{,"J?f*P;Jg WW ill ;f;te ffei.- lif I w H t lil'IlM*' iMM fr"! •''' f ,L it I'M i!0;J:f ,' ' i *fep - I I ' I I I! iii!:!;']11'' If 'M 11 If' U 11 , J^l NATIONAL LIBRARY MEDICINE Washington,D.C. 2/ NEW WORKS AND NEW EDITIONS PUBLISHED BY LEA AND BLANCHARD. LISTON AND MUTTER'S SURGICAL LECTURES. LECTURES ON THE OPERATIONS OF SURGERY. AND ON DISEASES AND ACCIDENTS REQUIRING OPERATIONS, DELIVERED AT UNIVERSITY COLLEGE, LONDON, By ROBERT LISTON, Esq., F.R.S., &c. EDITED, WITH NUMEROUS ALTERATIONS AND ADDITIONS, BY T. D. MUTTER, M.D., PROFESSOR OF SURGERY IN THE JEFFERSON MEDICAL COLLEGE, PHILADELPHIA. With Numerous Illustrations on Wood. In One Large Octavo Volume, beautifully Printed. This work contains much original matter of Professor Mutter's, embodying the results of his great experience, and adapting the whole to the wants of the Ame- rican Profession. The Lectures are those which attracted so much attention when published in the Lancet. They are here presented entire, omitting none of the original illustrations, and introducing numerous new and valuable ones. In Press, HUGHES ON THE LUNGS AND HEART. CLINICAL INTRODUCTION TO THE PRACTICE OF AUSCULTATION, AND OTHER MODES OF PHYSICAL DIAGNOSIS. Intended to Simplify the Study of the Diseases of the Heart and Lungs. By H. M. HUGHES, M.D.,&c. In One Duodecimo Volume, (nearly ready.) CHURCHILL'S MIDWIFERY, WITH NUMEROUS ADDITIONS. New Edition, just Published. L. & B. have just issued a new edition of this valuable and standard work on the Theory and Practice of Midwifery, edited by Huston, in One Octavo Volume, well bound, with numerous illustrations. Also Lately Published, NEW EDITIONS OF PEREIRA'S MATERIA MEDICA, REVISED, WITH ADDITIONS, BY CARSON, In Two Large Octavo Volumes, many Cuts, AND OF WATSON'S PRACTICE OF PHYSIC. EDITED BY CONDIE, in One Octavo Volume, of nearly Eleven Hundred Large Pages, bound in strong Leather, with raised bands. LEA & BLANCHARD'S LATE PUBLICATIONS. SIMON'S CHEMSTBY OF MAN. ANIMAL CHEMISTRY, WITH REFERENCE TO THE PHYSIOLOGY AND PATHO- LOGY OF MAN. Br DR. J. FRANZ SIMON, TRANSLATED AND EDITED BY GEORGE E. DAY, M.A. & L.M. Cantab., &c. TO BE COMPLETE IN TWO PARTS. Part I. now ready, in 8vo. boards, uncut. With a Plate. The first part of Dr. Simon's valuable work, as here presented, has been lately published by the Sydenham Society of London. As it is uncertain when the second part may be expected, the publishers have thought it best to issue it in the present form exactly as it appeared in London and uncut, so that when the second is published, purchasers may have them bound to suit their convenience. "A work that obtained for its author a European reputation, and is universally regarded as by far the most complete treatise that has yet appeared on Physio- logical Chemistry."—Editor's Preface. " No treatise on physiological chemistry approaches, in fullness and accuracy of detail, the work which stands at the head of this article. It is the production of a man of true German assiduity, who has added to his own researches the results of the labours of nearly every other inquirer in this interesting branch of science. The death of such a labourer, which is mentioned in the preface to the work as having occurred prematurely in 1843, is indeed a calamity to science. He had hardly reached the middle term of life, and yet had made himself known all over Europe, and in our country, where his name has been familiar for several years, as among the most successful of the cultivators of the chemistry of man. * * * It is a vast repository of facts, to which the teacher and student may refer with equal satisfaction."— The Western Journal of Medicine and Surgery. " Several reasons combine to render Dr. Simon's work peculiarly valuable. In the first place, the author evidently understands his subject, and discusses it with great ability , in the next place, his opinions have been formed, in a great measure, from original investigations; and lastly, he seems to have no theories beyond facts — no dogmas to sustain at the expense of truth and principle; but he enters upon the investigation like a true philosopher, and the result is such as we have seen.— The Western Lancet. BUDD OIV THE LITER. ON DISEASES OF THE LIVER, By GEORGIA BUDD, M.D., F.R.S., &o. With Woodcuts and Coloured Plates in the First Style of Art. In One Octavo Volume, Sheep. " We cannot too strongly recommend the diligent study of this volume. The work cannot fail to rank the name of its author among the most enlightened pa- thologists and soundest practitioners of the day." — Medico-Chirurgical Review. LEA AND BLANCHARD'S LATE PUBLICATIONS BIRD ON URINARY DEPOSITS. * URIJfARYDEPOSITS. THEIR DIAGNOSIS, PATHOLOGY, AND THERAPEUTICAL INDICATIONS. By GO L DING BIRD, A.M., M.D., &c. In One Octavo Volume, Cloth, with Cuts. " One of the best fruits of this 'revival' in urinary pathology is the work of Dr. Golding Bird, which we are about introduciug to the notice of our readers. " In 1843, Dr. Bird delivered a course of lectures on the diagnosis and pathology of urinary sediments. They were published in the London Medical Gazette, at- tracted much attention at the time, and were subsequently translated into German. These lectures form the groundwork of the present publication, though much ex- tended and nearly rewritten. " From the space which we have given to the consideration of this little vol- ume, our readers will naturally infer the exalted opinion we entertain of it. Yet we fear we have still conveyed a very inadequate notion of its merits. Where almost every thing is of value, it is difficult to select or condense. Such of our readers as wish to increase their store of practical knowledge, and enlarge the sphere of their usefulness, we refer to the volume itself, and recommend its pos- session. We now take leave of Dr. Bird, with an expression of great readiness to meet him again in the same, or some analogous line of investigation."—Amer- ican Medical Journal. DURLACHER ON CORNS, BUNIONS, ETC. A Treatise on Corns, Bunions, THE DISEASES OF THE NAILS, AND THE GENERAL MANAGEMENT OF THE FEET. BY LEWIS DURLACHER, Surgeon Chiropodist by Special Appointment to the Queen. In One small Duodecimo Volume, Cloth. " These important subjects are in this work lifted above the quackery which has generally invested them, and we find them treated with evident marks of sci- ence and education."— North American. " This is a work by an educated scientific man upon a subject which has been almost given up to quackery, but which thousands will agree to be of the highest importance. The advice and prescriptions are of great value to all who are trou- bled with the diseases of the feet." — Providence Journal. Lately Published, A NEW AND MUCH IMPROVED EDITION OF DRUITT'S SURGERY. THE PRINCIPLES AND PRACTICE OF MODERN SURGERY. Bv ROBERT DRUITT, Surgson. FROM THK THIRD LONDON EDITION. ILLUSTRATED BY ONE HUNDRED AND FIFTV-THREE WOOD ENGRAVINGS. WITH NOTES AND COMMKNTS, By JOSHUA B. FLINT, juriously. 4* 42 THERAPEUTICAL INDICATIONS 3. ORIGINAL CONFORMATION. There are many circumstances, connected with original conforma- tion, which exert a modifying influence, both hygienically and thera- peutically. Singular as it may seem, it is indubitable, that from the moment of a fecundating copulation, the new being is impressed with an impulse, which gives occasion to such a formation as may predispose the offspring, at some period of its existence, to a disease that affected the male or the female parent. In this way, a conform- ation may result, which may favour the development of consump- tion, apoplexy or scrofula, under the action of adequate exciting causes, at certain ages. Hence it is, that we find so much difference in the constitutions of different persons. The constitution of an indi- vidual is the organisation proper to him ; and he is said to have a strong, or a delicate, a good, or a bad constitution, when he is ap- parently strong or feeble, — usually in good health, or liable to re- peated attacks of disease. The varieties of constitution are, there- fore, as numerous as the individuals themselves. A strong constitu- tion is considered to be dependent upon a due development of the principal organs of the body; on a happy proportion between those organs ; and on a fit state of energy of the nervous system ; whilst a feeble or weak constitution results from a want of these postulates; but it is obvious, that our knowledge on this matter must be some- what limited, although, by a careful examination, we may be able to appreciate or rather to approximate it. It is daily observed, in our intercourse with man, in a state of health, or of disease, that some persons possess much more irritability or impressibility than others. This irritability or impressibility is mainly seated in the nervous system, and through it every tissue of the body may be affected, by virtue of the contractility or excitability which it possesses. Men certainly have very different degrees of nervous energy ; and of susceptibility to impressions ; and consequently great diversity in the degree to which they are predisposed to disease, and in the action of remedies. Persons of very great nervous susceptibility are sensibly alive to atmospheric vicissitudes ; have the Ccencesthesis, or " common feeling," Gemeingefuhl of the Germans, extremely acute; are languid, listless, and depressed in a lowering atmosphere ; buoyant, and elastic, or " corky"—to use the language of the " trainers" — when the air is dry and serene. We see the same variety in the way in which powerful emotions, or powerful impressions of the senses, affect dif- ferent individuals. Some persons faint on the slightest shock made on any of the senses ; others are thrown into convulsions by causes, which, in others, again, would excite no perceptible emotion. The over-excitement of a nervous individual concerns us materially, in the application and effects of our therapeutical agents. With such individuals, the slightest cause may produce fever, owing to the irritation of the nervous system extending to the vascular system, MODIFIED BY CONSTITUTION. 43 and causing in it augmented action. Usually, the febrile irritation, thus induced, is only ephemeral; but if there be any part of the capillary system, owing to obstruction, or morbid derangement, strongly predisposed to assume the inflammatory condition, such a condition may be induced by the force with which the blood is pro- pelled by the heart and arteries. The circulatory system is not directly influenced by the brain or spinal marrow, but it is so indi- rectly. We see this in the effect of emotions. The heart leaps with joy ; and under the influence of certain passions its actions are hur- ried and unequal. Nay, the effect extends even to the small vessels, — to those by which secretion is operated in the glandular system. At the sight of a cherished article of food, the salivary glands secrete so rapidly as to cause the " mouth to water," and the saliva to be pro- jected from it. It is an important principle, not to be lost sight of in Therapeutics, that the condition of the circulatory system is largely influenced by that of the nervous system ; and it is especially important to bear this in mind in the management of febrile and inflammatory diseases. If blood-letting be pushed to a very great extent, in such cases, it will induce irregularity of action, and irritability of the nervous sys- tem, and in this way local determinations may be, and often are, in- duced by the very means employed to obviate them. This effect of copious loss of blood is instructively exemplified in uterine hemor- rhage. A female, after delivery, may be reduced to death's door by the profuse discharge of blood. She may be almost pulseless, pale, and exanguious ; and yet, in the course of a few hours after she has rallied, the most violent determination may take place to the head — as indicated by intolerable cephalalgia and violent throbbing of the carotid, and temporal arteries ; — a state induced by the irregularity above described as apt to be engendered by that irritability of the nervous system, which follows a profuse discharge of blood. In such a case, farther blood-letting obviously cannot be indicated. The ir- ritability of the nervous system must first be allayed; and accordingly, the author has found the most decided advantage from the use of opium, administered in such a dose, and in such a form, as to ensure the speedy production of its full sedative influence. When this begins to be exerted, the activity of the cephalic circulation gradually yields ; and in a short time the whole mischief disappears. If blood- letting be had recourse to in such a case, — even to a moderate ex- tent, and it could not be carried far in this reduced state of the system, — it is calculated to augment the very pathological condition which it was intended to remove. The advantage attending a union of copious bleeding with sedative doses of opium can thus be readily appreciated. The abstraction of blood reduces the amount of stimulus in the sanguiferous system, whilst the opium keeps down the excite- ment of the nervous system. In particular diseases, the nerves are remarkably susceptible to impressions. In neuralgia faciei, the slightest motion of the mus- 44 THERAPEUTICAL INDICATIONS cles — the least breath of air—induces the most excruciating tor- ment ; and in hydrophobia, the distress and horror are chiefly occa- sioned by the impression of certain objects on the organ of sight. Some persons, again, suffer much more from pain than others. This is the case with different animals, and it is equally so with different men. The idea, that the beetle, when trod upon, feels as much as the giant when he dies, is poetical, but probably untrue. Some per- sons are thrown into the greatest nervous distress — the most intole- rable anguish — by the application of a blister; and it is well known, that all do not bear surgical operations equally well. This is doubt- less greatly dependent upon organisation, although it maybe modified by habits of endurance, or the contrary. The state of the mind exerts a powerful influence in this respect. The religious fanatic, and the martyr to political excitement, have exhibited a resistance to physical agents almost incredible. The condition of the nervous system can never be wholly disre- garded by the therapeutist. Whenever it is morbidly impressed, the operation of medicines is interfered with ; and regular physiolo- gical actions may be modified. We see this last effect exhibited in the parturient female. Labour may have been proceeding in the most favourable manner, but if any thing should interfere with the attendance of the practitioner who has been expected, and another should present himself; and still more, if the latter should have an unprepossessing appearance, the pains may subside, and the delivery- be greatly retarded; whilst if the accoucheur, in whom the female had reposed her confidence, had presented himself, the termination might have been as much facilitated. Dr. A. T. Thomson gives the following anecdote as illustrative of the control of the mind over the operation of medicines, where the whole effect must obviously have been induced through the nervous agency modifying the functions of the organs concerned. A lady was labouring under an affection of the bowTels, attended with severe pain and the most obstinate cos- tiveness. She was bled; the warm bath, and fomentations were frequently resorted to ; and purgatives and various anodynes were freely administered, but without the least effect upon the bowels, and without either sleep, or any diminution of pain ensuing. At length, the physician in attendance was informed that she had ex- pressed her conviction, that her usual medical attendant, who was in the country, alone understood her constitution, and was the only person who could relieve her. This gentleman was accordingly sent for; and although no change, either of measures, or of medicine, was resorted to, the bowels were quickly moved; sleep, and a ces- sation of pain followed, and in a few days the patient was conva- lescent. He further remarks, that he has witnessed frequent illustra- tions of this influence of mind in modifying the effects of medicines in the treatment of gonorrhoea contracted by married men ; and also by young men, possessed of a high feeling of moral rectitude. The anxiety of such persons to be speedily cured occasions the mind to MODIFIED BY TEMPERAMENTS. 