- mer fevers w;th typhoid tendencies. I have also had occasion lately to use it, and with equal benefit, in the genuine typhous fever, which, for the first time for many years, broke out, and prevailed to a great extent, in our public institutions. Not long after entering on the practice of my pro- fession, I learnt, that to check the violent vomitings incident to yellow fever, small doses of this medicine had been most beneficially used by Dr. Physick, and other medicai men of this city, who borrowed the re- medy from him.* Taught in some degree, by this fact, the peculiar powers of the article, I have since made a more exten- sive application of it, as well to that disease, as in some other cases which I conceived to bear an analogy to it. Convinced, from actual experience, of the utter in- efficacy of ali the existing modes of treating this form of pestilence, an experiment was made in eighteen hun- dred and twenty, the last season of its prevalence in Philadelphia, of a new practice, guided by a principle very opposite to the existing notions on the subject. Disssections, as well as the leading symptoms, had led to the suspicion, that the disease consists in a pe- culiar inflammation of the stomach, caused by the ac- tion of certain diluvia upon it. The analogy, indeed, between it and the effects of an acrid poison, in most respects, had long been confessed. Directed by these * I bave been lately told by Dr. Physick, that he employed the turpentine twenty years ago. ?s a general remedy in yellow fé. ver*.. 118 ELEMENTS or views, Dr. Hewson and myself, under whose care the hospital was placed, instituted a practice accordingly. After moderate evacuations of the bowels, we exhi- bited the turpentine, in doses adapted to the emergen- cy. Commonly a drachm was given every hour or two, sometimes alone, and at other times with carbo- nate of ammonia, or some essential oil, which rendered it less disagreeable to the taste, and the stomach more retentive of it. Of sixteen cases managed in this way, twelve reco- vered. Compared with what was done in the city by other modes of treatment, this success is exceedingly encouraging. It should, too, be recollected, that most of the patients were brought into the hospital, in an advanced stage of the disease, much reduced by vene- section and other evacuations. Unless it be employed at the commencement, or very early in an attack, the turpentine, in common with ali remedies, will be, for the most part, unavailing. The vitality of the stomach, in this fever, after ten or twelve hours, is destroyed, and, with it, ali those sympathies, direct and indirect, which link the differ- ent parts together, constituting a unity of system—so that impressions made at any one point are diffused over the whole. In this condition, remedies received into the stomach, or applied to the surface, are equally inert and inoperative. Dead to every impulse, I have known, under such circumstances, boiling turpentine to be poured on the skin without ereating any sensa- tion, and a large quantity ofit, and other stimuli, found, on a post mortcm examination, in the stomach, having THERAPEUT1CS. 119 undergone no change whatever—and of course, as re medies, were useless. The principle on which the turpentine was em- ployed in the early stage of this disease may be vindi- cated. Elsewhere I have said, that nothing is more delu- sive than the doctrine of the identity of diseased ac- tions, or of remediai agency. We cure some inflam- mations by direct reduction with the depleting mea- sures, while others are overcome by counteraction, at once subverting the morbid movements going on at the time, in a part, or the whole of the body. Do we not see this in the eflicacy of certain stimula- ting collyria in ophthalmia—of the copaiva and cubebs in gonorrhoea—of the eau medicinale in gout—of mer- cury in syphilis—of the capsicum in cynanche tonsilla- ris—of mercurial ointment in erysipelas—not to ad- duce other instances, which might be done by appeal- ing to the records of the Brunonian practice, which was sometimes successfully conducted on this princi- ple? Of the counter-agency of turpentine in scalds and burns we are aware. The stomach, in yellow fever, is in a state of inflammation, probably of a somewhat similar nature, which is overcome in the same Way. This conjecture derives support from the consideration that, in many instances, the turpentine is soothing in its effects, removing the sense of heat and irritation in that v iscus, subduing the force of vascular action and general excitement, and inducing, at once, a condition altoge- ther of more comfort and security. Nor is it to be overlooked, that, without any previous intercommuni- 120 ELEMENTS OF cation, the turpentine was prescribed, with advantage, nearly about the same time, in the plague at Malta,* —and is strenuously recommended as the best correc- tive of the inflammation of the stomach from poisons,f two cases, in many points approaching so closely to yel- low fever. Entertaining nearly similar views of the pathology of the disease, the saccharum saturni was prescribed, by Dr. Irvine of Charleston, one of our most distinguished physicians, and, according to the best evidence, with success. These coincidences are very striking, and in every view deserve our most serious attention. Even admitting, as has been contended, that instead of inflam- mation of the stomach, there is merely congestion of its vessels, which sometimes happens, leading to extrava- sations of blood, I do not know that the practice would be less appropriate, since in hematemesis and melsena it is one of our best remedies. The fact is, that while much is probably due to the turpentine in directly correcting morbid states of the stomach, we must as- cribe not a little to its diffusible stimulation, and its controlling influence over the capillaries generally. Notwithstanding, however, ali I have said, I do not propose the turpentine as a cure of yellow fever very confidently. My experience with it is too limited to warrant such a tone, and, from what I have seen of the disease, I am certain, that the more violent forms of it are wholly irremediable. It is only suggested as wor- thy of a further and more careful trial, and especially * Falkener on the Plague. t Orfila on Poisons. THERAPEUTICS. 121 since ali other plans of managing the disease have proved so ineffectual. In that stage of ordinary inflamed stomach, approach- ing gangrene, by the arrestation of which it is presum- ed to operate, the turpentine has long been known to be useful. Nor do I believe it to be less suited, though my ex- perience in this respect is narrower, to the same state in enteritis, whatever may be the cause, whether in- duced in the ordinary way, or associated with dysen- tery. The latter disease, indeed, at that point when gangrene is menaced, is said to be more controlied by the free exhibition of turpentine, than by any means with which we are conversant. It is also of great ser- vice in cholera infantum, at a stage somewhat earlier: and in chronic diarrhoea, with such discharges as de- note the mucous coat of the intestines to be chiefly affected, it is an incomparable remedy.* Much too may be expected from it in the spasmodic affections of the alimentary canal, such as flatulent co- lie, and sometimes it promptly relieves gout in the sto- mach. A favourite prescription of Dr. Dewees of this city, in such cases, consists of the oil of mint and of tur- pentine. This mixture is alleged to be particularly suited to periodical colics.f As an evacuant of the bowels, when obstinately con- >tipated, turpentine is deserving of great attention. * I have found the common resin, in the dose of ten or fifteen grains, repeated several times a day, to answer best in diarrhoea. t R. Terebinth. Oleum si.—01. Mcnth. 3i., M. The dose a tea-spoonful. \ ni,. Ti.—Dì 122 ELEMENTS OF Cases are reported by several of the British practition- ers, of its decided eflicacy. It is supposed to be pecu- liarly adapted to those states induced by affections of the brain. Combined in the proportion of a drachm to an ounce of castor-oil, it proves, indeed, a most active purge, under ali circumstances. Nor is the turpentine less useful in certain torpid conditions of the bowels, attended with depraved secretions of the mucous tissue, as indicated by the furred tongue, sour eructations, and acrid slimy stools. This fact has long been known to me, and I have acted upon it in practice, substituting in maoy instances, the turpentine for the blue pili, and other mercurial preparations. The turpentine has been greatly extolled by Brenan, a practitioner of Dublin, in puerperal fever. But he resorts to it in the early stages of the complaint, exhi- biting it freely, and at the same time applying cloths soaked in it to the abdomcn, so as to induce superficial inflammation. The late foreign and our own journals, contain some further evidence of its success from other practitioners. Of this practice, my theoretical notions will not allow me to approve, though I am not willing altogether to condemn it un tried. The action of turpentine is very peculiar, and it is not absolutely absurd to suppose that it may counteract peritoneal inflammation, which seems to have constituted the cases of puerperal fever in which it was employed. That it is eminently serviceable in the advanced states of ordinary peritonitis, I am entirely persuaded, and was employed in sudi cases, in this city, long before we derived any intelligence of its applica- bility from abroad. THERAPEUTICh 123 Not the least valuable application of turpentine is to •some of the forms of rheumatism, and, I think, especial- ly to chronic sciatica and lumbago. By several of the older writers, it was very much extolled in these affec- tions, and seems to have prescrved its reputation unim- ■paired to the present day. The use of it in hsemorrhagies is also an old practice. How far it is appropriate to ha^moptysis, menorrhagia, or epistaxis, I am not prepared to determine. It has however been much prescribed in passive hsemorrhage of the lungs, to which I should think it only adapted. But in hematemesis, as well as melsena, under similar circumstances, as previously intimated, I know it to be deserving of confidence. Equal proof have I of its utility in hsemorrhoids, alike restraining the flow of blood, and soothing irritation.* In the latter respect, its power is so manifest, that it was constantly ordered by f he late Dr. Kuhn in these painfully inflamed tumours. Lately, much has been said in the English periodical journals of the efficacy of turpentine in epilepsy. Cases are recorded by several highlyrespectable practitionersf of cures by it. But they are not entitled to the credit of having first used it. Long before I had heard of these publications, it was prescribed by me in the practice of our Alms-House, and I distinctly recollect, on claiming the remedy, being told by one of my pupils, that it was greatly employed by some one of the physicians of Charleston. Whether it is of much use in this disease, my experience does not enable me to state positively. * It has, on the authority of Mr. Hunter, been also used as a styptic. + Drs. Perrival, Latham, Lithgow, Scc. 124 ELEMENTS OF Epilepsy is sometimes excited by worms, or sordes, or even constipation, and, in such cases, the turpentine might be useful. Nearly the same thing may be said of it in chorea, and, in short, in the whole of this tribe of affections. There is one case of idiopathic tetanus recorded which was very speedily cured by it, and, from analogy, it is recommended in spasms generally, having their origin in irritation of the primse vise. The dose of the spirit of turpentine, in ali the cases which I have enumerated, is about a drachm, to be re- peated according to the nature of the disease. The best mode of giving it is alone, or poured on a small portion of water. By attempting to blend it with mucilage or any such vehicle, it seems in some degree to be volatil- ized, and is thereby rendered more pungent to the fauces, and difiicult to swallow.*f * Dutch, or Haerlem drops, so much used in the domestic practice of this country, consist of oil of turpentine, guaiacum, spirits of nitric ether, and the oil of amber and cloves. t To purify the oil of turpentine for medicinal purposes, without diminishing its eflicacy, though its taste is improved, as well as that it is less irritating to the kidneys, the following pro- cess has been lately suggested by Dr. Nimino, of Glasgow. " To eight parts of 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, acid an equal quantity of alcohol as before, agitate, and separate the liquids. If this be repeated three or fo,ur times, the oil becomes nearly tasteless, almost without smeli, and, when a portion of it is evaporated, it leaves no residue. The oil, however, speedily undergoes alteration, and returns to its originai state of greater or less impurity." Most of the essential oils correct its taste, and particularly the oil of lemons. IIIERAPEUTICS. 125 PHOSPHORUS. Early in the seventeenth eentury phosphorus was prepared by aGerman chemist, who kept the processa secret till discovered by the celebrated Boyle. It is considered as an elementary substance, and is commonly procured from bones, though it is also contained in urine. Almost as soon as known, it was used in various diseases, especially in France. But owing to the vio- lence of its action, which could not easily be restrained, and the fatai efleets it occasionally produced, it seems to have been universally abandoned, as, at least, an un- ruly and dangerous remedy. After a considerable lapse of time, it was once more revived, and its use may be traced in England, in nearly the sanie diseases in which it had been previ- ously tried on the continent. It there experienced a >imilar fate, and probably for the same reasons. As a medicine, we hear nothing more of it till about thirty years ago, when the medicai journals of almost every country of Europe, by the number of Communi- cations they contained relative to it, showed that it eommanded great attention. It was extensively em- ployed in the French military hospitals in low fevers, and with a view of checking gangrene from wounds and other causes. Nearly at the same time, the phy- sicians of different countries seem to have been busih engaged in experimenting with it in the diseases al ready mentioned—and also in the whole of the ner- vous and spasmodic affections—to which may be added, croni iiud rheumatism. dropsy. amenorrlnra, impoten- 126 ELEMEJSTS OF cy, uterine haemorrhages, and, finally, in correcting the effects of the minerai poisons, as lead, arsenic, &c. Much was said, for a succession of years, of the value of phosphorus in the treatment of this copious catalogue of diseases. But, whatever may have been the degree of its utility, it appears nearly balanced by its hazardous nature, and the positive mischief which is acknowledged occasionally to have resilited from it. Even in its moderate operation, it is described as stim- ulating the whole system, invigorating the circulation, augmenting animai temperature, promoting the secre- tions, particularly of the skin and kidneys, imparting force to the muscles, bracing the nerves, inflaming ve- nereal desire, and arousing the mind to animation and hilarity. How far this representation may be trae, my own experience is too limited to determine. During my residence at Edinburgh, I made, with my friend Dr. De Roche, some experiments with it on rabbits—and we were led to conclude, that the strong excitement evidently produced in these animals, was of a painful nature—and inarks of inflammation in the alimentary canal were uniformly found after death. Contrary to what has been said, we did not perceive that the ve- nereal appetite was at ali increased by it, and indeed, the most sensible effect was a Constant and prodigioti5 discharge of urine. To three individuals, I have administered phospho ras, and though with circumspection, and in the small- est dose recommended, I was very soon compelled to discontinue it, from the alarming consequences which took place. In each case the symptoms of gastritis THERAPEUTICS. 127 were induced in a greater or less degree, and in one of them to such a height as to create much solicitude as to the event. Nevertheless, I am not quite ready to surrender an article, universally admitted to be possessed of such active powers, and which, perhaps, by further inqui- ries and better management, may be turned to an im- portant account in combating some of those intractable maladies, now the opprobria of the profession. Different forms have been adopted for the adminis- tration of phosphorus. It has been made into a pili with conserve of roses, which, however, of ali modes, is the most improper, since it exists in substance, and can scarcely fail of doing mischief. To guard against its pernicious effects, it should only be exhibited in so- lution, and so mixed with mucilage, as to obtund its virulent qualities. Conformably to this idea, we have a formula from Professor Hufeland, here annexed.* Dissolved in oil, as has been proposed, it is so ex- ceedingly nauseous as hardly to be retained, and I have doubts, from what I have seen, of the safety of the prescription. A better process is to rub it down with sweet almonds, or gum arabic, and then add a portion of the spirit of nitre, or the anodyne minerai liquor, which disguises its taste and odour—making the whole into an emulsion. Many practitioners, how- ' R. Phos. urinae, gr. ij., subigantur longa trituratione cum mucilagine,—gum. Arabici, q. s. ut fiat cum aqua fontan. une. vi. emulsio—cui adda Syrupe de althsea une. i.—Liquor, anodyn. miner. Hoffm. gtt. xxx., D. S. omni bihorio cochlear sumendum aut plus prò re nata. 128 ELEMENTS OF ever, prefer a saturated solution of phosphorus in sul- phuric ether, which contains about eight grains to the ounce, and it seems on the whole as little objectionable as any other mode.* But it has also been proposed, to "melt it in hot water—to reduce it to a powder by constantly shaking it, till its solidity be restored—and to triturate this powder, after divesting it of humidity, with oil and sugar, or the yolk of an egg." Whatever mode is selected, the fourth of a grain is the largest dose, and the whole amount should not ex- ceed two grains in the twenty-four hours. Even in, this cautious and limited quantity, we have evidencè of its occasioning death, after an inexpressible degree of suffering from inflammation and spasms of the sto- mach, &c. CAPSICUM AXXUUM. This is a plant, a native of the East and West In- dies, cultivated, however, in our own country, hearing pods, which, when ripe, furnish a spice of a pungent odour and acrid taste. As a condiment, the people of most warm climates are much addicted to its use, and it seems to be a ge- neral sentiment, that it does less harm than any other heating article of the same description. I have found it even salutary? where the appetite and powers of di- gestion were feeble and defective. Many, indeed, * This has been used with advantage externally, in palsy and rheumatism. TIIERAPEUT1CS. 129 greatly rely on it in dyspepsia, and, if the cases be properly selected, there can be no doubt of its utility. To the disease, as it prevails with drunkards, or is oc- casioned by atonie gout, it has appeared to me to be the best adapted. Capsicum has been recommended by some practi- tioners as a diffusible stimulant, in the advanced stages of typhous fever, and other low states of disease. But this is a total misapplication of the article, from an in- correct estimate of its properties. On the stomach it operates locally, and in a large dose powerfully, creating strong sensations of warmth and excitement, which, however, are not much dif- fused, neither sensibly increasing the force of the cir- culation, nor promoting generally the actions of the system. The only indication which it is capable of fulfilling, in continued fever, is to alleviate gastric dis- tress, and, with this single view, it is sometimes bene- ficially directed. That it does good alone, or with the ordinary tonics, in typhoid and protracted intermittents, we bave suf- ficient authority. But this does not at ali militate against the preceding remarks—since, whatever makes a strong impression on the stomach, whether that im- pression be extended or not, will do the sanie—and, in- deed, sudi is the mode of operation of some of the best remedies in the disease. It follows, from this view of its powers, that little can be expected from it, except in cases where the stomach is principali}' concerned : and on this account, probably? it has been found useful in certain affections vol. n.—17 130 ELEMENTS OF of the eyes—in palsy, in epilepsy, and other neuroses of gastric origin—as well as in the putrid sore throat— a case in which the stomach is deeply affected. This last practice is derived from the West India physicians, who highly commend it, as having the effect particular- ly, to detach the sloughs, while it amends generally the condition of the parts. The common mode of exhibiting capsicum is in pili, and the proper dose is from Ave to ten grains, to be repeated as the case may demand. It is also prescrib- ed in the form of tincture and infusion. The prescrip- tion in cynanche maligna is somewhat different. We are directed here to infuse two table-spoonfuls of the pepper, and a tea-spoonful of salt, in half a pint of boiling water, adding thereto the same quantity of warm vinegar, to be strained through a fine cloth when it becomes cold. Of this, two table-spoonfuls are to be given every half hour. It is also used as a gargle, in simple infusion, in the proportion of one grain to an ounce of boiling water, or six drachms of the tincture to eight ounces of rose tea. This gargle is well fitted to arrest the progress of cynanche tonsillaris, when used in the forming stage of the disease. But the above West India mixture, I think, answers much better as a detergent gargle in putrid sore throat.* * Hymer's Cardiac Tincture. This is an infusion of capsi- cum, camphor, cardamom seeds, rhubarb, aloes, and castor, in proof spirit, with a little sulphuric acid. THERAPEUTICS. 131 PIPER NIGRUM. The black pepper is the unripe fruit dried, of a trailing plant of the East Indies. Its common uses are sufficiently known, both as a condiment and a medi- cine. In the latter relation, it has long been employed, pretty much for the same purposes as the preceding article, and especially to check inordinate vomitings, in fevers, cholera morbus, &c. An infusion of the pepper previously toasted, we are told by Ainslie, is very effectual for this purpose, and is much used throughout India. With the Peruvian bark and other tonics, it is united sometimes, as well in debility of the digestive organs, as in intermittent fevers. To the latter case, particularly, it seems to be adapted, when the stomach is feeble, and typhoid tendencies exist. I have certainly, under such circumstances, often done good with it—and the celebrated Frank, of Vienna, speaks even more favourably of its powers. The com- mon mode is to give six or eight of the berries every two or three hours, washing them down with a glass of water or wine, as the indication may demand. But Frank directs them to be dipped in the mucilage of gum arabic, and then into powdered colombo, forming pills.*f * The electuary, called JVard's Paste, so well known in hse- morrhoids, is made as follows : Take of black pepper and elecampane powdered, each, eight ounces, of powdered fennel seed twenty-two ounces, and of ho- ney and sugar, each, one pound, which are to be well mixed in a mortai-. The dose, the size of anutmeg thrice a day. t The active principle of pepper has lately been extiacted in an alkaline forni, and is called Piperà. 132 ELEMENTS OF EUGENIA CARYOPHYLLATA. Cloves are the cups of the unopened flowers of a tree, which grows in the Molucca Islands, of the family of myrtles. Like the two preceding articles, they have a pungent odour, though far more aromatic, and are warm and stimulating to the taste, and in their general effects. Being analogous to the peppers, they are employed in nearly the same diseases, and with similar views. Combined with the Peruvian bark, I have prescribed them with great advantage in intermittents, connected with a cold phlegmatic condition of the system, and delicacy of stomach. An infusion of them will some- times promptly relieve flatulent colie—and is also very useful in diarrhcea. The tincture, in small doses, is one of the most effectual means to check nausea and vo- miting, where so stimulating a remedy can be safely administered. The powdered cloves, quilted in flannel, and wrung out of hot spirits, applied to the stomach and bowels, I have seen do great good in cholera morbus, and stili more in cholera infantum. I have only to add, that the oil of elove, introduced on cotton or lint, into the cavity of an aching tooth, frequently removes the painful af- fection. PIPER CUBERÀ. This plant, a native of the island of Java, produc.es a bcrrv, which bus of late attraeted some share of atten- THERAPEUTICS. 133 tion as a remediai agent of considerable eflicacy. It formerly held a place in the materia medica, and enter- ed into the composition of mithridate, theriaca, &c. But, as in some other instances, it fell so completely into disuse, that, when again brought forward, it was consi- dered by many as a new acquisition. It is now about ten years since an account was pub- lished in one of the British Journals of its great powers in recent gonorrhcea, and some time afterwards its use was extended to gleet and fluor albus. The Javanese, it appears, have long been acquainted with its utility in the former of these complaints, and from them an English surgeon, on the Indian establishment, acquired a knowledge of it.* What is its precise vaine I cannot say positively. I have employed it repeatedly in the several diseases in which it is recommended, and though it has done good in gonorrhcea, by checking or suspending the discharge, no entire cure was accomplished. To the other cases it has struck me as being less adapted. Confidence, in a much greater degree, is, however, reposed in the article by some of the European practi- tioners, who even consider it as a specific in the dis- eases mentioned, and particularly gonorrhcea. Whether this difference of success be ascribable to the state in which the article is found in our shops, I cannot teli. It has been directed to be used in conjunction with copaiva, and in this mode undoubtedly proves more efficient. This same combination, and also with the concrete or oil of turpentine, I have prescribed very * Edinburgh Medicai and Surgical Journal, for 1818. 134 ELEMENTS OF advantageously in diarrhcea mucosa, and in dyspepsia, when the tongue was foul and loaded. What would be its effects in tussis senilis and humoral asthma ? The ordinary mode of exhibition of cubebs is in pow- der, of which the dose is from twenty to forty grains.* There is also a tincture of it. * Chemical analysis shows that, among other matters, cubebs contains a resinous substance resemblingcopaiva, in which pro- bably is resident its medicinal powers in the affections of the mucous surfaces. I annex a tabular view of the comparative success of different modes of treating gonorrhoea, in which the powers of cubebs are exemplified. • REPORT of Cases of Gonorrhoea in the Hospital of the Caslle of Edin- burgh, conducted under the care of Messrs. Johnstox and Bartlett, of the 88th regiment. Fifty-four cases of Gonorrhoea have been discharged cured, from the 25th June to 24th December, 1817. There were treated by injection (20 grs. of Argent. Nitr. dis- solved in %i. ofplain boiled water) twenty, of which One was discharged cured in 3 days. One - - 5 One - 6 Two - - 10 Four - 15 Four - - 17 Four - - 20 One - - 25 One - 28 One - - 42 Aver age \7\ days. There were treated by rest and abstinencc fifteen, of which Three were discharged cured in 3 days. Two - - - 5 Four - - 7 Four - - 10 THERAPEUTICS. 135 ZTNGIBER OFFICINALE. The ginger of the shops is the root of the above plant, belonging to both the Indies, to China, and other countries. It is cordial and stimulating to the stomach, though even more locai in its effects than either of the kindred substances I have noticed. As a carminative it is often serviceable in colie, and is greatly prescribed in weak and dyspeptic states of the stomach, more especially from atonie gout. Not many years ago, it attracted great attention in this case, and the evidence of its eflicacy was nearly as general and irresistible, as at present is that of the colchicum or eau medicinale. But its reputation was sustained only for a short time, and we now prescribe it merely as a grateful stimulus, without the least expectation of any specific or extraordinary effects from it. Ginger may be di- rected in tincture, infusion, or in powder. To complete the history of this class, ali the articles of which are more or less stimulants, I should next treat of cinnamon, nutmeg, mace, alspice, and several others, appertaining to it. But these are rather employed as One wa; > discharged cured in 18 days. One Average 8j days. 23 There were treated by internai medicines nineteen, of which By the Piper Cubeba. By Capsicum. By Camphor. Two in 4 days. Four in 8 days. One in 5 days. Two in 5 days. Two in 12 days. One in 8 days. Two in 6 days. Two in 24 days. One in 14 days. Average 5\ 131 9 days. 136 ELEMENTS OF condiments than medicines, or, at ali events, not having the power, so far as I know, of effecting so much in any case as the articles noticed, I shall dismiss them without further consideration. ALCOHOL. This is a term of alchymical origin, meaning the real essence of things, divested by sublimation of ali impuri- ties. To alcohol, or its combinations, it is not easy to as- sign a position altogether satisfactory. The difnculty arises principally from the striking difference in its ef- fects taken in a small or large quantity. It has, more- over, some other peculiar properties. Moderately used, in some of the states hereafter to be noticed, it is among the least equivocai examples of a purely cordial and exhilarating stimulant, whereas urged to any extent it loses this power, and produces, as certainly, dulness and stupefaction. It may hence, without much incongruity, be inserted between the in- citants and narcotics. Though undoubtedly allied in some respects to the latter class, we are so far from prescribing it generally with a view to its narcotic ef- fect, that it is even studiously avoided, and we so ma- nage it, that simple stimulation alone may be attained. As an article of the materia medica, therefore, what- ever may be its mode of operation when differently used, it can hardly be considered in any other light than as an incitant or stimulant. By the process of vinous fermentation it is procured, and afterwards separated from the mass in which it is TIIERAPEUTICS. 137 contained by distillation. Doubts have existed whe- ther it be the product or educt of this process. But the late experiments of Gay Lussac, and Brande, con- clusively show, that it preexists, though in a state of combination. The first portion procured, is in a di- luted state, and forms what are called ardent or spirit- uous liquors, which being subjected to repeated distil- lations, become pure and concentrated alcohol. Excepting as an external application to burns, and certain cutaneous inflammations, or to restrain haemor- rhages, in the two first of which it is excellent, alcohol itself is never employed as a remedy. Being a solvent of most of the vegetable proximate principles, such as resin, camphor, balsam, essential oil, extract and saccharine matter, as well as of sulphur, phosphorus, the alkalies, and many of the neutral salts, it may be said to be appropriated almost exclusively to pharma- ceutical purposes. Among other forms in which it is prescribed inter- nally, is that of ardent spirits, which differ only from pure defecated alcohol diluted, in retaining the flavour of the substance from which the fermented liquor is prepared. Of their effects, no very minute detail can be required, so familiar must they be to every one. Generally stated, in a limited quantity, they evince ali the qualities of a potent and diffusible stimulant, both as regards the functions of the body and operations of the mind. After a while, however, this condition of excitation, gradually subsiding, is followed by a corres- pondent degree of languor and collapse. By an increased quantity, the exciting effect is more VOL. II.—18 138 ELEMENTS OF speedily induced, and wc have, in rapid succcssion. the phenomena of intoxication, commencing with ex- hilaration, next delirium, and finally the most beastly stupefaction. But it sometimes happens, where the quantity is excessive, or the individuai is not habitua- ted to the impression, that death suddenly takes place without any of the appearances of excitement. No great difference is discoverablc in the effects of the several species of ardent spirits, though there is a considerable variety as to taste and flavour. It is said by those who have carefully investigated the subject, that brandy is most cordial and invigorating to the sto- mach—rum most hcating, and apt to affect the head— and gin and whiskey the least permanent in their ope- ration, owing to their diuretic qualities. Of the employment of ardent spirits as a medicine, I shall say little. Excepting some of the cases of drunk- ards, or where a morbid taste prefers them, or the stomach is more retentive of them, or in some extreme emergencies, I am stili to learn the disease in which they should be directed in preference to wine, and no practitioner, in my opinion, is warranted in sanctioning their use where it can be procured. It is the sacred duty of every one exercising the pro- fession of medicine, to unite with the moralist, the di- vine, the economist, in discouraging the consumption of those baneful articles, and, as the first step in the schcme of reformation, to discountenance the popular notion of their remediai eflicacy. Chained by a species of infatuation to the use of these intoxicating drinks, as firmly as Prometheus to his rock, mankind have hitherto seemed equally heedless IHERAPEUT1C». 139 to the admonitions of the wise, and to the suggestions of their own understandings. Leaving such as wish precise ìnformation, to consult some of the more formai disquisitions on the subject, which trace their perni- cious effects as well on the mind as body, I shall mere- ly remark, that so great is the extent of the mischief, in every view, that the emptying of Pandora's box was but the type of what has since happened in the diffusion of rum, brandy, gin, and whiskey, among the human species. Wines are the product of the vinous fermentation of the juice of fruits, the best and most common of which are afforded by that of the grape. Their active prin- eiple, however, is alcohol, which we shall presently see, enters into their composition in various proportions. Compared with ardent spirits, the action of wine is less injurious in a state of health. As is happily ex- pressed by an eloquent writer,* while the effects of the one, like those of tyranny in a well ordered govern- ment, are first experienced in the extremities, the other, as a bold invader, seizes at once on the vitals of eonstitution, producing irreparable mischief. It is a fact suflicienfly ascertained, in confirmation of the fidelity of this metaphorical description, that ardent spirits derange the chylopoietic viscera, the lungs, the heart, and brain, causing dyspepsia, hepatitis, dropsy, eonsumption, cardiac disorganization, apoplexy, pal- sy ?—whereas wine chiefly produces the arthritic affec- tions of the limbs. • Dr. Rush. 140 ELEMENTS 01 As a remedy in disease, it evinces the same supe- riority. The effect it produces, is slower and more permanent, combining also qualities, which, while they blunt the ardency of the stimulus, afford no in- considerable portion of nutriment, by which the sys- tem is sustained and invigorated. Ever since the practice of physic was emancipated from the authority of the Brunonian school, it is a settled principle, never to prescribe wine in any of the febrile affections, unless there is an obvious ty- phoid condition. It is prudent, under such circum- stances, to commence with the more moderate stimulus of wine whey, and reserve wine itself for the advanced stages. As excitability in the latter cases is greatly expcnd- ed, a copious exhibition of wine is generally demand- ed. Itis sometimes drunk in quantities so large as to be incredible, were we not acquainted with the fact which I have mentioned, of the great insusceptibility to its impression. Even here, however, we are cau- tiously to regulate its administration by the effects it manifests,—since, urged too far, it might induce indi- rect debility, and thus defeat our purpose. Wine may be considered as doing good, when it renders the pulse fuller, slower, and stronger, removes or lessens delirium, calms irritation, and composes to sleep. But if, on the contrary, it accelerates the pulse, flushes the countenance, increases the temperature of the skin, excites thirst, aggravates delirium or rest- lessness, and thus occasions an exacerbation, the evi- dence of its injurious tendency is no less decisive, and i'IIEUAPEUTICS. 14i «e should, at once, withdraw it altogether, or reduce the quantity. Carefully exhibited, it will be found not the least important of the stimuli, being readily taken, for the most part, even when medicines are rejected— and with unrivalled effect, itsustains, in many instances, the powers of life. To the treatment of some of the cases of neuroses, it has also been applied, and as regards tetanus, not always without advantage. Combined with opium, we bave, indeed, sufficient authority for stating, that it has occasionally cured the disease.* This is another instance in which the sensibility of the system to re- mediai impressions is much impaired, and hence, to be effectual, it must be freely given. Perhaps it would be right to urge it even to intoxication, so as to over- come muscular rigidity : and to the adoption of this course we are in some degree encouraged by the great facility such a condition affords in the reduction of dislocations, and particularly of the jaw, where the dimculty proceeds from the counteraction of the mus- eles. There is, in fact, no state in which muscular power is more enfeebled or relaxed, than when the system is under the full dominion of the inebriating drinks, as is illustrated in the loss of motion, in the giving way of the different sphincters of the body, and, what is strikingly applicatile to our purpose. in the i mi forni \y fallai condition of the jaw. * Case-; to this purport are recorded by Rtish, Currie, and Rosaci, 142 ELEMENTS OF Wine is often directed in various chronic cases, at- tended with debility, and also in the convalescence from acute diseases, to impart tone and animation. Yet the utility of the practice is exceedingly equivo- cai, and, unless properly controlied, may be productive of injury. As to the habitual use of wine, except under se- vere restrictions, it is a " custom more honoured in the breach than in the observance." Carried to ex- cess, it is only less detrimental than ardent spirits, pro- ducing a great degree of physical infirmity and inorai debasement. Among wines, there is no little variety, as relates to strength and other qualities.* The best of them for * Wines admit of four divisions, as follows : 1.—Sweex Wines. These are Malaga, Frontignac, Tokay, Malmsey, and others of the kind. They contain a certain por- tion of saccharine matter, which has not been fermented, or con- verted into wine. They may be produced by an imperfect fer- mentation, by partially drying the grapes before they are press- cd, or by boiling the unfermented juice. 2.—Sparkling Wines, of which Champagne is an example. These contain large quantities of carbonio acid, in consequence of their being bottled at an early period. Champagne is brisk if bottled any time between the vintage of the following May. If the bottling be omitted lìli Oclober, the Champagne is stili It is, however, somewhat improved in strength. 3.—Dry and Light Wines, such as Claret, Burgundy, Her- mitage ; also the German Wines, Hock, Rhenish, Mayne, Mo- ssile, &c. In these the saccharine principle is completely over- come by fermentation. The spirit produced, however, is small in amount, and the wines have an acidulous character. 4. Dry and Stroxg Wines. Madeira, Sherry, and Port, are. of this kind. In ali these a quantity of brandy is fretted in dur- ing the first or second fermentation. In Madeira care is taken THERAPEUT1CS. 143 medicinal purposes is Madeira or Sherry. I mean as stimulants, in low diseases, and the first should be pre- ferred. Now and then, however, we meet with cases where claret is more agreeable to the sick, and answers well. As a tonic, and particularly in weakness of the bow- els, port wine is usually selected, and probably on just grounds. But in dyspeptic, and other feeble states of the stomach, where wine is at ali admissible, I have found the old and dry Lisbon sometimes to prove most comfortable, and ultimately to be liked by the patients themselves. to frec the grapes from the stalks and unsound ones, before they are committed to the press. At Xeres, in Spain, where Sherry is made, the grapes are slightly dried, and sprinkled with quick- lime before they are subjected to the press. Hence Sherry is one of the least acid of wines. The red colour and rough taste of certain wines are owing to the fermentation being conducted on the skins of the grapes, which are red. The skins of white grapes will not produce the red colour. The bouquet, or odour of wine, depends upon a vo- latile principle held in solution. This, in the sweet and half fer- mented wines, as in Frontignac and Muscat, is derived imme- diately from the grape : but in the more perfect wines, as Claret, Hermitage, Stc. it bears no resemblance to the fruit, and is wholly the product of the vinous process. The nutty flavour, so well known in Sherry, Madeira, and some other wines, \s produced by almonds. Wines, especially those of the weaker kind are subject to be- come sour by the acetous fermentation. Thisdefect cannot be properly remedied, since alkalies, which neutralize the acid, com- niuiiicate to the wine an unpleasant taste. Oxides of lead cor- rect the acidity, and communicate a sweet taste, but render the wine deleterious to health. They may be suspected to be pre- sent if the wine gives a dark precipitate on the addition of some 'iquid sulphuret. Bigeloiv's Mat. Med. 144 ELCMEXTS OF The annexcd table* shows the portion of alcohol in the varieties of wine. It is not however to be inferred, that on this only depends their strength. Thus it ap- pears, that in some of them, one-fourth or fifth of it en- ters into their composition, so that in a bottle of wine, * The following table contains the average quantity of alco- hol, of the specific gravity of .825, in a hundred parts by mea- sure, of each wine: Lissa 25.41 Cape Muschat 18.25 Port 22.96 Cape Madeira 20.51 Raisin wine 25.12 Grape wine 18.11 Marsala 25.09 Calcavella 18.65 Madeira 22.27 Vidonia 19.25 Currant wine 20.55 Alba Flora 17.26 Sherry 19.17 Malaga 17.26 Bucellas 18.49 White Hermitage 17.43 Red Madeira 20.35 Roussillon 18.13 Claret 15.10 Red Champagne 11.93 Malmscy Madeira 16.40 Red Hermitage 12.32 Lunel 15.52 Vin de Grave 13.37 Sheraaz 15.52 Frontignac 12.79 Syracuse 15.28 Cote Rotie 12.32 Sauterne 14.22 Gooseberry wine 11.84 Burgundy 14.57 Tokay 9.88 Hock 13.68 Elder wine 9.87 Hock, old, in cask, 8.88 Orange wine 11.26 Nice 14.63 Cider,highest average 9.87 Barsac 13.86 Cider, lowest average, 5.21 Teneriffe, 19.79 Perry 7.26 Colares 19.75 Mead 7.32 Lachryma Christi 19.70 Burton ale 8.88 White Constantia 19.75 London porter 4.20 Red Constantia 18.92 Small beer 1.28 Lisbon 18.94 Brandy 53.39 Malaga 18.94 Rum 53.68 Tent 13.30 Gin 51.60* White Champagne 13.30 * Brande. THERAPEUTICS. 