45 be constantly directed to the seat of the disease; and more or less erethism is thus induced there, which renders the cure difficult. Dr. Thomson thinks, that " a vascular fulness of the mucous membrane, and a state resembling chronic inflammation " are thus superinduced, which resist the influence of medicines, that would readily cure the disease in those in whom it was a matter of less anxiety, and little mental reflection. It is obviously, therefore, of moment, in all affec- tions, particularly in those of an inflammatory character, that the mind should not be permitted to brood over the malady; and that every endeavour should be made to withdraw the nervous influence from the part affected, so far as this can be done with propriety. It is in this way, that revulsive applications exert a portion of their bene- ficial agency. They not only excite the parts to which they are ap- plied, so as to break in upon the morbid catenation elsewhere exist- ing, but they attract the attention, and the nervous influx, which would otherwise be directed towards the suffering organ, is directed towards the part artificially irritated. Much stress has been placed on the influence of temperament in a pathological as well as therapeutical point of view. The subject of the temperaments, usually admitted, belongs to physiology. The sanguine ; the bilious or choleric; the melancholic or atrabilious ; the phlegmatic, lymphatic or pituitous, and the nervous are generally re- ceived and described by writers ; but if we attend to their reputed characteristics, the imperfection of their definition and demarcation is obvious ; so imperfect, indeed, are they, that it is very rare for us to meet with an individual, whom we could unhesitatingly refer to any one of them. They are likewise susceptible of important modi- fications from climate, education, &c, and may be so combined as to constitute innumerable shades. The man of the strongest san- guine characteristics may, by misfortune, assume all those, of a men- tal character particularly, which are looked upon as indexes of the melancholic or atrabilious ; and the activity, and impetuosity, as- cribed to the bilious temperament, may, by slothful indulgence, be converted into the lymphatic or phlegmatic. All these temperaments acquired their names from a fancied predominance of certain sys- tems, which so tempered the different functions as to communicate certain evident characteristics. In a therapeutical consideration, they do not demand much attention, except perhaps so far as regards the two opposite — the sanguine, and the melancholic ; and perhaps the nervous. The first of these is presumed to be dependent upon a predominance of the circulatory system ; and hence is considered to be characterised by strong, frequent, and regular pulse ; ruddy complexion; animated countenance ; good shape, although distinctly marked ; firm flesh ; light hair ; fair skin; blue eyes ; nervous sus- ceptibility, attended with rapid successibilite, as the French term it, — that is, a facility of being impressed by external objects, and of passing rapidly from one idea to another. On the other hand, in 46 THERAPEUTICAL INDICATIONS the melancholic temperament, the vital functions are considered to be more feebly or irregularly performed ; the skin has a deeper hue ; the countenance is sallow, or sad ; the bowels are torpid, and all the excretions tardily accomplished; the pulse is hard and habitually contracted. In the nervous temperament, again, the susceptibility of being acted upon by external impressions is unusually developed. It is characterised by small, soft, and, as it were, wasted muscles ; and generally by a slender form, and great vividness of sensation. Such are the characters ordinarily assigned to these temperaments. Many of them are fallacious, and but few need be borne in mind in therapeutical investigations. As a general rule, it certainly would seem, that persons of strong sanguine characteristics have the nervous system more impressible ; the body more predisposed to in- flammatory action, and the vessels less protected by the tissues in which they creep, and hence they are more liable to obstructions, as well as to hemorrhage by rupture or transudation ; and it is manifest, that in such an organisation antiphlogistics may be more demanded, and stimulants ought to be employed with more caution, than in the melancholic. Again, the possessor of the nervous temperament may demand modifications of management, both hygienical and therapeutical, which may not be suggested in those of any of the other temperaments. After all, however, we cannot deduce much instructive matter, for our practical guidance, from the study of this topic ; nor does it seem to the author, that the doctrine of the tem- peraments in any of its relations — physiological or psychological — hygienical or therapeutical — is worthy of the consideration that has been bestowed upon it. In Therapeutics, the nature of the diseased action going on in an organ is the great object of study ; and if our thoughts are distracted from this, and directed to temperaments or tendencies, we may often be greatly misled. Some years ago, the author was requested to visit a lady for the first time, in the absence of the regular physician, who had long attended her, and had be- come what is called " acquainted with her constitution." She was labouring under profuse metrorrhagia, which had continued for some time, and had completely prostrated her ; she was deadly pale ; lips blanched ; pulse scarcely perceptible ; and every evidence present, that the hemorrhage was not continuing from activity of vessels ; or, at all events, that the idea of activity must be laid aside in the treat- ment, and the powers of life be supported, or otherwise she would sink. The uterus was in an unimpregnated state. The usual means with the tampon were adopted successfully, so far as regarded the immediate flow ; and atonic system of medication was recommended, under which the hemorrhage did not recur during the day. In the evening, the family physician arrived, who finding her in a comfort- able situation, and evidently improving, discontinued the tonics, under the apprehension, from the knowledge of her sanguine tem- perament, that violent reaction and consequent mischief might ensue ; but in the night he was called up, owing to the alarming recurrence MODIFIED BY IDIOSYNCRASY. 47 of the hemorrhage, and was glad to have recourse to the manage- ment, which had previously proved successful; under which she ultimately recovered, and since that period — twenty years ago — has had no return of the disease. In this case, a " knowledge of the constitution" was likely to have been attended with disastrous results. The diseased condition is, indeed, the only point to which attention has to be directed ; and it is the only one that can, in general, fall under the personal observation of the physician, in the mode in which the profession is regulated in England. The apothecary is there the family practitioner, and the physician is only called in consultation, so that the chief part of his practice must necessarily occur in per- sons, with whose constitutions he has had no opportunity of being previously acquainted. Temperament is conformation, but Idiosyncrasy—or the peculiar disposition which causes an individual to be affected by extraneous bodies, in a way in which mankind in general are not acted upon by the same agents — may be acquired, and when once it has been so, it is apt to continue, and frequently does so, throughout the whole of existence. The author possesses a singular idiosyncrasy of this kind. If a piece of thin biscuit, or oaten-cake, be broken in his presence, — nay, the idea alone is sufficient, — the muscles, that raise the left angle of the mouth, contract irresistibly. It is obviously of moment, that the practitioner should be acquainted with all idiosyncrasies or peculiarities, and so far the notion of "knowing the constitution," — which is apt to be used to the prejudice of the young practitioner, or of any except the accustomed medical attendant — carries reason with it. But it is the duty of the patient to put the practitioner in possession of the fact of such peculiarity, so that he may be enabled to guard against it, and not take that for morbid, which is the effect of simple idiosyncrasy. By virtue of these peculiarities medicines will often produce effects diametrically opposite to those they ordinarily exert. The author knows a gentleman, whom opium purges, yet this drug is usually administered to check inordinate action of the intestinal tube. Mr. Chevalier gives the case of a lady, who could not take powdered rhubarb without an erysipelatous efflorescence showing itself, almost immediately afterwards, on the skin; yet, what is singular, she could take it in the form of infusion with perfect impunity. It is impossible for the physician to detect these peculiarities by any signs. His in- formation has to be wholly derived from the patient. But when once acquired he is expected to retain it; and, strange as it may seem, all confidence in the practitioner is at times annihilated, be- cause he did not recollect that oil of peppermint, or some other trivial agent, was in the habit of disagreeing with his patient. It is apt to be regarded as an evidence that he did not attend sufficiently to the constitution, and the inference is drawn, that without this, his en- deavours could not have secured the full amount of success, whilst 48 THERAPEUTICAL INDICATIONS his inattention might have been productive of bad effects, owing to the irritation that might have been induced, by the development of this sympathy, in a frame perhaps already too much disturbed by morbid influences. , , r There are very few functions of the body that are altogether free from idiosyncrasies. An acquaintance of the author cannot be present where ipecacuanha is being powdered, without the most violent catarrhal and asthmatic symptoms being produced; and many similar cases are recorded. The smell of the callicanthus is so disagreeable to another as to be almost intolerable. Pope Pius VI. had such an antipathy to musk, that on an occasion of presentation, an individual of the company having been scented with it, his holiness was obliged to dismiss the party almost instantaneously. These are idiosyncrasies or peculiarities connected with smells, which are agreeable to the generality of mankind. On the other hand, by some, offensive smells are preferred. The author knew a lady, who always perfumed her snuff with assafcetida; and Louis XIV. is said to have preferred the smell of the urine of the cat to that of the rose. Some persons, again, cannot take peppermint, and with many, opium disagrees, producing the most intolerable headache, nausea, and vomiting, and exciting no anodyne effect whatever. Dr. Thomson refers to the case of an individual, who was always attacked with syncope when he took the smallest dose of calomel. But peculiarities of this kind are innumerable, and the practitioner ought to be put in possession of them, otherwise disagreeable results may take place; the economy may be'disordered, or effects, opposite to those which the article usually induces, may follow. Several such peculiarities are referred to in the author's Human Physiology. The different impressibility of the nervous system in different indi- viduals is often exemplified in practice in the effect produced upon the circulation at the appearance of the physician. The pulse of a delicate female, under such circumstances, is often quickened 20 or 30 beats in the minute; — a fact which the physician should bear in mind, or he might ascribe that to disease, which is the mere effect of idiosyncrasy, or inordinate impressibility. In some persons, the pulse is unusually slow. The ordinary number of beats of Napoleon's was 44 in the minute; the author knew one 36; and Lizzari refers to one, which did not number more than 10: but it is possible, that in this case there might have been intermediate beats unperceived by the physician. On the other hand, some individuals have the pulse much quicker than ordinary. Seventy beats in the minute is about the average in the healthy male ; but sometimes the number in health is as high as 90 or 100. The pulse of the aged is generally more frequent than that of the adult, and is irregular, or intermittent, but it is occasionally unusually frequent and regular. A change of this kind occurred to a valued friend of the author, who had filled the highest office in the gift of his countrymen. Until about the age of 80, his pulse possessed the usual character appertaining to that of MODIFIED BY IDIOSYNCRASY. 49 the aged ; but, for some years before his death, it became quicker, beating nearly 90 in the minute, and more regularly than it had done. During early childhood, the same intermittent and irregular character exists in health, but the pulse is faster than in the adult. As a general rule, at birth the number of pulsations is from 130 to 140; at one year, 120; at two years, 110; at three years, 90 and upwards; at puberty, 80; at the adult age, 70; and in old age, something higher. In the female, the pulse is on the average from 5 to 10 beats quicker than in the male. All these circumstances have of course to be borne in mind in in- vestigating any case of disease. But owing to individual peculiari- ties it becomes at times extremely difficult to pronounce upon the existence of a morbid condition from single symptoms, — as from the pulse, more especially from its degree of quickness or slowness, inasmuch as we are not alwTays acquainted with the number of beats in the state of health. It is partly on this account, that Celsus termed it " res fallacissima," yet, it has even been made the ground of discrimination in a case of suspected insanity, and by an illus- trious native of this country, whose eminent abilities were at times obscured by his unbounded enthusiasm, and too prolific imagi- nation. In counterfeited insanity, Dr. Rush remarks, the pulse will be natural; in real insanity — as has been since established by observers — it is generally more excited than in a state of health ; and this diag- nostic Dr. Cooper has introduced into his collection of " Tracts on Medical Jurisprudence," as a fixed and invariable law ; to which, at least, he has not attached any doubt or exception. " The know- ledge of this fact," adds Dr. Rush, "has once been applied with success in the administration of the criminal laws of the Linked States. One of the two men who were condemned to die for trea- son, committed against the general government in the western coun- ties of Pennsylvania in the year 1794, was said to have lost his reason after sentence of death had been pronounced upon him. A physician was consulted upon his case, who declared his madness to be feigned. General Washington, then President of the United States, directed a consultation of physicians upon his case. Dr. Shippen, Dr. Samuel P. Griffitts, and myself were appointed for that purpose. The man spoke coherently upon several subjects ; and for a while the state of his mind appeared doubtful. I suggested the propriety of examining his pulse : it was more frequent by twenty strokes in a minute, than in the healthy state of the body and mind. Dr. Shippen ascribed this to fear. I then requested that the pulse of his companion in guilt and fear might be felt. It was perfectly natural in frequency and force. This discovery induced us to unite in a certificate, that the man, who was only supposed to be mad, was really so ; in consequence of which his execution, as well as that of his companion, were suspended for two months; in which time the popular clamor for their lives so far subsided, that they vol. i.—5 50 THERAPEUTICAL INDICATIONS were both pardoned by the executive of the United States." This is perhaps the ne plus ultra of medical philanthropy, — rather than of science. From all that has been said, it is manifest, that idiosyncrasy must have much power in modifying the operation of medicines ; and that it is consequently important for the practitioner to be aware of this ; and it may not be amiss for him to make specific inquiries, where he wishes to administer such drugs as are apt to disagree with certain individuals, — of which opium and its preparations, and calomel, are perhaps the most prominent. 4. HABIT. By this is understood an acquired disposition in the living body, 'become permanent, and as imperious as any of those primitive acts, which have been also, in another sense, denominated habits. When a function is over and over again exerted to the utmost extent of which it is capable, both as regards energy, and activity, or is ex- erted beyond the ordinary extent, it becomes more and more easy of execution ; the organ is better adapted for its production ; and, it may become so habituated to this over-exertion, that a real want may be engendered,—a "second nature," — and the individual may feel uncomfortable, unless the organ is subjected to the accustomed action. In the same way, by habit, the action of an organ may be diminished, until ultimately it is but little adapted for full power. The knowledge of these facts has led one of the most gifted and in- genious naturalists of the present age — M. De Lamarck —to affirm, that the habits of an animal are not dependent upon its organisa- tion ; but that, on the contrary, its habits, mode of life, and those of its ancestors have, in the succession of ages, determined the form of its body, the number and condition of its organs, and the func- tions and the faculties it enjoys: —a position, which he has sup- ported with much plausibility, and at the same time with much that approximates to the reductio ad absurdum: for example, where he takes the case of reptiles, which, as well as other vertebrated animals, in his view, had originally, according to the great plan of organisation, four paws attached to the trunk. Serpents must con- sequently have had four ; but having assumed the habit of creeping along the ground, and of concealing themselves in the grass, their bodies, owing to perpetual efforts at elongation, to enable them to pass into narrow spaces, acquired an unusual length in no wise pro- portionate to their thickness. Paws would have been quite useless. Long paws would have interfered with their creeping, and very short paws would have been but ill adapted for moving the body. Hence, the want of employment of these parts being constant, they gra- dually disappeared; although, says De Lamarck, they may have originally entered into the plan of organisation of animals of their class. But, although this distinguished naturalist carries the effect of function on organisation to an extent, which cannot be main- MODIFIED BY HABIT. 51 tained ; it is certain, that the habitual exercise of an organ does add to its development, within certain limits, whilst inaction gives occa- sion to its impoverishment. We have this signally exemplified, if we restrict an animal to diet of a different character from that to which it has been accustomed ; or to one foreign to its nature. In birds of prey, the digastric muscle — which is strong in the gallina- ceous bird — has the bellies composing it so weak, that, according to Sir Everard Home, nothing but an accurate examination can deter- mine its existence. But if a bird of this kind, from want of animal food, be compelled to live upon grain, the bellies of the muscle become so large, that they would not be recognised as belonging to the stomach of a bird of prey. Mr. Hunter kept a sea gull for a year upon grain ; after which he found the strength of the muscle greatly augmented. This wondrous adaptation of structure to the kind of food, which the animal is capable of obtaining, is likewise elucidated in the case of the South American, and of the African ostrich. The former is the native of a more productive soil than the latter, and accordingly the gastric glands are less complex, and numerous, and the triturating organ is less developed. It is owing to the effect upon the body of long-continued action, that old and inveterate habits cannot be suddenly broken in upon with impunity. Hence, issues, or other discharges must be gradually checked prior to total occlusion ; otherwise, the irritation, and consequent afflux, may be directed to other and important organs, which may be, at the time, disposed to assume a morbid action. In like manner, where a person has been in the habit of daily in- dulging in the unmeasured use of spirituous liquors or of opium, we cannot safely withdraw, at once, the accustomed stimulus. The ner- vous system, habituated to stimulation, totters, if the excitants be withdrawn ; and delirium tremens, with all its horrors, almost surely supervenes. In times of spreading sickness, such sudden and total change of inveterate habits adds, no doubt, greatly to the extent of the calamity. The drunkard becomes alarmed ; abandons his stimu- lant; and, under the depression that follows, readily imbibes the morbific influence, and sinks a victim to incautious reformation. The effect of medicines on the frame is much influenced by habit. As a general rule, continued use detracts from their power. This is strongly shown in the case of opium. Instances are related, in which two drachms, or one hundred and twenty grains of solid opium, or five fluid ounces of laudanum, have been taken in twenty-four hours ; yet before the habit was induced these persons could not have taken as many grains without danger. But although this habit of endurance or resistance has been acquired in the case of opium, it does not fol- low that the system, thus rendered obdurate to it, will resist large doses of other narcotics. Notwithstanding these extraordinary quantities of opium may be swallowed with impunity, the same in- dividual may be affected with considerable facility, provided another narcotic be substituted. In like manner, if a person has been habit- 52 THERAPEUTICAL INDICATIONS uated to the use of aloes as a cathartic, it may altogether lose its effect; yet if we change the special irritant, or have recourse to ano- ther cathartic — castor oil, or sulphate of magnesia, for example — catharsis may be produced by an ordinary dose. It does not there- fore follow, that the sensibility of the mucous membrane of the intes- tinal canal becomes blunted in these cases. It merely loses its impressibility as regards one irritant; whilst it may be equally sus- ceptible of irritation from every other irritant of the class. According to this general effect of habit, it would follow, that the second dose of a cathartic ought to be larger than the first, provided it be administered within such a period, that the influence of the first dose continues to be felt; and it is the usual practice with the phy- sician to direct the after dose to be larger: but there are some cathartics, which appear to differ in their action upon the mucous surface so as to render it more impressible, — many of the salines, for example. This effect has long been ascribed to the Cheltenham water. It would seem, too, that the constitution, so far from be- coming reconciled to lead by habit, is rendered more and more sen- sible to its irritation. Emetics also frequently act more powerfully by repetition. Dr. Cullen affirms, that he knew a person so accus- tomed to excite vomiting on himself, that the one-twentieth part of a grain of the tartrate of antimony and potassa was sufficient to pro- duce a convulsive action of the parts concerned in vomiting. This difference as to the effects of agents by repetition we observe in disease. In certain cases, after the system has been once morbidly impressed, it is ever afterwards unsusceptible of the same mischief; in others, it is less susceptible ; whilst in others again it is rendered unusually impressible. The last effect is signally observable in the case of miasmata — those at least which give rise to intermittent fever. A person, who has once suffered under a pernicious, or severe, or even ordinary intermittent, may require a less dose of the malaria to reproduce the disease, than was required to occasion the first attack ; and, at times, the nervous system becomes so impressible, that a chill is experienced whenever the individual enters upon a soil which is exhaling the miasm. Persons so extraordinarilv im- pressible have, indeed, been used to indicate the existence or non- existence of malarious exhalations in given localities. In the seventy- second number of the " Edinburgh Review," a writer pronounces several districts surrounding St. James' Park, in London, to be unhealthy, owing to such exhalations, as tested in the mode just mentioned; — an officer who had suffered at Walcheren being the miasmometer ! It may be laid down then, as a general rule, that remedies lose their effect by habit; and this is often strikingly the case with tonics; yet if another tonic be substituted for a day or two, and the former be afterwards resumed, it will produce all its previous effects. Although, however, this is the general rule, it admits of numerous exceptions. MODIFIED BY CLIMATE. 53 5. CLIMATE. The capability of existing in all climates is one of the attributes of humanity. Man is however considerably modified in his physical and mental characteristics by situation. The temperate zone appears to be best adapted for his full development; and it is there that the greatest ornaments of mankind have existed, and that science and art have flourished in exuberance ; whilst in the torrid regions, the sensibility is over-excited ; physical and moral energy is obtunded ; and the native of the temperate zone, who has entered them full of life and buoyancy, has quitted them, after a few years' residence, listless, and shorn of his proudest characteristics. The frigid zone, on the other hand, is equally unfavourable to mental, and corporeal development; the sensibility being blunted by the rigors of the cli- mate. But the effect of locality is perhaps most signally exemplified in the cretin and goitreux of the Valais, and of situations at the base of lofty mountains in almost every part of the globe ; as well as in the inhabitants of our low countries, who are constantly exposed to malarious exhalations, and bear the sallow imprint on their counte- nances. The whole of the circumstances connected with the causa- tion of endemic disease exhibit the powerful influence of locality in the way of morbid impressions ; and the outward conformation of the natives of different countries is an equal exemplification of its physio- logical influence. It is owing to such climatic modification, that we are enabled to distinguish the Frenchman from the Spaniard, Italian and Portuguese, although belonging originally to the same great Ro- manic stem ; as well as to discriminate the different branches of the Teutonic race — the German, Dutch, and the Scandinavian — from each other. As regards the disposition to disease of particular organs, induced by climate, it may be laid down as a general truth, that hot climates dispose to bilious complications. The heat occasions erethism in the whole dermoid system; — hence diarrhoea, dysentery, cholera morbus, &c, dependent upon irritation or inflammation of the lining membrane of the intestines ; and this irritation, being propagated by continuous sympathy along the biliary duct to the liver, that organ is excited, sometimes inflamed, and in this way disease of the liver becomes induced by the influence of heat. The mode adopted at Strasburg and Metz, for enlarging the liver of the goose, is signally elucidative of this subject. (See the author's Human Health, p. 27, Philad. 1844.) On the other hand, in cold climates, there is a greater tendency to inflammation of the mucous membrane of the air pas- sages ; — the irregularity in the cutaneous and pulmonary transpira- tions giving occasion to local excitement in the bronchial mucous membrane, which is not always restricted to that texture, but in favouring habits may extend to the substance of the lungs, so as to develope pulmonary consumption. Hence, the effects of change of climate — especially the removal from a temperate to a torrid region, 5* 54 THERAPEUTICAL INDICATIONS or conversely — become an interesting topic of inquiry to the physi- cian in a hygienical as well as therapeutical point of view. The author has elsewhere shown, that owing to the great nervous suscep- tibility induced by the heat of the warmer climes, such climes are unfit for those that are predisposed to mania, and to head affections in general; whilst they are, cceteris paribus, the best that could be se- lected for such as are predisposed to pulmonary consumption, although most fatal to the same class of patients when the consumption has become confirmed. The circumstances, that modify the physiological and pathological condition of man, necessarily modify also the mode of fulfilling therapeutical indications which might seem to be obvious. The well-instructed physician readily detects those differences, otherwise it would be necessary, that every student should receive his educa- tion in the country where he has to practise his profession. The practitioners, who are destined to exercise their calling in British India, receive their education in the mother country, whilst Phila- delphia sends her alumni to practise in Maine, in Louisiana, and indeed in every part of the globe to which the interest of the nation, or the thirst of gain leads the hardy and venturous citizen. The principles of the science — as before remarked—are alike every where, and but slight observation is requisite to guide the properly in- structed mind to the appreciation of climatic differences of every kind. Climate has some influence, but not a great deal, in modifying the action of remedies. Dr. Harrison found, that narcotics produced more effect in Naples, than in England. He instances the extract of hyoscyamus, which, in doses of three grains, three times a day, at Naples, produced temporary amaurosis or nervous blindness, which disappeared and recurred on the alternate suspension and adminis- tration of the medicine. This was observed in two patients, who had often taken similar doses of the same remedy, in England with- out any unpleasant result, — an effect which Dr. Harrison refers to the increased nervous susceptibility or impressibility induced by the warmer climate. It might be imagined, that a source of fallacy ex- isted in the circumstance of the Italian extract being more powerful than the English ; but in answer to this, Dr. Harrison remarks, that the medicine, which he administered in Italy, was procured from London. The same gentleman found, moreover, as a general rule, that the doses of medicines, as ordered in England, were too large for the climate of Italy. The rule indeed may be extended, and it may be laid down, that remedies act more powerfully, or produce the same effect in smaller doses in hot climates, owing to the greater nervous susceptibility of the residents in such climates. Still, to this there are numerous exceptions. In referring to the subject, Dr. Thomson remarks, that " it does not always follow, that the doses of medicine require to be reduced in warm climates; on the contrary, in India, a scruple of calomel and a grain of opium are frequently administered, and repeated at short intervals, after depletion in dy- MODIFIED BY CLIMATE. 