145 nearly half a pint is contained. Combined as it is, its power is lessened, and which is proved, as well by com- mon experience as by the equally well established fact, that wines having a similar quantity of alcohol, differ materially in their effects. Much moreis their inebri- ating influence to be ascribed to the brandy added to preserve them, mixed only and not combined. Malt liquors result from the fermentation of the grains of vegetables previously decocted, and also owe their strength chiefly to the alcohol which they contain, though their narcotic and inebriating influence must in part be ascribed to the hop, itself a narcotic, used in the process of brewing. As a medicine, they are prescribed more as a tonic than stimulant, in the convalescence of disease, to re- stare vigour,—sometimes in the advanced stages of low fevers, and occasionally prove beneficiai in dyspepsia and other weak states of the stomach. Asrelates to the morbid effects of malt liquors, there is stili not a little difference of sentiment. Though less pernicious than ardent spirits, it must be confessed that they are wholly unsuited to the sedentary and studious, and not less so where there is any tendency to obesity, or fulness, or a predisposition to the complaints of the head, or the chest, and asthma particularly. They have been charged too with laying the founda- tion of gout and calculus. Yet, we have some very strong evidence against such an opinion. It is recorded by Cyprian, a lithotomist, whose reputation as an expert operator was diffused ali over Europe, that of the four- teen hundred patients, whom he had cut for the stone, not one had used malt liquor as a common drink. Tt i^ VOL. n.—19 146 ELEMENTS OF also stated, by Haller, that of one hundred persons who died under his care, with gravel, no one drank beer. By Sydenham, who was himself a victim of gout and stone, evidence of a similar import is furnished. " To prevent bloody urine, says he, whenever I am obliged to go very far in my coach, on the stones, I al- ways drink a large draught of small beer before I set out, and another on the way, if I am abroad a conside- rable time—by which means I secure myself pretty well from bloody urine. A draught of small beer serves me instead of supper, and I drink another draught after I am in bed, and about to compose myself to sleep, in order to cool the hot and acrid humours lodged in the kidneys, which breed the stone." Nevertheless, the predominant opinion among medi- cai men, at the present time, seems to be, that malt li- quors are prejudicial in this respect, and, as it is found- ed on enlarged experience, it is safest in practice to consider it as correct. THFRAPEUTICS. 147 SECTION VII. Narcotica, or Narcotics. OPIUM. Of ali the articles of the materia medica, this is the most extensively useful, there being scarcely one mor- bid affection, or disordered condition, in which, under certain circumstances, it is not exhibited, either alone or in combination. It is the product of the papaver somniferum, or poppy. This plant readily accommodates itself to the diversities of soil and climate, and hence is found grow- ing, in various situations, in almost every country. It flourishes well in different parts of the United States— and opium of an excellent quality has been made from it in considerable quantities. Most probably, however, the poppy is a native of the south of Asia, and the neighbouring regions, though found wild in some of the sections of Europe. Two kinds of opium are now im- ported, the Turkey and East India, the former of which is greatly preferred. It yields, according to recent ex- periments, nearly three times as much morphia as the latter.* * London Dispensatory. 148 ELEMENTS OF The leaves, stalks, and capsules of the poppy abound with a milky fluid, when near maturity, which is emit- ted through slight incisions made for the purpose.* Thus procured, the fluid, by exposure to the sun for several days, becomes a tenacious mass, which is then enveloped in leaves, and constitutes the opium of the shops. The purest and most active is, however, afforded by the capsules only. Concerning the operation of opium, medicai sentiment continues to be divided, though the preponderance is decidedly in favour of its stimulant properties, and with such an impression it is employed. In my general spe- culations relative to narcotics, I had constantly in view the effects of this article as the purest specimen of its class, and, from what I have there said, may be collected my notions on this disputed point. Every part of the- statement has been amply confirmed by experiments, and will be found, I presume, conformable to the expe- rience of most practitioners. These being too nume- rous to cite in detail, I shall be content with giving the general results, referring those who are curious on the subject, to the work itself, in which they are contain- ed. f " Opium applied to the eye, internai membrane of the nose, urethra, or other similar sensible surfaces, or to any other part of the body, deprived of its cuticle, is first productive of pain, a sense of heat, and of inflam- mation, and, after the cessation of which symptoms, * The seeds of the poppy have little or none of the narcotic, or other properties of the plant. They are used only as an emulsion, and from their oily nature answer very well. t Crumpe on Opium. 1HERAPEUTICS. 149 the naturai or morbid sensibility of the part is dimi- nished." Exhibited internally, in an adequate dose, opium produces the following changes in the vital functions. " The pulsations of the heart and arteries are first rendered quicker, fuller, and stronger, and afterwards slower than at the time of taking it. With the increase of frequency in the pulse, the heat of the body is gene- rally somewhat augmented. The respiration is little affected, except a large dose has been taken, towards the conclusion of the operation of which it becomes slow, stertorous, and laborious." The naturai fu a et ions are thus disturbed. "The appetite and digestion, from unusually large, or fre- quently repeated doses, are generally impaired, and vomiting often induced : the discharges from the intes- tines are diminished or suppressed, secretion and ex- cretion are impeded in every part of the system, except the skin, the discharge from which is evidently aug- mented, sometimes preceded or attended with a sense of pricking or itching of the skin, terminating now and then in a species of miliary eruption." The animai functions are affected as follows : "The hilarity of the mind is by degrees augment- ed, and continues to increase, if the dose be consider- able, until the delirium of intoxication is produced, which, as when resulting from spirituous liquors, is attended in different constitutions with different symp- toms. It is, however, more generally productive of a pleasant and joyous state of the mind than the con- trary, and, in many, it occasions an increased disposi- tion to venerv. After these effects have continued 150 ELEMENTS OF for some time, they are succeeded by others of a very opposite nature : the mind becomes gradually dull and languid, the body averse to motion, little affected by customary impressions, and inclined to sleep. If the dose has been considerable, ali these symptoms continue to increase, and tremors, convulsions, ver- tigo, stupor, insensibility, and deprivation of muscular action, appear variously complicated, and in various degrees, proportioned to the excess of the dose, and peculiarity of the constitution of the sufferer." Enough is contained in the preceding extracts to satisfy us of the highly stimulating nature of the me- dicine, and it would not be diflicult to run the pa- rallel between it and wine to a considerable extent. It is, indeed, actually used by some of the Orientai nations, for the same purposes that we seek stimu- lating potations. By the Turks especially, to whom our more generous beverages are prohibited by reli- gious prejudices, we are told,* opium is employed to inspire courage or to invigorate fortitude, to soothe sorrow or dissipate misfortune, to awaken the fancy to more brilliant exertions, or to create that mild com- posure and serenity of feeling, so desirable after the cares and solicitudes of an active, perplexing, and arduous scene. Like spirituous liquors among other people, it is, in short, "the support of the coward, the solace of the wretched, and the daily source of in- toxication to the debauchee." Thus habitually taken, nearly the same moral and physical debility and suf- * Vid. the accounts of Russel, Chardin, De Tott, and other travellcrs. THERAPEUTICS. 151 fering are experienced, as from any species of inebri- ating liquor. But, though the analogy to a certain extent exists, there is, in several respects, a material difference in the two articles, and in no dose, or by any mode of administration, can they be so assimilated, as to answer precisely the same purposes. To illustrate more distinctly the use of opium, I shall now proceed to treat of its application in those diseases in which it has been prescribed with the greatest advantage, commencing with intermitting fe- vers. This is no new practice. It appears, on the contrary, that it was pursued so early as the time of Galen, and continued by the Arabian physicians, some of whoin bear testimony to its eflicacy. Yet the powers of the medicine in these cases were not well de- fined or fully established till much more recently. It is recommended to exhibit opium about an hour before the period of the anticipated paroxysm, and it is afnrmed, that it sometimes prevents it altogether, or, if it should come on, that its violence is mitigated, and its duration abridged. Of the correctness of this statement I entertain no doubt, from my own observa- tion, independently of the testimony of Trotter, by whom the practice is highly extolled.* Even more than this may be accomplished. Taken during the cold stage, it produces the very best effects, and parti- cularly, in those malignant intermittents, where from the want of reaction, the state of collapse continues, with heavy congestions of the internai organs, the liver * Vide Medicina Nautica. 15& ELEMEXTS OF or spleen most frequently, though the brain is some- times implicated. We are told, moreover, by no less authority than Lind, that in the hot stage it is not less advantageous. As the result of an enlarged experience, he de- clares, that it speedily brings about a solution of the paroxysm by inducing perspiration, which relieves the distressing affections incident to the case—that it causes a more complete intermission, and more effect- ually prepares the way for the bark. Cases treated in this manner, he further states, are never followed by visceral obstruction, and the ordinary consequences of it, dropsy, jaundice, &c. Of the many, however, who have tried this practice, I know not more than one or two who have reported in its favour. It is said, as indeed seems probable, a priori, to increase the headach, to add to the heat and restlessness, and to prolong and aggravate, in every respect, the paroxysm. Being repugnant to ali my theoretical notions, re- lative to the properties of opium, I entered fully into the prejudices against it, and never submitted it to ex- periment till lately. I confess that I have been agree- ably disappointed, and now believe, from pretty ampie trials, that, though injurious where the system is ple- thoric and inflammatory, it will prove highly benefi- ciai under opposite circumstances. In speculating on this subject, it is a fact which ought to be recollected, that Lind practised almost ex- clusively in hot climates, among a people of relaxed habits, with little or no phlogistic diathesis, and where, of course, a strong tendency to perspiration at ali times TIIERAPEUTICS. 153 exists. It is hard to discredit the statements of such a writer. On more than one occasion I have endeavoured to inculcate the opinion, that ali continued fevers, not excepting genuine typhus, are in the commencement inflammatory, or bave those determinations and con- gestions which require depletory measures. To this state of things ultimately succeeds, however, more or less of debility, and to support the system becomes an indication of the utmost importance, with a view to which a variety of remedies is prescribed. The carbonate of ammonia or wine is to be preferred here, the latter particularly, being a stimulant, pow- erful and diffusible, and at the same time durable and nutritious. But though, as a leading remedy, these may be su- perior to opium, certain symptoms or conditions of the system do often arise in the course of the disease, in which it is indispensably necessary. What, for in- stance, so effectually removes low delirium, and espe- pecially in malignant intermittents, or calms inquie- tude and restlessness, or restrains the diarrhcea so often an attendant on typhous cases, which, in rapidly wasting the already too much impaired strength, counteracts the beneficiai tendency of ali our endeavours ? The Brunonians, however, did not thus limit its use. Con- sidering it as the first of the diffusible stimulants, they relied mainly on it to meet the general indications, in every stage of low fevers. That the practice was most fatai, is sufficiently shown by its universal abandonment. Even when it becomes appropriate as a stimulus, the *.ML. II.--20 154 elements of article should be directed in small, and frequenti)' re- peated doses, rather than largely, and at distant inter- vals, as calculated only in this way to sustain excite- ment. The reverse is proper, when our object is to allay irritation, or cairn the irregular and turbulent movements of the disease. Next I am to inquire how far opium may be used in the phlegmasiae. It is remarked by a late writer of some distinction, that we should never direct it where venesection is demanded, the remedies being wholly incompatible. As a general rule this may be correct, though it has many exceptions, some of which will be pointed out in the progress of this discussion. No practitioner, at present, thinks of prescribing it in ordinary pneumonia, without previous evacua- tions, and these urged to a pretty liberal extent. But the circumstances in which we should resort to it, have been so precisely pointed out by Cullen, that I cannot do better than cite the passage. "To me it appears," says he, " that in the begin- ning of the disease, and before bleeding and blistering have produced some remission of the pain and of the difiìculty of breathing, opiates bave a very bad effect, by their increasing the difiìculty of breathing, and other inflammatory symptoms. But in a more advanced state of the disease, when the difiìculty of breathing has abated, and when the urgent symptom is a cough, proving the chief cause of the continuance of the pain, and want of sleep, opiates may be employed with great advantage and safety." Given alone, however, opium having a tendency, not- withstanding what is said to the contrary, in some in- THERAPEUTKS. 155 .stances, to check the excretory efforts of the bronchiae, it is advisable so to combine it, as to do away this ob- jection to its use, and for the purpose we have a varie- ty of articles, the most approved of which I have else- where noticed.* Excepting catarrh, which, in the early stage, is more effectually arrested by an opiate than by any other treatment, the preceding directions will apply, with nearly equal propriety, to ali the acute inflamma- tory affections of the chest. Novel as the remedy I bave suggested in catarrh may seem, it is not without the support of experience. I have tried it many times on myself, and stili oftener with my patients, so that I can hardly be deceived. Taken on going to bed, which it should be, it soon excites a universal and equable glow, attended with lit- tle or no perspiration, and I am not aware that any ad- vantage is gained by uniting with it a diaphoretic. It probably operates bere simply as a diffusible stimulant, overcoming, by its superior powers, the feeble action of the incipient stage of the disease. Delayed till the attack is confirmed, opium becomes mischievous, and wc can only hope to subdue it, by calling into requisi- tion the depletory and antiphlogistic measures. Yet in the advanced stages, it again becomes useful, and even indispensable, to allay irritation and restrain the cough. Though such is our practice, with respect to opium, in genuine pneumonia, we may much earlier resort to Vid. Expectorants. 156 ELEMENTS of it in some of the spurious and irregular shapes of the disease. Of peripneumonia notha there are two spe- cies, which hitherto have often been confounded in the treatment. The one consists in an oppressed state of the lungs, from accumulations of viscid matters, and the other in congestion of blood, consti tu ting an apo- plectic state of the organs. The first is the catarrh us suffocativus or bronchitis of old age, and is managed by cupping, emetics, blisters, and expectorant mixtures, into which opium enters largely : in the second, oc- curring mostly in the meridian of life, after copious de- pletion, both general and topical, opium is found to be productive of advantage. Cases, however, of the latter form of peripneumonia notha are met with, where such freedom of depletion cannot be safely adopted. Engorgement of the great viscera, and especially of the lungs, takes out of the general circulation so large a portion of blood, and which is confined so closely that any considerable loss by venesection is very sensibly, and may be even fatally, felt. It is prudent, under such circum- stances, to detract a small portion at a time, keeping the finger on the pulse to determine the effect, and, by thus cautiously proceeding, we sometimes succeed in coaxing out the half stagnant blood, and in this way re-establish a just equilibrium in the circulation. But. where venesection is altogether inadmissible, we must substitute cupping, blistering, and, with other auxilia- ries, the liberal use of opium, which I have seen prove of immense service in these cases, at a conjuncture the most criticai and alarming. IHERAPEUTICS. 157 In typhoid pneumonia, whether originai, or induced by improper management of the inflammatory form of the disease, this medicine is indisputably useful. On this point, no difference of opinion exists, and we may even go so far as to lay it down as a principle, that in ali the varieties or stages of pneumonia, where vene- section is forbidden, or is an equivocai measure, opium should be employed, uniting with it small portions of antimony or ipecacuanha and calomel, or bringing into co-operation the carbonate of ammonia, with the infu- sion of seneka root, as the one, or the other, may seem * preferable. Of the use of opium in rheumatism little need bc said. It is sufficiently known that the disease is divid- ed, very properly, into acute or chronic, and the for- mer state being highly inflammatory, this medicine of course is wholly improper. The pian of cure in these cases, which, at present, is most followed, is to push the depleting remedies, such as bleeding, both general and topical, purging, and blistering, till vascular action is considerably abated. But if, after this is done, the pains continue, attended with moderate fever, which very commonly happens, we are to endeavour to ex- cite a profuse and long continued perspiration. To meet this indication, nothing has ever succeeded so well with me as Dover's powder. The mode of exhi- biting it bere, and, indeed, under ali other circum- stances, where we wish the full exertion of its powers, has been amply explained.* * Vii1.. Dktrhoreth■«*. 1.58 ELEMENTI Ol It is worthy of remark, that opium rarely fails to aggravate acute unsubdued rheumatism. Even in the shape of Dover's powder, and where it produces per- spiration too, it generally increases pain, and adds to the heat and restlessness. This fact is particularly en- titled to attention, as patients, in the anguish of this disease, very often demantl, in a clamorous manner, a dose of the medicine. But though, when rheumatism is inflammatory, our practice with regard to opium should be regulated by the preceding cautions, there are cases in which it may be employed in a much ear- lier stage. The state of the disease to which I refer, often succeeds the genuine acute rheumatism, after a few days continuance, though it is more commonly met with as an originai affection, in women, or persons of weak and irritable habits. There is, here, little or no inflammatory action, though much nervous or spasmo- dic irritation. Either alone, or in conjunction with calomel, antimony, or ipecacuanha, opium is unequivo- cally serviceable. As to its utility in gout, medicai men are not unani- mous. Yet in regular attacks of the disease in the extremities, it seems now to be sufficiently ascertained. that, so far from affording relief, it has often a tenden- cy severely to aggravate the paroxysm. A practice very different was recommended by the celebrated Brown, and has been pursued by his diseiples. Be- lieving the disease to arise in ali its varieties from de- bility, it was maintained, that it should be treated with stimulants, and, among these, that none was more eflì- cacious than opium. Need I say, that this was mere theory, which has been fully contradicted by experi- T1IERAPEUTICS. 159 enee. It was, indeed, the fate of Brown, to illustrate, in his own instance, the pernicious nature of his prac- tice. To a large dose of opium. taken in a paroxysm of podagra, which brought on apoplexy, it is said that his death was owing. Yet, when the force of phlogosis is subdued, and the bowels bave been freely evaewated, or in originai weak forms of the disease, erra tic or otherwise, it may be resorted to either to allay pain or procure rest. In retrocedent gout, and especially when it attacks the stomach with spasms, no doubt is entertained as to the propriety of opiates. But so great is the degree of torpor, under such cireumstances, that it is often neces- sary to prescribe it in very large doses. Not less than fifty or a hundred drops of laudanum, and this quantity to be repeated at short intervals, will be found to an- swer the purpose in many instances. The effect, how- ever, may be very much promoted by exhibiting, at the same time, some other stimulants, sudi as carbonate of ammonia, or ether, or musk, with the free use of strong ginger tea, or spiced wine, or hot toddy. In more than one of the exanthemata, this medicine is occasionally prescribed. Whatever may be the de- gree of irritation or restlessness, it is to be withheld so long as there is much febrile action, and relief must be sought by a strict pursuance of the whole antiphlogistic course, including active evacuations. To this general rule, I do not at present recollect a single exception, and it is pointedly applicabile to small pox, measles, erysipelas, and scarlet fever. In a reduced state of the system, however. or where there is a typhoid disposition, either originai or ac- 160 ELEMENTS OF quired in the progress of the case, opiates form a very leading part of the treatment. Besides the general in- dication they are calculated to meet in the whole of these cases, there are certain peculiar symptoms or af- fections, for which they are exhibited. Thus, in the fever which precedes the eruption of small pox, con- vulsions, especially in children, frequently occur. Though, when slight, these are not to be regarded, and, indeed, are even deemed favourable in variola dis- creta, stili, if violent, or the recurrence be at short in- tervals, they should be quieted, and, for which purpose, the warm bath, sinapisms, and an anodyne enema, are the proper measures. To promote the maturation of the pustules, whether in the discrete or confluent cases, where the process goes on slowly or irregularly, opium is also serviceable. Of the particular circumstances in measles, which exact the use of opium, the cough and diarrhcea are the most prominent. But so inflammatory is the common character of this disease, at least as it prevails in the United States, thatwe are not too early to appeal to the medicine. Direct depletion is often required to subdue the pectoral affection, and in this intention we are much assisted by the spontaneous discharges from the bowels. These, therefore, being prematurely checked, the cough and dyspncea will be found to return, or be ag- gravated. Nor, in the management of the diarrhcea, as regards the first stage, ought we too eagerly to resort to opiates. Dependent on more or less inflammation of the bowels, I have found that it yields more effectually to moderate bleedings than to any other course. But a necessity existing for its suppression, opium alone, or TIIERAPEUTICS. 161 with the balsamic or cretaceous preparations, as the case may be, must be employed. Except as a lotion, to allay heat and irritation of the surface in erysipelas, and here a watery solution of it is very successful, I know no particular affection, either in this disease or in scarlatina, which calls for the use of it. To sustain as well as to cairn the system, in the restless, irritable states, incident to the malignant forms of these diseases, it is, however, on general principles, prescribed, with other articles. In some of the hsemorrhages, opium has been not a little employed, and I suspect rather indiscriminately. Most practitioners are persuaded, that in the active species, with febrile heat and excitement, it must be hurtful. Yet, the force of the circulation being diminished, or in a case originally connected with fee- bleness of arterial action, it is useful. It allays irrita- tion, removes spasmodic stricture, and subdues the mo- bility of that state of the system, which is productive of, or at least is commonly associated with, passive hse- morrhages. Notwithstanding the preceding remarks, I suspect that in pulmonary hsemorrhages, particularly, we have been too much restrained by our speculative notions in the use of opium. What would be the effects of a large dose in the beginning of active haemoptysis, I cannot determine positively from my own experience. That it has done good, however, when thus prescribed, wv are not without some direct proof. But it may be asked, is not opium a stimulant, and can it be proper to give it where there is a full and disturbed circulation? To this it may be replied. does VOL. il.-—2.1 162 ELEMENTS OF not every surgeon, after an operation, to quietthe patient and prevent hrcmorrhage, resort to an anodyne, though a great degree of vascular action may exist at the time? In spcculating on the powers of opium, we should con- stanti y bear in mind, that they are so peculiar, that ge- neral rcasonings will not apply to the article. Most unquestionably it is a stimulant. To this point the evidcnce is irrefragable. But this is so tempered by the property of assuaging pain, and doing away irri- tation, that in many instances its effects are different— and hence it may be safely and efficaciously employed, where, proceeding on common principles, it would be prohibited. Yet I am not prepared to vindicate fully the practice which I have just stated. My knowledge of opium in the case is too narrow to allow me to do it. Whenever I have prescribed it in the early stage of haemoptysis, great irritation of the lungs existed, attend- ed 'by spasmodic cough, &c. No one, I suspect, will dispute its propriety under such circumstances, and on this footing I am content, for the present, to let it stand. Concerni ng uterine hsemorrhage, the eflicacy of the practice is better sustained. It has been of late particularly commended by Dr. Steuart,* and I recol- lect was as strongly enforced by Professor Hamilton, of Edinburgh, in his lectures. The cases to which it would seem to be only suited, though it is not thus limited, are such as depend on irregular spasmodic movements of the uterus, by which the flow of blood is continued or re- ne wed. Of the employment of opium in the profluvia, I have * Med. Chirurg. Trans. THERAPEUTICS. 163 already said so much under other heads, that very lit- tle remains to add. In treating of diaphoretics, I no- ticed its great utility in the bowel affections, and espe- cially in dysentery, cholera, and diarrhcea. Without recapitulating my preceding observations, I must again insist on its absolute necessity in each of these cases. It is the more important that I should do so, as regards the two former diseases, since the propriety of the practice has been controverted by some of the highest authorities in medicai science. Even by Cullen the use of opium in dysentery is condemned as a "preca- rious remedy, and to be avoided as much as possible." Consulting my experience, I must say, that in dysen- tery opium cannot be dispensed with. Deprived of its aid, I should really not know how tb proceed in the treatment of the disease. As a general rule, I am per- suaded, that it will be found good practice, throughout every stage of the case, that while other remedies are used during the day, to induce tranquillity and sleep at night by an adequate opiate : it is often required even at other times, to relieve certain symptoms arising from excessive irritability of the intestines, as tonnina and tenesmus, than which nothing is sometimes more painful and distressing. Cholera morbus usually proceeds from originai irri- tation in the alimentary canal extending itself to the biliary apparatus. This will appear by adverting to the ordinary causes of the disease, which may be traced to constriction of the surface from cold, or to a morbid impression made directly on the stomach or bowels by miasmata, or offensive food, or interaperance in drinking. It hence follows, admitting the truth of 164 ELEMEXTS OF this statement, that the only indication to be regarded is the removal of the primary irritation, which might be most effectually accomplished by the liberal exhibi- tion of opium. But it happens, that though a theory may be perfectly just, our practice cannot be a regu- lar deduction from it. In some of the cases of eholera, so copious are the secretions of bile, or such the vitia* ted contents of the primae vise from other causes, that a recurrence to opium must be anticipated by evacua- tions, which having been effected, it is then used with great advantage. Nevertheless, cholera sometimes oc- curs where the treatment may be reversed, or the opiate be made to precede the evacuations. It as- sumes a shape, not unfrequently, in which an anodyne given at the commencement of the attack, will speedily check the vomiting and purging, and subdue the at- tending spasms. Having already presented my views of the nature and treatment of cholera infantum, as much in detail as is consistent with my design, I shall dismiss the sub- ject with a single remark on the importance of opium, as well in the early state, combined with calomel to allay irritation, as alone, in the final stages, to re- strain the inordinate and wasting purgings, and that here, as an enema, it proves most serviceable. To dwell on its employment in diarrhcea, were superflu- ous. With a reference to what has been previously said,* it may sufiice to observe, that it is sometimes prescribed alone, though more frequently with the baìsamic, terebinthinate, cretaceous or astringent ar- ticles, according to the nature of the case. * Vid. Cathartics. THERAPEUTICS. 165 Directly the reverse of the preceding affections is that condition of the alimentary canal denominated colie, the naturai discharges being interrupted by spasmodic constriction. Yet, as located in the same parts, I may. perhaps, here introduce it without any great incongruity in nosological arrangement. Not a little was formerly said of the powers of this medicine in colica pictonum. By Riverius, Syden- ham, Huxham, De Haen, and Stoll, it is strongly re- commended, and especially when united with some active purgative. To be serviceable, however, the dose is required to be large, and repeated at no distant intervals. It has not been my lot to have had many cases of it, though the few which have come under my care were successfully managed by opium and calomel, directed for the two-fold purpose of overcoming spasili and evacuating the bowels. On the same principle have I prescribed this combi nation in bilious colie. Nothing can be more ob- stinate than the obstruction in some of these cases,— and, from the violent vomitings which also attend, pur- gatives are with difiìculty retained. The opium seems, therefore, a very proper addition, and I have some- times witnessed striking effects from it, by quieting the irritation of the stomach, and removing spasm, al- lowing thereby the calomel to operate actively. In common flatulent colie, every one is acquainted with its utility, and particularly when united with any of the carminatives. The ordinary objections to the employ ment of opium in the preceding cases, that it has a '«ndencv to bind the bowels, and stili further to con- 166 ELEMEXTS OF fine acrid and offensive matters, which rcquire to be removed, rest entirely on mistaken views of its opera- tion. It is now sufficiently established, that, though in health it generally constipates, its effects are very mudi the reverse in such states of disease, overcoming constriction, and promoting free discharges. Certain affections connected with dyspepsia require the use of opium. The stomach in this disease, owing to debility, is, in numerous instances, very liable to cranips of an exceedingly painful and alarming nature, which are more readily overcome by this than any other remedy. It is also given in pyrosis, and even Cullen reports favourably of it in this case. I have tried it repeatedly, though without any permanent ad- vantage, however it may relieve the uneasiness of the moment. The water-brash is an extraordinary affec- tion. To some sections of the world it is endemial, ex- tending in a greater or less degree to the whole popu- lation. This is the case as regards Iceland, and cer- tain parts of Norway, Sweden, and the neighbouring countries. It prevails throughout the highlands of Scotland—and our western States, I have heard, are not exempt from it. Linnseus says it is produced in the north of Europe, by an excessive consumptionofsmoked meats, and to be cured by a change of diet, which is probable enough. Commonly it may be traced to a connection with a mea- gre and penurious mode of living, though such is not always the fact. I have often met with it, on the con- trary, among the wealthy and luxurious. It depends on a vitiated secretory action of the stomach, and may proceed from a variety of causes. ! IlERAPEUTICS, 16; To mitigate pain, as well as to overcome spasm, opium is one of our chief means in nephritis calculosa, and from it the best effects are sometimes experienced. Aided by venesection and the warm bath, it will hard- ly ever fail to induce such a degree of relaxation of the ureters, as to remove the obstruction, and thereby af- ford relief. Taken by the mouth, it answers very well, though such is the irritability of the stomach com- monly attendant on these cases, that it is not always re- tained, and we are compclled to resort to an anodyne enema, which is probably even more effectual. Exactly with the same view, and with equal success, opium is prescribed in the spasmodic or other obstructed states of the duets of the liver, from biliary calculi, &c. incident to jaundice and other hepatic affections. Nor is it less serviceable in suppressions of urine, from somewhat si- milar causes affecting the bladder or urethra, though a combination of opium and calomel, originally recom- mended by Hamilton, of Lynn Regis, has been pre- ferred under these circumstances, and perhaps would be found a good prescription in ali the above cases. Notwithstanding the confidence once reposed in opium in the neuroses, I suspect its powers have been ovrrrated, and that there are few of these cases in which it has proved decidedly useful. In tetanus from wounds, though stili a favourite remedy, I cannot, from what I have seen, estimate it very highly, and -neh, I suspect, is the general opinion of the practi- tioners of this country. Yet it should be recollected, that the few instances of it reported to have been cured l»y opium, were by unusually large doses. In one case «sspeciallv. fifteen hundred grains of the medicine were 68 ELKMENTS OF taken in seventecn days, and in another, the stili more prodigious quantiry of twenty ounces of laudanum in tvventy-four hours.* In a late tract of much merit on this disease by Morrif.on, the opiate treatment, vigor- ously pursued, is very emphatically enjoined. To an adult, he says, I would never begin with less than one hundred drops of laudanum, the bowels being opened, increasing each dose one-third every two hours, unless sleep or stertor in the breathing ensues, and relates an instance where half an ounce was given at once. As the result of such practice, he states, that he has cured more than a dozen cases of the disease, and has never met with a recovery from it, in which he conceives it did not bear the principal part. This is doubtless true, though it is to be regretted, that he has not told us whether they were idiopathic or symp- tomatic, especially as he considers each form of the disease to be manageable in nearly an equal degree, a point on which he differs so materially from established authority. To which it is to be added, that he brought into co-operation with opium, the copious use of ardent spirits and wine, and that he confesses in Demerara, where he practised, the disease assumes a mitigated and less intractable character, than in most places. Yet the whole of the above facts are calculated to en- courage us to persevere in the use of opium, and to a greater extent than we have commonly ventured to do, with its adjuvants the alcoholic liquors, and especially since, perhaps, we have no mode of practice better Barton TIIERAPEUTICS. 169 supported to substitute. Enormous as are the doses mentioned, they are not wholly incredible to those who have attended to the extreme insensibility of the sys- tem, to the impression of medicine sometimes in this affection. Of the use of opium in hydrophobia I have little to say. On a former occasion I stated as my conviction, that this disease is incurable by any one of the reme- dies or modes of practice hitherto employed, and this was a deliberate and well weighed opinion, the result of some experience, and of much reading and research. As far as I know, there is not a solitary cure of genu- ine hydrophobia on record, so well authenticated as to be credited, though very many instances are to be met with of the imitative affections being relieved by vari- ous means. In relation to opium particularly, I have only to remark, that it is alleged sometimes to have mi- tigated the symptoms, and such is the full amount of its eflicacy. Even so mudi is denied by Magendie, who asserts, as the result of experiments, that no one of the narcotics has the slightest effect in the disease either in man or the inferior animals. Nor, highly as this medicine has been extolled in epilepsy, can I, from my own experience, place the slightest reliance on its powers, as ordinarily employ- ed. This disease, and ali other analogous cases, are most successfully managed by evacuations of the alimen- tary canal, and by venesection. Depletion of this sort will he found more readily to subdue nervous mobility ■—and, after this is accomplished, the usuai tonics ope- rate well, to corroborate the system, or interrupt mor- vol. n.—22 170 ELEMENTS OF bid associations. The paroxysm of epilepsy, however, is often preceded by certain signs. Being admonished of its approach, we should, if possible, ward it off, and, with this intention, where plethora does not exist, we shall sometimes succeed by a dose of opium, aided by a state of entire repose. By Fraser, a late writer on epilepsy, it is, with such a view, highly recommended, and he seems to claim it as a discovery. But it has longer been known, and often prescribed by me. Dar- win gave it successfully in two cases, where the fits came on regularly every night, and a similar instance is related by De Haen, averted by the same prac- tice. In acknowledging its occasionai power to inter- cept the paroxysm, I have no more to say of it in epi- lepsy. In chorea, opium has acquired, perhaps, a less du- bious reputation, many practitioners having borne evidence to its eflicacy. Notwithstanding ali that can be brought in its favour, I am disposed to think that it generally proves impotent to any permanently bene- ficiai purpose, if not mischievous. More than once I have known the disease, treated by opium, rendered worse, and I am not conscious that I ever witnessed the alleviation of any one symptom from its use. After adequate depletion, by venesection and purging, an opiate was prescribed in the evening by Sydenham, without, however, any great confidence in its power to control the disease. Even thus cautiously directed, it is an equivocai remedy. Nor can I say much more of it in hysteria. As a preventive or palliative of the paroxysm, it is some- TIIERAPEUTICS. 171 times advantageously administered, and this is ali that can be reasonably expected from it. In mania of every species, opium is freely used, though, I apprehend, with very little attention to the peculiarities of the case. Not meaning at present to enter into any inquiry relative to the pathology of the disease, or the varieties which it assumes, it will be suffieient for my purpose to state, that, so long as there is much vascular action, or general excitement, opium is not admissible. As preliminary remedies, venesection, purging, cupping, blistering, nauseating doses of emetics, and cold applications to the head, must be resorted to, and will be found more effectually to induce a state of tranquillity, the only indication which this medicine can be expected to fulfil. But, in the weaker forms of mania, or after the system has been reduced by such evacuations as have been men- tioned, opiates may be administered with decisive ad- vantage. To the above rule, there are two exceptions. These are mania, from habitual intoxication, and such as is incident to puerperal women. Of each of these va- rieties, I have had an occasion to say something, and indeed so very recently,* that I feel unwilling to re- touch the subject. Content, therefore, with what I have already stated, I shall only remark as to the first, that the opiate treatment of mania a potu, claimed within the last few years, by several of the European writers, as a great practical improvement, has been known and generally adopted in this city, as far back Vici. Camphor. 