55 sentery ;" and he adds, — what must amuse the residents of many of the malarious districts of this country, and especially of the valley of the Mississippi, — that " but few physicians would venture to pre- scribe this active remedy, in such large doses in this climate," — in other words, in temperate climates. The truth is, that the action of calomel is but imperfectly understood. The French speak with hor- ror of the doses administered by the English ; and in some parts of this country they are equally surprised at the small doses in which it is employed in England. The author well recollects the tone in which a distinguished French army physician spoke of the hardihood of the English physicians in prescribing three grain doses of calomel; yet there are practitioners in this country, who give it in the dose of one hundred, or one hundred and fifty grains, and even more. These immense doses do not produce a purgative effect in a direct ratio with the dose. On the contrary, two or three grains may be actively cathartic, whilst twenty may not produce more or as much effect. After bleeding especially, absorption is active ; the calomel speedily attains the circulation, and is given off by the cutaneous exhalants, as is evidenced by the effect produced upon a gold watch worn by the patient. Such appears to be the effect of a very large dose, even when blood-letting has not been premised, whilst a small dose irri- tates — without there being the stimulus of quantity to induce its absorption — and has a cathartic agency. In this way, a large dose of calomel may defeat the object of the prescriber if he wishes to produce catharsis, and by undergoing absorption and coming in con- tact with every organ, it may excite a new action in the whole se- cretory system ; and even if we admit, that when given in unusual quantity, it is altogether harmless, the superfluous amount must be a waste of the article. In all the cases in which such large doses of calomel are adminis- tered, the practitioner is led to persuade himself, that the climate requires them. But this argument is often fallacious, and it may be employed to bolster up any plan, that has received the approbation of a part or of most of the profession, too often, perhaps, without suf- ficient examination. Not many years ago, in the fevers of the South and West, calomel was considered to be indispensable. Now, it is affirmed by many to be unnecessary, and often injurious, whilst the sulphate of quinia is looked upon as the remedy par excellence. It has been a common opinion, too, that in our ordinary bilious fevers, copious blood-letting, and the most active and irritating cathartics are imperiously demanded; and the practice founded upon this belief was at one time universal; so much so, indeed, that no other was adopted extensively until of late years ; but since a greater degree of attention has been paid to the condition of the mucous membranes in these affections, and a better philosophy has suggested, that whilst we are keeping the different external sensitive surfaces free from all irritation, we ought not to be perpetually irritating the internal der- moid prolongation, practitioners have been induced to abandon the 56 THERAPEUTICAL INDICATIONS constant use of irritating cathartics; to keep the digestive canal free by the use of mild cathartics, which remove the morbid secretions as they are formed; and, by the proper use of sedatives—of which blood-letting is almost the only one—and of refrigerants, to reduce the inflammatory excitement. By such a plan—and experience can equally be adduced in its support — the ordinary bilious fevers of our country will be found to yield more satisfactorily, than under the mixed sedative and irritating treatment, which was formerly uni- versal, and still prevails too extensively. It is obvious, too, that where one system of medication is exclusively employed, it is im- possible to draw any deductions from comparison, and we are not justified in affirming, that climate requires one system more than another until an equal trial has been made of all. The therapeutist has opportunities for witnessing the modifying influence of climate, when individuals pass from a torrid to a tempe- rate or frigid region, and conversely. If the removal has been from a hot to a cold climate, the impressibility is diminished, and larger doses of medicines are necessary to produce the wonted effect; if from a cold to a hot, the impressibility is augmented ; smaller doses are necessary ; and, owing to the same cause, less powerful excitants produce fever, and stimulating drinks have to be carefully avoided. " With respect to inuring foreigners to a country," says a modern writer on Therapeutics — M. Begin — "we are to preserve their organs against the impression of the climate, whose influence has been studiously examined. Thus, the inhabitants of the south, when transplanted into cold and damp climates, should keep their bodies warmly clothed, to preserve themselves from bronchitis and pneu- monia, to which they become much exposed : they are to assume gradually the use of warm and somewhat stimulating drinks. A substantial diet, consisting of animal food, with the moderate use of spirituous liquors, are the precepts to be observed in passing from a warm to a colder climate. Complete sobriety, and the use of vege- getable food, are, on the contrary, necessary for those who pass from a northern to a southern latitude. In marshy places, abounding in simple or pernicious intermittents : — in those climates that are de- vastated by plague, yellow fever, cholera morbus, or dysentery, it is necessary to shun the action of the deleterious miasmata, to approach only by degrees the foyers of infection, to avoid intemperance of all kinds, and every excess, which, by increasing their susceptibility and irritating the digestive organs, evidently dispose to endemic diseases." These last recommendations are equally applicable where the change of residence has been from a warmer to a colder region, even where there may be no endemic disease. It has been a matter of repeated observation, that the habit, acquired during a sojourn of some dura- tion in any climate, remains for some time after a removal to one of opposite character. Dr. Edwards has shown this as regards the physiological performance of certain functions, and it has been long noticed pathologically in the watering and other places of Great MODIFIED BY MENTAL AFFECTIONS. 57 Britain, — the resorts of the healthy and the valetudinarian from Bri- tish India. Whatever complaint may attack the stranger, it is apt to assume the intermittent type, the foundation of which has been impressed on the organism by previous residence in a hot and mark- edly malarious region. In such cases, too, the predisposition to disease of those textures, in which erethism exists owing to great atmospheric heat, is manifest. It is in individuals thus circumstanced, that M. Begin recommends the tolerably free use of spirituous liquors — a measure, to say the least of it, doubtful, and in the author's opinion, more likely to produce irregularity of action, than any regi- men that could be advised, —as it is impossible to keep up the ex- citation uniformly; depression must therefore succeed to the stimu- lation, and the former in a degree proportionate to the extent of the latter. In such a condition morbific agents must necessarily impress the economy more powerfully than if all had been regularity in place of disorder. What has been said of climate, as respects temperature, applies also to seasons. During the summer, the tendency of diseased ex- citement is to the mucous membrane of the alimentary canal; during the winter, to that of the lungs. The summer season is extremely fatal to infants in our cities, owing to a disease which consists essen- tially in inflammation of the lining membrane of the tube, and is produced apparently by the combined action of heat and deteriorated air. The former alone appears to be insufficient to account for its prevalence, as it is rare in country situations, where an equal ele- vation of temperature may prevail; and one of the most certain modes of prevention is to remove the infant from the town to the country. 6. MENTAL AFFECTIONS. We have numerous opportunities for observing the powerful effects induced by the affective faculties on the different functions when in a state of health. All these are caused by sympathetic association with the brain; the organ secondarily affected being in a state of excitation or depression according to the precise character of the emotion. Of the therapeutical influence of different emotions, the author will have to treat hereafter; some of them being important agents in the removal of different forms of disease. The effects of one of the intellectual faculties, when inordinately exerted, on the bodily functions, are signal; and to these must be ascribed cures, that are said to have been effected by modes of management— often of the most revolting character — from time to time in vogue. In nervous, delicate, and imaginative persons, pains can be felt any where: sometimes, too, disease is developed in this manner ; and, at others, feelings as dis- tressing as if they resulted from actual disease. It is through the imagination and its influence on the body, that we must explain the effects of credulity and superstition, so long employed as therapeutical agencies. At one period in the history 58 THERAPEUTICAL INDICATIONS of medical science, the materia medica consisted almost wholly of the machinery of magic. Some, indeed, as Pliny, affirm, that magic was wholly derived from medicine ; but without inquiring into their precise order of precedence, it is certain, that there was a close affinity between them. The word Ananazipta, scrawled on parch- ment was said to cool fever. Abracadabra, supposed by Leiden to be the name of a Syrian idol, figured on an amulet, and worn round the neck, was supposed to possess the power of curing ague, and ot preventing many diseases, especially when uttered in a certain form and a certain number of times. An hexameter from the "Iliad allayed the agony of gout, and rheumatism yielded to a verse of the " Lamentations." In all these cases, the effects upon the physical ailment may have been produced through the action of the mind on the body, of which we have so many marked examples, and to some of which reference will be made presently; but, in other cases, the incantation was used, where such agency could scarcely be presumed. Cato, the Censor, for example, pretended to be able to reduce lux- ations, after the manner of the Etruscans and Pythagoreans, by bar- barous expressions, and by magical songs; —such as " motas vaeta daries dardaries astatutaries," or uhuat haut huat ista pxsta sista domiabo damnaustra et luxato." Homer, too, affirms, that the bleed- ing of the wounded Ulysses was stopped by a charm, and the notion has passed down to the present enlightened age, and prevails m certain parts of Great Britain. It is referred to by Sir Walter Scott in the " Lay of the Last Minstrel," and is noticed frequently in the popular poetry of the last century but one. In all these cases, how- ever, it is probable that the enchanter employed more direct appli- ances to the injured part, as in the "cure by sympathy," to which reference has already been made, and that he had not therefore implicit confidence in his charms. The only remnant of the notion of charms, yet retained in medical language, is the word " carmina- tive," applied to a class of medicinal substances, employed in cases, which were usually cured, or attempted to be cured, by carmina or in- cantations in verse, or to such as operated like carmina or verse charms. It is not much more than a hundred years since the doctrine of curing the scrofula or king's evil by the royal touch, or what Browne affectedly calls Adenochirapsologia, was implicitly credited, and not unfrequently followed. The first English sovereign, who touched for this affection, was Edward, the Confessor, who lived in the mid- dle of the eleventh century, and the last that encouraged it, was Queen Anne, who died about the commencement of the last century. One of the very last, subjected to the degrading mummery, was the illustrious Dr. Samuel Johnson, who, by the advice of a celebrated physician, Sir John Floyer, was carried to London in 1712, where he was actually touched by Queen Anne, but without effect. Much of the success, that often followed this practice, has been ascribed to the influence of the mind over the body ; but Wiseman, one of the fathers of surgery, who lived in the early part of the seventeenth MODIFIED BY MENTAL AFFECTIONS. 59 century, and who had the best opportunities for observation, asserts, that a part of the duty of the royal physicians, and serjeant-surgeons was to select such patients, afflicted with the evil, as showed a ten- dency towards recovery,— rejecting all others ; and as full confidence was placed in the effects of the royal touch, the disease was fortu- nately left to itself, and not officiously interfered with. (For some well written remarks on this and other strange fallacies, see two lec- tures entitled " Homoeopathy and its kindred delusions, &c." By Oliver Wendell Holmes, M.D., Boston, 1842.) It would be as impossible, as unadvisable, to instance the various shapes, which superstition, applied to medicine, has assumed ; and the hold, which it has taken on the minds of many, whose station in society, and whose general attainments, it might have been presumed, would have steeled them against the intrusion of such beliefs. The science of medicine has suffered largely from the credulity and igno- rance of those who profess it, and nothing can exhibit this more strikingly than the repulsive, and ridiculous agents, which have been had recourse to as a part of the materia medica ; some of which were introduced or recommended by individuals, distinguished in their day for superior intelligence. Thus, Bacon believed in the virtue of charms, and amulets; and Boyle thought the thigh bone of an executed criminal a powerful remedy in dysentery. Celsus ad- vised the warm blood of a recently slain gladiator, or a certain por- tion of human or horse flesh, for the cure of epilepsy ; and remedies of this description are said to have been actually exhibited, with success, for the cure of epileptics, in the poor-house at Haerlem, by Abraham Kaauw Boerhaave, nephew to the celebrated Hermann, and professor of medicine at St. Petersburg, who lived so recently as the middle of the last century. Amongst the specifies of Alexander of Tralles, were—the liver of a weasel freed from bile, taken for three successive days, fasting; the skull of an ass, and the ashes of clothes stained with the blood of gladiators. Pliny recommends stones, taken from the craws of young swallows, in epilepsy. De- mocritus mentions, that some diseases are best cured by anointing with the blood of strangers and malefactors, and others, with the blood of our friends and kinsfolk. Miletus cured affections of the eyes with human bile. Artemon treated epilepsy with dead men's skulls, and Antheus, convulsions with human brains. It may be said, that most of these degrading examples of credulous ignorance are taken from a far distant age, when physical science was yet in its infancy. It would be easy, however, to show, that, at a much later period, the same credulity reigned where it was least to be expected ; and even now the pharmacopoeias of certain coun- tries, eminent amongst nations for the advanced condition of mind in many of its aspects, exhibit evidences of the like degradation. Sir Theodore Turquet de Mayerne — who was physician to James the First, Charles the First, and Charles the Second, of England, and who was the most distinguished character of his day for learn- 60 THERAPEUTICAL INDICATIONS ing, and as a practitioner — mentions, among his remedies, the bal- sam of bats for hypochondriasis ; remedies taken from certain parts of adders; sucking whelps; earth-worms; mummy made of the lungs of a man who died a violent death, and many other articles equally gross, and irrational. Even a century after this period of defective observation and experience, no great advancement had taken place towards a knowledge of the effects of medicines on the animal economy. The doctrines of pathology were experiencing considerable mutation ; anatomy, and physiology were beginning to be vigorously cultivated ; many improvements had taken place in the practice of medicine and surgery, and an immense number of new articles had been added to the materia medica, of which com- paratively few, however, have been since retained; yet no great im- provement had occurred in the discrimination of false from true facts, so far, at least, as regards the medicinal virtues of those articles which act insensibly on the frame, and which have been commonly denominated " alteratives." The lists of the materia medica of this country and of Great Bri- tain are free from those offsprings of superstition and credulity, although they may be objectionable for the multitude of articles ad- mitted into them. Time, howTever, and improved observation and experiment will rectify this evil, until — fortunately for the student, practitioner, and patient, — the list will embrace those agents only, whose virtues and applications are understood. Valuable time is frequently lost in the exhibition of a remedy of doubtful efficacy. " Anceps remedium quam nullum" is, indeed a maxim of by no means universal application. The safety of the patient is often endangered by the credulity of the physician. In this way, the use of amulets, anodyne necklaces, camphor worn round the neck, &c, is objectionable. Presuming on their prophylactic or remedial pow- ers, the wearer is apt to pass rashly into infected situations, when he would otherwise have been cautious, and, if attacked with disease, postpones the employment of efficacious remedies until the time has gone by for their successful administration. Different bezoards or calculi found in the stomachs of animals, and at one time generally presumed to have the power of warding off contagious diseases, were to be found in the pharmacopoeias of Amsterdam, Brunswick, Spain, and Wirtemberg. A distilled water of young swallows — officinally called Aqua hirundinum cum cas- toreo—existed in the pharmacopoeia of Manheim,as an anti-hysteric and anti-epileptic; —the oniscus or woodlouse in most of the Euro- pean pharmacopoeias, as a remedy in dropsy, and asthma; —the powder of the dried frog, Bufo exsiccatus, in the pharmacopoeias of Spain and Wirtemberg, as an anti-hydropic; the powder of the human skull in the same pharmacopoeias, as an anti-epileptic ; the dried liver of the mad dog, and that of the wolf, in the pharma- copoeia of Wirtemberg, as an anti-hydrophobic; the Egyptian mummy in those of Spain and Wirtemberg, with the hoof of the MODIFIED BY MENTAL AFFECTIONS. 61 stag, formerly regarded as a specific in epilepsy ; besides many other articles equally absurd. Their retention is unfavourable to the sci- entific observation and induction of the people into whose pharma- copoeias they are received ; and it is somewhat surprising, that amidst the various pharmacopoeias of German origin, that of Wirtemberg should be so far behind in rejecting the relics of ancient ignorance. A useful lesson may, however, be deduced from all these facts. Many of the articles are calculated to produce considerable effect upon the imagination, and thus, they may really have been produc- tive of advantage in the treatment of disease. Who, for example, could be told, that he was about to take a pill made of the powder of the human skull, or of an Egyptian mummy, without considera- ble emotion ? Accordingly, it will be found, that most of these disgusting agents, as well as of the various nauseous remedies, yet retained in the pharmacopoeias,— assafoetida, castor, skunk-cab- bage, &c, —are administered to the nervous, and the hysterical, as well as in the various affections that occur in paroxysms, to make a powerful impression on the nervous system, and thus detract from the nervous irritation already existent. In this way, we account for the action of many anti-spasmodics, anti-epileptics, anti-hysterics, febrifuges administered for arresting intermittents, &c. ; and for^ the efficacy of those methods of acting on the imagination, — animal magnetism, Perkinism, &c, — that have excited the most extrava- gant enthusiasm, and then died away, leaving scarcely a vestige of their having been; but maybe resuscitated under some other form, unless the experience of the past — by which, however, mankind are slow to profit—and the rapid diffusion of intellectual and moral light should be sufficient to choke them at their resurrection. Perkinism, one of the most arrant delusions in the whole history of credulity, is the product of our own soil. Its proposer — Elisha Perkins of Connecticut — is represented to have been a man of strict honour and integrity ; but manifestly of an ardent imagina- tion, and unbounded credulity. Impressed with the idea, that me- tallic substances might exert some agency on the muscles, and nerves of animals, and be inservient to useful purposes, as external agents, in the treatment of disease, he professed to institute various experi- ments, until he ultimately fancied he had discovered a composition, which would serve his purpose, and of which he formed his " me- tallic tractors." These consisted of two instruments, — one having the appearance of steel, the other of brass. They were about three inches long, and pointed at one extremity ; and the mode of their application was to draw the points over the affected parts^ in a down- ward direction for about twenty minutes each time. The effects seemed to be miraculous. The whole class of diseases on which the imagination is known to exert its efficacy, — and it will be seen afterwards, that it is most extensive, — rheumatism, local pains of various kinds and in various parts, paroxysms of intermittents, &c, vol. i.—6 62 THERAPEUTICAL INDICA1 IONS yielded as if by magic. The operation was termed Perkinism by the faculty of Copenhagen, in honour of the inventor ; and institu- tions were formed in Great Britain, which were regarded for a time — that is, during the existence of the delusion—as sources for the dispensation of health to suffering thousands. The follow- ing is from the report of the " Perkinistic Committee" of London on the establishment of their institution! " Mr. Perkins," (the son of the proposer) " has annually laid before the public a large col- lection of new cases, communicated to him for that purpose, by dis- interested and intelligent characters from almost every quarter of Great Britain. In regard to the competency of these vouchers, it will be sufficient simply to state, that, amongst others, whose names have been attached to their communications, are eight professors in four different universities; twenty-one regular physicians, nineteen surgeons, thirty clergymen, twelve of whom are Doctors of Divinity, and numerous other characters of equal respectability. The cases published by these gentlemen in March last, the date of Mr. Per- kins' last publication, amount to about jive thousand. Supposing that not more than one cure in three hundred, which the tractors have performed, has been published — and the proportion is proba- bly much greater— it will be seen, that the number to March last will have exceeded one million five hundred thousand." With such apparently overwhelming testimony in its favour, can we be much surprised, that sufficient enthusiasm should have been excited amongst the credulous, for the establishment of the Perkinistic In- stitution ? A meeting was called for the purpose ; the undertaking was unanimously resolved upon, and a subscription opened to carry the proposed charity into effect. The list was soon honoured by- above a hundred subscribers, several with a donation often guineas, and only one or two subscribing annually less than one guinea. Lord Rivers was elected President of the Society ; and eleven other persons of distinction, among whom was Governor Franklin, son of the illustrious Doctor, composed the list of vice-presidents. On the 25th of July, 1803, a large house was opened in Frith street, Soho square, for the reception of patients, and in which the medical attendant, matron, and servants constantly resided. The objects of this establishment— as stated by the society in their publication on the subject — appeared to be philanthropic, and were as follows: — First. To afford relief to the disorders of the afflicted and industrious poor of the metropolis, if the remedy should be found capable of that desirable purpose : and—Secondly. To submit the long con- troverted question on the merits of the' metallic tractors to the test of the severest scrutiny, the ordeal of experiment by disinterested persons, and thereby enable the public to form a correct opinion on the just pretensions of Perkinism :" —and it was farther proposed, in the report of the committee, that the British Parliament should investigate the merits of Perkinism, " and if convinced of its utility, honour it with similar patronage to other modern discoveries for the MODIFIED BY MENTAL AFFECTIONS. 63 benefit of mankind." Yet, humiliating reflection ! In a very brief space of time, the enthusiasm and the institution died aw-ay ; and no one, at the present clay, believes that the effect was any thing more than an additional illustration of the success that must ever follow, for a time, the efforts of empiricism and pretension. Whilst the delusion regarding Perkinism was at its height, Dr. Haygarth determined to ascertain how far the effects might be ascribed to the imagination. He accordingly formed pieces of wood into the shape of tractors, and with much assumed pomp and ceremony applied them to a number of sick persons, who had been previously pre- pared to expect something extraordinary. He not only employed them in nervous diseases, but in all kinds of cases; and the effects were found to be astonishing. Obstinate pains of the limbs were suddenly cured. Joints, that had been long immovable, were restored to motion, and, " in short," says Dr. Bostock, " except the renewal of lost parts, or the change of mechanical structure, nothing seemed beyond their power to accomplish." Animal magnetism, as well as the employment of the magnet for the cure of disease, is, at the present day, exerting its therapeutical influence, partly through the same agencies. It is in such cases as those in which the tractors were found beneficial, that they succeed. All these facts lead us back to the great influence exerted by the moral on the physique. Daily experience shows how satisfactorily a case of disease may proceed, if the faith of the patient be implicitly yielded to the physician, and to the mode of treatment he is pursuing ; and how unhappily every thing is apt to go on, when the contrary is the fact. The author has already cited a case, in which the same remedy had opposite effects, when prescribed by two different phy- sicians — the confidence of the patient being reposed in the one, and not in the other. It is equally important, for the successful opera- tion of a medicine, that the confidence of the patient should be re- posed in it, otherwise disappointment is apt to ensue ; and, on the other hand, imagination or faith may render inert medicines effica- cious, and may even—as before remarked — cause a medicine to have effects very different from those which it usually exerts. A female patient was admitted into the County Asylum at Hanwell, under Sir William Ellis. She imagined she was labouring under a complaint which required the use of mercury ; but Sir William dis- covering that the idea of the existence of that disease was an insane delusion, yet considering that flattering the opinion of the lunatic to a certain degree might be favourable to her recovery, prescribed bread pills for her, and called them mercurial pills ; after a few days, she was salivated, and the pills were discontinued. On again pre- scribing them after the salivation had subsided, she was a second time affected in the same manner; and this happened again on a third recurrence to the use of the pills. The late Dr. James Gregory, of Edinburgh, was in the habit of relating an anecdote in his lectures, in illustration of the same 64 TIIEAAPEUT1CAL INDICATIONS subject. A student, who was labouring under fever, and who was under the care of the doctor, required the administration of an anodyne ; and he was accordingly informed by the doctor, that he would order one for him, to be taken at bed-time. The patient, however, thought he said cathartic. The next morning, when the doctor called, he inquired what effect the anodyne had produced ? " Anodyne !" replied the young man, " I understood it was a pur- gative, and a very active one it has proved. I have had four copious stools, and feel much relieved." In Paris's life of Sir Humphry Davy there is a case equally instructive. Dr. Beddoes having in- ferred, that the inhalation of the nitrous oxide must be a specific for palsy, a patient was selected for trial, and placed under the care of young Davy. Previous to administering the gas, Davy inserted a small thermometer under the tongue of the patient to ascertain the temperature. The paralytic, deeply impressed by Dr. Beddoes with the certainty of the success of the remedy, of which he knew nothing, no sooner felt the thermometer in his mouth than he declared he felt better. Nothing more was done, and the sick man was requested to return on the following day. The same ceremony was repeated with the same result, and, at the end of a fortnight, he was dismissed cured, — no remedy of any kind, except the thermometer, having been used ! In an interesting accountofthe influence exerted on the public health of Hamburg, by the great fire there in 1842, Dr. Zimmerman states that many bedridden invalids arose, and displayed supernatural force and energy ; and that some of them remained permanently cured. Diar- rhoea, mania, and apoplexy were the principal diseases observed. It will be easily understood, then, how important and extensive may be the influence exerted by the mind over the body, in a thera- peutical point of view, and that it is not unimportant to inquire into the likes and dislikes, the prepossessions and antipathies, of patients. It will often happen, that in the course of a long disease a desire may be felt for particular articles of diet, which may not seem, at first sight, extremely appropriate ; but, in such cases, unless manifest evil would be likely to result, it is better to humour the individual slightly, or at least not to resist him strongly; for it occasionally happens, that instinctive desires or appetites are felt, which may not only be indulged in moderation with impunity, but with obvious benefit. The refrigerant regimen was at one time carefully avoided ; — so long indeed as the doctrine of concoction of humours persisted ; and one of the greatest improvements in the practice of physic, as applied to febrile diseases, is the, free adoption of the cooling system, whenever the state of the body will admit of it. Instinct here led the way, and experience has proved the correctness of its monitions. The efforts of the practitioner, in a case of simple fever, are, indeed, mainly restricted to the employment of the refrigerant class of reme- dies. A prejudice is still found, however, against the use of iced water in fever where calomel is given. The feeling exists strongly MODIFIED BY FT.