17X ELEME>iTS OF as recollection or tradìtional reports extend. With respect to the second, though the means formerly mentioned will often succeed better, stili, in no few instances when a positive anodyne is indicated, an opiate becomes necessary and is productive of great relief. More than one of the cases of cachexiae are benefited by the use of opium. To alleviate the cough, or check diarrhcea, it is universally employed in pulmonary consumption. Nor are its powers limited to these two affections. The inflammatory stage of the case having passed over, I know not any better mode of treating the disease than by opiates. Even when of no permanent advantage, they alleviate the troublesome symptoms, and afford the only comfort at this distressing conjunc- ture. I am persuaded too, that they sometimes prove more than mere palliatives. Ali the narcotics are useful in certain ulcerations, and opium is among the very best of the class. Distinct from other evidence which might beeasilycited, itis remark- ed by Sir Gilbert Blane, " that in ill-conditioned ulcers in the West Indies, opium was found superior to ali other internai remedies for producing a disposition to heal." It is hence conceivable that in some instances of phthisis, it may promote the healing process, and this it may do as well from the property to which I have alluded, as by allaying cough, and restraining the violent action of the lungs. But, whatever may be thought of its powers in the view which I have presented, no one denies its utility in the hectic of consumption. As in intermit- tent fever, it is given in anticipation of the paroxysm, which in the same way it puts off or mitigates. This THERAPEUTIG.S. 173 is accomplishing a good deal, though I must repeat, as the result of considerable experience, that opium, as a general remedy in consumption, is entitled to much higher confidence than it has generally received. Of its use in scrophula, it is not necessary to say much. The cases in which it becomes proper are ob- viously such as are marked by great irritability, both of the general system and the locai affections. Much of what I have said in relation to phthisis, is scarcely less applicable to scrofula : the two affections, if not identi- cal, making due allowance for the modifications they receive from their locations, so nearly approach each other in diathesis and leading circumstances, as to re- quire essentially a similarity of treatment, and particu- larly in relation to opium. Towards the dose of the war of the American revo- lution, opium attained considerable repute in the prac- tice of the British military hospitals, as a specific in lues venerea. It was originally introduced into the treatment of the disease, by Mychaelis, chief physician of the Hessian forces, who gave of it in the twenty-four hours a quantity so enormously large, that I should ne- ver imitate the practice, though we have the assurance of its perfect safety. On a further trial of it, in the Kuropean hospitals, and particularly in those of London and Edinburgh, the statements in its favour were found to be fallacious, and ever since it has ceased to be pre- •vribed as an anti-venereal measure.* ' "The result of my experiments was very unfavourable to the credit of this new remedy, and I believe, that no surgeon in this country any longer relies on opium as a specific. against the venereal virus."—Peanon on the Effects of various articles of the Materia Medica, in the vure of J.ucs Venerea. 174 ELEMENTS OF Yet, during a mercurial course, certain states or symptoms often arise, which can only be managed by opium, such as extreme irritability of the general sys- tem, creating insomnolency and wretchedness, or of the stomach and bowels, preventing the retention of the mercury, or defeating its action. It is scarcely less useful in the painful phagsedenic sores incident to the disease, whether of a primary or secondary nature, as a lotion in the shape of watery so- lution, while its internai use is continued either alone or with mercury. On its power as a palliative in sy- philitic rheumatism, and other painful affections arising out of a general contamination of the system, I need hardly insist, it being universally acknowledged. But, perhaps, it is not so well known, that in the other form of the venereal disease, opium is deserving of some con- sideration. It was the practice of the late Dr. Kuhn to treat gonorrhcea exclusively by a grain of it morning and night, which pian he was led to adopt, after a trial of ali the different modes of managing this troublesome complaint, as, on the whole, the most successful. As a cure of the disease, I have in no one instance exclusive- ly relied on it, though, from the relief it affords, and especially when united with camphor, in chordee, and other symptomatic affections, it promises well. It is generally admitted, that opium rather restrains than promotes the urinary secretion in health. But, as is the case with other medicines, its effects are some- times different in disease, and hence it has occasionally been of service in dropsy. This was the impression of some of the earlier writers, and we are not deficient in evidence of the success of the practice. Facts to this THERAPEUTICS. 175 purport will be found in the works of Bartholine, Willis, Mead, Monro, Heberden, and Home, not to mention inferior names. As a remedy in dropsy, except to allay irritation, I do not know much of opiates. On a former occasion* I mentioned, incidentally, that I had several times seen very striking effects in the disease from the common sweating mixture, consisting of laudanum, spirit of ni- tre, and antimonial wine, by an action on the kidneys, and not at ali on the skin. Examples of this reversed operation are by no means uncommon, either in diapho- retics or diuretics : the articles of each of these classes, whenever disturbed in their ordinary tendencies, being very apt to be diverted into an opposite course. Mudi better is the reputation of opium established in diabetis. The prescription of Ferriar, into which it enters, I have given in my account of Uva Ursi—and by Warren, Elliotsonf and ProutJ opium has been sub- sequently employed, and with great advantage, urging it, in some instances, to a very great extent. There is a species of mortification incident to old peo- ple, described by Mr. Pott, " as beginning at the extre- mity of one or more of the small toes, and passing on, in more or less time, to the foot, ankle, and sometimes to a part of the leg, most commonly destroying the pa- tient," in which he advises the use of opium, as the only appropriate remedy. With this I complete what I have to say of opium in * Vid. Diaphoretics. t Vid. Elliotson on Prussic Acid. J Vid. Prout on Calculous Complaints. 176 l.LEMENTS OF the cure of disease. Many other cases in which it is given might have been added, and especially where it is used merely to lessen irritation, relieve pain, or in- duce sleep. But in doing this, I should probably have incurred the charge of prolixity, without affording any very important practical illustrations. Enough, surely, has been stated to serve as a direction in its further use, and to convince us, that, while susceptible of the most diversified applications, it can only prove beneficiai when prescribed by an enlightened and discriminating judgment. As it may be regulated, so, indeed, will it deserve to be considered, either as the u magnum Dei donum,"* or as a weapon of danger and of mischief. To dose my account of this article, it remains to make a few remarks concerning its pharmaceutical pre- parations. As it comes to us, opium is a thick, dark cake, some- times soft and adhesive, though more commonly hard and dry. When fractured, it is of a brown colour, having a strong foetid odour, and a nauseous taste. What is termed the extract differs only from the crude opium of commerce, in being defecated, or divested of its feculencies and impurities. Different menstrua operate on opium as solvents. Its resin is dissolved by alcohol, or proof spirit, making a tincture, commonly called laudanum, which retains its virtues. The gum is dissolved by water, forming, as it is termed, the aqueous solution, which is generally considered as not so active, though there is some dif- ference of opinion on this point. Wines also afford * Mead. J 1IERAPEUTICS. 177 a solution, which, however, is thought objectionable, as it becomes sour by keeping. The solutions by the ve- getable acids have been represented as comparativdy feeble, though it now appears that the re verse is true. Of opium and such preparations of it as are chiefly used, I must say a few words more in detail. Except that it is rather slower in its operation, I ani not aware of any objection to it in substance. Certainly it is not so apt to be rejected where the stomach isirritable, and especially if the pili has been preparedfor some Urne. It is said also to answer better in the affections of the alimentary canal', as colie, diarrhcea, &c. The average dose of opium is about one grain. Laudanum, formerly called Thebaic tincture, from opium having been originally procured from Thebes, in Egypt* is given in the same cases in which the article in substance is used, and is more commonly prescrib- ed. The dose for an adult is about twenty-five drops, for a child at the period of birth half a drop. Of the Elixir Paregoric, there are two kinds kept in the shops, the one an ammoniated,* and the other a camphorated tincture of opium.f These are of differ- ent degrees of strength, the first containing a grain of opium to the drachm, while the second has only this quantity in half an ounce. The camphorated tincture is a much less unpleasant preparation, and is usually preferred. It is supposed to be well suited to catar- rhal and other pectoral affections, occurring in aged people, and the dose is about one drachm, which * Tinctura opii ammoniata. Pharm. Ed. t Tinctura camphorae composita. Pharm. Lon. VOI.. li.—23 178 ELEMENTS OF contains little more than six drops of laudanum, but is rendered more powerful by some other ingredients which enter into its composition. To the above preparations may be added another un- der the denomination of Black Drop, which, though not oflìcinal, has long been vended as a nostrum in this city, and is now much employed here, and in Europe.* Of * Take of opium four ounces, sharp vinegar or lemon juice, four pints. Digest three weeks, and then add saffron, cloves, nutmeg, and cinnamon, of each an ounce, coarsely powdered. Continue the digestion a week longer, straijj through flannel, and evaporate the liquor, till reduced to the state of syrup. 2. Take half a pound of opium slieed, three pints of good verjuice, one and a half ounces of nutmegs, and half an ounce of saffron. Boil them to a proper thickness, and then add a half pound of sugar, and two spoonfuls of yeast. Set the whole in a warm place near the fire for six or eight weeks, then place it in the open air till it becomes a syrup. Lastly, decant, filter, and bottle it up, adding a little sugar to each bottle. As a substitute for the Black Drop as now made, the follow- ing preparations have been proposed : Denarcotized acidulous Extract of Ofiium.—Digest 3i. coarse- ly'powdered opium in ftjj. sulphuric ether of the specific gravity of .735, for ten days,* occasionally submitting to a moderate heat in a warm bath ; distil off the ether and add fresti portions until it ceases to take up narcotine or act at ali upon the opium, which may be readily known by dropping a little on acleanpane of glass, which will leave no trace when the opium is complete- ly exhausted : the second or third distillation will prove suffi- cient,most of the ether may be saved if prepared with care and in a proper apparatus. Professor Hare recommends the diges- tion of the opium in ether, to be performed in the Papin's di- gester, submit the opium thus treated to the action of spt. vin. rect. Sviii. acetic. acid. fort. ^j-t aqua^vii. and digest for seven • When it is necessary to prepare it in baste, less time may be employ- ed, by submitting it more frequently to the temperature of ebullition. f Acid pyroligneouspure, (concentrateci). THERAPEUTICS. 179 the two formili» annexed, the second is commonly adopted, and the tincture thus made has nearly twice days, filter and evaporate in a water bath to the consistence of an extract. This in fact will be an impure acetate of morphia, possessing most of the advantages of that valuable medicine. One ounce of the best Turkey opium yielded by this process 3vi. of extract. Laudanum and other preparations may be made of the usuai standard, calculating gvi. of the extract equivalent to 3ji. of opium. Denarcotized acidulous Tincture of Opium.—Digest Si. of coarsely powdered opium in one pint of sulph. aether, s. g. .735 for ten days, occasionally submitting it to the influence of* a moderate heat, until it ceases to act upon the opium ; separate the opium and dry it, then digest in spt. vin. rect. Sviii., acetic. acid. fort. ."fii., aqua 3 vi. for seven days, and filter. This prepa- ration will be found to possess great advantages over laudanum and the black drop of the shops, to which it will be much pre- ferable, inasmuch as it will be destitute of the stimulating prin- ciple (narcotine), which produces such distressing effects, and frequently forbids the administration of opium, where it might otherwise be extremely useful : the addition of acetic acid will contribute much to increase the calming or sedative effects, which are most generally desired, and for which opium is par- ticularly given. By its union with the morphia, it forms in solu- tion the active sedative salt of opium, (acetate of morphia) and differs only from the solution of the acetate of morphia of the shops, in its stale of purity; and as the extraneous matter with which itis associated has no effect on the animai system, itmay be considered as good an article, and should be preferred for general use, in consequence of being much less expensive. As this preparation will always possess uniform strength, and a like proportion of opium, it certainly deserves a conspicuous place among our pharmaceutical preparations, and justly merits to supersede entirely the common black drop of our shops, which is a very uncertain preparation, difltringevery where in activity from the indefinite and vague manner it is directed to be made, to say nothing of the worse than useless articles which enter into its composition, such as yeast, nutmeg, and saffron.* • Vid. Carpenter on Opium. 180 ELEMENTS OF the strength of laudanum. This preparation is one of value, and under an improved formula,* may deserve a place in our pharmacopceiae. It is distinguished by the property of being well received by the stomach, and while it produces the anodyne effect in the fullest extent, isnot so apt to leave behind it any distressing consequen- ces, such as sickness, head-ache, nervous tremors, &c. This superiority is owing to the acid menstruum em- ployed. It is an interesting fact, that laudanum, in a small portion of vinegar, operates much more kindly. This is indeed so true, that I have known several per- sons who were utterly precluded from the use of opiates in the ordinary forms, take this acetous mixture with great comfort and advantage. The same happens when the tartaric or nitric acid is added to laudanum, and which is doubtless to be ascribed in each instance to the formation of soluble salts with morphia.f It has recently been discovered, that opium, besides * The following formula has been suggested by Dr. Harts- horne, of this city. Turkey opium, ^j. Strong- vinegar, §vj. Alcohol, 3*iv. Triturate the opium with vinegar, add alcohol, and digest for ten days. t In the following preparation of opium, we are told the taste and smeli of the medicine are completely concealed, and that it' leaves no unpleasant effects on the stomach or head. R. Extr. glycyrrh. ----opii àà 3*ss. Potass. carb. gj. Aqualfci'j. The whole to be boiled to one pint, the clear liquor to be poured off and evaporated to twelve ounces; then add spirit of THERAPEUTIfìS. 181 its well known ingredients, contains two proximate principles denominated morphea and narcotina. The pimento five ounces, and half a drachm of finely powdered co- chineal.—Medico-Chirurgical Revieiv. ' There is another preparation of opium lately introduced by Dr. Porter, of Bristol, England, which is highly commended. It is entitled liquor morphii citratis. The following is his for- mula : R. Opii crudi optimi $\v. Acidi citrici, cryst.^ij. Semel in mortario lapideo contunde, dein aquae distillata? bul- lientis Oj affunde—et intime misceantur—macera per horas vi- ginti quatuor—per chartam bibulosam cola. In commenting on the above preparation, Dr. Paris observes, " I have lately submitted it to the test of experience, and it cer- tainly possesses the merit of a powerful anodyne, operating with less disturbance than the more ordinary forms of opium. I also take this opportunity of stating, that the pyroligneous acid was used as a menstruum, and the effect was similar to that of Dr. Porter." LIQUOR OPII SEDATIVUS. By this title a preparation of opium is made and vended by Mr. Battley, a well known apothecary of London. The exact composition or formula is not revealed. We are told general- ly, that it is " the sedative property of opium, separated or di- vided from every other property of opium, so far as I have suc- ceeded in effecting such division or separation, diffused in distilled water." " It has," continues he, " been ascertained by extensive ex- perience, in one of the largest fields of observation and proof, that it is superior to the vin. opii, and other preparations of opium, in affections of the eye requiring the use of opium—aud in the last stage of cancerous tumours, after the skin grows dry, and the fungous appearance takes place, the power of this medicine in allaying pain and mitigating suffering, would alone render itan object of professional and public interest." It is conjectured by Dr. Paris, that this preparation owcs its 182 * ELEMENTS OF first is an alkali which will unite with most of the acids, forming neutral salts, though the most active is with the acetic, constituting the acetate of morphia, now generally to be met with in the shops. Exhibited in only half a grain, it is represented as producing the effects of the largest dose of opium, differing, however, from it in this respect, that its operation is purely seda- tive, calming irritation, and composing to rest, without any of the distressing secondary consequences of opium itself. Narcotine, on the contrary, is described by Magendie, as stimulant, and to which he ascribes ali the unpleasant ultimate effects of opium. As regards the acetate of morphia, I have found from the most ampie experience, ali which has been al- leged in its favour, to be strictly correct. It is un- doubtedly among the purest of the sedatives, having every property of opium, except that of stimulation, and is applicable to similar cases, unless excitement is to be raised or sustained. Comparative trials have in- deed so completely satisfied me of its vast superiority over every other preparation of opium, that I have nearly ceased to employ them, and I believe, that many of our practitioners entertain the same impression, and act accordingly. The sixth of a grain of it, is about equal to a grain of opium. efficacy to the acetate of morphia. He says, that by being kept only a short time, it undergoes certain changes, which are an insuperable objection to its admission into practice. To this, it is replied by the inventor, that the addition of a sixteenth part of spirit prevents such changes for months, which, however, he rather inconsistently admits, would render it unfit for the very purposes for which he previously extols it. THERAPEUTICS. 183 Cases do occur, in which insuperable difficulties ex- ist to the administration of opium, or any of its common preparations, by the mouth, and under such circum- stances, we resort to anodyne enemata, the mode of making which has already been described.* But this is a disagreeable operation, which is often pertinaciously resisted, or, owing to irritability of the rectum, the defects of the machine, or clumsiness of the operator, cannot always be accomplished. As a substitute in sudi instances, I have often directed a suppository of opium, and derived from it, in the fullest degree, the desired effect. To put a pili of opium into the rectum is so perfectly easy, that it may be done without the pa- tient even knowing it—and it proves so little offensive to the bowels, that no effort is made to expel it, and consequently is mostly retained. By some practitioners, and especially Ward, who has written plausibly on the subject, f great confidence is reposed in the external application of opium, and also in laudanum, as an embrocation in many diseases. But the practice is altogether delusive, and deserves no attention. Let it be managed as it may, opium ap- plied to the surface produces no constitutional impres- sion. On this point I do not speak lightly. I bave seen independently of my general experience, a plaster on which an ounce of soft opium was spread, worn by a child, for many hours, without any perceptible effect on the nervous system, the circulation, or other func- tions. Yet, as a mere locai remedy to assuage pain, I * Vid. Enemata. t Vid. an Essay on the London Mcd. and Phys. Journal. 184 ELEMENTS OF have no doubt of the eflicacy of such applications, and there is even reason to suspect, that, placed near the nostrils, so that their fumes may be inhaled, they will, by their action on the olfactory nerves, affect the sys- tem generally. It has ^also been asserted, that a small portion of the acetate of morphia applied to an abraded external surface, displays ali its effects on the system, which, on trial, I have found to be equally a fallacy. In dismissing this subject, I shall once more remark, that, using opium by the rectum, it is necessary to tre- ble the dose, and that, however administered, the sus- ceptibility to its impression is speedily wasted, so that we are called upon to augment the quantity considera- bly.* The quantity of this article which has some- times been taken, where the habit is confirmed by long continuance, would be incredible, were not the fact at- tested by indisputable authority. I knew myself, a wine-glassful of laudanum to be given several times in the twenty-four hours, for many months in succession, to alleviate pain from the passage of biliary calculi, and the patient finally recovered, without suffering from this excessive use of the article. But, what is stili more extraordinary, in a case of cancer of the ute- rus, which was under the care of two highly respecta- ble physicians of this city, the lateDr. Monges and Dr. La Roche, the quantity was gradually increased to * It is stated by Orfila, that " the effects of opium are in general more decided when administered by the rectum, than by the stomach," in the relative dose—an opinion very ques- tionale, in the main, though in some instances true. TIIERAPEUTICS. 185 three pints of laudanum, besides a considerable portion of opiuin in the same period.* LACTUCARIUM. This is the title lately given to a species of opium, or, rather, to a substance having the leading properties of opium, which is procured by inspissating the milky juice of the common garden lettuce. It has long been suspected, that ali the lactescent plants have more or less of the narcotic principle, and, as regards lettuce, the point was well ascertained even in the earliest times. Among the fables of an- tiquity, we read of Venus, after the death of Adonis, throwing herself on a bed of lettuces, to lull her grief, and repress her lewd desires. Allusions to its anodyne qualities frequently occur in the medicai writings of antiquity : and we are expressly told thatGalen, in the * Incompatible substances.—Oxymuriate of mercury—acetate of lead—alkalies—infusions of galls and of yellow cinchona. The best mode of treating the inordinate effects of opium, vhcre the stomach cannot be emptied, is by aspersion with cold water, and particularly by cold applications to the head, which generally promote the operation of emetics and relieve the nervous system. Much relianee is also placed in the car- bonate of ammonia, strong coffee, and the vegetable acids. We are told byOrfila, that the decoction of coffee is less en- crgetic, as an antidote, than the infusion. " In combination with the vegetable acids," Dr. Paris says, " the narcotic powers of opium are increased, in consequence of the formation of so- luble salts with morphia. When the opium, however, has pas- sed out of the primae viae, vinegar and acids are then the best nemedies for counteracting its effect';." voi.. 11.—21 186 ELEMENTS OF decline of life, suffering much from a morbid vigilance, had recourse to the eating of lettuce in the evening, which he found "a sovereign remedy." Most of the older treatises on the Materia Medica contain similar notices in relation to the plant, though I cannot discover that it was subjected to any pharma- ceutical process, or incorporated with the regular re- medies. This was, for the first time, done by Professor Coxe, of this University, who, more than twenty-five years ago, very elaboratdy investigated the subject, and showed, by a series of experiments, that there is no es- sential difference between opium and the lactucarium, as regards medicinal effects, sensible qualities, or che- mical composition.* Mudi later, the same inquiry was prosecuted by the elder Duncan, of Edinburgh,—and, without, probably, having any knowledge of what had been previously done, he was conducted to results strikingly similar and confirmatory. As a medicine, he pretends not to any very great experience with the article, though he tells us, that he " has seen manifest good effects from it, in allaying muscular action, alleviating pain, and in- ducing sleep, the three great qualities of opium." The Ìnformation afforded us by Dr. Coxe, is more exact, who, indeed, seems to have used, or caused the the medicine to be used, pretty extensively : and we learn, that in spasms of the alimentary canal, in diar- rhcea, in cough, and in some other affections, its ope- * Vid. Transaclions of the Philosophical Society of Phila- delphia, for the year !797. THERAPEUTICS. 18? ration was precisely the same as opium, It follows therefore, that, as a cheap substitute for that medicine, it is worthy of attentimi, and might be manufactured in any part of the United States, without much trouble or expense. Perhaps it may also have some peculiar properties, which might adapt it to cases, where, from certain idiosyncrasies, none of the preparations of opium can be used. The preparation, dose, and mode of administration, of the two articles, are the same. TELA ARANEARUM. It is an old, and a very general notion, among the vulgar of most countries, that the spider's web, or the spider itself, is possessed of the power of curing ague and fever, and is actually employed with this view. But, with one or two exceptions, they were rejected in regular practice, and their curative effect, if admit- ted at ali, was imputed entirely to the strong sensations excited. by so disgusting a remedy. At his last visit to this city, some years ago, I was informed by Dr. Robert Jackson, of the British army, that, having largely experimented with the web, he had much reason to suppose that popular confidence in it was well founded. In intermittents, he said, its powers were indisputtfbly ascertained, and that as an anodyne to allay pain, or cairn irritation, it proved vastly superior even to opiates. The web, how- ever, had long been accredited as a remedy in these t ases. It is noticed in James's and other old dispen- satories, and was previously used by Lind and Gii Icspic. 188 ELLMENTS OF By one of my pupils,* in whom I could place re- liance, the subject was, at my request, not long after- wards, investigated—and by trial, on himself, as well as on others, he substantially confirmed the preceding statement. In a late work by Dr. Jackson, on fevers, I find a detailed account of his experience with the ar- ticle, which is so interesting, that I cannot forbear to extract it.f * Dr. Broughton, of South Carolina, who made it the sub- ject of his Inaugurai Thesis. t " I think I may venture to say, that it prevents the recur- rence of febrile paroxysms more abruptly, and more effectually than bark or arsenic, or any other remedy employed for that purpose with which I am acquainted : that, like ali other reme- dies of the kind, it is only effectual as applied under a certain condition of habit ; but that the condition of susceptibility for cob-web is, at the same time, of more latitude than for any other of the known remedies. The cob-web was rarely given before the subject was preparedby bleeding, emetics, or purga- tives: and given to a subject so prepared, it seldom failed to effect a cure comparatively permancnt ; relapsc, or conversion into another form of disease, being, upon the whole, a rare oc- currence where the disease had been suspended by this remedy. If the cob-web was given in the time of perfect intcrmission, the return of the paroxysm was prevented ; if given under the first symptoms of a commencing paroxysm, the symptoms were suppressed, and the course of the paroxysm was so much in- terrupted, that the disease for the most part lost its character- istic symptoms. If it was not given until the paroxysm was advanced in progress, the symptoms of irritation, viz. tremors, startings, spasms, and delirium—if such existed as forms of febrile action, were usually reduced in violence, sometimes en- tirely removed. In this case, sleep—cairn and refreshing, usu- ally followed the sudden and perfect removal of pain and irri- tation. Vomiting, spasms, and twisting in the bowels, ap- pearing as modes of febrile irritation, were also usually allay- ed by it : there was no effect from it where the vomiting or THERAFEUTICS. 189 The web has been prescribed by myself and several of my medicai friends, particularly by Dr. Physick and Dr. Dewees, and, though different degrees of value are pain was connected with real inflammation or progress to dis- organization. In cases of febrile depression, deficient anima- tion, and indifference to surrounding objects, the exhibition of eight or ten grains of cob-web was often followed by exhilara- tion :—the eyes sparkled ; the countenance assumed a tempo- rary animation ; and, though the course of the disease might not be changed, or the dangers averted, more respite was ob- tained from a pili of cob-web, than what arises from, or be- longs to the action of wine, opium, or any thing else within my knowledge. " Further, the power of cob-web has been tried, and its good effects have been proved, in other forms of irritation besides those that are strictly febrile. In spasmodic affeotions of vari- ous kinds, in asthma, in periodic head-aches, in general rest- Iessness and muscular irritabiiities, its good effects are often signal. The cob-web gives sleep, but not by narcotic power ;— tranquillity and sleep here appear to be the simple consequence of release from pain and irritation. Cob-web has also been applied locally, under my own eye, to ulcerated and irritable surfaces, with singular good effect. At first, the pain which it occasioned was sharp,—but it was momentary ; and the sur- faces, which had been painful, irritable, and untractable to other applications for weeks or months, were healed up in the course of two or three days at farthest :—the experiment was made on superficial sores only. " I have not made a chemical analysis of the substance in question ; for my chemical knowledge is not of the kind which w»uld enable me to conduct the operation correctly. The cob- web may, perhaps, be thought to belong to the class of poisons; but il is somewhat singular, that I have not been able to dis- cover much difference of effect from a dose of ten grains and from a dose of twenty. The changes induced on the existing state of the system, as the effect of its operation, characterize it as powerfully stimulant. 1. Where the pulses of the arteries are quick, frequent, irregular, and irritated ; they hecome 190 ELEMENTS OF attached to the article, we are well satisfied, that the representation of its virtues, to which I have referred, is very little if at ali exaggerated. In doses of five grains, repeated every fourth or fifth hour, I have cured some obstinate intermittents, suspended the paroxysms of hectic, overcome morbid vigilance from excessive nervous mobility, and quieted irritation of the system from other causes, and particu- larly as connected with protracted coughs and other chronic pectoral affections. Among those who have used it much, I find a contrariety of opinion, as re- spects its mode of operation. While some consider it as highly stimulant, invigorating the force of the pulse, increasing the temperature of the surface, and height- ening excitement generally—others, witnessing no such effects, are disposed to assort it with those remedies which seem to do good chiefly by soothing the agita- tions of the system. I confess that I concur in the lat- calm, regular, and slow—almost instantaneously after the cob- web has passed into the stomach : the effect is moreover ac- companied, for the most part, with perspiration and perfect re- Iaxation of the surface. 2. Where the pulses are slow, regu- lar, and nearly naturai; they usually become frequent, small, irregular,—sometimes intermitting. 3. Where languor and depression characterize the disease ; sensations of warmth and comfort are diffused about the stomach, and increased anima- tion is conspicuous in the appearance of the eye and counte- nance. 4. The cob-web, applied to a bleeding surface, occa- sións a very sharp and transient pain :—the bleeding instantly ceases. The cob-web here recommended is the produce of the black spider, which inhabits cellars, barns, and stables : that which is found upon hedges in autumn does not possess the same power, if it be actually of the same nature." THERAPEUTICS. 191 ter view of its properties. There is much difference in the web of the various species of spider. That used in this city is collected in cellars, and is, probably, the product of the common black spider, which is to be generally met with in such dark and damp places. I have satisfied myself, that the web found in light ex- posed situations, the product of the grey spider, is in ert—and also the web of the other, when old. The recent may be known by its glutinous feel. HUMULUS LUPULUS. The hop is a native of Europe and also of this coun- try. It has hitherto chiefly attracted attention as an article of commerce, from its importance as an ingre- dient in malt liquors. But it is also possessed of such medicinal qualities as entitle it to a place in the mate- ria medica. The flowers of the plant, which only are used, are aromatic, bitter, astringent, and decidedly tonic and anodyne. Of the bitters, there is scarcely one more agreeable to an enfeebled stomach than the hop, and hence it is advantageously prescribed in dyspepsia, particularly where it proceeds from intemperance. Yet it is, per- haps, as a narcotic, that it has the highest claims. The fact of its having this property was long known, so gene- rally so, indeed, that a pillow of it came to be a popular expedient to quiet nervous irritation and procure sleep.* * It is said to have been directed by Dr. Willis in the insa nity of the late king of Great Britain, and with effect. My own trials of it have not, however, inspired any confidence in its powers as an anodyne. 192 ELEMENTS OF An exact investigation of its powers was first made about twenty-five years ago by my friend Dr. De Roche, in his inaugurai essay, at Edinburgh, and since that period it has been much employed in regular practice, both in Europe and this country. Asan anodyne, it may be substituted for opium, where the latter, from idiosyncrasy or other causes, does not suit the case. It is well adapted to drunkards, and I have found it a useful auxiliary in the treatment of mania a potu. The nervous system or stomach being much deranged, the hop will always prove beneficiai. As an antispasmodic it is indeed not without power, and has been prescribed in the neuroses, though with what effect I do not know. I have sometimes tried it successfully in the advanced stages of typhoid fevers, where nervous tremors or subsultus tendinum existed. It is also serviceable in spasmodic uneasiness of the uterus, either before or subsequently to delivery. The hop may be exhibited in decoction or infusion, in tincture, or pills made of the extract. As a tonic, I have found the infusion best, and, as an anodyne, the tincture. The former may be taken in the dose of a large wine-glassful, and the latter in that of a tea-spoon- ful, each to be repeated and increased as the case may demand.* * It has lately been shown by Dr. Ives, of this country, that ali the valuable properties of the hop are resident in a substance only one-sixth part of its weight, which may be separated from it by the processes of threshing and sifting. He denominates it Lupulin. Equally useful in brewing, he has found it far more efficacious as a medicine in diseases the consequences of ex- hausted excitability, or more directly of a deranged state of the stomach and bowels. It frequently induces sleep, and quiets THERAl'EUTICS. 193 HYOSCIAMUS NIGER. The black henbane is a native of several countries in Europe, and succeeds very well among us. Of ali the articles of the materia medica, it is said most to resem- ele opium, at least as regards its narcotic qualities. But it differs from it in several respects. Every part of the plant is possessed of activity, and the root not less than the leaves. The former resembles that of the parsnip, and when eaten through mistake, has sometimes induced the most fatai consequences. It is not used medicinally. Moderately exhibited, henbane invigorates the pulse, with some augmentation of temperature, followed by diminished sensibility, and sometimes by such general composure of the system as to induce sleep. In a larger dose it occasions thirst, sickness, stupor, and dimness of vision—and in excess, delirium, subsultus tendinum, risus sardonicus, coma, apoplexy, convulsions, with a remarkable dilatation of pupil, distortion of counte- nance, weak tremulous pulse, cold sweats, &c. The lower extremities sometimes also become paralytic, or are covered with a gangrenous eruption. Being analogous to opium in its leading effects, it has been resorted to in a variety of cases, as a substitute. It is supposed to have the hypnotic power in a con- siderable degree, without creating constipation of the great nervous irritation, without causing costiveness orimpair- ing, like opium, the tone of the stomach, &c. The preparation commonly used is the tincture prepared by digesting |ii. of the lupulin in Oj. of alcohol, of which the dose is from 3i- to 5ii- It may also be given inpills, in the dose of from six to twelve grains. VOL. il.—25 194 ELEMENTS OF bowels. My hopes, I confess, in the former respect, have not been fully realized. Yet, undoubtedly, it will ease pain, or soothe irritation, and in this way some- times disposes to rest. It has been much extolled in mania, and is also prescribed in a variety of nervous and spasmodic affections, as epilepsy, chorea, tic doloii- reux, asthma,* pertussis, palpitations of the heart, &c. in haemoptysis, attended by spasmodic cough, and gene- neral irritability of system. Nor is it less known as a remedy in scirrhus and cancer, and in scrofulous and other painful ulcerations. To meet these last indica- tions, it is exhibited largely, while the diseased parts are washed with a decoction of it, or covered with a cataplasm of the leaves. The dose of the extract or of the powdered leaves, the only preparations internally used, is one or two grains, to be increased very consi- derably where it is continued for any length of time. There is also a tincture to be met with in the shops, the dose of which is thirty or forty drops. The smoke of the seeds directed to the decayed tooth by a funnel, is said to be an excellent odontalgie remedy. f * The following prescription is recommended by Bree in Bpasmodic asthma : R. Tinct. scili, gtt. x. Acidi nitrici gtt. vi. Extr. Hyoscyam. gr. ili. Aq. font. §iss. M. To be repeated every third or fourth hour during the pa- roxysm. f Lately the chemists have detected an alkaline element in henbane, which they denominate Hyoacyama. T1IERAPEUTICS. 195 C0NIUM MACULATUM. Cicuta is indigenous to Europe. It grows, however, in many parts of the United States, and can now be pro- cured in abundance, and of an excellent quality, in the neighbourhood of this city. No part of the plant is destitute of strength, though the leaves are possessed of most activity. Taken in the ordinary dose, not much sensible effect is created—when increased, vertigo, dis- turbed vision, tension of the forehead, nervous tremors, &c. are induced—and urged stili farther, we have ali the violent consequences described under the preceding article. Cicuta was known in the earliest times. The Greeks used it to inflict the punishment of death, and among the victims of its poisonous agency, was one of the most celebrated of the philosophers of antiquity. Nothing, however, seems to have been accurately ascertained re- specting its medicinal virtues, till Baron Stcerck com- menced his experiments with this and many other of the narcotic plants. Having proclaimed its eflicacy in scirrhus, and in cancerous sores, the weight of his au- thority speedily attracted a good deal of attention to it, and cases in attestation of its powers were published by many distinguished practitioners in every section of Europe. These annunciations were so confidently made, that the medicai world appeared to be persuaded, that what had so long been desiderated, a remedy for these dreadful affections, was at length obtained. But a more candid estimate of its powers has led to the con- elusiun that, while it is inconipetenl to a radicai curcof genuine cancer, its utility as a palliative is undeniable. 196 ELEMENTS OF It relieves the pain, renders less acrid the quality of the matter, and sometimes improves the general condition of the ulcer. Even more does it accomplish, in the antecedent state of cancer, in resolving glandular indu- rations, real or approaching scirrhosity, and particularly in the testicles, mammse, or uterus, and here it succeeds best united with small portions of corrosive sublimate or arsenic. Its utility in the latter case, though denied by Alibert from his own experience, which he tells us was extensive, I have seen proofs of so frequently, that my confidence remains unimpaired. Be this however as it may, there are few remedies more unequivocally serviceable than the cicuta in scrofulous ulcerations. These commonly appear about the neck, or seize on the fauces, the tongue, the scrotum, in men, or the labia in women, and the rectum in both sexes, which are ali sometimes of a very intractable nature. It has also been found advantageous in the ulcerations of the advanced stages of the venereal disease, and it is most unquestion- ably one of our best means in the irritable sores of pseudo syphilis. In such cases, while given internally, it should also be used as an external application, in the shape of a lotion or cataplasm. Thus employed, if it do not al- ways advance the cure, it stays the progress of the dis- ease, and mitigates the violence of pain. Nor is it scarcely less serviceable in several of the cutaneous diseases. Even in leprosy, it has done good, having, in the hands of the late Dr. Kuhn, great- ly relieved, if it did not entirely cure, a case of it. Elephantiasis, perhaps a species of this foul distem- per, is certainly sometimes successfully managed by it. To this point we have the evidence of the West Indian, THERAPEUT1CS. 197 as well as of some of the European writers. No op- portunily has ever occurred to me of seeing it employ- ed in these more inveterate affections, though, with the facts which have been stated, I cannot doubt of its utility. My experience is limited to more ordi- nary and venereal eruptions, in which I prescribe it sometimes with advantage. Combined with arsenic or corrosive sublimate, or a very small quantity of calomel, too small even to excite salivation, we improve the ef- ficacy of hemlock in the whole of the cutaneous affec- tions. Cicuta has been found useful in the chronic state of rheumatism, venereal, mercuria], or ordinary—in the former instance with corrosive sublimate, and, in the two latter, with antimony. It has also been recom- mended in the advanced stages of pneumonia, and there is some reason to suppose advantageously. Cer- tain it is, that I have palliated symptoms by the use of cough mixtures, in which cicuta was substituted for opium. Cases are indeed recorded of confirmed genu- ine phthisis having been cured by it alone. I have never witnessed any such signal effects from it, though it is altogether likely that it might contribute to heal scrofulous ulcers of the lungs. Much was once said of it in asthma, without, how- ever, the cases to which it is applicable having been pointed out with perspicuity. I formerly employed it a good deal in this disease, and with varied success. To spasmodic asthma, it seemed to be best suited, and, as a palliative of the paroxysm, is, at least, deserving of some slight attention. In pertussis, it has been stili more celebrated by Buttcr and others. That it proved beneficiai in some 198 ELEMENTS OF instances, is too well authenticated to be doubted : yet it seems by degrees to have lost its character, and now is nearly rejected. Baffled in my attempts to cure this obstinate complaint by the ordinary remedies, I formerly resorted to it. Like an opiate, I found that it allay ed the cough for the moment, but made no very decided impression on the disease. No inconsiderable reputation did it once maintain in other nervous and spasmodic affections, as epilepsy, chorea, hysteria, tic doloureux, &c. But I suspect that few now doubt of its inefficacy in most of these cases. No one, I am sure, would at present think of trusting to it in epilepsy or chorea. In very large doses, I am inclined to believe that it is occasionally produc- tive of advantage in neuralgia. I have seen more than twenty cases of this extraordinary affection, and, in most of them, the pain was at least mitigated by the free exhibition of the medicine. One radicai cure Dr. Fothergill effected by it, and lately, my friend, Pro- fessor Jackson of Boston, than whom I should in vain look for higher medicai authority, has greatly extolled it. By the very liberal and long continued use of it, I am assured, he has been exceedingly successful in several instances of the disease. Its reputation is, perhaps, as well established in jaun- dice, particularly when proceeding from spasili of the biliary ducts. The New-England physicians seem much attached to it, it having received the unequivocal commendations of Drs. Jackson, Bigelow, Fisher, and Thatcher. " When," says the latter of these writers, i( the dose is graduaily increased until its effects are distinctly felt in the head, the ydlowness of the skin and eyes, in most instances, bcgins to disappear by the THERAPEUTICS. 