* 7I>>:\N5. ETC. 65 in many parts of the S uthern and dviidule state?. b"t it is raridlv yielding, and otLojht to be altogether abolished. Some cases have occurred in which individuals have caugh: cold, or Lave had dis- agreeable symptoms snpervtrd.u;;. a:her cold water hs followed calo- mel: but they have been case? of the post hoc. rather than ■:: the propter hoc. The author has been far veans in the habit of allowing the use cf iced water after calomel in fevers, and has never had the slightest evidence of any disagreeable results from it. 7. PROFESSIONS, A5D WAT OF LIFE. These ctreumstances exert much influence not only on the sus~ev- tibility to disease, but on the iaciicati^ns of cure, ana the made in which these indications have to be fulrlDed. This is strikingly ex- empltded in the agency :f those physical circumstances, that affect the economy through the mucocs membraiae of the digestive tube. If this aas been regularly, and for a .cr:z period, excited beyond its healthy action by the use of alcoholic potatims. not only is the foun- dation laid for diseases in other organs, bat the whole frame becomes liable to unhealthy imbammatorv excitement, en the aaalication ot causes which would have been incapable of producing the same results on the individual before his system had been thus inordinately excited. The draymen, p rter-. c:al-h_-avers and others of the British met: polls, who urink a galhon or more of strong porter durir.u me day. and uahy. although they bear tae appearance cf rude heahan, are liable t: erysipelat: as inflammation after the slightest external injury : and. when attacked bv Severe inter::?., disease, do not bear the amt:a;t;:n oi blood Hie those cf stand constitution and tern ae- rate ha its. But. in icpendently of such habits, mode *f life has a manifest edeet upon the crganism. The laoourer. who is exposed to every vicissitude, is less sasceatible of impressions, and consequently de- mon us larger drses of medicines to produce the same effect, than he who is brought up in idleness and luxury. The effect of such hal its is to render the frame cxtremelv impress! le. and hence the number of the nervous and the hysterical is infinitely greater amongst the upper e.a-ses of society. In this country, we have not the coherence of way of life so signally exhibited as in Oriental climes, where a distinct classification exists in society. Amid>t the revolutions, that occur in the fate of families, where the law cf primogeniture does not hold, there is not much opportunity for tracing the erie:t? of labour or of luxury thrtugh manv Generations : but in Hindustan, where a id : nee cf castes has existed from time immemorial, and where the barriers are effectuailv closed so as to prevent the entrance cf the unprivileged, the edb t is clearly shown. Tne artisans arc above the tillers of the sill, and they exhibit in their conformation. as weh as in their functions, the ind^ence of a greater cegree of re- ilnement. The same remark applies to the Ftiynesians. where a like division .-xists. 6* 66 THERAPEUTICAL INDICATIONS It is in the investigation of disease that the knowledge of the pro- fession or calling is a more important topic of inquiry than in Thera- peutics. In order to appreciate accurately, in many cases, the causes and seat of a disease, the nature of the daily occupation must be known. The flax-dresser, for example, the glass-cutter, the needle- pointer, &c, are liable to diseases of the chest, owing to the minute particles given off in their operations entering the lungs, and ex- citing irritation there, so as to produce many and fatal pulmonary maladies. Lead, again, gives rise to a series of symptoms, which have been called, collectively,' lead colic,' or colicapictonum. When a person, consequently, labouring under those symptoms, presents himself to"the pathologist, the inquiry suggests itself, whether he may not belong to one of those occupations in which lead is used, — as in smelting the metal, manufacturing sheet lead, or white lead, plumbing, glazing, painting, and composing in printing offices. By handling the metal, the carbonate of lead gets upon the fingers, and is swallowed, provided due cleanliness be not adopted. That this is the mode in which the poison of lead is often received into the system is shown by the fact, that at an extensive smelting establish- ment in Cornwall, at which cases of colica pictonum were extremely common, the disease was almost abolished after an order had been issued, and rigorously enforced, that no artisan should be permitted to partake of food until he had washed his hands carefully with the assistance of a nail-brush. These inquiries are altogether etiological, and they afford us ex- amples of the cessation of the effect after the removal of the cause. Reference has already been made to the fact, that although this may often follow, — in an immense multitude of cases, the diseased action may still persist after the removal of the cause. In the large class of diseases, that are symptomatic, every thing depends upon the ac- curate investigation and appreciation of the primary lesion; and this is often one of the most difficult points of pathological inquiry. wt The greatest attention of the physician," says Begin, " is often required to enable him to discover the real causes of the disease before him. A few months ago I was called to a woman labouring under oppression of the chest, with a dry and frequent cough, and a painful sense of suffocation recurring at intervals : besides these symptoms, there was constant headache and vertigo, the conjunctiva was injected ; and the pulse was full, hard, and not much acceler- ated. For two months her menses had disappeared, in consequence of a violent mental affection. A copious bleeding, warranted by her vigor and youth, caused a subsidence of the cerebral symp- toms ; the menses re-appeared; but the pectoral symptoms con- tinued. During ten or fifteen days, I directed my treatment against what I considered to be irritation — either sanguineous or nervous — of the bronchi, but unsuccessfully. At last, during one of ray visits whilst conversing with my patient, I observed her executing M DIFIED BY CACSZS; ETC., OF THE II5EASE. >\~ that remarkable motion which accompanies difficult and painful de- glutition. On my inquiring whether she often had to execute that motion, she answered in the ahurmative. I tl n proceeded to ex- amine the mouth : a slight irritation existed about the pharynx and t n-iis: the uvula was elongated, filiform, and descended along the base of the tongue as far as the epiglottis. The true cause of the disease was now disclosed. The exuberant appendage of the velum palati was immediately removed in the usual way. and all the symp- toms disappeared." This ct.se is not novel — although M. Begin seems to regard it so. It has long been admitted, that elngttion of the uvua. by irritating the top cf the larvnx, may develope the ordinary symp- toms of phthisis, in such as are predisposed to the disease: and it can readily be seen, that if tubercles already exist in the lungs, it may excite them to suppuration. 1M. Begin, how- ever, uses the case cited as the foundation for a remark. *• that cir- cumstances of this kind are net unfrequeut. The • physiological doctrine,' in unfolding the origin and nature of a vast number of symptoms, heretofore considered as essential affections, has dimi- nished the catalogue of diseases, and rendered their treatment more methodical and efficacious.'" Ihe ;i physiological doctrine," has c :- tainly not been without its good fruits ; but the case selected by M. Begin to prove this is not a happvone. It was not the doctrine, that attracted his attention to the uvula, but the symptoms, and they would equally have done so, had no •■ physiological doctrine"' ever existed. The '■ doctrine" has been as much injured by injudicious friends as by open enemies ; and it is partly owing to want of ms- creti n. that it is now scarcely spoken of, except as a matter of medical history. :. CAUSES. SEAT. PERIOD, if., Of THE DISEASE. Enough has been said respecting the modifications of the indica- tions, and the mode of fulfilling them, according to the causes, and seat of the malady. It need scarcely be remarked, that the period of the disease likewise exerts considerable influence, and is occa- sionally a source oi difficulty to the therapeutist. In febrile diseases. the use of stimulants has been almost abandoned : but cases at times occur, when they seem to be indicated, and the practitioner is compelled to proceed with caution, and to decide with judgment. in his appreciation, whether they be indicated or the contrary. Dr. Rush affirmed, that there was a period in fevers, when blisters might be had recourse to with advantage as stimulants, and to this period he gave the name •• blistering point.': If the excitement was above this point, blisters were improper : if below, the contrary. The urn ultv would manifestly be to know it. It is not fixed with ther- mometric accuracy, and, consequently, the idea of the blistering point fell to the ground with its distinguished proposer. It will be seen. t ,o. hereafter, that blisters are by no means unobjectionable agents 68 THERAPEUTICAL INDICATIONS in the very cases, referred to by Dr. Rush as requiring the adminis- tration of excitants. In inflammatory affections, the period of the disease occasions modifications, which cannot escape the observant practitioner. In- flammation is apt to terminate in various ways, and it is important for the therapeutist to determine whether such termination — as it is technically called — has supervened; inasmuch as many of the ordi- nary signs of inflammation may be still kept up in consequence of the disordered action persisting, to a greater or less extent, in the affected tissues. Pneumonia, for example, may end in the effusion of a serous fluid into the lungs, or into the cavity of the pleura; and this fluid may keep up irritation there. The excited state of vessels, too, may continue in the seat of inflammation, though not to the same extent; and a very different system of medication may be ad- visable from that which was adopted before such effusion occurred; or at least the same activity of management may be altogether in- admissible. In like manner, in the inflammations of mucous mem- branes, which have persisted for a long time — or, in other words, have become chronic — excitant applications are made to take the place of the soothing, which were adopted in the earlier stages with obvious advantage. Under different states or conditions of the body, remedies are found to produce the most various effects. During the existence of spasm in any portion of the system, opium may be given in immense quantities without inducing its wonted action. The author has sat by the bedside of a delicate female, labouring under the cholelithus means of Good — that is, under gallstone in its progress along the ductus communis choledochus — to whom he has given tincture of opium by the tea-spoonful, until she took upwards of an ounce, yet without any stupor following its administration. In like manner, in neuralgia, extreme doses of narcotics may be demanded, as well as in mania and melancholia, delirium tremens, tetanus, hydrophobia, &c. — diseases in which the cerebro-spinal nervous system is pro- foundly affected, and in which the great nervous centre can be im- pressed with extreme difficulty. It is but lately, that an interesting lady, labouring under puerperal mania, took twelve grains of solid opium in the period of twenty-four hours ; and an engineer of one of the Philadelphia steamboats, affected with a severe neuralgic attack in the intestines, took fifteen grains in the same time ; and much larger doses than these have been given under similar circumstances without the least evidence of narcosis. It is unnecessary to dwrell upon this point. In every case of diseased manifestation, the mode of treatment has to be modified by the intensity, character, and period of the affection, whether the morbid action be above the medium line or below it; or, in other words, whether excitants or sedatives appear to be indicated from the first. MODIFIED BY CA.5LS. ETC., OF TliE IISEASE. 69 To sum up. — It has been shown, that, amongst the most imnrrt- ant circumstances, which modify the indications of cure in disease, and the mode of fulfilling those indications, are,— age, sex. original confoimation.ifhafit, climate, mental adeetious. professions, and way cf life, as well as the causes, period, and seat of the disease: and that all these have to be attended to, in order, that the therapeutist may be enabled to administer his medicinal agents with judgment and efficiency. 70 ACTION OF MEDICINES. CHAPTER III. OF MEDICINES. A medicine defined—General action of Medicines—Various modes of action—By sim- ple, direct or local action—By indirect or general action—Through the nerves—Through absorption—Through revulsion—Medicines divisible into Excitants and Sedatives — Classification of medicines—Barbier's Classification—A. T. Thomson's Classification —Author's Classification. A Medicine, in the enlarged sense, is any agent which is adminis- tered for the purpose of curing or allaying morbid action. The de- finition would include the different articles of diet and regimen, which are employed medicinally ; and if we were to go into a nicety of definition, we might have to point out the difference between ali- ments, medicines, and poisons ; but this is unnecessary. The term is well understood to be appropriated to those agents, that are had recourse to therapeutically ; or, in other words, to the various arti- cles, which are received into the pharmacopceias or dispensatories, or which, in consequence of their action upon some tissue of the body, ought to be received into them. The Greek word tfag,"**" signified both poison and medicine ; and the generality of medicines are capable of exerting a deleterious agency if administered in too large a dose. Every medicinal agent — to produce its effect—must impress some surface of the body, and it "must perhaps be capable of impressing the surface, whether in a healthy or diseased state. To this, however, some plausible objections might be urged, — both directly, and from analogy. For example, it is well known, that the secretions do not act upon the parts with which they are destined to come in contact, when such parts are in a state of health ; but if they become diseased, then the same secretions may excite violent irritation. This is exemplified in ardor urinse, an appellation, which indicates a symp- tom, not a disease. When the lining membrane of the urethra is healthy, the urine passes over it without exciting any uneasy sensa- tion ; but when it is inflamed — as in blennorrhoea—the'healthy fluid excites violent irritation, and such a sensation of heat as to cause the mischief to be ascribed to the urine ; — hence the name ardor urirm— and the French name chaudepisse. An acrid condition of the bile has often been adduced as the cause of diarrhoea. A better pathology teaches us, that the primary source of irritation is usually — universally perhaps — in the lining membrane of the digestive tube, and that the liver is secondarily implicated;—a vitiated condition of the bile being very rarely, per- haps, the main cause of bowel affections. MOIL'S CPERANII OF MEDICINES. ~1 Again, we have an instance in which the same remedy has verv different effects according to the varying condition of the organ. 21 st of the believers in the abortive powers of the Ergota or t;g:d of rye consider it devoid of action upon the unimpregnated uterus: manv of them think it is capable of producing abortion ; and all, that it adds to the efficiency of the parturient efforts, when once the pro- cess has become established. These, and other facts, might induce us to accord with Sir Gilbert Blane, and Dr. Paris, that medicines are frequently but relative agens, producing their effects in reference ■"my to the state of the living frame : and there is truth in the remark of sir Gilbert, that the virtues of medicines cannot be fairlv essay- ed, nor beneficially ascertained, by trying: their effects on sound sub- jects, because that particular morbid condition does not exist, which they may be exclusively calculated to remove; ••thus, in certain states of debility, tonics may excite the system when languid, by their sympathetic influence upon the prima vice.; while in a robust condition oi the body, the effects of the same agents may be wholly inaypre la- ble. As a general rule, howev-r. we should be justified m doubt- ing the patent medicinal efficacy of any agent, which produces no effect whatever on the healthy bodv. 1. MODTS 0P2RA5DI OF MEDIC IMS. The modus operandi of remedies is not always clear; yet. by care- ful analysis, we can generally appreciate it — in the main results at least. — although we mav have much difficulty in comprehending the precise mode in which these res Its are accomplished. This applies especially to those cases in which the agency takes place by sympa- thetic influence. — an influence proverbially obscure, and frequently invoked with the view of covering the ignorance of the observer: as vitality, and ogo nic action are, at times, used by the physiologis", when a function cannot be explained by any known physical facts or arguments. The modes in which the agencv of remedies is exerted are chiefly as follows. a. BY SIMPLE, DIRECT, OH LOCAL ACTIOX. When a drug is taken into the stomach, it may merely afreet that organ bv simple contact; and no sensible impression may be made elsewhere. This is the simplest mode in which remedial agents act : and we have examples of the same kind in the application oi caustics ;o parts, which we are desirous of eroding or destroying: in the use of astringents in haematemesis, and in cases of hemorrhoids when the remedy is applied so as to come into immediate contact with the ,:ib:ted parts : in the use of collutories for sore mouth : of external agents in ordinary local inflammation; and cf a poultice in suppu- rative inflammation. Inflammati n. according to its degree, affords us a good example f the mode in which disease may cither be wholly local, or impli- 72 ACTION OF MEDICINES cate the general system; and, likewise, of the way in which our remedial agents may affect the frame locally or generally. In a slight case of inflammation, we have the morbid action confined altogether to the capillaries implicated. The heart and larger ar- teries do not participate ; and the efforts of the practitioner are prin- cipally directed to the use of agents, whose operation may be confined to the inflamed part. But if the inflammation be more severe, the whole circulatory system sympathises, and remedies are required, which will act both on that system generally, and on the vessels more immediately concerned. At times, however, we see the very best results from applications, which are directed simply to the in- flamed part; and as the increased action becomes soothed in the part, the soothing influence is propagated to the rest of the system, in the same manner as the morbific influence was in the first instance. In cases of inflammation of the conjunctiva, a few drops of a weak solution of nitrate of silver, thrown on the eye, will often allay the irritation almost instantaneously, and the increased action of the ves- sels communicating with the over-dilated capillaries speedily sub- sides ; but if, on the other hand, a very strong solution of nitrate of silver, or of any other astringent, be dropped on the diseased eye, it may excite intense irritation there, and the vascular apparatus of the part, and even of the whole system, may be thrown by it into a state of turmoil. If we then soothe by appropriate applications, the turmoil ceases. In these last cases, we have examples, not only of the purely local or direct action of medicines; but also of the exten- sion of this action elsewhere, — constituting the next mode of ope- ration which we have to consider. b. BY INDIRECT OR GENERAL ACTION. This is the mode commonly adopted in the administration of re- medies. In most cases of internal exhibition, the agent must first come in contact with the stomach, and, through this organ-—the great "centre of sympathies," as it has been long considered, and designated—other parts become impressed, according to the elec- tive affinity of the particular article for some tissue or organ rather than for another. It is owing to the stomach being so intimately associated with other parts, that it is generally chosen as the organ, through which remedies are to act. If the functions of the stomach be disordered, as in dyspepsia, the whole system sympathises; there is not an organ that does not feel the depressing irradiations; the brain and nervous system may become so disordered that the patient is subject to all kinds of hallucinations; and hypochondriasis thus becomes a common concomitant of dyspepsia. Nauseating remedies, again, exert their effect, through the stomach, on the whole system, so as to be most valuable agents in diseases of increased action ; and, in short, as the different parts of the system can be affected by im- pressions conveyed through the stomach,— so, conversely, no irrita- tion can persist for any great length of time in any organ without the THROUGH THE NERVES. 73 stomach suffering: hence it is, that it has been designated the centre of sympathies. The manner in which this indirect effect of medicines is induced. is as follows. 1. Through the JWrvi.s. Between every part of the capillary surface of the body there is the greatest sympathy or consent: so that if any one be inordinately and irregularly excited, parts at a distance sympathise : and this to a greater or less degree, according as such parts are more or less dis- posed to take upon them, at the time, a similar derangement. This is seen when the feet are exposed to cold and moisture : derange- ment takes place in the functions of the capillaries of the feet, and this derangement is reflected to every part of tie capillary surface, so that in a dozen individuals exposed to this cause of disease, the derange- ments maybe as various in their seats as are the individuals themselves: owing to the greater predisposition of some particular organ to as- sume a morbid action in one rather than in another. Now. that which applies to the external capillary surface applies equally to the internal expansion of the skin forming the mucous membranes, so that medicines received into the stomach, by impressing the capil- laries of that organ, may produce sympathetic results on parts at a distance. That medicines do exert their influence through the nerves— as one modus operandi— is unquestionable. Dupuy divided the pneu- mogastric nerves in a horse, and then introduced two ounces of mix vomica, in the form of a bolus, into the stomach. No unpleasant consequences followed ; whilst another horse — equal in size and strength to the former — to which the same quantity of the poison was administered, died in a few hours in violent tetanic convulsions. It is probable, that the reason why the former did not suffer, was the division of the nerves : but a doubt might be raised, with much plausibility in its favour, whether it was directly dependent upon this, or indirectly, owing to the function of absorption having been destroyed by the section. The researches of modern toxicoiogists have indeed furnished us with cases that are unequivocal: one of which is sufficient for our purpose. If strong hydrocyanic acid be applied to the tongue of an animal, it dies instantaneously:— so ra- pidly, indeed, that there may not be time enough to remove it from the lap of the experimenter before life has ceased. In this case, it would seem to be impossible for the p oison to have entered the blood- vessels, and to have passed, with the current of the circulation, to the great vital organ on which its deleterious agency is exerted. In many cases of poisoning, death is doubtless produced by the action of the poison on the nerves distributed to the coats of the blood- vessels, — as where the poison is injected into the veins, and destroys life instantaneously. Several of our medicinal agents, it will be found, act by preference vol. i.—7 <4 ACTION OF MEDICINES on the nervous system, and of these all do not act upon it in the same way. Opium, for example, affects the brain, causing stupor ; strych- nia, the brain and spinal marrow, producing tetanic convulsions ; and prussic acid excites coma with tetanus. The precise ground of these differences is inscrutable ; yet that they exist cannot be denied. There is a manifest affinity between particular remedial agents, and particular parts of the frame ; and in whatever manner these agents are administered — whether by the stomach, or by the skin, or by infusion into the blood — they seek out the organs on which they act by preference ; yet, why tartrate of antimony and potassa should produce vomiting, when injected into the venous system, and rhu- barb purge— why this elective affinity should exist — is unknown. We can likewise affect distant parts by applying our remedial agents to the cutaneous surface. The author has already referred to the effect, produced on the capillary system elsewhere, by the irre- gular action induced through exposing the feet to cold and moisture. The effect of ablution, as a refrigerant in fever, is another example. If the skin be steadily hot and dry, cold or tepid water may be ap- plied by ablution or sponging, so as to greatly diminish the morbid heat; and, accordingly, it is one of the most valuable febrifuge remedies which we possess. The capillary system, to which the cold or tepid fluid is applied, has its action diminished, and, through that extensive sympathy, which has been mentioned as existing be- tween every part of the capillary system, the sedative influence is speedily extended to the rest of the frame. It is to the external capillary surface that most of our energetic counter-irritants or revul- sives are applied ; although we shall find, that various local stimu- lants, administered internally, are indebted, for much of their efficacy, to the derivation or revulsion they excite. It obviously would be a matter of moment, if we could discover the parts that more particu- larly sympathise with each other, in order that our revulsives and other agents might be applied with full effect, but this is a matter of difficulty, demanding a degree of patient investigation, which but few possess. Dr. Thomson regards the organ of smelling as a third medium for receiving the impression of medicinal agents on the nervous system : the effect, he remarks, " is chiefly produced on the first and the fifth pairs of nerves distributed over the schneiderian membrane, lining the nostril, the adjoining sinuses, and the convoluted bones, so beau- tifully contrived to extend this surface in a limited space ;" and he adds, that " many substances, which are supposed to enter the sys- tem by pulmonary absorption, such as the fumes of alcohol, tobacco, and ammonia, affect the habit solely by impressions made on the nerves of smelling." In support of this opinion, he quotes numerous experiments by Dr. Rousseau, of Philadelphia, which appeared to warrant the conclusion, that by simply closing the nostrils, either by compressing them with the fingers, or by filling them up, the fumes of ardent spirits, or of a strong decoction of tobacco, or an infusion of opium might be inhaled for an hour, without any unpleasant effect; THROUGH THE NERVES. 75 whereas if the precaution were omitted, the consequences were found to be most distressing. Notwithstanding, however, the mode in which these results are stated, the author cannot help doubting the accuracy of the experiments, and, of necessity, the deductions founded upon them. When these substances are inhaled, either by the nose or the mouth, they come in contact with branches of the fifth pair of nerves. In the nose, it is true, they impinge also upon the ramifica- tions of the first pair or the olfactories ; but, on the other hand, in the mouth, they meet with branches of the hypoglossal and glosso- pharyngeal. It is admired, that more effect is produced on the ner- vous svstem, when they are passed through the nose, than when they traverse the mouth ; but this is perhaps owing to the greater degree of velocity with which they are made to enter the former than the latter cavity, so that the nasal nerves are more powerfully impressed than the buccal, and — as the supporters of absorption would say — their entrance into the circulation through the mucous membrane rendered more ready ; but it is not necessary — as Dr. Thomson thinks is the general belief—that such absorption should be pulm- nanu All the mucous membranes are absorbing surfaces, and al- though a portion of the fumes may pass, along with the inspired air, into the ultimate bronchial ramifications, and be there absorbed, im- bibition takes place in every part of the mucous membrane, from the place where it commingles with the skin at the mouth to the point of termination oi the minute air-tubes ; nor did the author know, that any one entertained the opinion, that ammonia enters the sys- tem by pulmonary absorption. As well might it be presumed, that any inorganic and mechanical excitant, applied to the nasal nerves, exerts its agency by such absorption. Of the precise mode in which medicinal agents influence the nerves, we know little or nothing. It is not necessary, that the surface, with which they come in contact, should be physically modified, or that any organic change be perceptible. In the case oi the instantaneously fatal application of the hydrocyanic acid, to which reference has been made, there is no time allowed for the supervention oi organic modifications in the part to which it is applied. The lethiferous influence is at once exerted on the nerves with which it is placed in contact, and the irradiations proceed from thence along the nerves — with the rapidity of lightning along con- ducting wires— to the great vital centres, whose action ceases on the instant, and immediately afterwards that of every tributary organ. The mode in which the influence of medicines is extended to different organs, through the nerves, probably differs. In many cases, the impression made upon the part to which the agent is applied passes immediately to the brain, and is thence reflected to the sympathising organ. This is probably the way in which medi- cinal agents generally produce their effect through sympathy; but in certain cases it would seem that this reflection is not indispensable. A demulcent, by passing over the top of the larynx, may produce a 76 ACTION OF MEDICINES soothing influence there, which may extend to other parts of the pulmonary mucous membrane — by what is termed sympathy of con- tinuity, effected perhaps through continuous nerves. In the same manner, the action of a suppository, or of a glyster. excites the upper parts of the intestinal tube to contraction. Physiology and pathology, indeed, furnish multitudes of examples of this kind of sympathy, as well as of the sympathy of continuity, of which we have an instance, where the muscular coat of the intestines is aroused to increased action by the irritation of a cathartic on the mucous coat; or, where we attempt to produce an emmenagogue effect by the administration of cathartics—such as the preparations of aloes — whose action is mainly exerted on the lower part of the bowels. The generality of physiologists of the present day look to the nervous system as the great source and medium of communication of the different irradi- ations by which distant organs are supposed to react sympathetically upon each other. The rapidity, indeed, with which the various actions of the nervous system are executed. — the apparent synchro- nism between the reception of an impression on an organ of sense. and its perception by the brain, as well as between the determinations of the will and their effect upon a muscle, — naturally attracted the attention of physiologists to this system as the instrument of sympathy: and we certainly know enough to infer, that, in many cases, in ani- mals, the nerves appear to be the conductors: that the brain is. in others, the centre, to which the organ in action transmits its irradi- ations, and by which they are reflected to the sympathising organ: whilst, in others, again, the effect is caused in the absence of nervous centre, and perhaps even of nerves, in a manner, which, in the present state of our knowledge, is inexplicable. It is not difficult, however, to conceive, that by means of contractility, impressions — vibratory or other — may pass rapidly from one part of the organism to another, as they do in the vegetable, which — if we admit it to be possessed of a nervous system at all — has it in a primitive and ruui- mental form, and has certainly nothing like a nervous centre for the reflection of impressions. Vibrations, it is well known, communi- cated through the air from a sonorous body when struck, impress the organ of hearing: light probably acts in a similar manner upon the visual apparatus, and we may suppose, without any violence to probability, that a similar vibration may exist over the organism, so that an impression made upon one part may rapidly oscillate to another, independently of any thing like nervous communication. 