199 second day, and the disease is soon removed." How far this can he relied upon, my own experience does not enable me to say. But of this I am persuaded, as indeed I have previously attempted to show, that the icteric affections are in the beginning more gastric than hepatic, and that it is by correcting the morbid condition of the stomach this article produces its saluta- ry effects. That it is highly useful in certain dyspep- tic states of that organ, attended by much irritation, with pain in the epigastrio and right hypochondriac regions, furred tongue, and sallow complexion, is a fact which I consider as amply established. Cicuta has been very indiscriminately prescribed in mania, and, of course, with opposite results. Of its powers in these diversified cases, I cannot speak from my own experience. But it is obvious, that its ad- ministration ought to be regulated by nearly the same principles which guide us in the use of opium. To puerperal insanity, and that species induced by in- temperance, though supposed to be particularly suit- ed, I have not the least doubt, it is incomparably in- ferior to combinations of opium and camphor, in both cases. In concluding the history of this article, I wish to press its importance. There are indeed several dis- eases, in which it is of great value. We have, per- haps, no medicine, or set of medicines, capable of producing precisely the same effects. I am led to en- force my recomraendation of it strenuously, as, in conse- quence of the denunciations of some late authorities, it is at present not mudi prescribed. Having employed it very extensivcly, both in pub- lic and private practice, 1 ani convinecd. that its pow- 200 ELEMENTS OF ers have been much less exaggerated by Stcerck than is now generally supposed. As an active remedy, it has lost its reputation, I suspect, in this country, from its being formerly found in the shops in a very inert state, and, probably, stili more from the small quantity in which it is exhibited. The extract of hemlock imported from Europe, is rarely possessed of any strength. But the several prepa- rations of the plant from the American growth, may be now had in great perfection.* Being at ali times an article of uncertain operation, I generally begin with about three grains, thrice a day, and cautiously enlarge the dose, till it acts powerfully on the system. In se- veral cases, I have given as much as half an ounce of the powdered leaves, or recent extract, in the day, and once nearly doublé this quantity of the extract. My rule, in short, is gradually to increase the dose, till some very positive effect is produced, and the only circumstances which cali for a reduction of it, are gid- diness, nausea, or purging. When these come on, we must intermit it for a time, or lessen the quantity. Bold- ly prescribed, as I have directed, I may venture to re- peat, that the cicuta will rarely disappoint our just ex- pectations.f Its inordinate effects are best controlied by the use of vinegar. $ * In the preparation of the extract, much care is demanded. We are told by Orfila, that a drachm of it prepared by himself was more efncient than an ounce of such as he procured in the shops. t The medicinal activity of this plant, resides in a resinous element, which may be obtained in an insulated form. It is called conehi. The solubility of this principle in alcohol, ren- ders a tincture of cicuta an cligiblc mode of preparation. t Vid. Orfila. THERAPEUTICS. 201 ATROPA BELLADONNA. The deadly night-shade is a perennial plant, grow- ing in different parts of Italy and Switzerland, which I believe has not been cultivated to any extent in this country. It is usually found in dark and sequestered places, remote from other vegetation. Every part of it is ac- tively virulent. It bears fruit, which, when ripe, re- sembles the cherry, and is frequently eaten through mistake. Where the effects are comparativdy light, much nausea exists, with a universal sense of weak- ness, amounting to inability to move or stand, with frequent swoonings, or we are presented with the phenomena, and especially in children, of intoxication, or a sort of gay delirium, in which take place the most sudden alternations of singing, crying and laugh- ing,—agitation] of the muscles as in chorea, curious gestures, the countenance fixed or occasionally moved by an unmeaning smile, from ali which there is a gra- duai restoration, without any consciousness of what had passed. But in excess the symptoms are of the most alarming and distressing nature, as dryness of the mouth, insatiable thirst, convulsive tremblings of the tongue, diflìculty of deglutition, great anxiety about the praecordia, with an inability to vomit. Delirium next ensues, accompanied by gnashing of the teeth, and the most horrible spasms and convulsions. The eyes are protruded, with a droll or violent and furious ex- pression, the pupil remains widely dilated, being in- vol. n.—26 202 ELEMENTS OF sensible even to the strongest giare of light. The face is tumid, and assumes a dark red colour, with the jaws locked, as in tetanus, the pulse is feeble and irregular, and there is much tonnina and tenesmus. Death taking place, the body rapidly putrefies, emitting a stench singularly offensive. On dissection, the marks of extensive mortification of the stomach, intestines, and neighbouring viscera, are revealed. Deleterious as are its effects, under such circumstances, it may stili be so managed, as to become a safe and useful medicine. Experiments show, that, with very considerable narcotic power, it slightly promotes most of the secretions and excretions, and especially the perspiratory, urinary, and salivary discharges. It is one of the narcotic articles much employed half a century ago, in a great variety of complaints. Those, however, who were led to its use, speak very contra- dictorily as to the result of their experience. In epi- lepsy, chorea, tetanus, paralysis, and some other cases of neuroses, it is now generally conceded, that very little has been done with it. Yet, of late, it is extol- led in neuralgia facialis, by an English writer,* and much has been said on the continent of Europe, of its powers in hydrophobia. It has also been recommend- ed in dysmenorrhcea, and stili more strongly in pertus- sis, by Brera, Huffeland, Alibert, and other foreign writers, by some of whom indeed it is pronounced to be a specific, no confirmation of which I have witnessed. 4 Bailev on Belladonna. THERAPEUTICS. 203 Medicai opinion is low in relation to its powers in the several forms of mental derangement. Excepting a notice of its utility in those cases, dependent on sup- pression of discharges, or recession of eruptions, in a late British journal, it has received no attention of late in the disease. But it has retained more reputation as a remedy for cancerous ulcers, and other kindred com- plaints. Even Cullen, so sceptical on the subject of medicines, and especially of this very class, expresses some confidence in its eflicacy. He states, that he has known a cancer on the lip entirely cured, a scirrhosity in a woman's breast dissipated, and an ulcer below the eye which assumed a cancerous aspect, considerably amended by its use. " But," continues he, "I must at the same time own, that in several cases, both of scirrhosities and open sores, it has not answered my ex- pectations." It would be easy to collect, from the writers of the period when the medicine was in repute, many addi- tional facts of the same purport, were it not superflu- ous to multiply authorities on this point. There can be little doubt, from a survey of the whole evidence, that it has occasionally been of service in these cases, and that, either from the caprices of medicai fashion, or from the dread of prescribing so poisonous an article, it has been prcmaturely abandoned. Evincing, as before remarked, some diuretic pro- perties, it has been used in dropsy, though with what degree of advantage, I cannot say. Nor do I possess more knowledge of its use in iutermittent fever, a dis- ease in which it is proposed, as a substitute for opium, to avert the paroxysm. 204 ELEMENTS OF Applied to the eye, in a weak watery solution, the extract of belladonna widely dilates the pupil, and it is said, by the action which it induces, the crystalline lens is, in some degree, brought forward. To effect the former, it is resorted to by surgeons, in the extrac- tion of cataract, and to facilitate some other operations on the eye. An analogical extension of the practice has recently been made to some of the purposes of midwifery. (( In a few of those perplexihg and wearisome cases of labour, arising from rigidity of the os and cervix uteri, and which often harass both patient and prac- titioner, through successive nights and days, I have," says Dr. Conquest, "seen decided benefit result, from the introduction of about a half to a drachm of the ex- tractum belladonna^, by gently rubbing it about the mouth and neck of the womb. It has suspended un- productive uterine action, and produced relaxation of parts, so that, on the recurrence of expulsatory efforts, the os uteri has readily yielded, and permitted the head of the child to pass." This suggestion, I am in- duced to notice, more from the respectability of the source whence it proceeds, than any conviction of its importance. More attention does the practice deserve in the highly inflamed and irritated states of gonorrhcea, attended by chordee, which are often very speedily re- lieved, either by an injection of a weak solution of the extract, or by a plaster of it applied along the course of the urethra. The most extraordinary application of this article, is to the prevention of scarlatina. With this view it was directed by Hahneman twenty years ago, but having THERAPEUTICS. 205 inspired little confidence, the practice was neglected. It has again been revived, and there is some respecta- ble evidence of its success. Berendt, an Austrian phy- sician, declares, that under the use of belladonna, only fourteen out of one hundred and ninety-five children exposed to the contagion, took the disease, and who had it very mildly. We are further told by Professor Herholdt, of Copenhagen, that he found it to preserve several hundred children, during its prevalence as an epidemie in that city, and on a subsequent occasion, he remarks, when it appeared even more violent, out of nearly an hundred families, ali escaped except one, and of this, he is doubtful whether they took the me- dicine. To what extent these statement^ are to be credited, I shall not attempt to determine. The facts, however, are curious, and adverting to the strong impression of the article, we may, on the principle of the incompatibility of two actions simultaneously ex- isting, get an explanation of its modus operandi, and be not altogether incredulous. That maintaining a Constant impression on the stomach, by food, cordial drinks, and even by certain medicines, as opium, or bark particularly, has proved prophylactic in other diseases, is amply established. Ten or fifteen drops, morning and night, of the watery solution of the ex- tract of belladonna, in the proportion of two or three grains to the ounce, was the common mode of exhibi- tion. The dose on ordinary occasions is one grain, either of the extract or powdered leaves, or twenty-five or thirty drops of the tincture, to be repeated every four 206 ELEMENTS OF or five hours. The root, though said to be more ac- tive, is rarely employed.* SOLANUM NIGRUM. The black, or garden night-shade, as this species is familiarly termed, may be met with very generally throughout the United States. Whether it be indi- genous I do not know, though I believe it is consider- ed by the botanists as a foreign plant, derived from the middle countries of Europe. In its medicinal qualities it resembles belladonna, and may be employed in nearly the same circle of cases. The chief differ- ence consists in its commonly exciting the secretory actions, particularly of the skin and kidneys, more ac- tively : it also purges sometimes very copiously. Never having employed the article, I am prepared to say little concerning it. But, like the narcotics of the same family, it was at one time much extolled in scirrhus, cancer, scrofula, syphilis, scurvy, as well as in many of the nervous and mental affections. As a cataplasm, it is said to prove discutient and lenitive to painful tumours, scrofulous, cancerous, &c.—and, moreover, " to abate the violence of inflammation in the eyes, headach, pain in the ears, acrid defluxions, * An alkali called atropia, has been discovered in Belladon- na, by Mr. Brande, to which this medicine owes ali its peculiar properties. The immediate effects of Belladonna, are most promplly corrected by the internai use of vinegar, and external ablutions with cold water, by which the action of emetics is promoted, £cc. THERAPEUTICS. 207 syphilitic and erysipelatous inflammations," Scc. In this mode, and for nearly similar purposes, it was used by the ancients. But in the progress of time the ar- ticle was lost sight of, and continued to be disregarded, till revived by Gataker, an English surgeon of emi- nence, who wrote on the subject about the middle of the last century. Dried or recent, a grain of the leaves, infused in an ounce of boiling water, is directed by him at bed-time, every night. But the quantity is gradually to be in- creased, so that some of the sensible effects which I have mentioned shall be constantly produced. It has indeed been remarked, that without such a decisive action on the system, it does no good in any one disease. SOLANUM DULCAMARA. The woody night-shade, or bitter sweet, is found abundantly in this country, of which it is indigenous, in common with Europe. It delights in a damp soil, protected in some measure from the sun, and hence is to be met with on the side of ditches covered with bushes, or under the eaves of houses not inhabited, or other shaded positions. While it possesses most of the properties of its congenera, it is distinguished by some peculiar ones, and is less deleterious or hazar- dous. Dulcamara promotes the action of the bowels, the skin, and kidneys. It proves, indeed, on some occa- sions, so actively diuretica that it has been placed with that class of medicines, and it would not be diflìcult 208 ELEMENTS OF to collect some evidence of its doing good in dropsy. It is, however, in cancerous, and the analogous cases mentioned under preceding heads, that it has been chiefly employed, more particularly as a wash, where the sores are irritable and ill-conditioned. My own experience with it is limited more to the syphiloid af- fections of this kind, and I have been sometimes well pleased with its effects. Yet, I have derived stili greater advantage from it in chronic eruptions, which I have known it to remove, when even the better es- tablished remedies had totally failed. Willan and Bateman speak very favourably of it in these re- spects, and the latter especially, as a cure for lepra. It is useful, too, in chronic rheumatism, and will oc- casionally afford relief in the painful affections of the advanced stages of syphilis. What are its powers as a deobstruent in glandular obstructions, in which it was once much celebrated, I cannot say from my own ob- servation. Boerhaave speaks favourably of it in phthi- sis, without probably any foundation, and Linnseus, in asthma. On the whole, I believe this to be a valuable article, and entitled to a much more prominent place in the materia medica, than it at present occupies. It is pre- scribed in strong decoction, of which the dose is an ounce, often repeated, and gradually increased till a pint or more is consumed daily. This may also be used as a wash.* * The bark of the root, simmered moderately for some hours in fresh butter or cream, forms one of the most efficacious oint- ments, in the excoriated nipples of nursing women. Thatcher's Dispcntatory. THERAPEUTICS. 209 SOLANUM TUBEROSUM. Being a species of solanum, the potatoe might be suspected to have qualities similar to the other arti- cles of the same family. But it is only within a very short time, that this has been demonstrated satisfacto- rily. Experiments, conducted under the auspices of Dr. Latham, president of the College of Physicians of London, have so fully ascertained its narcotic pro- perties, as to warrant the expectation that it will hereafter hold some rank in the catalogue of medi- cines. He has prescribed it in protracted coughs—in chro- nic rheumatism—in angina pectoris—in cephalalgia— in a case of calculus lodged in the ureter—and in can- cer of the uterus, in ali which diseases it proved highly advantageous. " I am unwilling," he observes, " to say more of the solanum tuberosum, lest I should hereafter be found to have said too much. But I think it superior to hy- osciamus and conium, and, therefore, with confidence reeommend it to my professional brethren, not only in cases where those medicines have been most commonly employed, but generally in ali chronic cases where there may be excess of painful irritations, or irregulari- ty of action." The preparation used is an extract of the leaves and stalks of the plant, of which the dose is half a grain, vol. n.—27 210 ELEMEXTS OF several times a day, to be increased to a mudi larger quantity. *f DATURA STRAMONIUM. This plant is also known by the familiar title of James- town weed, and by a variety of other names, as hen- bane, thorn-apple, stink-weed, &c. Doubts have been entertained whether it be a native of the United States. Be this as it Riay, it now grows in every section of the country. It is one of those ve- getables which delight in a rich soil, and is most com- monly to be seen on a dunghill, or other spots of great fertility. The stramonium is among the most powerful articles of the materia medica, in many of its properties closely allied to the belladonna, though in other particulars it differs. Taken in excess, actions arise of the most vio- lent and irregular nature. It has been known to excite tetanus, hydrophobia, and the wildest forms of mental derangement. Cases of each of these affections, thus produced, are recorded by writers of such respectabi- lity, as to leave no distrust of their truth. * It appears that about a pound of the extract may be pro- cured from seven pounds of the leaves and stalks. t The above experiments have recently been repeated by Dr. Worsham, on the potatoe of this country, and with very oppo- site results. He could not detect any active principle in the extract, pre- pared precisely in the same way, which may probably be as- cribed to the degeneracy of the plant among us, by peculiari- ties of soil, culture, climate, &c. THERAPEUTICS. 211 In Bcverley's History of Virginia, there is a very curious account of its effects. It is related, that at the first settlement of that colony, a party of British soldiers having eaten freely of it as greens, they were soon attacked in a very strange way, or, as he terms it, the 6i effect was a pleasant comedy, for they turned naturai fools." ii One would blow up a feather in the air, another would dart straws at it with much fury, and another stark naked was sitting up in a corner like a monkey,'grinning and making mouths at them : a fourth would fondly kiss and paw his companions, and sneer in their facés, with a countenance more antic than any Dutch droll. In this frantic condition they were confined, lest they should, in their folly, destroy them- sel ves, though it was observed that ali their actions were full of innocence and good nature. Indeed, they were not very cleanly, for they would have wallowed in their own excrements, if they had not been prevented. A thousand such simple tricks they played, and, after e.leven days, returned to themselves again, not remem- bcring any thing which had passed." Duly prescribed, however, it operates as a narcotic stimulant, as has been demonstrated by a series of well conducted experiments.* It is mentioned, indeed, by Prosper, Alpinus, and Kaempfer, that the Turks and Indians, who are not allowed to drink wine, sometimes use stramonium, on account of its exhilarating proper- ties. As a remedy this article was introduced by Stcerck, to whom we are indebted for our knowledge of so many * Cooper* Inaugurai Essay, 1797. 21 a ELEMENTS OF of the narcotic poisons. It was employed by bini in mania, in epilepsy, and in spasmodic and nervous dis eases generally. He ascribed the most valuable powers to it, and was soon imitated in its use by other practi- tioners, who confirmed the accuracy of his observations. More diversified trials, however, gradually diminished its reputation, till finaliy it ceased to attract any atten- tion. Cullen is one of those who speak slightingly of its eflicacy, without, however, pretending to have had much experience with it. In the revival of the medicine, by the American physicians, which was in anticipation many years of what has been published in Britain of its use, it has been more generally applied to the treatment of disease than before, and especially in this city. Mudi evidence exists, to its eflicacy, in epilepsy. It were easy to collect from the medicai records of this country and Europe, a considerable number of cases of that disease, alleged to have been cured or palliated by its steady exhibition. The practice of our hospital and al ms-house might afford some of these instances, as, at one period, it was prescribed very commonly in both of these institutions. No one, however, seems to have reposed sudi implicit confidence in it as Dr. Archer, of Maryland. He does not hesitate to advance the opin- ion, that " the stramonium, in regular epilepsy, is as efficacious as the Peruvian bark in intermittents." But other writers, as Wedenberg, Greeding, Walaborne, Odhelius, and Lind, of Europe, and Fisher and Bar- ton of this country, give a much more temperate estimate of its properties in this disease. As the result of their experience, they state, that it will often miti- gate symptoms, and sometimes even effect a cure. Ex- fUERAPEUTICS. 213 cepting the mixed case of epilepsy with chorea, whicli occasionally arises from the influence of lead, where I have undoubtedly seen it serviceable, my confidence in this medicine is slender, though I would not exclude it altogether in ordinary epilepsy. The fact is, there is only one indication, that the narcotics are capable of fulfilling in the disease, which is, to allay excessive mo- bility of the system, without, however, conducing in any great degree to the advancement of the cure. Con- sidered merely as palliatives, they may occasionally be advantageously introduced, as auxiliary or subordinate measures to the general pian of treatment. The stramonium has also been prescribed in tetanus. No opportunity has occurred to me of witnessing its effects. I do not know that it promises much, though we are told by Dr. Archer, that he once succeeded in moderating the symptoms of the disease by this article, and that a pupil of his effected a complete cure by the same means. It is perhaps worthy of further trial. As a leading quality of the article seems to be to as- suage pain, particularly from inflammation of the neuri- Iema of the nerves, it was to be presumed that it would be useful, under sudi circumstances, and has according- ly proved so in neuralgia, sciatica, and certain palsies. In chronic rheumatism, whether ordinary, venereal, or mercurial, as well as in gout, it is also serviceable in the same way, and has been long employed in these cases, in the regular and domestic practice of this country. Combined with the lactucarium, it is strongly recom- mended by Scudamore, in arthritic spasmodic uneasi- tiess. Manv of the European writers speak favourably of 214 ELEMENTS of it in mania. By professor Huffeland, it is said to be superior to ali the other narcotics, and that he has treat- ed with it very successfully the most obstinate affections of the mind. Bergius employs pretty nearly the same confident tone in recording its effects. He appears to have tried it in ali the shapes of insanity, as in mania proper, in melancholia, in puerperal derangement, in that species which is caused by the habit of intoxication, and also in the low delirium of typhous fever. In our public institutions, it has been resorted to in a great variety of mental affections, and, though with opposite effects, it has, undoubtedly, in some instances, proved useful. To this point we have the concurrent testimony of almost every practitioner who has been attached to these establishments. But the practice, so far as I have observed, has not been regulated with suf- ficient discrimination to enable us to designate thej&rc- cise cases to which the medicine is best suited. Ali that seems to have been particularly attended to, is not to administer it in an active condition of the sys- tem. It has been said, however, to exert its best powers in mania, produced or associated with epilepsy, and where the mind is sunk so low as to approach towards fetuity. The stramonium has been tried in several other af- fections, as asthma,* pertussis, spasmodic cough, and palsy. We, however, have no distinct account of the results of the practice. Judging from its properties, I should suppose it well calculated to do good in these, as * I allude to the internai use of the article in asthma. The smoking of it I have noticed under the head of inhalations. TIIERAPEUTICS. 215 well as in some other cases. Trials, far more extensive than probably have hitherto been made with it, ought at ali events to be undertaken. That a medicine so extremely active should not be more general in its practical applications, is not conceiv- able. Of the diseases in which it proniises to be of the greatest service, are some of those of the eye, as inci- pient gutta serena, and also in certain of the cachexiae. Exhibited alone or in combination with mercury, I have found it a useful substitute for cicuta, in venereal, mer- curial, and scrofulous ulcers of an ili condition. It cor- rects the state of the sore, while it subdues the pain and irritation incident to it. In the management of most cases, it is proper to per- severe in a course of the medicine for two or three weeks, commencing with small doses, and increasing the quantity by degrees, till it produces some striking effect which is generally evinced by gastric distress, giddiness, or headach, and stili more by a dilatation of the pupil, with vision more or less disordered. As an external remedy, stramonium has not been ne- glected. The leaves steeped in brandy are used as an embrocation to rheumatic limbs—and, boiled in milk, make a poultice, which is said to afford much relief in gouty and other painful swellings. Whether either of these popular applications is serviceable, I do not know. An ointment prepared by boiling the leaves, previously bruised, in lard, is also in common use, in burns, in hsemorrhoids, and in psora, and other eruptions, in each of which cases I have witnessed its good effects, parti- cularly in piles. This ointment has, moreover, on ac- count of its supposed relaxing effect, been a good deal 216 ELEMENTS OF resorted to in the case of club feet, and the attestations to its eflicacy are indisputable. I once saw it employed in a painful tumefaction of the knee joint, resembling white swelling, with signal advantage. Every part of the stramonium is active. The ordi- nary preparations internally exhibited are, an inspissat- ed juice, or extract from the recent, and the powder of the dried leaves or seed, made into a pili. Of each of these the dose is about a grain several times a day, to be increased as circumstances demand. I have given twenty, thirty, and forty grains of the medicine in the twenty-four hours, by thus cautiously proceeding. It may also be exhibited in tincture.*f PRUNUS LAURO CERASUS. I This species of laurei is not to be found, so far as I know, in any section of the United States, unless it be preserved as a curiosity. It is indigenous to Europe. Medicai attention was directed to it as an article of the materia medica, nearly a century ago. Experiments made at the time, and subsequently, clearly evince its prodigious power over the system. In a large dose, it extinguishes life at once, without a struggle : more mo- derately given, it occasions convulsions, tetanus, palsy, and those other effects common to ali the narcotic poi- sons. Cullen remarks, that, however violent its opera- * Vid. Inhalations and Emmenagogues. t Mr. Brande has discovered, in the seeds of stramonium, a peculiar ingredient, supposed to be an alkali, which he cali* Daturia. THERAPEUT1CS. 217 tion may be, it never produces any inflammation, as is proved by inspection after death. To this circumstance, he seems disposed to ascribe the speedy and entire re- covery of animals subjected to its influence, which sometimes happens. In small doses, it is said to lower the pulse, and to diminish the sensibility and irritability of the system. It has on this account been tried in pulmonary consump- tion, and, according to the reports on the subject, not entirely without success. In mania, hypochondriasis, and hysteria, it is alleged to have done good, and we are told, that it imparts tone to the stomach, invigorates appetite, and exhilarates the spirits. By some of the German practitioners, it is recommended in hydropho- bia, and we learn from the same source, that a cataplasm of the leaves is an excellent emollient application to painful tumours and ulcers. It has lately been much extolled in intermittents, and is probably serviceable, since bitter almonds, having the same active constituent, according to the reports of Bergius and Huffeland, and some of the French writers, have proved eminently so. We have also representations of its being exceedingly efficacious in very inflammatory gonorrhcea, ophthalmia, and similar cases, which may perhaps be explained by reference to its powers over the circulation. With this article I have no experience. But it seems probable, that it might be made an important remedy, in many of the cases in which the other narcotics are so beneficially employed. I think it promises much in some of the forms of neuroses, and perhaps stili more in scirrhus, cancer, and such like affections. The preparations of the laurei are a saturated tinc- vol. il—28 218 ELEMENTS OF ture, and a distilled water, both made from the green leaves, which, in the recent state, are fragrant and bit- ter, resembling, in a considerable degree, in these re- spects, the leaves of the peach and cherry. The dose of the tincture is from five to ten drops, and of the dis- tilled water from thirty to fifty drops. To the prussic acid which it contains, ali the virtues of the laurei are undoubtedly owing. ACIDUM PRUSSICUM. This acid was discovered by Schede in 1780. It is contained in a variety of vegetable substances, as the leaves of the preceding plant, and of the peach, as well as in the kernel of the cherry, the bitter almond, the peach, &c. Not long after its discovery, it was ascer- tained to be exceedingly active, even poisonous, and a variety of experiments was made by different indivi- duate in illustration of its effects. But it is only within a few years, that attention has been directed to it as a remediai resource, and its properties in this view deter- mined, with any certainty or precision. Concentrated prussic acid, prepared according to the process of M. Gay Lussac, is proved indeed to be, of ali known agents, the most decidedly deleterious. A single drop of it introduced into the throat, or applied to the eye, or injected into the vein of a dog, destroyed life as instantaneously as if he had been struck by a " cannon shot, or by lightning." Even the inhalation of the vapour of the acid, which, from the want of care, was done in one of these experiments, caused very un- pleasant effects. But, poisonous as this article is, it is THERAPEUTICS. 219 ascertained that, when properly diluted, it may be safely, and perhaps usefully prescribed, in various affec- tions. Its operation is immediatdy on the brain and nerves as a sedative, lessening or extinguishing, accord- ing to the force of the impression, the vital energy de- rived from these sources. As a consequence, when moderately exhibited, sensibility and irritability are di- minished, the powers of the heart andarteries reduced, and the other actions of the system in a correspondent degree subdued, without any previous excitation or in- flammation.* By M. Magendie, to whom we are indebted for much of our Ìnformation relative to the practical appli- cations of it, we are told, that having first tried it with success, in nervous and convulsive coughs, he was induced to extend its use to consumption, and found that though he could not confide in it as a cure, in the advanced stages of the disease, it restrained the cough, facilitated expectoration, and procured sleep at night, without colliquative sweats. Encouraged by these accounts, the prussic acid has been pretty extensively employed, more particularly, it would appear, in Great Britain. But, as usually hap- pens in such cases, there is great contrariety of opin- ion among practitioners, as to the precise nature of its powers, and the degree of its eflicacy. By Dr. Gran- ville, of London, who has written a niemoir on the sub- ject, it is declared, as the result of much experience, that he has found it highly beneficiai in most of the * The recent experiments by Mr. Murray show in animals killt'd by it some marks of congestion and inflammation. 220 ELEMENTS OF pulmonary affections, and even in phthisis, at least as a palliative. In several instances of confirmed con- sumption, the effects are represented, indeed, as stili more decisive, and, on the whole, he is led to conclude, that it may sometimes prove a radicai cure of that dis- ease. To these favourable reports, we have the counter- representations of Dr. Elliotson, also of London, who, in a subsequent publication, tells us positively, that he has never derived the slightest advantage from it, as a permanent remedy, in phthisis, and, though oc- casionally useful in simply dry cough, and spasmodic asthma, he found it otherwise in pneumonia and per- tussis. Yet, in a different view, he presents the article with no less ardourof commendation. Having witnessed its salutary effects in a case of violent dyspepsia, in which it was given through mistake, he was induced to try it on an extensive scale, in every variety of that disease. It was employed with success "in the af- fection of the stomach, attended by pain and tender- ness in the epigastrium simply,—as well as where were superadded flatulence, vertigo, headach, loss of appetite, nausea, vomiting, debility, nervousness, cough, dyspncea, pyrosìs, gastrodynia, palpitations, He found it useless in the neuroses, in mania, in active hsemorrhage, in rheumatism, and in other dis- orders, in which it is necessary i( to restrain the force of the blood's motion." He suspects it to be an an- thelmintic—and in the proportion of one or two drachms to a pint of water, it allaycd the irritation of TllERAPEUTICS. 221 prurigo pudendi, and some other cutaneous affec- tions. Might it not be serviceable in prurigo formi- cans, used internally, and as a lotion ? To these accounts many others might be added, prò and con, from the periodical journals of Europe, and I think it may be deduced from the whole, that the arti- cle is stili sub judice, though its reputation is already rather on the wane. In the United States, it has been a good deal em- ployed. We learn, that so early as the year 1811, it was prescribed by Dr. Oliver of Salem, Massachusetts, by whom the credit is assumed of its originai adminis- tration, and his title seems indisputable.*f In this city, most of the physicians have used it, chiefly in the pectoral affections, but, so far as I have been able to ascertain, without having their confidence in its powers at ali confirmed. To this general re- mark, my friend Dr. J. Nancrede must* be excepted, who, in a very interesting Paper, has borne testimony to its utility, in the incipient stages of phthisis, and lends no small support to the preceding statement of * New-England Med. Journal. t I do not know, that, prior to 1811, the prussic acid was used as a medicine. It is true, that the laurei water, which is essentially the same, was the subject of experiment so early as 1730. But this inquiry, which was conducted by Dr. Madden, had for its object, the determination of the pernieious effects of the agent on the living body, and though, not long afterwards, Dr. Langrish instituted a set of experiments to ascertain its medicinal properties, I believe, for it is long since I saw his paper, he made no actual application of it to the cure of dis- case. 222 ELEMENTS OF Magendie.* The same estimate is made of it by Dr. Anthony, a respectable physician of South Carolina.f Lately, I have had some favourable reports of it in in- termittents, which, on several accounts, deserve atten- tion. My own experience with this medicine is too limit- ed to warrant my expressing any decided opinion re- garding it. But I do apprehend, from the trials I have made with it, that there is some enthusiasm in the representations we have had of its efficacy, and that, as to genuine consumption, particularly, though it may palliate distress, it must be added to the catalogue of remedies in that disease, which have so often come forward with " bloated promise and lank perform- ance." There are several modes of preparing the prussic acid, from an absurd propensity to get up hard Greek names, now called hydrocyanic acid, three of which are recommended in the French codex, under the names of Schede, Gay Lussac, and Vauquelin. The two latter are much stronger than the former, though ali three Jose their strength by an exposure to light and air, in a very short time. " To obviate this objection, Dr. Cooper has prepared a solution of the acid in alco- hol, and in this form it certainly is much more easily preserved. Yet, it would appear, that it is stili liable to a slow decomposition, from the circumstance of its peculiar flavour, resembling that of bitter almonds, de- * Vid. the Philadelphia Journal of the Med. and Phys. Sciences, Voi. II. p. 66. t Ibid. Voi. Vili. TIIERAPEUTICS. 223 creasing after being kept for two or three weeks, and therefore, it becomes desirable that it should be re- newed as often as possible." This preparation has been principally used in this city. It is directed in the proportion of one drop to an ounce of sweetened water, of which mixture a table- spoonful may be given, two, three, or four times in the twenty-four hours, gradually increased to a much larger quantity.* DIGITALIS PURPUREA. As a diuretic, I have treated of this article pretty much at length. But there are many cases in which it is employed, where its good effects are ascribed to the power it possesses of reducing vascular action, and lessening general excitement. It is in the relation of a narcotic sedative that it claims to be inserted in this place. Directed by such views of the powers of digitalis, it has, by some of its more ardent admirers, been resorted to, even in the early stages of inflammatory diseases. Many of the ablest physicians adopted this absurd practice, and became completely deceived in the re- sult, by the warmth of their devotion. In this extra- ordinary course the lead was taken by Ferriar, who * It appears from the experiments of Mr. Murray, formerly referred to, that the antidote to prussic acid is ammonia, taken internally or applied to the nostrils and mouth. He is so con- fident of its efficacy, as to declare " that he would feel no hesila- tion whatever, in taking a suflicient quantity to prove fatai, pro- vided there stood by a skilful band to administer the remedy." 224 ELEMENTS OF maintained the article to be even a substitute for the lancet. u It is well known," says he, " that bleeding is very inadequate to the purpose of lessening the ve- locity of the circulation, unless it be carried to a dan- gerous excess. The fox-glove furnishes us with the means of regulating the pulse to our wish, and of sup- porting a given state of velocity, as long as we judge it proper. Entertaining these impressions, he was led to exhibit the medicine in cases of synocha, and, as he informs us, "with much advantage." Nor was the confidence of Currie less in its powers. " I have," he says, (( employed the digitalis to a very considera- ble extent in inflammation of the brain, of the heart, and of the lungs, and in rheumatism, and have suc- ceeded with it, in situations where I should other- wise have despaired." By Mossman we are told, that " by a judicious management of the medicine, various- ly combined, pneumonic inflammation may be obviated with as much certainty as the progress of intermittent fever is arrested by the Peruvian bark. In a subse- quent publication, he further remarks, " My predic- tion respecting the future reputation of the fox-glove, will, I have no doubt, be eventually accomplished. In this town and neighbourhood, the plant is now in more general use than any other healing agent, and, either in a solitary or combined form, it is employed in almost every case of increased vascular action. In pneumo- nic inflammation, and in active hsemorrhage, it certain- ly possesses powers approximating to specific, and even in cases of continued fever, of various types, I have repeatedly witnessed the most beneficiai effects from its administration. By recurring to the periodi- TIIERAPEUTICS. 225 cai publications of the day, it would not be difncult, were it necessary, to swell the number of authorities in favour of the use of this medicine in the phlegmasise and inflammatory fevers. But, whatever may have been the support given to this practice, in the first moments of excitement, it is now abandoned, or very feebly sustained. The phenomena of active hsemorrhage seemed also obviously to cali for the use of digitalis, and it has been accordingly had recourse to, indiscriminately, in bleed- ings of the nose, the uterus, the stomach, and the lungs. Many proofs might be adduced in confirma- tion of its eflicacy in this state of hsemorrhage, and par- ticularly in hsemoptysis and uterine floodings. The publications of the time are filled with cases of its suc- cessful administration, supplied by Currie, Ferriar, and Drake, not to mention a number of other respectable names. Notwithstanding this weight of authority, I am not a convert to the propriety of the practice. Digitalis can never be substituted for venesection in active hsemorrhage. That increase of arterial action, which causes the rupture of the vessel or effusion of blood in any other way, is only to be removed by the lancet. Yet there are cases, in which it may be ser- viceable. Previously to the effusion in active hsemorrhage, the pulse is full, quick, and hard, accompanied with ali the symptoms of the febrile condition. The lancet here is indispensable, as well as in the subsequent stages. But on a considerable loss of blood, the pulso becomes soft, the skin cool, and many of the indications of the phlogistic diathesis disappear. Yet, though the voi., n.—29 226 ELEMEXTS OF impetus of the circulation be lessened, it stili continues more rapid than in health, and, even when thus di- minished, the vessels in some instances are unequal to resist it, and a repetition of the hsemorrhage takes place. It is not always safe, under such circumstan- ces, to resort to direct depletion, the system being so much reduced as not to bear it. Digitalis, on these occasions, is one of our resources, and often displays its best powers. No great inflammatory disposition existing, it abates the force and velocity of the pulse, and this effect may be prolonged without diflìculty, till the vessels recover their naturai capacity of resistance. Even here, however, I doubt whether it is equal to the preparations of lead, ipecacuanha, or antimony. But it is well to be in possession of a number of re- medies, of nearly similar properties, since cases may arise in which, owing to peculiarities of constitution, or other causes, some one may be preferable. What I have said relates to hemoptysis. As to ute- rine hsemorrhages, these may take place either in the impregnated or unimpregnated state of the womb. The former are usually denominated floodings, and the latter menorrhagia. In the management of the first, previous to delivery, with fulness and activity of pulse, we must have recourse to venesection, and afterwards to those articles calculated to subdue and keep down action. It is with this view that digitalis, if at ali admissible, would be proper. But, though it has been so generally com- mended, I doubt whether it is exactly adapted to these cases. I have heard of several, and know of one in- stance where the bleeding became most profuse under its operation. To check this species of hsemorrhage, a THERAPEUTICS. 227 medicine seems to be required, possessitig the two-fold power of lowering the force of the circulation, and con- stringing the gigantic vessels of the pregnant uterus. Digitalis, instead of doing this, has the contrary tenden- cy of inducing a greater degree of relaxation, and, therefore, of aggravating the mischief. I do not say that such is invariably the consequence, or that it may not occasionally be serviceable. Yet I am convinced we have better means, and that on the whole the use of it is precarious, and somewhat dangerous. Let me here repeat, what I believe I have before said, that uterine hsemorrhages, in the unimpregnated state of the organ, which observe a periodical regular- ity, are too apt to be confounded with an increased flow of the menses. To this error we are, perhaps, to im- pute, in some measure, the uncertainty of our practice in these cases. Ali very profuse sanguineous discharges from the uterus, under such circumstances, I maintain to be hsemorrhages, or, in other words, effusions of pure blood, and these are often to an extent threatening immediate danger. Genuine menorrhagia, on the con- trary, even when most copious, is never alarming, ex- cept in its remoter consequences. The former com- plaint may be checked like other hsemorrhages, by an appropriate treatment. But the latter, as resulting from a naturai secretory action of the uterus, will run on to the usuai period of its termination, whatever may be done, unless the discharge be suppressed by some rash and violent interference. Little else is required, in menorrhagia proper, during the flow, than a cool room, rest, some laxative, as castor oil, to open the bowels, and occasionally. if there be pain or irritation, an ano- 228 ELEMENTS OF dyne. But in the intervals of menstruation, we should endeavour by various means to make such an impression on the system, as may restore to the uterus its healthy actions. As regards the application of digitalis to the latter form of uterine hsemorrhage, I have only to ob- serve, that it has rarely proved useful with me, though it is conceivable, that in a certain state rather of irrita- tion than of excitement of the circulation, it might be serviceable. Much was said, at one time, oftne utility of digitalis in some of the neuroses, and especially in epilepsy. It is mentioned with great praise in Salmon's Botanologia, a work upwards of a century old, and more recently by Percival and many other respectable writers. Though it has not been prescribed by myself, I have seen it em- ployed both in Europe and in this country, in almost every shape of the disease, and never with any manifest advantage. In mania, I suspect it is a more important remedy. Yet my experience does not enable me to state, with any precision, the indications which it is best calculated to fulfil. Were I to use it, which I have not done, it would be in the acute stages of the disease, and after venesection, purging, and other directly depleting re- medies. Exhibited under these circumstances, it might, perhaps, lessen the sensibility of the system, and contri- buto towards calming the agitations of the patient. It is here pointedly recommended by Cox, a practitioner of ampie experience, and particularly where there is some fulness of the vessels without fever.* * Cox's Practical Observations on Insanity. THERAPEUTICS. 229 With very few, or, perhaps, not a single exception, digitalis has been used in ali the pectoral affections. It is even now prescribed in the declining state of acute pneumonia, catarrh, and in asthma, angina pectoris, dyspncea generally, and in the cough and hoarseness which follow measles, &c. Conformably to the ordinary prescription in most of these cases, it is added to some cough mixture, to keep in check the activity of the circulation, which it sometimes does exceedingly well. But it is to its use in phthisis pulmonalis that I wish more particularly to attract attention. Not many years have elapsed since the confidence of practitioners was so strongly placed in this remedy, that consumption, even in its last stage, was by its agency to become subject to our control. Need I say, that these high-wrought expectations and brilliant prospects have never been realized ? Yet, it does appear, after mak- ing the amplest deductions for the exaggeration of the moment, that it has evinced occasionally valuable pow- ers in the disease. To deny it would be, indeed, to discredit some of the strongest evidence which has ever been presented in favour of any remedy. By Darwin it was early noticed as an important arti- cle in the treatment of certain forms of phthisis, and not long afterwards it began to attract more general atten- tion. Ferriar resorted to it in several cases, with con- siderable success, but no one has used it so extensivdy as Drake, and his opinion relative to its properties is altogether favourable. " This medicine," says he, " has for several years been given in pulmonary hsemorrhage with effect, and certainly will continue to be, with the intelligent, what- 230 ELEMENTS OF ever may be the result of its trial in phthisis. I am happy, however, to say, that the success which has hi- therto attended the exhibition of digitalis in phthisis, has been very considerable. Many patients in its con- firmed state have been cured by this remedy, and al- rr/bst ali have been relieved. Life has ever been pro- tracted by it, and when death has taken place, whilst the system was under its influence, it has been free from pain or struggle. My cxpectations here have been fully answered." The paper from which I have extracted the preced- ing observations, contains the history of fifteen well- delineated cases of confirmed consumption treated by digitalis, and the result was nine completely cured, one relieved, and five died. These cases, au- thenticated, would be suflìcient alone to entitle the me- dicine to a very great degree of confidence. But I doubt, whether so large a proportion of cures of genuine phthisis was ever effected by any separate ar- ticle of the materia medica, or, perhaps, I might add, by a combination of ali our resources. Nearly about the same time, a series of trials was also made with digitalis by Fowler, and scarcely with less success. Next came Beddoes, who, in an essay on consumption, after stating that his experiments fully corroborated ali the preceding accounts of its eflicacy, makes use of the following emphatic language. u I daily see many patients in pulmonary consumption, advanc- ing towards recovery with so firm a pace, that I hope consumption will henceforward be as regularly cured by the fox-glove, as ague by the Peruvian bark. Could wc obtain a single auxiliary to fox-glove, such as we TIIERAPEUT1CS. 231 have in many instances for the bark, I should expect, that not one case in five would terminate, as ninety- nine in the hundred have hitherto terminated. But I believe that a majority of cases will yield to fox-glove alone. It is evident that no new cases need be suffer- ed to advance beyond the first stage, with the applica- tion of this medicine, and few into it." In the year 1800, M'Ginnis, physician-general of the Naval Hospital at Plymouth, in England, deter- mined, if possible, to settle the question of the degree of eflicacy of digitalis, by an extensive and diversified set of experiments. He enjoyed every possible advan- tage for an inquiry of this description. The cases under his care were numerous, and, being in a public institution, he could enforce those observances in the exhibition of the medicine, necessary to the accurate appreciation of its properties. But, with every allow- ance for the peculiarly favourable circumstances in which his patients were placed, his success was extra- ordinary, and wholly unprecedented. The number of cases he has reported, amounts to seventy-seven, of which, fifty-three were advanced in the purulent, and twenty-five fin the incipient stage of the disease. Now, of these, forty-four recovered, twenty-two were discharged much relieved, and ten only died. It is worthy of remark, that in ali the instances of recovery, the pulse was reduced by the medicine considerably below the naturai standard, and the amendment seemed commensurate with the reduction. In the cotemporary medicai journals, many papers on the subject of digitalis in consumption are given by respectable practitioners. Without any particular 232 ELEMENTS OF analysis, we may collect generally from them, that it very frequently effected cures, and, even where it fail- ed to do so, it almost invariably produced some alle- viation of the symptoms. Notwithstanding, however, ali these accumulated reports respecting its vast pow- ers in this disease, it has, of late, most unquestionably, lost much of its reputation, and seems to be falling into disuse. To the extravagant praise it once received, there has succeeded a more temperate and just estimate of its value. Comparativdy, very little has recently been written upon it. The periodical journals no longer contain any of those illustrations of its eflicacy, or discussions relative to its properties, which, only a short time ago, engaged so much attention, and even the regular treatises on consumption do not always notice it as a remedy of much importance. But this, surely, is running, in some degree, into the opposite extreme. No doubt can be entertained of the eflicacy of the medicine in the pulmonary af- fections. It is equally true, however, that its effect has been very various, and for the most part extremely uncertain. Though a considerable number of cases, under the general denomination of phthisis pulmonalis, have received advantage from digitalis, it stili appears, where the disease was so far advanced, as to be unequivocally marked, the benefit has not been perma- nente and, on the whole, it may be safely affirmed, that the chance of success with it is infinitely less than has been generally aflìrmed. As the result of my own ex- perience I should say, that it is only suited to the early stages of consumption, and such seems to be the view which is taken of its powers by ali the very recent THERÀPEUTICS. 233 writers whom I have consulted. In a work of King- lake, better known by his Treatise on Gout, fourteen cases of the disease are given, chiefly in the incipient stage, in about one half of which, this medicine was decidedly advantageous. But in the suppurative or ulcerative stages he accomplished only one cure. It is stated by M'Clean, a writer on the fox-glove, (i that it will sometimes cure, when the most approved remedies fail. When it is insufficient of itself to sub- due the disease, it will prove a valuable auxiliary to other means. It has always quieted and soothed the sufferings of the patient more or less, and, where it ultimately failed, it lengthened the duration of life, and smoothed the avenues of death. This is ali, I appre- hend, it will be found capable of performing—but this is doing a great deal. Those who expect wonders from it, or that it will in general cure consumption, will be disappointed." In a stili more recent work on consumption, by Reid, nearly the same language is held. He observes, " that it is only in the early stages of this disorder, that we can with any confidence hope for a cure. But that, however violent the previous symptoms, if no ex- pectoration of purulent matter nas taken place, we may, in general, with safety pronounce the disease curable, and that this remedy, under due regulation, and with suflìcient attention to other circumstances of regimen and diet, may be then employed with a pros- pect of almost invariabile success. Fox-glove," continues he, iC although great, has limited powers—and both rea- son and expeiience authorize the condusion, that where the substance of the lungs is generally discased. vol. n.—30 234 ELEMENTS OF and extensivdy ulcerated, neither the digitalis, nor any other agent, can effect more than to alleviate the patient's sufferings. This, indeed, forms the distinc- tive and mdancholy character of pectoral and other affections of organs, which undermine the fabric of mortality, and divide the slender thread by which ex- istence is supported." To these foreign authorities, I may add the sentiments of the medicai men of this coun- try, who, whatever might have been their confidence at one time in the remedy, seem now very generally to distrust its powers, and though it continues to be pre- scribed, it is more from the poverty of our resources in this disease, than from any high expectations of its salutary effects. In the preceding review, I have traced, with some minuteness, the progress of medicai opinion relative to the powers of digitalis in pulmonary consumption, that we may be enabled more justly to appreciate its eflica- cy, and to determine how far this celebrated remedy is deserving of our confidence. Notwithstanding, how- ever, the detail in which I have indulged, I do not know that I have Succeeded in my design, the particular forms or cases of the disease, to which the digitalis is applicable, not being yet clearly made out. Nor, per- haps, can it be done. After ali, much must be left to the sagacity of the practitioner, and the power of discrimination, which is only to be acquired by observa- tion and reflection. I have said, that it seems, at present, to be very generally admitted, that it is only useful in the early stages of the complaint, and of this I am fully persuad- ed. But even bere it proves exceedingly precarious, and very often is manifestly injurious, by prostrating THERAPEUTICS. 235 strength, and accelerating the progress of the disease. Like mercury, and some other articles of the materia medica, digitalis would seem, in many instances of con- sumption, to exchange its medicinal for a poisonous action on the system, and, whenever this happens, we have a train of affections induced, which hurry the case to a fatai issue. Yet, every practitioner has probably been occasion- ally surprised by effects so strikingly salutary from it, that his confidence becomes once more revived, and, thus encouraged, he proceeds with its use, till, by the frequency of its failures, or the mischief it occasions, it is again abandoned in disgust and despair. No doubt much of the uncertainty of the article may be ascribed to the very vague and indistinct notions en- tertained with regard to consumption, including under one general title, which is too commonly done, affec- tions of the lungs, essentially different both in their nature and treatment. As the result of no slender ex- perience with digitalis, I am prepared to state, that the only case of phthisis, in which it can be much relied on, is in the incipient stage, attended with a slight hsemop- tysis, a small, quick, irritated pulse, short and impeded respiration, and a hard, dry, diminutive cough. By subduing irritation, and regulating vascular action, it sometimes proves advantageous, and, though even bere it will very often disappoint us, stili, in the management of such a case, it is one of the resources which ought not to be overlooked. As an external application, a decoction of digitalis is useful in scrofulous and other irritable sores, and per- haps a cataplasm of the leaves is stili more so. A poul- 236 ELEMENTS OF tice may also be prepared with the decoction and ìin- seed meal.* STRYCHNOS NUX VOMICA. Nux vomica is the kernel or nut of the fruit of a tree growing in the East Indies, to which Linnseus has given the above title. With little odour, the nut is very bit- ter, and in its operation evinces some narcotic proper- ties. Largely given, it violently disturbs many of the functions of the animai economy, exciting vomiting and purging, accelerating the pulse, impeding respiration, and occasioning much anxiety and distress about the prsecordia, followed by nervous tremors or convulsions, and sometimes by paralysis or tetanus. But it is said, that, whatever may be the severity of its operation, no signs of inflammation are discoverable by dissection, in which respect it corresponds with the lauro cerasus. Delisle tells us, that, according to his experiments, no effect whatever is induced when it is applied directly to a denuded nerve. But injected into the cavity of a serous membrane, its operation is most decisive, and, in a considerable quantity, would speedily prove fatai. No doubt, however, he has been deceived, as ali the phe- nomena go to show, that its force is mainly expended on the nervous and muscular systems. In common with the rest of the narcotics, nux vomica was, at one period, pretty generally employed, and is reputed to have done good even in plague, by inducing a plentiful perspiration. But, though this statement * Vid. Diurctir:. THERAPEUTICS. 237 may be made on equivocai authority, we have sufficient reason to belicve that the medicine has manifested no inconsiderable power in the more obstinate forms of in- termittent fevers, and particularly in quartan agues* The German writers, who seem most conversant with the article, have also commended it in mania, and in the whole of the neuroses, including epilepsy, and hy- drophobia, as well as in chronic rheumatism, gout, ce- phalalgia, lues venerea, scrofulous sores and chronic eruptions. To these diseases I may add dysentery, in the epidemie form of which, as it prevailed some years ago in Sweden, it is stated to have displayed remarkably beneficiai effects. It was here prescribed, probably as a substitute for opium, in a large dose once or twice a day, evacuations having been premised. But we are told by Bergius, that, though it suspended the com- plaint for a time, relapses uniformly took place, and that its immediate operation was sometimes unpleasant, and its remoter consequences painful and distressing. I have, moreover, understood, that it has proved service- able in fluor albus, and in virulent gonorrhcea, the nut, when given in the former of these cases, being previous- ly roasted. Notwithstanding ali this, it seems never to have had a well established reputation, and so little is it at pre- sent estimated by the British practitioners, that it is retained in no one of the pharmacopceise of their col- leges. But medicai attention has been again called to it by some interesting Communications relative to its use in paralysis. It was remarked, in describing its effects, that it sometimes induces a tetanoid rigidity of the muscles. Being persuaded that this is a very con- 238 ELEMENTS OF stant effect, or one which at least may be commanded, Fouquier, of Paris, some years ago, conceived that it might be applied to the cure of palsy, considering the latter disease to depend on an opposite or relaxed state of the muscular fibre. In the interval which has since elapsed, it has been fully tried—and his own experience, as well as that of Dumeril, Magendie, Hebreard, Hus- son, Asselin, and other highly distinguished physicians, is represented as confirming the truth of the specula- tion, and the vai uè of the practice. Not long after the administration of the medicine, we are told that the tetanoid condition takes place, which ought to be continued by the repetition of the dose, for a greater or less time, as the case may demand. This state is described as having ali the characteristics of real tetanus, and may be partial or universal, according to the force and extent of the impression made. What is very singular, it is declared, that, by a sort of elec- tive affinity, the action of the medicine, when it is given in the proper dose, is directed to the affected limb, leaving ali the sound parts untouched, and this is apt to take place in proportion as the limb is deprived of sensation and motion. Yet, however violent or general the tetanoid affection may be, no danger results from it: the patient, on the contrary, is so little disturbed, that he often sinks into a sweet sleep. To attain the precise effect desirable, it is recom- mended to exhibit four grains of the medicine in sub- stance, or two grains of the alcoholic extract, several times in the day, watching with care the operation of each dose, that it may be duly regulated. But it is sometimes required very largely to increase the quan- THERAPEUTICS. 239 tity, so much so, that in some cases thirty or forty, or fifty grains of the powder have been given at a time. What degree of credit is to be attached to this very extraordinary account, I am unable to determine, having never employed the medicine. But I under- stand it has been done in our public institutions, in a few cases, with little or no success. Yet I do not think that we should draw any condusion against the practice from so imperfect an experiment, especially as it comes to us supported by some of the best authorities of Eu- rope, and so confidently afnrmed that there is scarcely room for doubt or deception. Even admitting that it was fairly tried in the cases to which I have just allud- ed, we may discover sources of failure, without im- peaching its general value, or the credibility of those by whom it is reported. As much as most diseases, paralysis is diversified by its causes—and, while the more simple cases of it are easily managed, there are others, proceeding from some altera tion of structure, or mechanical pressure of the brain or its dependencies, which are placed beyond the reach of ali our means. To correct the poisonous effects of this article, a mix- ture of sulphuric ether and the oil of turpentine, with sweetened water, to be frequently repeated, is, accord- ing to Orfila, most eflicient, the stomach having been previously evacuated.* * Messrs. Pelletier and Caventou have detected in nux vomica a principle termed strychnine, to which its active powers are referrihle. As in the other narcotics, it is of an alkaline nature. 240 ELEMENTS OF SECTION Vili. Antispasmodica, or Antispasmodics. MOSCHUS. Muse is one of the few medicines derived from the animai kingdom. The animai* which affords it, is a native of Siberia, Thibet, China, and many other parts of the eastern world. It appears to be a peculiar secre- tion, deposited in a sac near the umbilicus of the male. Enclosed in small membranous bags, it comes to us in grains, of a black colour, a bitter taste, an unctuous feel, with a very strong and peculiar odour. Musk was at one time a remedy much confided in, and, as may be supposed from its powers, more particu- larly so in the nervous and spasmodic affections. It has been given in tetanus, and, according to Heberden, with considerable advantage. He prescribed it in com- bination with opium, and never, he says, without afford- ing more or less relief. To this point many additional * The moschus moschifcrus. THERAPEUTICS. 241 authorities might be cited. The West India writers,* especially those of an early date, bear decisive evidence to its eflicacy in these cases. It has also been, much used in hydrophobia, alone, or with other medicines, as opium, camphor, valerian, cin- nabar, &c. Yet, in common with every other mode of practice, it has wholly failed to cure, or even essentially to mitigate the symptoms of this horrible disease. Nor does it appear that it has been productive of much greater service in epilepsy, or chorea. By the power- ful and prompt impression it makes on the nerves, it has sometimes been resorted to with utility, in the hys- teric paroxysm, and, on the same principle, it evinces a beneficiai effect in hypochondriasis, spasmodic asth- ma, in pertussis, singultus, palpitations, and most other similar complaints. Musk has acquired great reputation in the treatment of gout in the stomach. It was originally, I believe, employed in this case by Pringle, whose practice has been since imitated, and fully confirmed. Cullen is among those who report favourably of it, declaring that he has relieved many patients, by the free use of it, who would probably otherwise have sunk under the at- tack. This is high praise from him, who is always sparing in his commendations of remedies, and, I am inclined to suspect, not at ali exaggerated. Like most of the articles to whicli it is allied, musk has been used in the various states of mental derange- ment, and is highly extolled by Hillary, and several other respectable authorities. In the first edition of * Hillary, &c. VOL. li.—31 242 ELEMENTS OF his Materia Medica, which was surreptitiously publish- ed, Cullen asserts, without any sort of reservation, that he has done more good with it in mania, than with any other remedy. As, however, he advanced in life, and had a wider scope of experience, his confidence in its powers considerably abated, and he speaks of it in lan- guage more measured and qualified. Musk continues to be employed in ali the low states of disease, and it is here that it probably displays its best powers. As early as the time of Mead, it was ap- plied to the management of typhous fever, and has since,' amidst the vicissitudes of its fortune in other re- spects, maintained, with little or no diminution, its re- putation. Perhaps, no article, in the latter stages of low fevers, is productive sometimes of more advantage. The symptoms which it is particularly calculated to re- lieve, are, nervous tremors, subsultus tendinum, singul- tus, and delirium. Conjoined with carbonate of ammonia, it has been celebrated for its powers in arresting gangrene. By Mr. Simmons, an eminent surgeon of Manchester in England, this practice is particularly praised. The dose of the medicine is from ten to twenty grains every three or four hours. It is best exhibited in the form of bolus, or julep.* In the case of children, it may be directed as an injection. * R. Mosch.—Gum. arab.—Sacch. alb. àa. 3j.—- Aq. font. Siij. m. The dose a table spoonful. TI1ERAPEUTICS. 213 MOSCHUS FACTITIUS. This is prepared, by pouring three drachms and a half of concentrated nitric acid, on one drachm of the oil of amber, and afterwards thoroughly washing the pro- duct.* As possessing the properties of naturai musk, it is prescribed for similar purposes, though, on the author- ity of the celebrated Bailie of London, it is used more particularly in whooping-cough. By him it is highly extolled, and his praise is never hastily or gratuitously bestowed. The few trials, however, which I have made with it, in this disease, did not inspire me with an increased confidence in its powers. Yet in some other cases, and particularly in the spasmodic affections of the alimentary canal, I have derived great advan- tage from it. As the naturai musk can hardly ever be procured unadulterated, it might be best, in most in- stances, to substitute the factitious. It is given as an emulsion, or tincture, and in the same dose as the na- turai musk. CASTOR. Near the rectum of the Castor Fiber, or beaver, in both sexes, there are two little bags, containing a * In another formula we are directed to digest half an ounce of nitric acid for ten days upon one ounce of fetid animai oil, obtained by distillation. To this is next to be gradually added, a pint of rectified spirit, and the whole is then to be left to di- gest l'or one monili.—Paris's Phartnacologia. 244 ELEMENTS OF brownish oily matter, called castor. The best of this article is imported from Russia. That which is com- monly found in our shops is derived from Canada, and the northern parts of New-England, and is of a very inferior quality. Castor was formerly in much repute as an antispas- modic. By Van Swieten, De Haen, and many other German practitioners, it was highly esteemed, in the neuroses, and especially in epilepsy. It has, however, lost its reputation, and excepting whooping-cough, in which it has lately been recommended, in conjunction with bark, by Morris, of London, is now occasionally directed by some practitioners of the old school, in the hysterical paroxysm. It may be given either in pow- der or tincture, the dose being, of the former, ten or fifteen grains, and of the latter one or two drachms. FERULA ASAFCETIDA. The asafcetida of the shops is a fcetid concrete juice, obtained from a large plant hearing the above name, resembling the fennel, a native of Persia, which proba- bly might be raised in the United States. It comes in large irregular masses, composed of numberless little shilling lumps or grains, of various hues. It has a strong pungent smeli, something like garlic, and a bitter acrid taste. By keeping, it loses its sensible properties, and becomes comparativdy inert. Of the fcetids, this is one of the most powerful and efficacious. Its action is quick and penetrating, and it may be given with great advantage, to meet a variety of indications. In many of the affections of the nervous THERAPEUTICS. 245 system, it is much prescribed, and is indisputably use- ful in hysteria and hypochondriasis. It was formerly employed in epilepsy and chorea, without, I suspect, much success. Of late, it is a good deal substituted for musk, in the last stages of typhous fever, and some- times with effect. To some of the complaints of the alimentary canal, it seems well adapted, and especially in states of weakness and derangement by intemperance or other bad habits. It will, under such circumstances, " restore tone to the parts, promote digestion, remove the tendency to flatu- lence, invigorate the general system, and renovate the animai spirits." Being laxative, it also obviates cos- tiveness, which is a common, and one of the most mis- chievous attendants on this depraved state of the stomach and bowels. To correct the morbid condition of the stomach, which generates acidity, we are as- sured by Richter, that a mixture of equal parts of asafcetida and the gali of the ox, is so useful as to be en- titled almost to be considered as a specific. By many practitioners, this medicine is exceedingly commended in ali the spasmodic affections of the chest. With its use in asthma I am familiar, and I can speak of its efficacy with confidence. I do not, indeed, know that we can sometimes manage the distressing paroxysm of this disease, by any other means, with greater cer- tainty. To be effectual, it should be given in pretty considerable doses, and often repeated. Nor is its reputation less in whooping cough. A practice which I think is pretty generally adopted at present, in this city, consists, in the first place, in purging on alternate days, for a week or more, with 246 ELEMENTS OF calomel, and, after the disease is somewhat broken, which it will generally be by this course, completing the cure by the exhibition of the watery solution of asafoetida. In more violent cases, however, we bring into this pian of treatment some auxiliary remedies, as emetics, blisters, and even venesection. But these are not often required, if the calomel and asafoetida be judiciously prescribed, and the case has otherwise been properly regulated. There are several other pulmonary affections, in which asafoetida is beneficially employed. It is often prescribed in the second stage of obstinate catarrh, particularly where expectoration is deficient, with tightness and diflìculty of respiration. In circum- stances of the same kind it is also applicable to protract- ed pneumonia, croup, measles, and pulmonary consump- tion. Whenever, indeed, an active expectorant is de- manded, it will probably be found useful. It may be given in pills, or tincture, or watery so- lution. The latter, I think, in many respects, is the preferable mode of exhibition, as it acts more promptly than the pili, and is less stimulating and heating than the spirituous preparation. The dose of asafoetida is from five to ten grains.* SIMPLOCARPUS FCETIDA. This is a common indigenous plant, which, having an odour like the skunk or pole-cat, has received the name of Skunk Cabbage. What is its precise value as a * Vid. Expectorants. TIIERAPEUTICS. 247 remedy, I am unable to say from any experience of my own. It is, however, commended, by several re- spectable practitioners, as exceedingly useful in the paroxysm of asthma, in spasmodic coughs, hysteria, pertussis, chronic rheumatism, o:c. The root is the only part used, of the powder of which, thirty or forty grains is the dose. * VALERIANA OFFICINALIS. This plant is a native of Europe. The root, the only medicinal part, is possessed of various powers. Differently exhibited, it produces very diversified ef- fects. But it is as an antispasmodic that it retains the highest reputation, and is now chiefly employed. To the neuroses, as epilepsy, chorea, and hysteria, it has long been thought particularly suited. That it is sometimes productive of advantage in these diseases, my own experience fully assures me. Being, how- ever, pretty actively stimulating, it should not be re- curred to in ordinary habits, without evacuations having been premised—and then it is well fitted to overcome a state of system morbidly susceptible. In using the valerian, I have remarked, that it is one of the articles which expends much of its force on the stomach itself, and hence proves most serviceable in those cases of nervous affection, which seem to be radi- cated in that viscus. It is for the same reason that it relieves hemicrania, and arrests the progress of gutta * The seeds, I have lately heard, are more active than the root. 248 ELEMENTS OF serena, both of which diseases, I believe, are often pri- marily of gastric origin. In the former it is strongly recommended by Fordyce, and in the latter by Richter. Considered as closely allied to the serpentaria, in several of its leading properties, valerian was formerly much relied on in low fevers. But such an applica- tion is no longer made of it. Of its alleged anthelmin- tic and emmenagogue virtues, as well as of its alleged eflicacy in relieving tormina and tenesmus, I know noth- ing. The valerian is given in powder, infusion, or tinc- ture.* It answers best in the first shape, and the dose is from a scruple to a drachm. Sometimes it may be combined with bark, camphor, myrrh, or carbonate of ammonia, with much utility, the one or the other of these articles being preferred as the case may indicate, f ALLIUM SATIVUM. Notwithstanding I have already noticed this article on several occasions, I deem it of so much value as to require some further attention. Convulsions in children are relieved by it—and I have known it highly ser- viceable in dyspepsia attended with gastrodynia, palpi- tations, nervous tremors, vertiginous affections, &c. This last is a common and troublesome complaint, occurring * The decoction is an inefficient preparation, and the extract stili more so. The ammonìated tincture is useful where an in- crease of cordial power is demanded. f Incom/iatible substances.—The salts of iron. | Vid. Antilithics, Expectorants, Rubefacients. THERAPEU 1ICS. 249 in gouty and intemperate persons, and is often a source of great anxiety and alarm. Not at ali dependent on fulness of the vessels, it is, I believe, almost always pure- ly of gastric origin. Be this as it may, I have found it more readily to yield to garlic, than to any other reme- dy. To stomachs enfeebled by excess of stimulation, garlic proves exceedingly cordial, and it may be re- marked that drunkards recur to it as it were instinctive- ly. Whether it is of use in any of the neuroses, except hysteria, in which it is sometimes beneficially pre- scribed, I have not heard. By Cullen, Lind, and others, it is recommended in scurvy, and, as onions, and indeed ali the analogous vegetable articles are so, there can be no doubt of the fact. By Bergius, garlic was employed in intermittent fe- ver with success. Exhibiting one elove of it morning and evening, gradually increasing the quantity, he says, that it hardly ever failed of putting off the paroxysms, and that in some instances he cured by it confirmed quartali agues. Of the truth of this statement, to a cer- tain extent, I entertain no doubt. I have witnessed effects almost as striking from the medicine. Given in any kind of ardent spirits, it is much used by the com- mon people of this city, in ague and fever, and I have seen some of the most inveterate cases removed by it. In deafness from rheumatic affections of the head and other causes, we are told by Bergius, which is corrobo- rated by Cullen, that, introduced into the meatus audi- torius externus, it will occasionally afford relief. It may be applied in two ways, either by cotton or wool soaked in the juice, or the elove itself put into the ear, wrapt in one of these articles. Whether it will cure vol. n.—32 250 ELEMENTS OF deafness I do not know. But I have many times wit- nessed good effects from this latter expedient in the ear-ache, the garlic being previously roasted, though a cataplasm of itis stili more effectual. MONARDA PUNCTATA.* This may be considered as a new accession to the materia medica. I do not know that I assort it proper- ly. But having, of late, mostly used it as an antispas- modic, I prefer, for the present at least, to give it this position. This plant, commonly designated by the title of horse mint, grows very abundantly in the neighbourhood of this city, and probably in other parts of the United States. An infusion of the recent or dried leaves has been for some time employed to allay nausea, or check vomiting, and was the common remedy, for these pur- poses, especially in bilious fevers, of the late Dr. Kuhn. He also thought well of it as an antilithic, and freely used it in ordinary strangury from blisters, &c. As an emmenagogue, he concurred in the popular notion as to its virtues—placing it on a footing with rosemary, pennyroyal, and similar articles. This was nearly the amount of our knowledge of the article, prior to the publication of a paper on the sub- ject, by Dr. Atlee, of this city. By distillation, it appears, the plant yields a volatile oil, of an amber colour, approaching to red, which, if * Willdcnow. THERArEUTICS. 251 exposed to a greater degree of heat, leaves a beautiful straw-coloured camphor. This oil is represented as being among the most pow- erful irritants, the smallest drop immediately diffusing a pungent aromatic heat over the tongue and fauces, which remains for a considerable time, and, when ap- plied to the back of the hand, excites redness, heat, pain, and vesication. As a rubefacient, I have already noticed its applications, to which I may add, that I have found it exceedingly useful as an antispasmodic or carminative in flatulent colie,—in gastrodynia and py- rosis—in retrocedent gout in the stomach, and in the singultus of low fever, and similar affections. SUCCINI OLEUM. By distillation, an oil is procured from amber, a pe- culiar bituminous substance dug out of the earth, or found on the shores of the north of Europe. This oil was formerly much prescribed as an antispasmodic, in some of the neuroses. It has, however, gradually lost its reputation, and is, at present, hardly retained in the treatment of any disease except pertussis, where it is stili highly commended. Yet I have sometimes recurred to it with great effect, in the singultus of low fevers— and it is unquestionably entitled to attention as a reme- dy in pyrosis, and especially where this affection is attended with cramps or spasms. Nor am I altogether convinced that its former reputation in chronic rheuma- tism and palsy was unfounded : it is at least useful as an external application in both cases. The dose is from ten to thirty drops. 25^ ELEMENTS OF CAJEPUTI OLEUM. Cajeput oil was once supposed to be procured from the mdaleuca leucadendron, a tree of India, though this is now denied, and, with apparently more certain- ty, it is ascribed to one of the same class, on which the title of mdaleuca cajeputi is conferred. The oil is highly fragrant, having in some degree the odour of tur- pentine or camphor, with the taste of peppermint. Like most of the articles to which it is allied, it is actively stimulant, and not without antispasmodic powers. Though not very long incorporated into the materia medica, its reputation is pretty well established as a carminative or antispasmodic in tympanites, flatu- lent colie, and whooping-cough : and as a diffusible sti- mulant, it is not less prescribed in chronic rheumatism, and in palsy, hysteria, and some other of the neuroses. It is now, however, most used in pertussis, and proba- bly with the greatest effect. Externally it is applied to relieve arthritic and rheumatic pains, and in sprains and similar affections. It is also a cure for tooth-ache, put on lint or cotton. The dose is from five to ten drops, though in the adulterated state in which we ge- nerally receive it, much more may be given. SPIRTTUS .ZETHERIS SULPHURICI. When alcohol and the minerai acids are distilled, a liquor arises, which is called ether. The product, however, varies according to the acid employed, though there is considerable resemblance in the general prò- TIIERAPEUTICS. 253 perties of the whole. Of these preparations, sulphuric ether is preferred for medicina! purposes, and to it I shall confine my observations. Ether is an active stimulant and antispasmodic, some- what analogous to alcohol in its leading effects, though more powerful and less permanent. It is sometimes prescribed in the low states of disease, and particularly in typhous fever. But its impressions are so evanes- cent that little is gained by it, and it is difficult to inda- gine a case in which it should supersede wine, &c. With much greater advantage, it is employed to pre- vent the paroxysm of interniittents, and as an antispas- modic in colie, singultus, retrocedent gout—in cholera, to check vomiting—and in certain other spasmodic or nervous affections, as hysteria,—in asthma, angina pec- toris, ózc. Lately an opinion has been advanced, that ether acts ii directly sedative on the spinai system," the foundation of which seems to rest chiefly on the conspi- cuous relief afforded in a case of tetanus.* As, how- ever, only a drachm of it was given as an enema, I think too much was ascribed to it, and that the effect was probably accidental or referrible to some other cause. Yet I would not discourage a further and more accurate trial of it in this truly intractable disease. Ex- ternally applied, it affords relief to muscular pains, as in rheumatism or gout, and in cephalalgia, Sic. It is an excellent remedy in burns, and has lately been ad- vised in strangulated hernia. In these latter cases, it must operate chiefly by the cold induced from evapora- * Rcid on the Pathology and Treatment of Fever. Trans. Dublin College, voi. ili. 254 ELEMENTS OF tion. The dose is from a drachm to half an ounce, ac- cording to the urgency of the case.* SPIRITUS jETHERIS SULPHURICI COMPOSITUS. This is intended as an imitation of Hoffman's ano- dyne minerai liquor, the composition of which he did not reveal. It differs chiefly from ether in containing less alcohol and some oil of wine. As a narcotic, calm- ing irritation, and lulling to sleep, it would seem in- deed to be superior to ether itself, and will sometimes succeed in these respects, when even opiates fail. Being weaker, it may be given more freely than ether. It is one of those articles which is found generally adulterated, or ili prepared, in the shops of our apo- thecaries. * The best formula for the exhibition of ether, is as follows : R. Aq. font. Sjiij. Sacch. alb. |y. M. ft. solut. adde Ether Sulph. gj. The ether is here so suspended by the syrup, that it does not fly off, and is easily swallowed. THERAl'EUTICS. 255 SECTION IX. Sialagoga, or Sialagogucs. These are such substances as promote the salivary discharge. An increased flow of saliva may be excited, either by chewing acrid matters, or by the internai exhibition of certain medicines. The first are, with great propri- ety, termed masticatories. These, as conducing to no practical purpose, I shall wholly exclude. The articles which excite salivation through the me- dium of the general system, as a pretty uniform result, are limited to the mercurial preparations. It is true, there is a series of others, which occasionally evince this power, such as arsenic, copper, lead, prussic acid, the narcotic stimulants, the minerai acids, and, above ali, the polygala senega. But the effect is partial, ex- ceedingly uncertain, and, even when it occurs, answer» no curative indication. Considering mercury, there- fore, as the only real salivant medicine, I ought to re- scind the class of sialagogues. It is also absurd to found a title on an article of so diversified an operation as mercury, from an effect that is incidental, rarely displayed by some of its prepara- tions, and which perhaps is not necessary to the cure of 256 ELEMENTS OF disease. Yet, in obedience to custom, I am induced, at least for the present, to retain the title. hydrargyrus. Being so peculiar in its properties, it is very difficult to assign to mercury its proper position among the arti- cles of the materia medica. But I do not know that a very precise adjustment in this case is of much conse- quence. As partaking in a considerable degree the pow- ers of each class, it may, perhaps, be as well put be- tween the stimulants and tonics, as any where else,— and it is here that I shall locate it. Exhibited in different modes, its several preparations may be made to imitate the effects of every class of me- dicines. We have already seen that it is emetic, ca- thartic, diaphoretic, diuretic, antilithic, expectorant, anthelmintic, emmenagogue, and hereafter we are to contemplate it as a stimulant, sedative, or tonic, or as- tringent, alike capable, by proper management, of ex- citing and invigorating, or allaying and restraining the actions of the system. Of the modus operandi of mercury in the cure of dis- ease, a question once of great interest and warmly dis- cussed, I have nothing new to say, and shall therefore dismiss the subject with one or two remarks. The well- known explanation of Mr. Hunter, that its eflicacy in syphilis depends on its general and permanent stimu- lant power, by which it induces and keeps up an action that ultimately supersedes the morbid one, may be ex- tended, it seems to me, to ali other cases. Confessedly there is no article of the materia medica so diffusive in TUERAPEUT1CS. 257 its effects, which, pervading the whole system, enters into every recess, and, acting on every part, leaves no morbid impression untouched. It is by virtue of this general and revolutionary action, that it is calculated to meet such a vast variety of indications, to an extent, indeed, that it is now prescribed, in the practice of this country particularly, in ali cases, with some few excep- tions, where other modes of treatment have failed. Of the notions relating to the mode of operation of mercury, that which alleges its entrance into the circu- lation is sureiy the most gratuitous and absurd. Else- where* having stated, somewhat in detail, the leading objections to this theory of the action of remedies, I shall not renew the discussion. The sensible effects of the mercurial impression, are at first an increase in the volume and force of the cir- culation, soon followed by tenderness of the gums, with a cupreous taste, and peculiar fcetor of the breath, and of the perspiration. Being farther urged, the gums become swelled and spongy, the teeth are loosened and painful, the tongue, fauces, and salivary glands, are inflamed, with the throat and face somewhat blèated. This state of active phlogosis, continuing for a tirke, is succeeded by a copious flow of saliva, and not unfre- quently by an augmented discharge from the liver, the yiancreas, the kidneys, and the bowels, the latter attend- ed by pain, which is also felt in the stomach. In its more inordinate operation, extensive and foul ulcera- tions appear in the gums and adjacent parts, the system sinks into debility, the countenance is haggard, with a * On the Modus Operandi of Medicines. VOE. II.—33 258 ELEMENTS OF singularly distressing irritability, and insomnolency —emaciation rapidly taking place, with hectic irrita- tive fever. Deviating, however, from this ordinary course, mer- cury, in some instances, exhibits at once ali the pheno- mena of a poisonous action, productive of the most mis- chievous, and sometimes even of fatai consequences, as will hereafter be indicated. How far it is proper, could we obviate it, to induce salivation, is a point that has not been very satisfactorily decided. Certainly it is not required as a visible sign of the constitutional affection by the remedy, the evi- dence of such effect being by other symptoms abun- dantly manifested, and I am quite sure that the remediai agency is not generally improved by it. The most ob- stinate and deeply radicated diseases we find gradually to give way to the alterative process of mercury, and, indeed, thus to regulate it is the established practice in most chronic cases, experience having taught that otherwise the end is frustrated. The locai affection very obviously, in most instances, seems to control the specific agency of mercury, instituting, in a degree, a new mode of action, impotent to the cure, or aggravat- ing the existing morbid condition. Even proving the contrary, it probably serves only as a focus concentrat- ing excitement, and thereby relieving other diseased parts, acting on the principle of a seton, issue, or per- manent blister. It hence follows, that the medicine should be prescribed in small doses, so as gradually to induce its impression, and whenever this in any way is manifested, we are to reduce the dose, or suspend its use. As an austere atmosphere, or a cold THERAPEUTICS. 259 damp room, or bed, or clothing, is very apt to deve- lope the violent effects of mercury, ali sudi exposures ought to be carefully avoided. It will be perceived, from the subsequent inquiry, that there are at least four modes by which the system may be put under the mercurial impression. But it some- times happens, owing to peculiarity of condition, that there is a total insusceptibility to the medicine, and in spite of ali our efforts, it proves inert and unavail- ing. In highly excited states of the system, we most commonly meet with this resistance, and especially where much fever prevails. The actions of the two are incompatible, and that of the disease must be lessened before the remedial one can take place, with which view, venesection particularly, with a low diet, must be called into requisition. We are equally frustrated sometimes in our attempts to salivate under different circumstances, or in cases in which there is, at least, no uncommon vascular vigour or general excitement. Co- pious purging, or vomiting, or even nausea, I have found occasionally to succeed in awakening susceptibili- ty to the remedy, so that the desired end is fully attain- ed. The skin being dry and hot is another condition of resistance, which is to be overcome by the warm bath, or tepid, or, what sometimes succeeds better, cold ablutions, and by a combination of the mild diaphoretics with mercury. In making an application of this article to the cure of diseases, I must unavoidably be led into a very copious discussion. It is known that no one article is possessed of more various powers, or, perhaps, with the exeep- 260 ELEMENTS OF tion of opium, in the present state of our practice, em- ployed in so many and in such diversified cases. Of the medicinal properties of mercury the ancients were totally ignorant. The physicians both of Greece and Rome considered it, on the contrary, highly poisonous.* The first that used it were the Ara- bians, who enriched the materia medica with so many valuable articles. But they restricted it to the cutaneous affections, which they treated with ointments, prepared somewhat in the way of those now in use. Among its earliest applications wras to the cure of lues venerea, a disease which at that time was spreading its ravages over the fairest portions of Europe, and me- nacing the most calamitous consequences to human hap- piness. It has been said by some writers that this dis- covery, among the most important which our science claims, was the result of accident, or at least the off- spring of empirical practice. By comparing, however, the evidence brought into the controversy on this point, it appears, I think, pretty distinctly, that it was origi- nally adopted as a remedy in the venereal disease, by regularly educated practitioners, to which they were led by analogy, having observed its eflicacy in other complaints accompanied with ulcerations or eruptions. I shall commence with its use in fevers. This would be a very interesting inquiry, could I enter fully into the subject. But it presents so ampie a field, that, with my limits, I dare not encounter it. Ali I can at- tempt will be little more than a few desultory remarks. The introduction of mercury into the treatment of * Dioscorides, lib. v. cap. ex. TUERAPEUTICS. 261 the febrile affections, is by no means a new practice. In the sixteenth century, it was given by John de Vigo in the plague, and we shall find, that it was soon after- wards prescribed occasionally in the more ordinary fevers, though it seems not to have commanded entire confidence. Of those who employed it, we are told the celebrated Radcliffe was among the most conspicuous. Early in the last century it seems to have been adopted very generally in New England, and as far back as tra- dition extends, the physicians of Virginia, and probably of the other southern states, were familiar with its efli- cacy. But, since the reputed success of the mercurial treatment of yellow-fever in the West Indies, it has be- come fashionable in many sections of this country to re- sort to it in nearly every variety of the febrile condition. The fever of tropical climates was once thought to be managed with greater advantage by the liberal exhibi- tion of mercury, than by any other course. To this point we have the concurrent evidence of some of the highest authorities. Many of the West-India practi- tioners appear to have trusted almost exclusively to it. As to its eflicacy, however, there is now a wider differ- ence of opinion than formerly. The practice of Chis- holm I find, indeed, to be utterly condemned by severa! late writers of great authority, and the probability is, that it, in common with ali other modes of treatment, has there failed, as in the United States.* When the yellow fever originally occurred among us, the same practice, so far as relates to the copious use of mercury, was imitated. It was applied, as well to evacuate the * Vid. Bancroft. 262 ELEMENTS OF bowels copiously, as to excite salivation. At first this pian was deemed so singularly efficacious, that, in the enthusiasm of the moment, it was proclaimed that death never took place after mercury evinced its effects. But a cooler and more deliberate observation soon exposed the illusion, and the propriety of the practice became universally distrusted. It appeared that mild cases of the disease were cured without it, and, when violent, so rapid was the career, that death took place long be- fore the system could be brought under the mercurial impression. As described by some of their best writers, the yel- low-fever of the West-Indies is a bilious disease, or the hepatic system is much affected in it.* But the very reverse of this takes place in the pestilence of our cities. Dissections very numerous, and made under every variety of circumstances, have shown conclusive- ly, that it is purely a gastric affection, in which the biliary organs have little or no concern. These were rarely found deranged even in the slightest degree. The stomach, on the contrary, was universally met with in a state resembling that produced by the action of certain poisons, or, in other words, presenting the phenomena of malignant gastritis. After considerable fluctuation of opinion, the practice at last adopted consisted of copious venesection in the early stage of the case, plentiful purging with calomel and the neutral salts, cold affusions at first, and next sweating, continued for a length of time, with a succes- * Perhaps they have confounded the bilious fever of that cli- ni atc with y3 418 ELEMENTS OF rosis, and other affections with this incident—and, though with less efficacy, in the cases generally where the chalybeates are directed, in the dose of from five to twenty or thirty grains. FERRUM SQUAMA OXIDI. These scales are detached by hammering red hot iron, and appear to be the metal in the first degree of oxidisement. They are used in the same dose, and for similar purposes, as the filings, and, when preferred, may be reduced to a powder by trituration. FERRI SUB-CARBONAS, VULGO RUBIGO FERRI. This is commonly given in powder, in the dose of from ten to sixty grains, mixed with syrup or mucil- age. In cases of debilitated stomach, an aromatic may be united to it, such as the powder of ginger. It is also exhibited in the shape of pills, and sometimes as a chalybeate wine. As a stomachic and tonic, the last form answers extremely well. My mode of preparing it is as follows.* The carbonate is certainly among • R. Rub. ferr. giss.—Cort. aurant,Rad. gent. aa^ss.—Vin. Lusitan. ifeij. M. The bottle containing these ingredients is to be exposed to a mod rate heat, for three days, and repeat- edly shaken during this time. This is a more powerful prepa- ration, I think, than the chalybeate wine, made agreeably to the direction of the dispensatories. THERAPEUTICS. 419 the very best of the martial preparations, and may be used in most cases to which the others are appropriate. It has lately been particularly extolled by Mr. Hutchin- son, of whom I have previously spoken with great re- spect, as a remedy in tic doloureux. With little or no preliminary treatment, he enters at once on it, in the dose of half a drachm, gradually increased, two or three times a day, to be continued for several weeks. Notwithstanding the favourable reports of this practice from abroad, I am not disposed to think very highly of it, and sudi, I suspect, is the estimate of it by most of our yiractitioners, by whom it has been tried. FERRI SULPHAS, VULGO SAL MARTIS. The green vitriol, or copperas, is another prepara- tion of much value. Yet I do not know that, in any respect, it is to be preferred to the carbonate, except that, the dose being smaller, it can be given more con- veniently. Besides many other cases in which it is directed, it is thought, however, more applicable to some of the bowel affections. It is now quite common to resort to it, variously combined, in dysentery, diar- rhoea, and cholera infantum in the advanced stages, af- ter the bowels are well evacuated, and the symptoms of irritation have subsided.* Though my own experi- • i.—R. Sai. mart. 3j.—Acid. sulph.Iss.—Aq. font.^x., M. The dose for a child is from 3 tOslO drops, and for an adult, from 20 to 30 drops three or four times a-day. 2.—Sai. mart. gr. ij.—Acid, sulph. gtt. x.—Sacch. alb. sj.— 420 ELEMENTS OF enee will not enable me to say a great deal in favour of these combinations, they have been so highly extolled, that I can hardly doubt their claims to attention. In its ordinary uses, the sulphate of iron is given in pills, in the dose of from two to five grains, either alone, or in conjunction with bark, asafoetida, aloes.*fj FERRI PH0SPHAS. The phosphate of iron has lately been introduced as a remedy. There are two preparations of it, the blue and the yellow, of which the former is the more active, and is chiefly used. Though strongly recommended in dyspepsia, amenorrhoea, chronic rheumatism, and cu- taneous eruptions, I am not aware, that it has any claims to superiority. It is said also to be well adapt- ed to dropsy, and we have recently been told that in diabetes, u it proves almost as certain an astringent on the excessive action of the kidneys, as opium on that of the alimentary canal."§ Itis the preparation in which Mr. Carmichael much confides, in scrofulous and can- Aq. font. 3j-, M. The dose is a teaspoonful, for a child, to be repeated as above directed, and for an atlult a table spoonful. * Eaton's Styptìc—Calcined green vitriol gss.—proof spirits tinged yellow with oak bark, ìbj. f Aromatic Lozenges of steel.—These consist of sulphate of iron, with a small proportion of the tincture of cantharides. \ Incompatible substances.—Every salt whose base forms an insoluble compound with sulphuric acid, the earths, the alka- lies, and their carbonates—borate of soda—nitrate of potash— muriate of ammonia—nitrate of potash and soda—acetate of ammonia—nitrate of silver—of lead—and soaps. § Venables on Diabetes. TIIERAPEUTICS. 421 cerous ulcerations. The dose of the blue phosphate is from ten to twenty grains. FERRUM TARTARIZATUM. Carefully prepared, this is a doublé salt, consisting of the tartrate of potash and the tartrate of iron. Being highly deliquescent, it is not easily administered in any other way than in solution, which readily takes place in water or wine.* To the ordinary chalybeate virtues, it is supposed to add those of a diuretic, and hence is sometimes employed in dropsy, &c. Yet it is mainly directed as a tonic, and is particularly recom- mended by the tastelessness of its solution. The dose of the salt is from ten to thirty grains.t TINCTURA FERRI MURIATIS. In point of activity, the muriate of iron exceeds most of the martial preparations. It is now employed only in tincture, in the dose of from fifteen to thirty or forty drops. But in cases of great irritability of the sto- mach, even the smallest quantity mentioned, cannot he taken without exciting nausea or vomiting, and hence * As the red oxyd of iron, from which the vinum ferri of the pharmacopoeise is made, is only soluble from the tartaric acid which wine contains, and, of course, is very variable in strength, it would be better to substitute the above preparation. The dose of the officinal chalybeate wine is one or two drachms. ] Incompatible substances.—AU strong acids, lime-water, hy- dro-sulphuret of potash, astringent vegetables, and the fixed al- knlirs, and their carbonates more slowly. 422 ELEMENTS OF it is not a favourite medicine with practitioners. It is, however, sometimes prescribed in dyspepsia, and is used, on the authority of Mr. Cline, in certain cases of suppression of urine from spasm. FERRI PRUSSIAS. Of this preparation I know little. It has been parti- cularly extolled by several practitioners of this coun- try, and particularly by Dr. Zollichoffer, in intermit- tent fever, exhibited as well in the paroxysm as the apyrexiq, in the dose of five grains, three or four times in the twenty-four hours. In uterine haemorrhage, it has also acquired considerable reputation, and I have understood from Dr. Worthington, a very eminent practitioner of the city of Washington, that he has found it highly useful both in restraining the bleeding and doing away the pain and irritation, by which it is kept up, or renewed. He, however, recommends it in the dose of a scruple. CUPRUM. Copper is not, like other metals, insipid and inodo- rous. It has, on the contrary, an unpleasant styptic taste, and, when rubbed, emits a perceptible smeli. Notwithstanding these sensible qualities, it has been held to be altogether inert, in its metallic state, except as a mechanical irritant, which is not true. When a piece of it is swallowed, it is sometimes acted upon by an acid of the stomach, converting it into a soluble salt, and a train of morbid effects is produced, among which TIIERAPEUTICS. 423 not the least conspicuous is a copious salivation.* As a medicine, however, it is never employed in the native state. To convert it to such uses, it is subjected to certain chemical processes, by which several prepara- tions are formed. CUPRI SULPHAS, OLIM VITRIOLUM CCERULEUM. Of this article I have already in part treated, under the head of emetics and escharotics. But it is applica- ble to some other purposes, which I am now to notice, and of these perhaps the most important is to the cure of intermittente. It has been used in these cases more particularly by Dr. James Adair, and Dr. Donald Mon- ro, the latter of whom adopted the annexed formula.f On his authority, I have prescribed the medicine in protracted intermittente, and with such advantage that I am disposed to rate it very highly. To quartan agues it is especially adapted, so much so, indeed, that I know not a remedy entitled to much greater confidence. My * The late professor Barton was accustomed to relate the case of a child, who, having swallowed a cent, continued for some time to discharge daily several pints of saliva. Yet, in other instances, copper money has been retained in the stomach for many months, without any effect. To this point several facts are recorded by Dr. Paris in his Pharmacologia. t R. Vitriolum cceruleum gr. iv.—Extr. cort. peruv. gr. xxxii. —Syrup. q. s. m. div. in pil. xvi. One of these pills he gave four times a day, and continued them for two weeks. 424 El.EMENTS OF mode is to commence with a fourth of a grain at a dose, united to a small portion of opium, to be repeated three or four times a day, gradually increasing the quantity. From its great power in this case, I suspect that it is deserving of more attention than it has hitherto re- ceived, in diseases of periodical recurrence. It would, at 'least, be well to try it fairly in epilepsy, and the more so, as Cullen found it beneficiai in hysteria. By Boerhaave, particularly, it was used in dropsy, and he seems to have confided much in it. But there are few traces of this practice having been imitated since his time. Itis, however, a diuretic, and perhaps might be advantageously introduced into the treatment of some forms of the disease. As an injection in the second stage of gonorrhcea and gleet, a solution of blue vitriol is said to answer well. It may be made of va- rious degrees of strength, from three to six grains to the ounce of water. This solution may also be used for divers other purposes.*fJ * Bates'saqua camphorata, so strongly recommended by Mr. Ware. R. Cupr. Sulph., Boli Gallic. àa. gr. xv.—Camph. gr. iv. Solve in aq. ferv. siv.—Dilueque cum aq. frigid. ffeiv.—ut fiat collyrium. f Vid. Escharotics. \ Incompatible Substances.—Alkalies and their carbonates, sub-borate of soda—acetate of ammonia—tartrate of potash— muriate of lime—nitrate of silver—sub-acetate, and acetate of lead—oxy-muriate of mercury—ali astringent vegetable infu- sions and tinctures. THERAPEUT1CS. 425 CUPRUM AMMONIATUM. The cases to which the ammoniated copper is consid- ered chiefly applicable, are some of the class of neuroses, as hysteria, chorea, and epilepsy. In the latter disease, it has probably done good. Cullen declares, that in many instances it has cured epilepsy, though in others it did not succeed. As strong testimony might be col- lected in its favour from other respectable authorities. An Italian wTriter,* states that he hardly ever failed in epilepsy with it, provided it was of the idiopathic spe- cies, and the system of the patient a good deal exhausted. The latter part of this statement contains an important practical observation. This article is stimulating, and hence requires, for the attainment of its beneficiai ef- fects, a previous reduction of action. This is a rule, indeed, which I have endeavoured to enforce with re- spect to the employment of ali such medicines in the nervous affections. The practice in these cases has been too often destitute of principle, and on this account is distinguished by much contrariety of opinion relative to the powers of remedies, and by an opprobrious defi- ciency of success. The result of a pretty extensive experience with this article is, that, though, in some instances, and particu- larly in children, it will postpone to a more distant in- terval the recurrence of the paroxysms, it has not, within my knowledge, accomplished one single cure of * Dr. Ballo, of Genoa. VCL. II.—51 426 ELEMENTS OF epilepsy. Yet, I wish not to discourage its use. It comes to us too strongly recommended to be hastily abandoned, and, at ali events, is one of the means by which the disease may be mitigated or suspended. To chorea it is, perhaps, not less suited, under pre- cisely the same circumstances of the disease. We have the assertion of Walker,* that he cured a number of cases by it, attended with debility and relaxation. In pertussis I have found it useful, and perhaps it may prove so in other spasmodic coughs, as well as in asthma. Lately it has been highly commended by Brera in intermittent fever, associated with a general loss of strength, and particularly of the primae viaa. Externally a solution of it is used as a wash in ill- conditioned ulcers, and has been proposed as an appli- cation for the removal of opacity of the cornea. In the exhibition of this preparation, it is prudent to commence with doses not exceeding a grain, though they may soon be considerably augmented. Cullen ad- vises to intermit it after a month, lest the introduction of a large quantity into the system might, like lead, in- duce deleterious consequences. But I suspect there is no cause of solicitude on this subject. I have continued it for a mudi longer time, without the slightest mischief. Ballo, whom I have cited, gave in one case sixteen drachms in the whole, and Russel, in another, nine grains three times a day for many weeks, and, so far from doing harm, it is said, completely cured their pa- tients. f * Treatise on Nervous Diseases. t Incompatible substances. Acids—the fixed alkalies—lime water. • 4 TIIERAPEUTICS. 427 ZINCUM. In its metallic state, zinc exerts no very sensible ac- tion on the system. By chemical processes, however, several active preparations are produced, the first of which is the oxid. ZINCI OXYDUM, VULGO FLORES ZINCI. The oxid of zinc is used very generally in this city, and I have the most satisfactory evidence of its having done good in epilepsy, chorea, and the analagous affec- tions. Commonly, however, it is prescribed in too small a dose to be productive of the greatest advantage. It has,' at least in my hands, been of little use, till the quantity was increased to fifteen or twenty grains, seve- ral times in the day. I have more than once given a drachm of it in the twenty-four hours. The only dis- agreeable effect from sudi a quantity is nausea, which, however, is not of a distressing nature. We may safely commence with a dose of four or five grains.* • Exactly this course I find to be recommended in a late English work of merit, Bedingfield's Medicai Practice. As regards myself, it is, however, known to be originai, having publicly taught and pursued the practice long before the ap- pearance of that work 428 ELEMENTS OF ZINCI SULPHAS, VULBO VITRIOLUM ALBUM. This preparation is highly esteemed in the cases just enumerated. It would not be diflìcult to collect from the records of our public institutions, and the histories of private practice, as well as from other sources, much evidence of its efficacy. I have resorted to it with ad- vantage in chorea and epilepsy, though I think it infe- rior to the oxid. Cullen and other European writers also commend it in the latter disease. Lettsom speaks favourably of it in hysteria. It has been thought particularly useful in hooping- cough. I do not now mean by exciting vomiting, though in this way it is beneficiai. It is exhibited in small doses, with a view to its tonic and antispasmodic effects. This was the practice of Saunders, who con- sidered it as incomparably the most successful pian of managing the disease. It was also commended by the late Dr. Kuhn. That in some of the forms of asthma, it might be of service, it is reasonable to presume. But I have had here no satisfactory experience with it. Concerning its employment in paroxysmal fevers, I have little to communicate. Dispersed through our medicai records, some evidence exists of its efficacy. But in my trials of it in intermittents, I have been generally disappointed. As an injection, in gonorrhoea and gleet, and as a collyrium, its application is sufficiently known. In re- THERAPEUTICS. 429 cent gonorrhoea, it may be used either alone, or united with the sacch. saturni in equal portions.* In gleet, the solution may be of doublé strength, or, what I think answers better, a small portion of corrosive sublimate may be added. f As a collyrium, there should not be more than one or two grains of zinc to an ounce of water, or, if it can be had, rose water. $ * R. Vitriol. alb. gr. x. Gum arab. 3ij. Tinc. theb. 3j. Aq. font. ^viij. t R. Vitriol alb. gr. x.—Corros. sub. gr. ii. Aq. font. 3VÌÌÌ. 1 We have a preparation, into which the sulphate of zinc en- ters, which has acquired considerable repute, called the vitri- olic solution, made agreeably to the annexed prescription, co- pied out of Mosely's work on Tropical Diseases.§ It is stated, that whatever he added to give the mixture a more agreeable taste, always detracted from its efficacy. Nor are the same in- gredients so powerful, when administered, even in the same quantity, in a pili. As an emetic, this solution is exceedingly active, though it is used chiefly as a nauseant. To procure this effect, the dose for an adult is a small table-spoonful. Not a little has been said of the importanee of this medicine in some of the bowel affections. " I have," says Mosely, " used the solution in dysentery, with the greatest success. I give it at first without alum, in sufri- cient doses to cause evacuations, and afterwards with the alum, in nauseating doses, and frequently with opiates at night. This.I have found far more efficacious than emetic tartar, ipecacuanha, rhubarb, or salts, as evacuants, in whatever manner combined or administered. In diarrhcea," continues he, " of long stand- ing, the cure must necessarily be performed by slow degrees. The treatment here is a dose every morning, to be persevered in, where the case is intractable, for weeks or months, omitting now and then for a few days." My knowledge of this preparation, in the preceding cases, is not intimate or extensive. I have occasionally tried it, and § "Take of white vitriol jiij., Rock alum 3j., Cochineal gr. iij., boil- ing water Rjj. Mix these together in a marble mortar, until the solution iscold, and the sedimenti» deposited, then pour it ofl'clear for use." 430 ELEMENTS OF ZINCI ACETAS. The acetate of zinc has only been employed within a few years. What are its powers as a tonic I do not sometimes not entirely without effect. To the medicine, how- ever, there is one objection, which is insuperable where delica- cy of stomach exists, and this is a very usuai attendant on the bowel affections. It is so nauseous, that, even if we force it down our patients, it is not retained. Colica pictonum is another case in which the vitriolic solu- tion is stated to be in the highest degree serviceable. After the constipation incident to the complaint is removed by pur- gatives, a dose of it is directed every five or six hours, while the pain continues, and, to prevent relapses, the same dose should be repeated for several successive mornings. To cleanse the foul ulcers in angina maligna, moderate vomiting by this medicine, we are told, is peculiarly well suited. But I know nothing of its powers myself. It is also alleged to be pre-emi- nently useful in the disorders of the chest. Taken in small doses, says Mosely, several times in the day, it proves an excel- lent expectorant, and is beneficiai in ali pulmonic oppressions in which respiration is performed with difficulty, and where the bronchial vessels require to be relieved, by discharges of accu- mulated phlegm or mucus. Nor is this ali. The worst haemor- w rhages of the lungs, continues he, are sometimes suspended by the steady exhibition of nauseating doses of the medicine. Even in pulmonary consumption, that most hideous of the opprobria medicorum, it has, according to him, very advantageously displayed its powers. To its utility, in any one of these cases, I can myself bear no evidence. But there are practitioners, and some of high respectability, within the immediate sphere of my acquaintance, who repose more confidence in the powers of the medicine than I have ventured to express. They, perhaps, have had a wider experience with it. Confiding, as I do, in the combinations of ipecacuanha or antimony, in most of the cases where the vini- TIIERAPEUTICS. 431 know. As an emetic, however, it is said to operate actively and very promptly in the dose of five or six grains, and seems to be adapted to ali the purposes for which the sulphate is proposed. By some of the English practitioners it has been praised as an injection in gonorrhoea, being preferable to the sulphate, as exciting less pain and irritation. Having nearly abandoned the treatment of this com- plaint by injections, I have no experience with this preparation. But it is used by some of my medicai friends, who corroborate ali that has been reported of its efficacy. It is to be employed in the same quanti- ty, and in like manner, as the white vitriol. The fact, indeed, is, that in the common formula, where the white vitriol and sugar of lead are united, we have, from the chemical action which takes place, an acetate of zinc. BISMUTHUM. The only preparation of this metal which has been introduced into practice is the oxid, or, as some of the chemists state it to be, the sub-nitrate. B1SMUTHI SUB-X1TRAS. To Dr. Odier of Geneva we areindebted for this ac- quisition to the materia medica. It appears, that so olic solution might be applicable, I have hesitated to prescribe it, in preference to medicines, the efficacy of which I had habi- tuallv witnessed. 432 ELEMENTS OF early as the year 1786, he published a paper on the subject, in which the attention of physicians was so- licited to the powers of the medicine, in several of the affections of the stomach. But prejudices arising against it, which have since been proved to be unfound- ed, prevented its gaining ground, as a remedy, on the continent of Europe. The first notice of its being employed in Britain, is in the Medicai and Physical Journal, for July, 1799. It is mentioned by the editors of that work as a medicine either neglected or forgot- ten, u though," say they, " it is stated to be a power- ful remedy in spasmodic pain of the stomach and bowels, particularly if it arise from organic debility, or a re- laxed and emaciated constitution." To Dr. Marcet, a very distinguished practitioner in London, the credit of reviving this article, and perhaps of establishing its re- putation, is due. In a paper which he has published relative to its use, he says, " I have had frequent op- portunities, in Guy?s Hospital, of trying the oxid of bismuth, in spasmodic affections of the stomach, and those trials have fully confirmed the opinion which I formerly gave of its great utility." Confidence in the medicine being thus inspired, it came soon into general use, and the most ampie evidence was collected in con- firmation of the preceding statement of its efficacy. Nor perhaps has less been done with it in the United States. It is very extensivdy employed, by the most eminent physicians of New-York, who concur in reporting very favourably of its powers, in ali the affections connected with dyspepsia, as gastrodynia, cardialgia, pyrosis, and in the depraved state of the stomach incident to pregnaney. In Boston, it is also a 1HERAPEUTICS. 433 remedy much trusted. The highly respectable editors of the New-England Medicai Journal, thus express their opinion of its utility. " The action of this substance on the stomach is that of a mild and effectual tonic, and, from our own expe- rience of its virtues, we do not hesitate to affirm, with Odier, Marcet, Bardsley, and Moore, that in pyrosis, cardialgia, and more particularly gastrodynia, it ope- rates more speedily, and with more certainty, than any other article of the materia medica." I have tried this medicine in several of the gastric affections, to which it is considered most applicable, and though sometimes with success, I confess my ex- pectations have often been disappointed. Yet my con- fidence in it has not, on this account, ceased. No cases are more diflìcult to cure than those I have noticed, and none in which the powers of medicine are so often baflled and counteracted, by the neglect of the regula- tions as to diet and other circumstances, the strici ob- -ervance of which is indispensably required. This is a safe and active medicine, and therefore has strong claims to our attention, independently of the weight of evidence collected in ite favour. It is usuai to exhibit it in the dose of five or six grains twice or thrice a day, mixed in any convenient vehiele, such as sugar or gum arabic, or it may be made into pills, which is perhaps the better mode.* * The oxid of bismuth, I have learnt, has been much used in the treatment of intermittents, and with success, by Dr. Car- michael, a distinguished physician of Virginia. The same practice has of late been adopted in Europe. Vid. Phil. Med Journal, Voi. IV. voi. il.—55 434 ELEMENTS OF ARGENTI-'M. This metal is distinguished among other circum- stances by an insusceptibility to oxidation. But the acids which readily yield oxygen, act upon and dis- solve it, particularly the nitric acid. The solution, when evaporated, affords the nitrate of silver, which being again dissolved and cast in moulds, forms lunar caustic. ARGENTI NITRAS. This is the only preparation of the metal employed internally. It appears, that even in very early times it was exhibited, and that the harshness of its operation led to its disuse. To Dr. Sims we owe its re-intro- duction into the materia medica, who, some years ago, was induced to apply it to the treatment of epilepsy, and, as he in forms us, with great advantage, having cured several cases by it. Not long afterwards, he was followed by Drs. Cappe, Bostock, Wilson, M'Ginnis, Gough, Roget, Halford, and other practitioners, who also boasted of their success with it in the same dis- ease. Lately, much has also been said of its utility by Sementini, an Italian writer. In this city, it has been extensivdy tried, both in private and public practice, as well by other physi- cians as myself, and our decision would not be very strongly in ite favour. Admitting it to palliate symp- toms, or to protract the return of the paroxysms, this is the extent of what could be said of its effects. THERAPEUTICS. 435 It is alleged also to have been productive of service in chorea, and is extolled particularly by Dr. Powell, of London, a practitioner deservedly of high reputa- tion. In angina pectoris, it has been likevvise used, and two cases of complete cure by it are reported, on the authority of Dr. Cappe, of one of the provincial towns in England. It is moreover recommended in palsy from lead, more especially by several of the English and Continental writers. To several other complaints it is thought to be adapted. Leucorrhcea is represented as having been cured by it, dropsy sometimes benefited, and the proof is decisive of ite utility in counteracting the effects, or rdieving the diseases originating either from the im- pression of lead or mercury. It has also been used in intermittent fevers. Lately, it has moreover been strongly recommended in certain dyspeptic states, and particularly when attended with morbid sensibility of the stomach. On the whole, I think this article mei ite attention, though the evidence of its efficacy, in many instances, is stili unsatisfactory. It is given in the dose of half a grain at first, gradually increased so as to amount to ten or twelve grains a day, being previously dissolved in water, and then worked up into pills, with the crumb of bread.* Externally, this article in weak so- * Perhaps we do injustice to this medicine by giving it in too small doses. By Dr. Powell, to whom 1 have just alluded, who is said to employ it with advantage in most of the nervous affections, from two to five grains are given every six hours. In one case of epilepsy, I gradually augmented the dose to eighteen grains in the twenty-four hours without producing any troublesome effect. Even, however, in this large quanthv, it did not cure the di scaso. 436 ELEMENTS Ol lution has been recommended by some of the Frendi surgeons as an excellent remedy for haemorrhoids of long standing, and has sometimes proved useful in gleet, as well as in the puriform discharge from the ear.* AL RUM. As long ago as the time of the alchymists, this metal was supposed to be possessed of medicinal properties, and was actually employed, though soon afterwards it came to be expunged from the materia medica, as being either hurtful or inefficacious. It is again, how- ever, brought forward, as a powerful remedy, in the management of several diseases. In a publication by Dr. Chriestien of Montpdier, which appeared some years ago, its powers are extolled with ali the extrava- gance of enthusiasm. It appears, according to bini, that gold may be employed in the state : 1. Of minute division. 2. Of oxid. 3. Of oxid in combination with ammonia. 4. Of oxid in combination with the oxid of tin. 5. Of muriate. Numerous detailed cases are reported of the effects of each of these preparations, though they differ very mudi in activity, the oxids producing more speedy effects than the powdered gold, and the muriate a more powerful action than the oxids. They were ali * The antidote to the nitrate of silver is a solution of the muriate of soda. therapeutics. 437 administered by friction on the tongue, cheeks, or gums. The first was prescribed "to the extent of three grains a day—the second in the dose of half a grain, gradually increased to one or two grains—the third and fourth in rather smaller quantities, and the fifth from one-tenth to one-fifteenth of a grain." From the evidence which he has furnished, we may collect, that within a very short time, these prepara- tions '-cure chancres, warts, secondary ulcers, sore throats, and other forms of inveterate lues—and, like- wise, that they are of the greatest utility in the affec- tions of the uterus, of the stomach, and in glandular and lymphatic complaints generally." If it should really prove to be true, that they are endowed with such properties, they will be an invaiu- able acquisition to the stock of our remedies, as they are represented to effect radicai cures of syphilis with- out producing salivation, or any derangement of the functions of the body, and that no season, no tempera- ment, and no complication of the disease, can create any obstacle to their exhibition, or detract in the slightest degree from their efficacy. But of this I am distrustful. The only evidence in support of the prac- tice, which I bave been able to collect in this country? is from Professor Mitchell, of New York, who con- siders the muriate of gold as quite equal to the muriate of mercury, in ali syphilitic affections, and as less in- convenient in its effects. These aurine preparations have also been used in scrofulous, and even cancerous ulcers, as well as in the chronic cutaneous affections, with no better proof, how- ever, of utility. 438 ELEMEMS Ol ARSEXICUM ALBUM. In ite metallic state, arsenic is inert. But at a high degree of temperature it is oxidated rapidly, forming a white vapour, which condenses. This product was onee regarded as an oxid, though of late it is more generally believed to be an acid, and is called the ar- senious acid. Whatever may be its precise nature, this is the substance which, in different states, affords our medicinal preparations. It is among the most deleteri- ous of the poisonous articles. Taken in excess, it pro- duces a train of distressing symptoms, very analogous to those described under the head of corrosive subli- mate. • Even in our remediai applications of it, when too freely administered, after a while it is apt to induce nausea, or vomiting, burning sensation in the stomach, diarrhcea, with tormina and tenesmus, much prsecordial uneasiness, reduced pulse, nervous tremors, numbness of the extremities, great exhaustion of muscular power, cold damp surface, and cedema of the face and limbs. As in the instance of mercury, its action would seem to accumulate in the system, sometimes so gradually as scarcdy to be perceived, till itsuddenly bursts forth in the inordinate effects I have noticed. Cautiously directed, however, these may be generally obviated, and it made a safe and useful remedy in various dis- eases, some of which I am now to indicate. In the course of the last thirty years, arsenic has been extensivdy employed. But it is in intermittent fever that its efficacy is supposed to be best ascer- tained, and, perhaps, most highly appreciated. Early TIIERAPEUTICS. 439 in the last century, it was proposed with this view by Jacobi. To Fowler, however, we are chiefly indebted for the establishment of its reputation. Thatit may be advantageously used in such cases, I ain not disposed to deny, though 1 must stili say, it is much overrated, and that whoever expeets any great uniformity of success from it, will often be disappointed. Whether these failures proceed from intrinsic deficiency in the pow- ers of the remedy, or from the very loose and indis- criminate manner in which it is prescribed, I am not prepared to decide. Yet so mudi I may state, that in ali the weak forms of intermittent fever, either approaching to typhus, or associated with a caehectic condition, it will prove inefficient, and most generally mischievous. This might indeed be anticipated from its acknowledged effects. The bark, as well as most other substances employed in intermittents, seems to operate by imparting tone to the stomach, and through it to the general system. But, though placed with the tonics, arsenic has no one property of this class of articles, and produces diame- trically opposite effects. In its immediate action, when largely given, there is more or less nausea and lassitude, and, among its re- moter consequences, many of the symptoms of constitu- tional depravation. It would hence appear to be inap- plicable to the cases of debility, and in further con- firmation of this opinion, I can state, that with the patients of our Alms-House, who are nearly ali of this description, either from age or intemperance, it has failed in my hands. Even when judiciously adminis- tered, and under circumstances the most propitious. 440 ELEMENTS OF it will not, generally, cure the disease. Compared with the Peruvian bark, it is very inferior, and, I think, ought rarely to be prescribed to the exclusion of that artSfcle. Cases, however, may arise, in which we shall be warranted in having recourse to it, and especially with children, to whom it is better suited on many ac- counts, though since the introduction of the sulphate of quinine it is less demanded. Doubts have been expressed, whether the use of the article should be limited to the apyrexia, or continued during the successive stages of the paroxysm. My own impression is, that no rule need be strictly adhered to on this point. The only objection to its continuance throughout, that I have observed, proceeds from the ir- ritable state of the stomach, which it is apt to nauseate and distress. Notwithstanding the chemical incompa- tibility of the two articles, it is now a fact pretty well authenticated, that, in certain instances, where it/fails of itself, cures may be accomplished by combining the bark with it. By some, indeed, it has been contended, that the one medicine prepares the system for the operation of the other, somewhat like a mercurial course, and that it will be found useful, in ali very refractory cases of ague and fever, to precede the bark by a temporary ex- hibition of arsenic. Of this I have no knowledge my- self, though the observation seems to be entitled to some respect. Equally, as in the case of bark, is it necessary to prepare the system, by evacuations of the primae viae, and, where a phlogistic state exists, by venesection. To the neglect of this preliminary management, I am disposed partly to ascribe the frequent failures of ar- senic. 9 THERAPEUT1CS. 441 Arsenic is also used in remittent and continued fe- vers, where there is a tendency in the case to give way, and is probably sometimes serviceable in hectic fever. It has been recommended even in ordinary typhus, pre- cisely under the same circumstances in which bark is prescribed. Of this practice, I have not the slightest experience, and, from the opinion which has been al- ready expressed of the nature of this medicine, it may be presumed, that I do not approve of it. To sustain the powers of life, is one of the leading considerations, at this conjuncture of low fever, and, perhaps, it is as little calculated as any article of the materia medica to answer such a purpose. Yet it is favourably mentioned, under sudi circumstances, by Ferriar, whose reports ge- nerally are entitled to confidence. During my attendance in the London hospitals, it was mudi used in rheumatism, and was formerly com- mended by several practitioners of this city. I have seen it prescribed in the acute disease, accompanied with pain and inflammation. But surely this is an im- proper application of it. In chronic rheumatism of a moderate degree of action, it obviously promises more : though, even in this instance, it should not generally supersede medicines, the efficacy of which is so mudi better established. Yet I have used it occasionally with advantage, and especially where the case was marked by the intermittent type. In some of the nervous and spasmodic affections, ar- senic is said to evince considerable powers, and among which are epilepsy and chorea. Whether it be so, my own observations, though I have repeatedly used it, do not enable me to state positivdy. The remedy has the voi., n.—56 442 EEEMEXTS OF confidence of several of our practitioners, and I find it favourably noticed in the late English journals.* Ex- hibited freely in tetanus, in conjunction with laudanum, it has cured several cases of the disease, on the testi- mony of a highly respectable practitioner.f To some of the forms of asthma it would seem also to be appropriate. I once gave it, in large doses, in a singularly intractable case of the spasmodic disease, with apparent advantage. Paroxysms, which had re- curred almost every ten or fifteen days, were suspended for upwards of nine weeks. What was the final event, I do not know, as the patient left the city. In angina pectoris, it has been found useful, especially in one in- stance, which was cured by its long and persevering employment,^ and it is strongly commended by Ferriar in pertussis. To these may be added the spasmodic affections generally, though more particularly of a periodical nature, as tic doloureux, hemicrania, ce- phalalgia, &c. In that species of the latter disease, called nervous, or sick head-ach, it often proves highly useful, when attention is paid to the primse vise, and regulation of diet. By those who have insisted on the analogy between arsenic and mercury, its use is urged in visceral ob- structions, as of the spleen, the liver, &c. But if ever * In chorea particularly, it is commended by Mr. Salter, who has reported four cases of the disease, cured by it. Vid. Trans. Med. Chirurg. Voi. X. Part I. t I state this fact on the authority of Dr. Taylor, a graduate of this university. The prescription consisted of ten drops of Fowler's solution, and fifty of laudanum, every third hour. \ By Dr. Cappe, of York. THERAPEUTICS. 413 productive of service here, of which I doubt, it is pro- bably in cases kept up by intermittent fever. In some respects, indeed, it seems to be the counter-agent of mercury. I have long known its utility in removing the series of affections, as nodes, cutaneous blotches, ul- cers of the throat, rheumatic pains, which, though usually ascribed to a venereal taint, are nearly always of mercurial origin.* In real syphilis, whether pri- mary or secondary, I believe it to be useless, and the reputation which it has acquired, especially among some of the German practitioners, in the healing of venereal ulcers especially, can only be imputed to a mistake of the cases. Of its use in cancer, I have little or no personal ex- perience, and, though this was among its earliest ap- plications, the degree of its utility is not determined. As, however, this article has constituted the basis of almost ali the popular remedies for cancer, it is pre- sumable that it is possessed of some peculiar powers, in the healing of obstinate ulcers. It is administered internally, while at the same time it is applied to the sore, in the mqde formerly described.* * My use of the medicine in these cases, (the credit of having prescribed it originally I believe is due to myself,) has been more extensive since the first edition of this work, and in part with a confirmation of its utility. It sometimes seems appro- priate to every condition of the system from this cause. Yet I have known it to fail entirely, and even to be productive of harm, which is, probably, owing to the want of proper discrimination in the cases, a point, at ali times, exceedingly difficult and em- barrassing. t Escharotics. 444 ELEMENTS OF Being one of those medicines long known to have a relation to the surface of the body, it has been employ- ed in chronic eruptions, from leprosy down to the low- est and more ordinary species. With cicuta, or dulca- mara, which, I am convinced, enhances its properties, I have often prescribed it in some of these affections with great success. These are the chief diseases in which arsenic is pre- scribed. It would have been easy to have swelled the catalogue to any extent. But I am incredulous as to the sanguine representations which are made from time to time, relative to its extraordinary and diversified powers. Arsenic is prescribed in several forms, the most com- mon, however, of which, at present, is that denomi- nated Fowler's solution, or the liquor arsenicalis of the London College. This is the arsenite of potash, which is usually given in the dose of ten drops three or four times a day, gradually increased, till nausea, oedema- tous swellings, &c. take place. Nearly doublé this dose, however, has been given by some of our practi- tioners in intermittent fever, and, though sometimes with marked success, the practice must be deemed hazardous. As an alterative in chronic affections, par- ticularly of the surface, whether eruptive or ulcerative, I am persuaded that we commit an error, by the free- dom with which the medicine is administered. My own course under such circumstances, of late, is di- rectly the reverse, never exceeding two or three drops at a time.* * My friend, Dr. Holcombe, of New Jersey, whose authority on a former occasion I cited in relation to the use of corrosive THERAPEUTICS. 145 The arseniate of potash is a second preparation, dif- fering from the "preceding among other respects in be- ing a crystallized salt. It has the sanction of the Dub- lin college, and is occasionally used in the dose of a sixth or eighth of a grain. Bysome practitioners, the oxid, or acid, as it may be, is preferred in the solid state, made into pills. The dose is exactly the same as of the preceding preparation. It was thought by Darwin, that a stili better mode is a solution of the oxid in wa- ter, which he made by boiling more than a saturated solution for half an hour, letting it subside, and then filtering it through a paper, of which eight or ten drops may be taken at once. That there is no great superiority in any one of these preparations, is probable. They are ali suffi- ciently active, and may be exhibited with nearly equal convenience. The solutions are, however, safest, as the article in this mode is susceptible of a more accu- rate di vision.* As an external remedy, having already treated of arsenic under the head of escharotics,! I have now sublimate, gave me this suggestion, and I have since acted upon it with great advantage. * I have learnt from my friend Dr. Physick, since the former editimi of this work, two years ago, that the oxid of arsenic is decidedly in ali cases the most active and effìcient preparation, particularly in intermittents, and my recent experience is en- tirely confirmatory of the accuracy of his observation. f Plunkett's Ointment, consists of arsenious acid, sulphur, and the powdered fiowers of the Ranunculus Flammula, and Co- tuia Fcctida, levigated and made into a paste with the white of an cgg, and applied, on a piece of pig's bladder, to the surface of th« cancer. Paté Arsenicale. This favouritc remedy of the Freuch sur- 446 ELEMENTS OF only to mention the fact, that it is clearly demonstrated, as well by direct experiments as by numerous cases re- corded, that thus applied to an abraded part, it ope- rates even more deleteriously than when internally ad- ministered. Hence the utmost caution is required in its use.* geons consists of 70 parts of cinnabar, 22 of sanguis draconis, and eight of arsenious acid, made into paste with saliva, at the time of applying it. This combination, observes a periodical writer, is similar, with the exception of the ashes of the soles of old shoes, to that recommended by Father Cosmo under the name of " Pulvis Anti-carcinomatosa." Davidson's Remedy for Cancer, arsenious acid, and powdered hemlock. Singleton's Eye Salve, or Golden Ointment. Under this name is sold a preparation which consists of sulphuret of arsenic (orpiment) with lard, or spermaceti ointment. The Unguentum Hydrargyri Nitrico-Oxydi of the London College is also sold under the same title. Delcroìx's Poudre Subtil, " for removing superfluous hair in less than ten minutes." This fashionable depilatory appears upon examination to consist of quicklime and sulphuret of arse- nic, with some vegetable powder. It is, however, so unequally mixed, that in submitting it to analysis, no two portions afford- ed the same results. It can scarcelybe necessary to state, that such a composition is incapable of fulfilling the inlention for which it is so confidently vended. In Paris, arsenic forms the basis of several blistering cerates. Such applications cannot be safe. Paris's Pharmacologia. * No antidote has been discovered for arsenic. The case is to be managed on general principles. Lately, however, mag- nesia has been proposed with this view. Two instances of poi- # soning from arsenic of a very desperate character, were man- T1IERAPEUT1CS. 447 SULPHUR. This article has been already noticed.* To what I have said, it remains to add, that it is so far entitled to be placed among the tonics, as evincing considerable powers in intermittent fever, and several other parox- ysmal affections. In the former disease, ite efficacy is well attested, where obscure and ill-defined, and parti- cularly when attended by circumstances which exact the combined effect of a purgative and tonic. It is no less useful in hectic fever, in periodical headach, as well as in a variety of other affections observing the same law of recurrence. This is particularly the opin- ion of Dr. Physick, whom I have observed to prescribe the article with much confidence in ali such cases. It is generally given, with this view, in small and repeat- ed doses, so as moderately to affect the bowels. aged with success by Mr. Hume, of London, by the following mixture : R. Magnes. caib. 3;j. Aq. distili. 5 xv. Vin. opii ^iss. Sp. lavend. comp. 3'iij. Sacch. alb. 3SS. M. To be given in the dose of two table-spoonfuls, frequently re- peated. * Vid. Cathartics and Diaphoretics. 448 ELEMENTS OF SECTION XVI. Astringentia, or Astringents. Cullen has defined astringente to be <( such sub- stances, as, applied to the living body, produce con- traction and condensation in the soft solids, and thereby increase their density and force of cohesion." Consulting his reasoning on this subject, it appears, that he considers astringents as acting on the living precisely as they do upon the dead body. The opera- tion of this class of articles he actually illustrates by the process of tanning. But surely there is no sort of ana- logy in the two cases. In tanning, the astringent liquor soaks through every part of the skin, and a chemical action takes place be- tween it and the animai fibre. By this union the hide is rendered more dense and firm, putrefaction prevent- ed, and we have fabricated whatis termed leather. But let the same astringent be applied to the living body, and no such changes take place. As I have repeatedly insisted, so long as vitality endures, every chemical ac- tion or combination is repdled, by powers and resources peculiar to the animated condition. Nevertheless, there would seem, at the first view, to be a class of articles endowed with the property of THERAPEUTICS. 449 eorrugating or contracting the living fibre. This is especially evinced by the sensation which they impress on the tongue and fauces, and perhaps stili more conspicuously by their efficacy in restraining hse- morrhages from wounds. Yet how they operate has never been very intelligibly explained. Their effects are ascribed altogether by Darwin to the power of promoting absorption. Whether they have such a property is exceedingly doubtful. Conceding it to them, however, it will not in the slightest degree ar- count for their suppression of haemorrhagcs. The articles comprehended in this class vary in their nature, and so much in their mode of operation that it cannot be reconciled to any one principle of action. Those properly so called, seem to possess a modifica- tion of the tonic power, by which the solids are ren- dered more dense, and an increased tone and energy thereby imparted to the system. The cretaceous pre- parations and opiates, on the contrary, probably prove so only by correcting acidities, or allaying irritability in the first passages. It follows, therefore, that astrin- gente are either positive or relative, and in further illustration of the latter view, we may, as I have done in the instance of tonics, advert to the effect of this kind produced in oppressed states of the system even by direct evacuations.* The property of astringency is very widely dif- fused among piante, the number being almost infinite which possess it in a greater or less degree. But it * Topical astringents applied to check haemorrhage chiefly, are denominated styptics. vol. il.—57 450 ELEMENTS of has long been a matter of controversy in what it con- sists, and is stili scarcdy determined with absolute pre- cision. As a peculiar acid can be traced in ali the more ac- tive astringents, termed gallic, from its abounding most in galls, it was for a time generally ascribed to this acid. In the progress, however, of more accurate in- quiries into the subject, it was ascertained that this could not be the case, since, other objections apart, the acid itself, in a separate state, has no such property. Aware of this diflìculty, the late professor Woodhouse, who investigated this point with his usuai industry, was led to the condusion, that the acid exists here com- bined with alum, forming a gallate of alumine. But this has been proved to be not less erroneous. The later researches of Seguili have brought into view another principle of vegetable composition, which, as giving astringents the property of tanning, is denomi- nated tannin. That this is the principle of astringency seems to rest on pretty solid grounds, and is now gene- rally admitted. Tannin is styptic in taste, has the power of corrugation, and is universally met with in vegetable astringents, circumstances which strongly sup- port the hypothesis.* Whatever the principle may be on which they operate, the collection of remedies denominated astringente are thought capable of meet- ing a variety of indications—and hence employed in no small number of diseases. It is, however, in check- * Mr. llatchet has shown that tannin may be artificiali)' pro- duced by the action of nitric acid upon various vegetable sub- stances. THERAPEUT1CS. 451 ing or more permanently curing discharges, whether of blood or morbid secretions, that their powers are most sigually displayed, and their superior utility fully re- coguized. Exemplifications of their appropriate uses, will be reserved till I come to the consideration of the different articles of the class. In resorting to these, in common with every descrip- tion of tonics, or stimulants, we should, however, be careful not to be led astray by the illusive symptoms of debility. Most of the cases to which they are consi- dered as fitted, though apparently dependant on relax- ation and weakness, are really associated with sub-acute or chronic inflammation of tissues, or visceral irritation, and are better managed, at least as preliminary measures, by general and locai bleeding, the first sparingly, though frequently repeated, moderate purging, blisters occa- sionally renewed, an abstemious diet, and finally by the alterative use of mercury. These remarks apply to the profluvia, and particularly the bowel affections. Debility is not a disease of itself, remediable by mere tonic impressions. As the effect of functional or orga- nic derangement, let this be removed, and the recupe- rative energies of the system, under a proper regimen, will soon, in most instances, renovate strength and re- store the healthy condition. QUERCUS ROBUR. The bark of the English oak is calculated to fulfil some of the indications for which astringents are pre- scribed. In the dose of half a drachm, every two or three hours, it is said by Cullen, and other writers, to 452 ELEMENTS 01 suspend, with tolerable certainty, the paroxysms of in- termittent fever. It has also been found useful in hse- morrhage of feeble action—in diarrhoea, and in the last stages of dysentery. But as a gargle in sore throat, an injection in leucorrhcea, or as a wash in hsemorrhoidal tumours, or in prolapsus of the anus or uterus, from re- laxation, it is much more employed.* QUERCUS CERRIS. Galls are tubercular productions caused by the bark, or leaves of the oak, being pierced by an insect of the genus eynips, resembling the common gnat. The sap or juice escaping through this pimcture is inspissated, nnd gradually hardens into these knotty substances. Being mere excrescences, they have ali the qualities of the tree from which they are formed. The most active * Several species of our native oaks do not appear to be at ali inferior to the foreign, and are resorted to under similar circum- stances. Of these, the white oak most nearly resembles the En- o-Hsh in its properties. The bark of the Spanish oak, however, is more generally used, and has acquired considerable reputa- tion in the cure of ague and fever—in gangrene, and a variety of other cases. But by some practitioners the bark of the chest- nut oak is preferred. It seems to be admitted that the bark of the black oak is less valuable than any of the rest, and is apt, from the greater quantity of extractive matter which it contains, to gripe, and even to run off copiously by the bowels. As in- ternai medicines, 1 have not the slightest experience with the bark of any one species of the American oaks. But I have no doubt of their possessing powers sufficiently active to entitle them to attention, though, at the same time, I repose no confi- dence in those representations which would place them on a footing with the Peruvian bark. THERAPEUTICS. 453 are the product of the eastern section of Europe, im- ported from Aleppo. But those of our own country are not deficient in power. As possessed in an eminent degree of the principle of astringency, galls are used in many cases. They are thought, however, more particularly adapted to chronic diarrhcea, produced, or kept up, by debility, or to restrain the colliquati ve purgings incident to the last stages of pulmonary and other affections. They are commonly given in powder, or simple infusion, in the dose of half an ounce of the latter, or of ten or twen- ty grains of the former preparation. But their effect is improved, by adding to the infusion the prepared chalk, with laudanum.* Externally, they are used as an ointment in hsemor- rhoidal tumours, and with great success, where inflam- mation is previously reduced. To be of much service. however, the ointment should be made considerably stronger than is usually done. I generally direct three parte of lard, and two of finely powdered galls. When the tumours are seated so far up the rectum, as to pre- vent the application of the ointment, an infusion of galls may be injected several times a-day, and in pro- lapsus of the uterus, or rectum, it will prove beneficiai as a wash. Nor is less said of ite utility in gonorrhoea, gleet, and leucorrhcea—or as a gargle in relaxed states of the throat. By Swediaur, who is among the most experienced practitioners of Europe, in the two former complaints, it is highly extolled as an injection.f * R. Gali, infus. siv.—Cret. prep. 3ii.—Tinct. thcb. gtt. xl. \I. The dose is a table-spoonful. t Incomfiatihlc substances.—Metallic salts, especially those of 454 ELEMENTS OF RINO. The substance distinguished by this name was in- troduced about half a century ago into the materia medica, as a powerful astringent, little being known with regard to its origin, except that it came from Africa, and was, most probably, the exudation of some plant. Even at the present moment this point is not satisfactorily determined. It is stated by the Edin- burgh college to be the product of a tree of New Hol- land, the eucalyptus resinifera, whereas the Dublin college ascribe it, on the authority of Roxburgh, to the butea frondosa. It is said by Duncan to be afforded by the cocoloba uvifera. The prevailing opinion seems to be, that, whatever may have been the source of the primitive kino, that which is now generally found in the shops is made from various vegetable substances. It is, however, occasionally to be met with in a state of purity, and, then, has a very different appearance from the factitious preparation. That which is genuine comes in much larger masses, is intermixed with the bark and fibres of the plant, is of a less brittle texture, and, united to its astringency, has a maukish sweetish flavour—while the fabricated species looks like a com- mon resinous extract, purifìed and dried, is of a smooth- iron, produce precipitates—also acetate and sub-acetate of lead —tartarized antimony—sulphate of copper—sulphate of zinc— nitrate of silver—nitrate of mercury—oxymuriate of mercury —the minerai acids—the carbonates of ali the alkalies, lime water. THERAPEUTICS. 455 er and much darker surface, and has a taste blended of astringency and bitterness.* One of those who earliest employed this medicine was Dr. John Fothergill. He alleges that he gave it with such success in intermittents, as to effect cures in cases which resisted Peruvian bark. In the practice of this city, kino is sometimes prescribed, in con- junction with some of the more active bitters and opium.f It was also prescribed by Fothergill in me- norrhagia, and has since acquired reputation in atonie haemorrhage generally. Of late, it is favourably mentioned in diabetes, and in several of the affections of the stomach, particolari \ in pyrosis. In the latter case, it is recommended in strong terms by Pemberton, in his excellent treatise on the diseases of the viscera.J It is, I suspect, by re- storing the stomach to a sounder condition, that kino proves beneficiai in diabetes, gastric disorder in some degree being always associated with that disease. The most common application, however, of this me- dicine, at present, is to diarrhcea, and certain states of dysentery. To restrain purging, under most circum- stances, I scarcdy know an article more decidedly ser- viceable. Many practitioners prefer giving it in wa- * There are three kinds of kino found in the shops, desig- nated by the titles of African, Botany Bay, and Jamaica kino, tìVe best of which is the last. t R. Gum kino ,"ii.—Rad. gent. gss.—Gum opii gr. ii. M. div. in pulv. xii. One to be taken every two hours during the interval of the paroxysms. | R. Gum kino gr. x.—Gum opii gr. i.—Mucil. g. arab. q.s. ft. pil. ii. Of which, take one every four hours. 456 ELEMEXTS OF tery solution, but it succeeds better in tincture, witii prepared chaik and laudanum.* As an injection in gonorrhcea, it is directed by Mr. Bell,f of which I cannot speak from any experience of my own, though I presume that it might be better adapted to gleet. It is somewhat curious, and deserves to be recol- lected, that kino, combined with colomba, constitutes a certain and powerful purgative. It is one of the anomalies produced by the combinations of medi- cines.^ MIMOSA CATECHU. This plant, a native of Hindostan, furnishes an ex- tract formerly called terra japonica. It is now vended by the title of catechu, and is an active astringent, con- taining, according to chemical analysis, more of this principle than any other substance. It is hence em- ployed in nearly ali the cases to wliich the preceding article is deemed applicable. The powder, sprinkled on relaxed sores, especially of a venereal nature, sudi as ulcerated bubo, is highly commended by the surgical writers, and I have found * R. Tinct. kino—Cret. prep. al 51V.—Tinct. theb. gtt. xl. Aq. font. §iv. M. A table-spoonful every two or three hours. t R. Pulv. kino -ii.—Pulv. alum. 3Ì.—Mucil. g. arab. 51.— Aq. font. ibi. M. et collat. | Theaccuracy of this statement, I find, haslately been qucs- tioned by Dr. Paris. But I have made the experiment too often to be deceived. I find also it is noticed in Lewis's Materia Medica. § Incon\i\atible substances.—The same as galls. THERAPEUT1CS. 457 it serviceable.* It is, moreover, useful in certain atonie states of the fauces and uvula, and forms, with an equal proportion of Peruvian bark, and one fourth the quantity of powdered myrrh, an excellent dentri- fice, when the gums are spongy. Catechu may be given in substance, in the dose of ten or twenty grains, or in tincture, or watery solution. It is often combined with kino advantageously.f PUNICA GRANATUM. The pomegranate tree is a native of Europe, Asia, and Barbary. It, however, meets with a more conge- nial climate in the West Indies, and, perhaps, in our southern states, into which it has been introduced, where the fruit, at least, is said to be of superior size and flavour. The bark and flowers, the latter known in our shops by the title of Balaustines, are only used for medicinal purposes. Each is astringent, though the former, particularly of the root, is most so, which, in decoction, was formerly much relied on in ali the cases in which similar articles are employed. I have found * It is said by Mr. Kerr that the following ointment is ex- ceedingly useful in ulcers, I presume of a relaxed and ill-con- ditioned kind. It is borrowed from the Hindoos. R. Pulv. Cupr. Sulph. giv. ----Catechu giv. ----Alum. jix. ----Resin. alb. §iv. 01. Oliv q. s. ft. ung. f lncompatible substances.—Its astringency is destroyed by alkaline salts, and the metallic salts, especially those of iron, produce precipitates. vol. 11.—58 45S f.l.L.MEMS Ot it serviceable r.i diarrhcea, in the dèclining stages of dysentery, and especially under similar circumstances, in cholera infantum. Of its efficacy in taenia, I have already spoken, and shall now only add, that so far from being a new remedy, as is generally supposed, it is mentioned by Celsus as used by the ancients for such purposes. The dose of the powder, which is some- times prescribed, is about a drachm, and, of the de- coction, an ounce. H^EMATOXYLON CAMPECHIANUM. This is a tree of South America, and also of the pro- vince of Honduras. Logwood is much used as a dye.* Nor is it deficient in medicinal virtues. In decoction, or infusion, it has proved beneficiai in chronic dysen- tery, in diarrhoea, and above ali in the dèclining stages of cholera infantum. It is in this latter complaint chiefly prescribed by our practitioners. The infusion is best suited to the cases of children : and a dessert-spoonful, repeated every two or three hours, is the proper dose. An extract of logwood, which is an officinal preparation, has been proposed as a substitute for kino.f * To the colouring matter, which has lately been analysed, the name of hematin is given. f Incompatible substances.—Precipitates are produced by the acetate of lead—alum—the sulphates of copper and iron—tar- tarized antimony—antl sulphuric, muriatic, nitric, and acetic acids. CllERAPEUTlCS. 459 VISCUM. Of the misleto, once so celebrated, I have not much to say. It is known as a parasitical plant, growing on different trees, as the oak, the appiè, and more par- ticularly the gums of our country. But, whatever may be the source of ite nourishment, its properties are pre- cisely the same. It affords, therefore, an additional proof of the great power which vegetables, in common with animals, possess, of digestion and assimilation, through their absorbent apparatus. The misleto is a pretty active astringent. It was formerly much trusted in the treatment of epilepsy, and analogous diseases. Besides, it is reputed to have proved serviceable in quartan agues. I know nothing of it myself, and am disposed to think ithas been great- ly overrated. Yet it is an interesting article as con- nected with the ancient superstition of the druids, and perhaps stili more as an object of naturai history. Being very abundant in the United States, it may be worthy of trial in several diseases, and especially in nephritis, a case in which I hear it has done good. The virtues of the plant are resident chiefly in the bark, which may be given in powder. in the dose of forty or fifty grains. GERANIUM MACULATUM. This species of geranium, or crowfoot, or spolted cranesbill, grows in the neighbourhood of this city, and is also met with in other seetions of the United States. 460 ELEMENTS OF By its sensible qualities, as well as from its effects on the system, it seems to be highly astringent, and may become an acquisition to the stock of our remedies. As a styptic, a strong decoction has been found active, and is much used, for this purpose, in many parts of our country. Itis also prescribed in internai haemorrhages, and especially those of the alimentary canal. To diarrhoea, and the chronic stages of dysentery, and cholera infantum, it is moreover known to be adapt- ed. It is stated on good authority, that some of the Indian tribes rely on this article almost exclusively in the cure of the venereal disease. But I do not know to what form of that disease they apply it. From its general properties I should suppose that it might be useful as an injection in gonorrhcea and gleet. It ap- pears, however, that they use it as a beverage. Even in this way, it may be serviceable in those complaints. as they frequently submit to astringents and other ge- neral remedies. It has, moreover, it is said, done good in nephritis, and I have remarked, that articles which operate on the kidneys, extend their impressions, more or less, over the whole of the urinary and genital organs. The virtues of the plant are in the root, which, as an internai medicine, in the bowel affections especially, is commonly prepared by being boiled in milk. PRIXOS VERTICILLATLS. The black alder is another of our indigenous astrin- gents deserving of notice. It grows almost in every section of our country, and delighte in a damp marshv soil. The bark, as well as the berries, is astringent. THERAPEUTIC9. 461 The latter may be made into a tincture with wine or spirits. The bark is used either in substance or decoc- tion. It is said to cure intermittent fever, and may be successfully administered in the incipient stages of gan- grene, as a substitute for Peruvian bark. But in these cases I know nothing of its powers. The only applica- tion which I have ever made of it, has been to the cure of some of the chronic cutaneous affections, in which I have found it useful. RUBUS PROCUMBENS ET RUBUS VILLOSLS. The first of these piante is the dew berry, and the second the black berry. In popular practice both of them have long been used in the bowel affections. The knowledge of the fact induced me some years ago to try them in these cases, and I was so pleased with the result, that I have since very extensivdy prescribed them. Of the vegetable astringents, I have reason to believe that they are among the most active and efficacious. To the dèclining stages of dysentery, after the symp- toms of inflammation are removed, they are well suited, though I have given them, I think, with greater ad- vantage, under nearly similar circumstances, in cholera infantum. To check the inordinate evacuations which commonly attend the protracted stages of this disease, no remedy has ever done so much in my practice. They, moreover, are useful in ali excessive purgings, from 462 KLEMENTS OF whatever cause proceeding, especially in the diar rhcea of old people, and when it occurs at the dose of diseases. My experience with these articles is limited pretty much to the cases wliich I have mentioned. But I can- not help bdieving, that they will hereafter be found susceptible of a more diversified application, and, per- haps, under ali circumstances where an agreeable bitter tonic or astringent is demanded. As an antilithic, and, indeed, as a corrective of ali the depraved states of the stomach caused by debility, I am persuaded that they will display valuable powers. Of the comparative utility of the dew and black ber- ry, I am hardly entitled to decide very confidently. My impression, however, is, from what I have observ- ed of their effects, that the former is the superior me- dicine. Certain it is, that it is more pleasant to the taste. Every part of the plant is actively astringent, as the root, the leaves, the bark, the fruit, and ali may be employed. But the root is to be preferred. The mode in which I have used it is in decoction, taking about an ounce bruised, to a pint of water. Thus pre- pared, we have a beautiful claret-coloured liquor, having its bitterness, which is not very great, temper- ed, by a pleasant aromatic flavour. OltOBANCHE VIRGINIAXA. This is a small, parasi tic, indigenous plant, known by the vulgar title of beech drop, of which the root is considerably astringent. What is its value, as an in- THERAPEUTK*. 463 tcrnal remedy, in diarrhoea, dysentery, and haemor- rhages, in which it is used in domestic practice in some parts of our country, I have not accuratdy ascer- tained. Ite applications externally are better known. The cancer powder of Martin, once so much conflded in, was mainly composed of this article, and though in this case ite reputation is now gone, a simple decoction of the root is stili employed by some practitioners in obsti- nate ulcers, as well as in aphthae and chronic cutane- ous affections. It would be easy very much to enlarge the catalogue of indigenous astringents, our forests and fields being redundant with articles of this description. But their properties have been imperfectly examined, and I _know nothing of the practical applications of them mvself. 464 ELEMENTS OF SECTION XVII. Minerai Astringents. PLUMBUM. The preparations of lead are various. But I shall confine my observations only to that produced by a .ombination with the acetic acid. PLUMBI SUPERACETAS, OLISI SACCHARUM SATURNI. This preparation of lead was originally employed by Paracelsus, to whom we are indebted for many of our heroic medicines. As an internai remedy, it seems to have been continued by some more cautious practition- ers for a considerable period afterwards. Ite use, how- ever, was denounced by Boerhaave, Stahl, and Hoff- man, and such was the deference to their authority, that it ceased to be employed. But, in the progress of time, it regained its reputation, and, with some occa- sionai protestations against it, came ultimately to be THERAPEUTlCS. 465 considered, under a careful administration, as an im- portant acquisition to the materia medica. Among other cases it is applied to the cure of inter- mittent fever, and we are not without some authority in its favour. Distinct from other facts, we are told, that during the late war it was resorted to with much ad- vantage by some of the physicians of our army. It is, indeed, stated, that in many instances it proved supe- rior even to arsenic or Peruvian bark. But these ac- counts, I suspect, are exaggerated, and should be re- ceived with some doubt and hesitation. My experience with it in intermittent fever is not great, though I have tried it sufficiently to convince me, that if ever it does good, it is rarely, and should be placed among the more precarious of our remedies. Ite character is better established in hectic fever. Many of our best practitioners confide in it, and I have heard, that, by Dr. Irvine, of Charleston, who is among the highest medicai authorities of our country, it is par- ticularly commended. The practice, indeed, is not new, so far, at least, as regards pulmonary consump- tion. It is strongly recommended by Paracelsus in ali the thoracic affections, and more precisely directed by Etmuller in genuine phthisis. That it was commonly used in such cases, is further and conclusively shown, by the older dispensatories containing a formula into which it mainly enters, hearing the significant title of Tinctura antiphthisica.* The later Cerman writers • R. Sacch. Saturn. 5ÌJ. Sai Martis 3Ì. Infus. Sp. Vin.lbi. M. Of which twenty or forty drops is the dose- Vid. Salmon's Dis- pensatory. VOL. II.—5l.) 466 ELEMENTS OF abound with attestations in its favour. As before stated,* it has also been employed with success by Dr. Irvine, in ydlow-fever, as well to meet the general or leading indication in the second stage of that fell disease, as particularly to allay the gastric distress incident to it. That the practice was comparativdy successful, suf- ficiently appears from the evidence he has adduced. In the few trials made with it in this city, during the last occurrence of the fever, we were ali satisfied of the vast power of the lead, in controlling irritability of the stomach—and I have since, acting on this intelligence, used it, with the most unequivocal advantage, to check bilious vomitings, in the different forms of cholera and autumnal fever. The treatment of internai hsemorrhages by it, was onee common in Europe, and is noticed by one or two of the early writers of this country. But, in conse- quence of the clamour raised by Sir G. Baker, and other distinguished men in England, against it, a sort of panie terror seized upon physicians, and it was gene- rally abandoned. To the late professor Barton, the credit is undoubtedly due of dissipating these idle alarms, and for having, at least among us, fully re-esta- blished confidence in the safety and efficacy of the prac- tice. In every species of haemorrhage, whether active or passive, and from whatever part of the body pro- ceeding, the lead has been found useful, according to the reports of different practitioners. Nothing, how- ever, is more certain, than that ite use ought always to * Vid. Ol. Terebinti!. THERAPEUTICS. 467 be preceded by copious venesection, where fulness and activity of pulse exist. This precept applies with pe- culiar force to the case of haemoptysis. Unless vene- section be practised, it will certainly prove inefficient, and sometimes even mischievous. Nor will a single bleeding always suflìce. The rule, under such circum- stances, is to deplete so long as there is increased vigour in the circulation. It is, however, more celebrated in uterine than in any other hsemorrhage. To be advantageously pre- scribed, the cases must here too be properly discrimi- nated. The haemorrhages of the gravid uterus may precede or follow delivery, though, in either event, if the flow be copious, this medicine will prove wholly inadequate to the emergency, as such is the magnitude of the vessels, in this state of the organ, that its bleed- ings can only be checked by compression, through ite own contractions. Often, in the course of a very few minutes, were these floodings not arrested, death must be the conse- quence. On the treatment of them in detail, it would be improper for me enter. I shall indeed merely re- mark, that if they come on, in an alarming manner, prior to delivery, the child and secundines are as promptly as possible to be removed—or at least the membranes ruptured, which, however, is a more doubt- ful practice—and then cold applications applied over the whole abdomen, with a complete plugging up of the vagina. The lead, under such circumstances, I repeat, would be altogether unavailing. This medicine is ap- plicable only to the moderate degree of haemorrhage, which sometimes precedes misearriage. or is incident 468 ELEMENTS OF occasionally to regular yiarturition, from partial detach- ment of the placenta. But to hsemorrhages which take place in the unim- pregnated state of the uterus, it is stili better adapted, which indeed it hardly ever fails of rdieving, when judiciously administered. By Heberden, it is said, that if " ever there was a remedy which deserves to be con- sidered as a specific in any disease, it is surely the sac- charum saturni in uterine hsemorrhage.7' My expe- rience will not allow me to go quite so far in praise of it, though I am prepared to concur in a very high eu- logium on ite powers, and to the same purport might the authority of many distinguished writers be cited.* To some of the complaints of the alimentary canal, acute as well as chronic, lead has been considered as well suited. As a tonic or astringent, it is serviceable in dyspepsia, and particularly in pyrosis. Exhibited with the same view, it is represented as productive of greater advantage in dysentery, cholera infantum, and diarrhcea, in each of which cases it is now often pre- scribed in this city, and in other parts of the United States. It would indeed be no diflìcult task to collect some very respectable testimony to its decisive efficacy, as well from our own as foreign sources. The practice is older than we have generally sup- posed. It is mentioned by Etmuller, and several later writers, among whom are Adair, Jackson, and Bamp- * I have understood from my friend Dr. Dewees, that he has found, under such circumstances, much advantage from injec- tions of the solution of sugar of lead up the rectum, much more so than into the vagina. THERAPEUTIC9. 469 field, though not exactly under the same circumstances in which we prescribe the article. I have for several years occasionally employed it, both in cholera infantum and dysentery, not, however, to the same extent or with such success as recently. These diseases prevailed in this city in a very unusual degree, during the summers of 1822 and 1823, which afforded me ampie opportunities of testing the powers of the medicine. Evacuations having been premised, by venesection and purging, I have found nothing more effectually to relieve tormina and tenesmus, to correct the morbid secretions of the intestinal canal, to allay febrile excitement, or to conduce to the comfort and general improvement in the condition of the pa- tient. These remarks apply more especially to dys- entery, though in cases of cholera infantum, approach- ing the same character, I have derived nearly equal advantage from it. In some instances, where it was desirable to act on the surface, I have added a small portion of ipecacu- anha, with utility, it meeting well this particular indi- cation, without at ali impairing the specific properties of the lead. In the progress of some protracted cases, it will be necessary, about once in the twenty-four hours, to intermit this course of treatment, in order to interpose some purgative, to remove any foul accumu- lations which may take place in the bowels. It may be inferred, from what has been said, that the same prac- tice might be advantageously extended to diarrhoea, and such I have found it. As part of the treatment of some of the cases of neuroses, this medicine has acquired no inconsiderable 470 ELEMENTS OF reputation. During the last twenty years, it was mudi and fairly tried in the public and private practice of this city in epilepsy, and though in some cases of the disease occurring in children, it manifestly mitigated the paroxysms, it never, so far as I have been able to learn, effected one solitary cure. Experiments have also been made with it in chorea, as well as in hysteria, and, I am inclined to believe, with nearly the same re- sulte. To chronic affections, like epilepsy, especially, it does not seem to be appropriate, as they require for their removal, the steady continuance of a course of treatment for a period longer than, perhaps, as respects this article, it is safe to pursue. By the celebrated Hunter, it was proposed as a remedy in tetanus, and it appears from a late French Journal, that Burbach has actually cured a case of this disease by it. What would be its efficacy in hydrophobia? By some of the late English writers it is represented as an almost infallible remedy in pertussis. WThen I first received this Ìnformation, I employed it in several cases, without any sensible effect. Notwithstanding, therefore, what is affirmed in its favour, I cannot help placing it very low in the management of the disease. Confiding at one time in these reports, I was induced from analogy to try it in asthma, with results, however, equally unsatisfactory. Dysphagia, dependant on spasm, is said to have been cured by it. In union with camphor, we are told, it is serviceable in several of the forms of mania. But as this prescrip- tion is a compound one, embracing another very active ingredient, the evidence to the efficacy of the lead is too ambiguous to be trusted. Etmuller, however, pro- nounced it a specific in melancholia. THERAPEUTICS. 471 It was once thought also useful in some of the ca- chexiae, and particularly dropsy. The practice, how- ever, was never supported by much testimony, and probably merits no attention. Might it not be useful in diabetis? This is thrown out as a conjecture only, never having tried it. But ite general power of sooth- ing the irritations of the primse vise, and ite control over some of the excessive discharges, particularly colliqua- tive perspiration, seem to concur in recommending such an application of it. As an injection in gonorrhoea, a solution of saccha- rum saturni, in the proportion of one or two grains to an ounce of water, is a popular remedy. But I have found it one of the worst resources for the cure of that affection, commonly proving ineffectual, and is very apt to induce hernia humoralis. Diluted stili more, it forms a safe collyrium in the second stage of locai ophthalmia—rendered stronger, it is beneficially ap- plied in superficial inflammations—and a saturated so- lution, mixed with one third of vinegar or brandy, proves among the most active of our discucente.* The saturnine poultice, made with lead water, and the crumb of bread, is a common application to phlegmo- nous swellings, and with the addition of laudanum affords much relief in painfully inflamed hsemorrhoidal tumours. In the internai employment of lead, there is one pre- scription which I have found appropriate to most cases, consisting of about two grains of it, with a quarter of a * Goulard's extract, though differing slightly from the pre- ceding preparation in its chemical composition, being a true acetate of lead, is similar in its effects, and is employed for the same purposes externally, in a state of dilution. 472 ELEMENTS OF grain of opium, made into a pili, to be repeated as often as circumstances may demand. What would be the effect of exhibiting a large dose of it in hsemorrhage, is problematical. It ought to accomplish much more, and certainly might be done with safety. Yet on one occasion, in hsemoptysis, I gave twenty grains of it at once without any advantage. Perhaps, as in the case of mercury, the mode of action of the article is regulated by the quantity. The former is a salivant or purgative, ac- eording to the dose, and the latter may prove astrin- gent or otherwise, in the same way. I entertain such a suspicion from having observed, in ali cases in which lead by accident had been taken largely, it ran off by the bowels, occasioning little or no impression, except some tonnina and tenesmus. Two drachms I have known to be taken at a time, through mistake. We shall, on the whole, probably hereafter ascertain, that, as with some other articles, the specific operation of lead is only, or more effectually attained by a small than a large dose.* * Incompatible substances.—.The alkalies, alkaline earths and their carbonates—most of the acids—alum—borax—the sul- phates andmuriates—soaps—ali sulphurets—ammoniated and tartarized iron—tartarized antimony—undistilled water. Certain medicines, too, seem to be incompatible with lead, not from any chemical changes, but on account of the counter- agency which they exercise in their medicinal action. Of this description is mercury, as is illustrated in the effects of that ar- ticle in saturnine colie, and perhaps, also antimony. By M. Marat, the case of an apothecary is related, who was cured of colica pictonum, of an extremely violent character, by eighty grains of emetic tartar taken in eight days. The proper anti- dote of the acctates of lead is the sulphate of soda or sulphate of magnesia. THERAPEUT1CS. 473 ARGILLA. Though, in a pure state, this earth is without activi- ty, ite combinations are very different. The one used internally, is a super-sulphate of alumine and potash, which only I shall notice. SUPER-SULPIIAS ALUMINJE, ET POTASSA : VULGO ALUMEN. This preparation was known to antiquity only as an external application. Hippocrates speaks of its utility as a lotion in various ulcers, and his immediate succes- sors held the same language. The credit of prescribing it internally is accorded to Van Helmont, in which he was soon followed by practitioners generally. By some writers, it is regarded as a remedy in in- termittent fever. Lind asserts it to be, when used with nutmeg, the most efficacious which he ever tried, ex- cept the Peruvian bark. Cullen, however, who pre- scribed it in the same way, says that it proved so irri- tating to the stomach, as not to be useful. My own experience enables me to advance no positive opinion on the subject. Yet it was recommended by Chalmers in the remittent fevers of South Carolina, and, under similar circumstances, is favourably mentioned by Adair. The latter directs it in union with canella alba and bark. By Darwin it is supposed to be better adapted to fever, connected with intestinal disorder. voi., n.—60 474 ELEMENTS OF To the chronic affections of the bowels, it is cer- tainly applicable, such as protracted dysentery, diar- rhoea, and especially cholera infantum. It is here usually given in solution, with laudanum, gum arabic, and sugar. Nor has it less reputation in some of the spasmodic affections of the alimentary canal. Benefi- ciai, perhaps, in ordinary flatulent colie, it is decidedly so in colica pictonum, and particularly when induced by lead. This is strongly affirmed by Richter, and equally so by Percival and Mosely, the latter of whom, however, gave his vitriolic solution. To be useful, it requires to be exhibited in large doses. To restrain other discharges it is also much pre- scribed. Combined with bark, we are told it does good in leucorrhcea and gleet. Nor is it less advan- tageous in diabetes. This is no new practice. It was employed by Dover, with distinguished success, and it has since been tried, and its efficacy in some degree confirmed. Useful, however, as it may be in the preceding cases, it is stili more so in hsemorrhages, to every va- riety of which it has been thought suited. My con- viction is, that it is too indiscriininatdy prescribed in both the active and passive states. Being powerfully astringent, and even stimulant, it should never be re- curred to without the previous reduction of vascular action and general excitement. Nor is it equally appropriate to every species of atonie hsemorrhage. Cullen denies its utility in hsemoptysis, in which I concur with him. It is now indeed chiefly restricted to uterine hsemorrhage, which was its originai applica- tion by Van Helmont, who acquired great fame by the THERAPEUTICS. 475 cures he effected with it. No doubt, it is here service- able, though, of late years, it has been in a considera- ble degree superseded by articles deemed of greater eflicacy. Yet there is one form of the disease depend- ant on extreme laxity of the uterine vessels, in which it retains its reputation unimpaired. It is also pre- scribed with advantage in haemorrhage of the alimenta- ry canal. The dose of alum is from five to ten grains. To pre- vent ite exciting nausea, which it is apt to do, when so freely administered, an aromatic may be joined with it. But the neatest mode of exhibition, is that of whey,* prepared by boiling two drachms of powdered alum in a pint of milk, of which the dose is a wine-glass- ful. Externally, alum is employed as the basis of gargles in ulcerated throat, in relaxation of the uvula—as an injection in gleet, and as a collyrium, in chronic inflam- mations of the eyes. In recent ophthalmia, relief is sometimes afforded by the alum curd.f This, which is a coagulum formed by rubbing a piece of alum in the white of an egg, is an exceedingly cooling preparation, and will sometimes reduce pain and inflammation very rapidly. It should be spread on a fold of fùxn, and applied over the eye. Dissolved in water, with an equal portion of the strN phate of zinc or copper, alum constitutes one of the most effectual of our styptics—and a saturated solution of it in ether is found very effectual in tooth-ache.jG * Serum aluminosum. t Albumen aluminosum. f Vid. Escharotics. § Incompatible substances.—Alkalies, and alkaline salts, after 476 ELEMENTS OF BARYTES. Of the preparations of this earth, the muriate, for- merly called terra ponderosa, is the only one employed as a medicine. Not many years ago it was introduced into practice, and promised to be a considerable ac- quisition to the materia medica, and especially as a re- medy in glandular and lymphatic affections. We are assured by Crawford, that it has cured the most inveterate cases of scrofula, and is also beneficiai in scirrhus and cancer. Of this statement, a part is confirmed by Clarke, a highly respectable writer, who says that cases of scrofula, in the negroes of the West Indies, which resisted mercury, the bark, and many other of the active remedies, very readily yielded to the muriate of barytes. Nearly the same account is given of it in scrofula by Mr. Pearson, who also speaks confidently of its utility in checking the progress of malignant venereal ulcers. By Huffeland and other German authors, it was, more- neutralising the excess of acid, precipitate the alum. It is also decomposed by carbonate and muriate of ammonia, carbonate of magnesia, and tartrate of potash, by lime water, super-ace- tate of lead, and the salts of mercury, as well as by many vege- table and animai substances, especially galls and kino. It is on this account very injudicious to combine alum ivith any ve- getable astringent. The above is the language of Dr. Paris. But, though what he saysis doubtless chemically true, I suspect it is contradicted by practical experience. The very vegetable combinations which he particularly proscribed I have employed beneficially. THERAPEUTICS. 477 over, commended in various cutaneous eruptions, and in amenorrhoea, mania, &c. At one period, I tried this medicine freely, in most of the preceding cases, with so little success, however, that I have since been disposed altogether to abandon it. It is given in the dose of fifteen or twenty drops several times a-day.* CALX. As a lithontriptic, I have already treated of this substance, in the shape of aqua calcis, which, perhaps, is the most common mode of using it. Mixed with an equal portion of milk, and exhibited in the dose of a table-spoonful, to be repeated every half hour, or even oftener in some instances, lime water is well fitted to cairn irritability of the stomach, and to check vomit- ings. Nor is it scarcdy less useful as a tonic and anta- cid, in dyspeptic and other vitiated states of the sto- mach. Besides which, it has been found serviceable as an astringent in leucorrhcea, in the last stages of dysen- tery, in diarrhoea, and in cholera infantum. I know not, indeed, of any remedy so well suited to the bowel affections of very young children. They are subject to purgings, produced or aggravated by acidity in the primae viae, which it perhaps neutralizes, and thus re- lieves the complaint. Being little offensive to the taste, it is easily given under ali circumstances. Externally, lime water is employed as a wash in old ulcers—and? blended with an equal part of olive oil, * The antidote is the same as that of lead. 478 ELEMENTS OF it forms an excellent application to recent burns or scalds, and irritable blisters. Two other preparations of lime, the creta praeparata, and oculi cancrorum, both carbonates, are much em- ployed, chiefly as antacids, or astringents, to check diarrhcea—and, for this purpose, commonly in the form of the cretaceous julep. The muriate of lime, or what was once called fixed ammonia, is a preparation of perhaps some value. Dis- tinct from its tonic or astringent properties, it has been very much commended, as well in Europe as this coun- try, in venereal, scrofulous, and similar affections. My own experience does not enable me to say much of this article. I have occasionally prescribed it, though not with any very conspicuous advantage, and, I suspect, such would be the general report on the subject. The dose is from half a drachm to a drachm of the saturated solution.* Of the phosphate of lime, I shall say no more, than merely to observe that it is no longer used—the little reputation which it once acquired, from purely theo- retical views, in rickets and mollities ossium, being en- tirely lost. ACIDUM NITRICUM,f OLIM AQUA FORTIS. Of the minerai acids, the nitric is perhaps the most * Edinburgh Pharmacopoeia. f The nitric acid used in medicine is diluted. But the foreign Pharmacopoeix do not agree in their directions on this subject. THERAPEUTICS. 479 useful. Not many years ago, it was introduced as a' remedy, in the treatment of syphilis, and received an extensive trial. That it did good, in some instances, can hardly be doubted, from the very great weight of testimony collected in its favour. But the result of a more enlarged experience seems to be, that, though it cannot be relied upon in the primary stages, it often proves highly beneficiai in the secondary forms of the disease, and not less so in repairing the mischievous consequences of an undue mercurial impression. Nitric acid is diffusible in its operation, pervading every part of the system. It is, hence, a useful reme- dy in a great variety of affections besides the cases mentioned. Of these, perhaps, the most striking are certain forms of hepatitis, especially where there is too much debility to justify the use of mercury, or when it has already been used ineffectually. To most glandu- lar diseases, it is, indeed, well adapted. Of ali the remedies which I have tried, it has proved the most successful in those ill-conditioned scrofulous sores which approach the nature of cancer. Not a few of these cases, which had previously resisted the best establish- ed modes of treatment, I have cured by the free inter- nai use of it, aided by dressings with citrine ointment. Communications, too, of its eflicacy, under similar cir- cumstances, have been made to me by several of my correspondente, Nitric acid is also prescribed in the complaints of the alimentary canal. I bave sometimes directed it with effect in dyspepsia, and particularly when arising from svmpathy with a diseased liver, or some other of the abdominal viscera. Yet in chronic diarrhoea and dys- 480 ELEMENTS OF entery, it is much more employed. It operates here as well by changing the morbid secretions of the intes- tines, as by its astringency. Nor is it less serviceable, perhaps, in chronic eruptions. But to attain its full effect, in these very intractable affections, it must be long and steadily continued. Extensive experience has satisfied me, that of ali the articles of the materia medica, nitric acid is the best substitute for mercury. Their mode of action may not be exactly alike, though they are serviceable in the same description of diseases. It is, therefore, a rule with me, where mercury is indicated and cannot be used owing to certain circumstances, which often hap- pen, I resort to the acid, and sometimes with great effect. Yet it must be confessed, that, of late, the general estimate of ite powers is not so high as formerly, in syphilis, and the hepatic affections especially. To Dr. Scott, by whom it was originally recommended in these cases, in a very confident tone, it is due to state, that he has recently published a defence of his former reports, coupled with an explanation of the cause of the failure of the remedy in the hands of other practi- tioners. It is alleged, that, while in India, whence he trans- mitted the accounts alluded to, the article he employed was produced from a manufactory, in which, from the very nature of the process carried on, as he has since discovered, nitro-muriatic acid was formed. To this mixed acid, therefore, he ascribes the effects he expe- rienced from what he supposed at the time to be pure nitric acid, and now declares, that he derives as for- merly, froin this compound, every advantage. THERAPF.UTICS. ^8J It further appears, that, with nearly equal utility, the remedy may be applied externally in the shape of a bath, either partial or general, as the case may de- mand, or by sponging the surface—the "acidulated water being made about as sour as vinegar, or of sudi strength as to prick the skin a little after an exposure to it for twenty minutes or half an hour." In whatever case the acid is employed, he considers every trial as inconclusive, where "a ptyalism, some affection of the gums, or a very evident constitutional effect does not arise from it. As with mercury, the system should be kept charged with it for a longer or shorter time, according to circumstances." " The bath," he says, '■' appears in a particular man- ner to affect the glands, and to alter their secretions— and, on this power, a great part of its value, in derange- ments of the liver, seems to depend. It, sometimes, very suddenly increases the secretion of bile, and this effect may be kept up for a great length of time. It in- creases the perspiration, often to a great extent. From this account of its effects it follows, that it is well adapt- ed, independently of its applicability to hepatitis, to ali diseases denominated bilious, or which, in other words, arise from deficient, superabundant, and depraved se- cretions of bile." Nor is he less assured of its powers over syphilis, particularly pseudo-syphilis—in the cor- rection of a strumous condition—in the healing of ul- cers from any cause, and in the cleansing the surface from foul eruptions. What is the precise degree of credit to be given to these statements, I am unable to determine. My expe- rience with the remedy, though pretty extensive, does VOL. n.—61 482 ELEMENTS OF not allow me to express any positive opinion in relation to ali its applications. But the character of Dr. Scott is sudi as to shield him against any ungenerous imputa- tion, and to claim for him a fair hearing on this subject. By some of our best practitioners it is much commend- ed, particularly in visceral obstructions attended with diminutive fever, and the attestations from abroad are not less conclusive. Of these, one of the most autho- ritative, is contained in a paper by Mr. Guthrie, an eminent surgeon, from which I select the following pas- sage, as exhibiting the result of the use of the bath in Chelsea-Hospital. " I have shown," says he, 6i that the acid bath has two principal effects :—one, that of promoting the se- cretions from the intestinal canal, even with pain, and often proving completely purgative—the other, though infinitely more uncertain, of increasing the flow of sali- va, and especially if mercury has been previously used. It cannot then be denied to possess considerable power. As a remedy, though extremely uncertain in its effects, it is peculiarly applicable to those diseases in which the use of mercury and alteratives is indicated : in many cases it may and will be successati where these have failed—though it should not be relied on altogether as superseding their use. It will, on the contrary, be found more efiìcient on many occasions, when used as an auxiliary in combination with them. In ali cases of constitutional derangement, dependant on the state of the primse vise—in nervous cases dependant on the same cause—in derangement of the functions of the liver— and of the chylopoietic viscera, it will be found of es- sential s«rvice. I do not believe the acid bath, alone, THERAPEUTICS. 483 is equal to mercury in the influence it exerts on this class of diseases—though it is even in them very ser- viceable." As regards the composition of the acid, Dr. Scott seems to have varied his directions at different periods. We are told, in one of his publications, that it should consist of three parts of muriatic, and two of the nitric acid : in a second, of equal parts of these acids : and in a third, of one part muriatic, and three parts nitric acid. Not less vague and unsatisfactory are his in- structions, as noticed above, for the formation of the bath. The formula generally adopted among us, requires equal portions of the two acids, of which an ounce is added to a gallon of warm water, increased or diminish- ed according to the nature of the case, and especially the degree of delieacy of skin. Two gallons of this mixture, warmed to the temperature of about 96° Fahr., in a deep, narrovv vessel, will answer as a pediluvium, in which the feet should be continued for twenty or thirty minutes every night. The same bath may be used for a week, by warming each time a partof the mixture in a glazed vessel, and pouring it into the rest. By sponging the surface^Dr. Scott considers the effect as the same, and that it is of no consequence whether the mixture be warm or cold. On these points, however, most of those who have tried the process, differ from him. With whatever view nitric or the nitro-muriatic acid is used internally, not less than from one to two drachms should be ultimately taken in the twéirty-four hours. We commence with a smaller doso, gradually inereasing 484 ELEMENTS OF it to this quantity. The usuai prescription is to dilute a drachm of the acid in eight ounces of water, which may be sweetened with syrup, and its sharpness obtund- ed by mucilage.* ACIDUM MURIATICUM.f Of the muriatic acid, I have little to say. It has been tried in ali the cases in which the nitric is employ- ed, though not generally with equal success. The only superiority claimed for it is in malignant sore throat, where it is used internally, and at the same time as a gargle, fifteen or twenty drops being given at stated intervals, in some bitter tea, and for the other purpose barley-water, or some such fluid, is acidulated with it. These applications of the article wcr«; origin- ally made by Sir William Fordyce, and the practice has since been a good deal followed. About thirty years ago, muriatic acid was in such high repute in the treatment of camp fevers, that the king of Prussia, as a reward to Professor Reich, who pretended to the discovery, granted him a most liberal pension. In extreme emergencies, we are told, that it was exhibited in very large quantities. These reports, however, I have always considered as partaking so mudi of the extravagance of empiricism, as to deserve little confidence. Of late it has been a good deal commended, particu larly in the more obstinate chronic eruptions. What is the precise extent of its powers under such circum- stances, my experience does not enable me to deter- * Vid. Antilithics—Expectorants—Escharotics—and Epis- pastics. f The hydro-chloric acid of some chemisti THERAPEUTICS. 485 mine very confidently. As a corrective of contagion, and, indeed, of foul conditions of air, from any cause, it is probably entitled to more attention. The prac- tical objection to it is, that in crowded positions, as in hospitals, where it is mostly demanded, the pa- tients are so suffocated by the vapour, as often to pre- clude its use—and we are compelled to recur to the fumes of nitrous acid, which are less distressing, though not so effectual. It is more suited for cleansing empty wards, or the apartments of prisons, where contagion may exist, or places annoyed by the noxious effluvia from animai or vegetable putrefaction.*f ACIDUM SULPHURICUM. The sulphuric acid is prescribed chiefly in the shapr of elixir vitriol,J which is the acid, in a state of dilu- tion, with an aromatic added. It is a very pleasant and useful tonic, given alone, in sweetened water, in the dose of fifteen or twenty drops, every two or three hours. But it is also sometimes added to the infusion of bark, &c. It is now commonly directed with the view of invigo- rating appetite, and of restoring tone to the digestive organs, or to restrain colliquative sweats. But, at one time, and that not very remote, its powers were so * Chlorine may be procured for these purposes, by taking three parts of common salt, one of the black oxid of manganese, and rather less than three of strong sulphuric acid, water being previously added to the two first ingredients. The nitrous vapour is disengaged by putting nitre to the sul- phuric acid, previously v: urned over a lamp. f The hyper-'ixy muriate of potash, at one time, had much re- putation in syphilis, and hi ali other cases in which nitric acid was reronimcnded. What is its value I do not know. T'ir dose is ten graini.. \ Acidum Mibruivicum aromaticum. 486 ELEMENTS OF THERAPEUTICS. much more highly appreciated, that it was supposed to be serviceable even in some of the cases of neuroses, as chorea and epilepsy. No one, at present, however, would think of confiding in it in such diseases. To haemorrhage it is much better suited. It is here a popular remedy, and I have sometimes seen it used with very good effect in restraining moderate uterine effusions. In epistaxis and haemoptysis, it is stili more frequently prescribed. The elixir vitriol, in ali these cases, was the favourite remedy of Sydenham. In the course of the last few years, much has been alleged of the utility of the sulphuric acid itself, in the chronic eruptive complaints. Continued for a long pe- riod, it might, perhaps, prove adequate to the removal of some of these affections. Externally, it may be applied to the same purpose. In the proportion of one drachm of acid, to an ounce of lard, an excellent unguent is formed, with which I have cured tinea capitis and psora. But a neater pre- paration, in the latter case, is the acid diluted, and applied as a lotion to the surface several times a day. With this, I bave removed itch, almost as speedily as with the ordinary sulphur ointment, and it is exempt from ali disagreeable properties. As an injection it is sometimes used in gonorrhcea, gleet, and leucorrhcea, and, stili more diluted, as a collyrium.* * The antidotesof ali the minerai acids are the fixed alkalics, or magnesia. L'UE END. INDEX. A. Acetatis ammoniae, olim spiritus mindereri, 312. Acidum muriaticum, ii. 484. -------nitricum, olim aqua fortis, ii. 66. 79. 478. Acidum prussicum, ii. 218. -------sulphuricum, ii. 485. Actaea racemosa, 475. iErugo, ii. 80. Alcohol, ii. 136. Allium sativum, 430. 473. ii. 25. 248. Aloe perforata, 256. Aloetic preparations, ii. 27. Alumen, ii. 473. -------ustum, ii. 79. Ammoniacum, 471. Ammoniae carbonas, 317. 417. 478. ii. 96. Anthelmintica, or Anthelmintics. ii. 9. Anthelmintics, particular, ii. 18. Anthemis nobilis, ii. 406. Antilithics, 405. Antimonial preparations, 306. Antimonium, 173. ------------tartarizatum, vel Tar- tris antimonii, 175. ii. 65. Antispasmodica, or Antispasmodics, ii. 240. Apium petroselinum, 368. Aqua fortis, ii, 66. 79. 478. -----calcis, 418. Arbutus uvaursi, 425. Argenti nitras, ii. 434 Argentum, ii. 434. Vrgilla, ii. 473. Arsenicum album, ii. 438. Artemisia satonica, ii. 25. Arum tryphyllum, 474. Ascarides, ii. 26. Asclepias tuberosa, 320. Astringentia, or Astringents, ii, Astringents, minerai, ii. 464. Atropa belladonna, ii. 201. Aurum, ii. 436. B. Balsamica, 481. Balsamum copaivae, 388. 483. ----------Peruvianum, 483. ----------tolutanum, 482. Barytes, ii. 476. Bismuthi sub-nitras, ii. 431. Bismuthum, ii. 431. Blisters, ii. 39. —-----, practical application of, ii c. Cajeputi oleum, ii. 252. Calomelas, ii. 18. 27. Callicocca ipecacuanha, 161 Calx, ii. 477. Camphora, 317. ii. 25. 72.106 Cantharis vittata, vel Lytta vittata n. 63. Capsicum annuum, ii. 128. Carbo ligni, ii. 407. Carbonio acid, 423. 488 INDEX. Carbo vegetabilis : vel Carbo ligni, 242. Cassia Marilandica, 261. - senna, 259. Castor, ii. 243. Cataplasma sinapis, ii. 73. Cataplasm. rad. albi, ii. 75. Cathartica, or Cathartics, 189. Cathartics, particular, 234. ----------, practical application of, 195. Caustica et Escharotica, or Caustics and Escharotics, ii. 76. Causticum lunare, ii. 78. Chenopodium anthelminticum, ii. 22. Chimaphila umbellata, 402. Chironia angularis, ii. 395. Cinchona, naturai and pharmaceuti- cal history of, ii. 378. Cinchona officinalis, ii. 351. ---------Caribaea, ii. 389. Classification ot the materia medica, 88. Colchicum autumnale, 394. 4-81. Columba, ii. 400. Conium maculatimi, ii. 195. Convolvulus jalapa, 255. ------■-----scammonia, 263. Cornus florida, et Cornus sericea, ii. 395. Croton eleutheria, ii. 405. ------tiglium, 271. Cucumis agrestis, 268. -------colocynthis, 267. Cunila pulegioides, 449. Cupri sub-acetis, olim JErugo, ii. 80. Cupri sulphas, olim Vitriolum coeru- leum, ii. 79. 423. Cuprum, ii. 422. -------ammoniatum, ii. 425. Cusparia febrifuga, ii. 399. D. Daphne mezereum, 330. Datura stramonium, ii. 210. Daucus carota, 429. Diaphoretica, or diaphoretics, 282. Diaphoretics, particular, 306. ------------} practical application of, 288. Diffusible stimulants, ii. 85. Digitalis purpurea, 223. Diuretica, or Diuretics, 349. Diuretics, particular, 361. Diuretics, practical application of, 354. Doliches pruriens, ii. 33. Drastic purgatives, ii. 30. E. Emetica, or Emetics, 99. Emetics, particular, 161. -------, practical application of, 108. Emmenagoga, or emmenagogue?. 436. Emplas. picis Burgund. ii. 75. Enemata, 274. ii. 28. Epispastica, or Epispastics, ii. 38. Erigeron heterophyllum, 430. Escharotics, ii. 76. Eugenia caryophyllata, ii. 132. Eupatorium perfoliatum, 318. ii. 392. Eupatorium pilosum, ii. 394. Euphorbia ipecacuanha, 168. Expectorantia, or Expectorants, 462. Expectorants, particular, 465. External means of producing perspi- ration, 341. F. Ferri prussias, ii. 422. ---- ramenta et fila, ii. 417. ---- sub-carbonas, vulgo Rubigo ferri, ii. 418. Ferri sulphas, vulgo Sai martis, ii 419. Ferrum, ii. 25. 414. - squamae oxidi, ii. 418. -------tartarizatum, ii. 421. j Ferula asafoetida, 474. ii. 244. Fixed alkalies, 414. Flores zinci, ii. 427. Fonticuli et cetacea, or Setons and issues, ii. 68. Fuligo ligni, ii. 409. G. Gentiana lutea, ii. 402. Geoffraea inermis, ii. 24. Geranium maculatum, ii. 459. Glycyrrhiza glabra, 467. Guaiacum officinale, 326. H. Hxmatoxylon Campechianum, u. 458. INDEX. 489 Ilelleborus foetidus, ii. 20. ----------niger, 266. 450. History of the materia medica, 1. Humulus lupulus, 460. ii. 191. Hydrargyri nitrico-oxydum, olim Hydrargyrus nitratus ruber, ii. 81. Hydrargyri oxymurias, vulgo Hy- drargyrus muriatus corrosivus, ii. 82. 332. Hydrargyri sub-murias, olim Calo- melas, ii. 18. 27. Hydrargyri sub-murias, vulgo Hy- drargyrus muriatis mitis, 248. ii. 339. Hydrargyri sulphuretum nigrum, ii. 332. Hydrargyri sulphuretum rubrum, ii. 329. Hydrargyrum cum creta, ii. 323. Ilydrargyrum praecipitatum album, olim Calx hydrargyri alba, ii. 81. Hydrargyrus, ii. 256. ' Hyoscyamus niger, ii. 193. I. Improvement of the Materia Medi- ca, 31. lncitantia, or Incitants, ii. 96. Inhalationes, or Inhalations, 484. lodine, ii. 410. Ipecacuanha, 313. Issues, ii. 68. Juglans cinerea, vel Juglans cathar- tica, 262. Juniperus sabina, 333.446. K. Kino, ii. 454. L. Lactucarium, ii. 185. Lactuca virosa, 383. Laurus sassafras, 332. Leontodon taraxacum, 369. Lichen islandicus, 465. Liriodendron tulipifera, ii. 398. Lithontriptica et antilithica, or li- thontriptics and antilithics, 405. I.ithontriptics, particular, 414. Lobelia inflata, 172. -------syphilitica, 401. Lumbricoides, ii. 10. vol. il.—62 Lytta vesicatoria, ii. 61. - vittata, ii. 63. M. Magnesia, 239. 419. Materia Medica, classification of, 88. ---------------, history of the, 1. ---------------, improvement of the, 31. Medicinal tonics, ii. 35r. Medicines, modus operandi of, 52. Melia azedarach, ii. 21. Meloe niger, ii. 64. Meloe vesicatorius, vel lytta vesica- toria, 384. ii. 61. Mentha pulegium, 448. Mercurial preparations, ii. 30.81. Mercury, pharmaceutical history of, ii. 320. Mimosa catechu, ìi. 456. ------nilotica, 468. Minerai acids, 421. Minerai astringents, ii. 464. Minerai tonics, ii. 414. Modus operandi of medicines, 52. Monarda punctata, ii. 250. Moschus, ii. 240. --------factitius, ii. 243. Moxa, ii. 77. Myrrha, ii. 412. N. Narcotica, or Narcotics, ii. 147. Naturai and pharmaceutical history of cinchona, &c. ii. 378. Neutral salts, 244. 308. Nicotiana tabacum, 170. 382. Nitras potassae, 310. 0. Oleum monardae punctata:, ii. 71. Olivae oleum, 236. Opium, 314; ii. 147. Orobanche Virginiana, ii. 462. Oxyduin arsenici album, ii. 80. P. Particular anthelmintics, ii. 18. --------■ cathartics, 2 < l. --------diaphoretics, J06. 490 INDEX. Particular diuretics, 361. ---------emetics, 161. ---------expectorants, 465. ---------lithontriptics, &c. 414. --------- stimulants, ii. 96. ---------tonics, ii. 345. Perspiration, the external means of producing, 341. Pharmaceutical history of mercury, ii. 320. Phosphas ferri, ii. 420. Phosphorus, ii. 125. Pilulae hydrargyri, ii. 321. Piper cubeba, ii. 152. Piper nigrum, ii. 131. Plumbi superacetas, olim saccharum saturni, ii. 464. Plumbum, ii. 464. Podophyllum peltatum, 262. Polygala Senega, 400. 444. 476. Polypodium filix mas, ii. 31. Potassa: acetas, olim Sai diureticus, 363. Potassae carbonas, et Potassae sub- carbonas, 381. Potassae carbonas, et Sodae carbonas, 478. Potassae nitras, 366. --------- super-tartras, olim Tarta- rum cristalli, 364. Potassae tartras, olim Tartarum so- lubile, 364. Potassa fusa, ii. 77. Practical application of blisters, ii. 47. Practical application of cathartics, 195. Practical application of diaphore- tics, 288. Practical application of diuretics, 354. Practical application of emetics, 108. Preparations, aloetic, ii. 27. ------------, antimonial, 306. ------------, mercurial, ii. 30. 81. Prinos verticillatus, ii. 460. Prunus lauro cerasus, ii. 216. Prunus Virginiana, ii. 396. Punica granatum, ii. 457. Q. Quassia excelsa, ii. 403. ------ siinarouba, ii. 404. Querctis cerris, ii. 452. -------robur, ii.451. R. Ranunculfts bulbosus, ii. 67. Rheum palmatum, 252. Rhus toxicodendron, 339. Ricini oleum, 234. Rosemarinus officinalis, 448. Rubefacientia, or rubefacients, ii. 70. Rubia tinctorum, 447. Rubigo ferri, ii. 418. Rubus procumbens et Rubus villo- sus, ii. 461. S. Saccharum saturni, ii. 502. Sai diureticus, 363. Sales neutri, or neutral salts, 244. 308. Sai martis, ii. 419. Sanguinaria canadensis, 168. Saponaria officinalis, 338. Scilla maritima, 173. 391. 473. Secale cornutum, 452. Serpentaria Virginiana, ii. 390. Sesamum orientale, 467. Setons, ii. 68. Sialagoga, or sialagogues, ii. 255. Simplocarpus fetida, ii. 246. Smilax sarsaparilla, 330. Solanum dulcamara, ii. 207. ---------nigrum, ii. 206. ---------tuberosum, ii. 209. Spigelia marilandica, ii. 19. Spiraea trifoliata, 167. Spiritus aetheris nitrosi, olim Spiritus nitri dulcis, 311.367. Spiritus aetheris sulphurici, ii. 252. -------------------------composi- ti^, ii. 254. Spongia usta, ii. 408. Stalagmitis gambogioides, 264. Stannum, ii. 33. Stimulants, diffusible, ii. 85. ----------particular, ii. 96. Strychnos nux vomica, ii. 236. Sub-sulphas hydrargyri flavus: vul- go Hydrargyrus vitriolatus, 186. Succini oleum, ii. 251. Sulphas cupri : vulgo Cuprum vitri- olatum, 184. Sulphur, 237. 322. ii. 447. Super-sulphas ahiminae et potassae : vulgo Alumen, ii. 473. Swietenia febrifuga, ii. 404. INDEX. 491 T. Taenia, ii. 29. Tanacetum vulgare, 450. ii. 23. Tartarum crystalli, 364. ——— solubile, 364. Telaaranearum, ii. 187. Terebinthinae oleum, 425. ii. 34. 70. 116. Terebinthina veneta, 387. Tinctura cantharidis, ii. 73. ---------capsici, ii. 73. ---------ferri muriatis, ii. 421. Tonica, or tonics, ii. 341. Tonics, medicinal, ii. 351. -------, minerai, ii. 414. ------, particular, ii. 345. Trichuris, or tricocephalus, ii. 29. U. Ulmus rubra, 469. Unguentum hydrargyri, ii. 323. ----------------------nitratis, ii. 82. Unguentum picis liquidx, ii. 83. V. Valeriana officinalis, ii. 247. Vegetable acids, 422. Vesicatoria, or blisters, ii. 39. Viscum, ii. 459. Vitriolum coeruleum, ii. 423. ---------album, ii. 428. X. Xanthoxylum fraxineum, 338. Z. Zinci acetas, ii. 430. ----oxydum, vulgo flores zinci, ii. 427. Zinci sulphas : vulgo vitriolum al- bum, 187. ii. 428. Zincum, ii. 427. Zingiber officinale, ii. 135. ! \ NLM032781218