2. Through Absorption. The proofs, that medicines may be absorbed from the alimentary canal and elsewhere, in their entire state, are as numerous as they are satisfactory. It is but necessary, that a substance should possess the requisite tenuity to soak through the coats of the veins, and, in this way, get into the circulatory current. The facts and arguments, connected with the absorbent function of the veins, are so fully de- THROUGH ABSORPTION. 77 tailed in the author's Human Physiology, that a simple reference to them here, will be all that is necessary. But few physiologists of the present day doubt, that those vessels are capable of this function; yet it is denied by one therapeutical writer, Prof. Chapman, of Phila- delphia, that medicines can pass unchanged into the venous system. or, in other words, that they can be absorbed in their entire state: the assertion and belief are designated by him as a "relict of the humoral pathology;" and he arSrms, that '*it must at least be acknowledged, that no substance in its active state does reach the circulation, since it is shown, that a small portion, even of the mildest fluid — as milk, or mucilage, oil, or pus — cannot be injected into the blood-vessels, without occasioning the most fatal conse- quences."' Setting aside the multitude of facts, which show, that substances may be absorbed by the veins, and be detected by chemical re- agents in the blood, we know well, that they can be injected directly into the blood without producing death; and that, since the time of Harvey until the present day, the " infusion" — as it has been termed — of medicinal agents into the blood has been a common practice. It is asserted to have been first employed in 1657, at the suggestion of Sir Christopher Wren, and it has been practised at the veterinary school of Copenhagen, with complete success, — the action of the agent being more speedy, and the dose required much less when thus administered. Experiments of this kind have con- firmed the well known but singular fact — already referred to — that medicinal substances exert their action by preference upon certain parts of the body, in the same manner as if they had been received into the stomach. Tartarised antimony vomits, and castor oil purges, not only as certainly, but with much greater speed: for, whilst the former requires to be in the stomach for fifteen or twenty minutes before vomiting is excited, it produces its effects in one or two minutes when thrown into the veins. Of late years, the custom has been, in certain diseases and in numerous experiments, to load the blool-vessels with warm water so as to induce a state of preternatural fulness, and, in cholera, the quantity of saline solution injectea has been enormous. The great, the necessary precaution appears to be, that the fluid should not be too viscid: for it has been found, that thick fluius. such as oil. or mixtures of powders, are unable to pass through the pulmonary capillaries, in consequence of which the cir- culation is arrested, and death follows: and within these limits the remark of Professor Chapman is correct. Such was the result of several experiments on animals with powdered substances, under- taken by an enthusiastic physician of Boston — Dr. E. Hale, junior. — who had nearly fallen a victim to an experiment of the kind in- stituted on himself. Dr. Hale, desirous of observing the effects of castor oil when thus injected, attempted to pass it into a vein of the arm: he experienced, however, considerable difficulty in introducing it, and to this his safety has been ascribed. Soon after the injection 7* 78 ACTION OF MEDICINES he felt an oily taste in the mouth, which continued for a length of time, and the medicine acted powerfully as a cathartic. Again, a good deal depends upon the mode in which the injec- tion is sent in, — as regards velocity. If a drachm of healthy bile be suddenly thrown into the femoral vein in a state of concentra- tion, death soon follows ; but if it be suffered to pass in very slowly, little or no inconvenience results. It was the opinion of Bichat, that if a bubble of air should accidentally enter the venous system, it would cause death ; but the experiments of Nysten and Magendie have shown, that if it be introduced slowly, no unfortunate event need be apprehended. It is a cause of death after severe surgical operations, although it is not more than a quarter of a century since the ratio moriendi, in such cases, was first suspected. Some animals will admit enormous quantities of air into the veins without perish- ing. Magendie instances the case of* a horse, into whose veins he sent, as rapidly and forcibly as he was able, forty or fifty pints of air without occasioning immediate death, although the animal ulti- mately expired ; and Lepelletier de la Sarthe alludes to similar experiments of his own, from which he infers, that the fatal action of the air is mechanical, and that it is possible to prevent the result by injecting so gradually, that the blood has the power to dissemi- nate, and perhaps even to dissolve the gas with sufficient prompti- tude to prevent its accumulation in the cardiac cavities. No doubt, then, ought, we think, to exist, that medicines can be absorbed from the stomach or elsewhere in their entire state, and that when once in the circulation they may act on the nerves distributed to the inner coat of the vessels, so as to affect the great nervous centres, or may proceed with the current to act upon those organs for which they have a preference. Substances may be absorbed from the cutaneous surface, although this is infinitely less easy than from its prolongation, which consti- tutes the mucous membranes. The cuticle is a great obstacle to absorption, for if it be removed in any manner, so that a substance, capable of absorption, can come in contact with the vessels of the corpus papillare, absorption takes place readily. The same thing happens — to a more limited extent — if we force the substance by friction through the cuticle. This is the mode in which we affect the system by means of mercurial unguents. We select a part of the body where the cuticle is thinnest, and continue the friction until the globules of mercury disappear, or until it has been forced through the cuticle into contact with the corpus papillare. The most un- doubted evidence exists, that mercury enters the blood. Dr. Colson detected it by introducing plates of polished brass into the blood, which became covered with a coating of mercury; and Dr. Christison affirms, that it has been obtained from the crassamentum of persons salivated, when no mercury could be detected in the serum. Many such cases have been recorded. Moreover, by means of the microscope, Dr. Oesterlen detected minute globules THROUGH ABSCRrTIiN. ''j of mercury in the tissue-, in the blood, and in the secretions of mm and animals to whom mercurial ointment had been given internally. and applied bv frictions to the skin. The method of administration by friction is called the iatrchiptic: the one which consists in placing remedies in contact with an abraded or vesicated surface, the endermic. The latter method has been chiefly employed in recent times, and it has been advised by Bally and others, where it was conceived digestion would interfere with the action oi the drug. — a succedaneum, which, according to the peculiar views of Profess:r Chapman, would be wholly inoperative. inasmuch as he considers every section of the absorbent system to be endowed with the power of digestion and assimilation, and the lymphatics quite as conspicuov sly as the lacteals: a capacity given as a provision of nature to exclude noxious matters from the circu- lation. This opinion is a necessary pendant to the Professor's doc- trines regarding the mode in which substances can enter the vessels. Suostances may likewise be received into the system, in their en- tire state, by the lungs. The whole of the respiratory apparatus is linec by a mucous membrane resembling that of the digestive pas- sages, and as the substances, which enter the air tubes, are extremely tenuous, they can pass with facility into the bloo -vessels. It is with this view, that narcotic and certain ether inhalations are em- ployed. The different rcspirable gases produce their effect in this way ; and hence the hilarity caused by the protoxide of azote or the '■ laughing gas :'" and the exciting or depressing influences, that can be produced by inhaling appropriate gases. Reference has already been made to the opinion of Rousseau and Thomson, that ardent spirits exert their intoxicating influence by impressing the nasal nerves : but it is more likely, that much of the intoxicating effect produced on those who pump ardent spirits from large casks into small vessels, in extensive wholesale establishments. is owing to the vapour of the alcohol entering the lungs with the inspired air. and being imbibed by the pulmonary vessels. It is probably in this way, that miasmata — both terrestrial and animal — exert their influence ; — their first impression being made either on the nerves distributed to the coats of the pulmonary blocu-vesse.s. or on the brain when carried thither with the circulatory fluid. That they, occasionally at least, act in the former way seems to be sug- gested by the rapidity with which the effects are exhibited, when a person, who — owing to previous attacks of malarious disease, has teen rendered unusually susceptible to the action of miasmata — is subjected to their influence. Thus far attention has been directed to the absorption of medicinal substances in their entire state. It often happens, however, that they are decomposed prior to, or after entering the circulation. One writer on Therapeutics, already cited, Prof. Chapman, has. indeed, sup- posed, that in all those cases in which salts appear to have entered the Liood in their entire state they are decomposed in the stomach ; that 80 ACTION OF MEDICINES their components enter the circulation under the influence of the vital energies, which prevent them from recombining ; but that, as soon as they reach the secretory or excretory organs, they are thrown, as it were, beyond the sphere of those energies; and their chemical affinities being brought into play, they recombine, and the substance is again perceptible, or can be detected, by tests, in the excretions. A satisfactory reply to this hypothesis is, that substances have actually been detected, in their entire state, in the blood ; and besides, no great advantage to the economy could accrue from the decomposition in many cases, as the elements would be more injurious than the compound. The objections, indeed, to this view are signal. When substances can pass so readily into the vessels by imbibition, there is no necessity for invoking this operose process ; and it has been seen, that no advantage to the economy could result from it. There are, however, many medicinal agents, which require to be set free in the stomach before they can act on that organ. When certain vegetable substances are administered, especially in decoction or infusion, the parts that are susceptible of digestion, — the mucilage, extractive, &c, — are converted, whilst the medicinal component exerts its ap- propriate agency. Dr. Thomson thinks it is to this circumstance, that we may ascribe the time, which elapses between the swallowing of certain medicines, and the period when their operation becomes apparent. " Thus," he says, " if half a drachm of powder of the root of ipecacuanha be swallowed, from fifteen to thirty minutes generally elapse before vomiting is produced, a circumstance, which we may fairly attribute to the envelopment of the emetina — the active constituent of the ipecacuanha, in the wax, gum, starch, and ligneous matter of the root; it cannot exert its influence until ex- tricated from these by the process of digestion." But this is not a happy illustration of his position, inasmuch as the same length of time is required for the emetic operation, when ipecacuanha is given in forms that are devoid of these vegetable accompaniments, as in the vinum ipecacuanha of the pharmacopoeias, or in the various prepara- tions of its active ingredient — emetia. Tartar emetic, too, is as long in inducing emesis, although it is well adapted for rapid absorption, or for instantaneous action on the nerves of the stomach. It will be seen hereafter, that a more satisfactory mode exists of accounting for the delay in the operation of both these useful drugs, when exhibited for the purpose of acting as emetics. Almost all writers on pharmacology affirm, that the acetate of potassa is decomposed in the stomach,— the acid being digested, whilst the alkali passes into the circulation, and is excreted by the kidneys. This, however, may be questioned,— at least as regards a part. The free acids, which are present in the stomach in a state of health, are the chlorohydric, and the acetic; and if the alkali of the acetate of potassa were set free during digestion, a part at least would be laid hold of by the chlorohydric acid, and enter the circulation as chloride of potassium. The fact of the existence THROUGH ABSORPTION. SL of those acids in the healthy stomach shows, that many substances, when taken into that organ, must undergo decomposition throng!. their agency. In the case of the acetate oi potassa,— the free chlt- rohydnc acid, doubtless, lays hold of all the potassa, unless the quantity of the acetate be very large. In the dyspeptic, affected with unusual predominance of acid, any alkaline carbonate taken into the stomach excites effervescence, in the same manner as when added to the chlorohydric. or acetic acid cut c: the body. Nitrate of silver is a substance, which can rarely or never enter the circulation unchanged. It is possessed of caustic rrcoerties. and is often used to destroy fungous granulations in wounds anu ulcers. When applied in such cases, the nitrate is decomposed by the animal matter with which it is made to come in contact: the oxide of silver remains on the surface, and bv exposure to the air, becomes black. If the sadd. too. be taken internally, for any length of time, it is apt to produce a leaden hue of the surface. ■• Now it is evident."" says Dr. Thomson, "that this effect could net take place if the nitrate oi silver were not taken into the circulation in an undecomposed state : for if the nitrate were decomposed in the stomach, and converted into muriate of silver, this is an insoluble salt, and consequent.y not fitted to be taken up by the absorbents. But if we admit, that the nitrate of silver is taken into the circulation in its undecomposed state, we can readilv explain the manner of its decomposition by the capillary vessels of the skin, and its deposition in the rete mucosum. in the state of an insoluble muriate, which would necessarily render any tinge, communicated by it to the skin, permanent." It is diffi- cult to see how the nitrate can escape decomposition from the chlo- rohydric acid always existing in the healthy stomach, as well as from the chloride of sodium, which is present in the humours. It is probable, indeed, that, in the small quantity, in which it is admi- nistered internally, it never enters the circulation in the state of nitrate, I at always in that of chloride: which,— as Dr. Thomson properly remarks,— is insoluble; but this :s not an insuperable ::- stacle to its absorption. Calomel is equally insoluble, yet we want no proof, that the system is capable of being readily affected ~z\ it. The insoluble chloride oi silver enters the sanguiferous system, is deposited in the corpus mucosum. and—under the influence ot night— is converted from a white, to a dark violet colour,— an effect, which can be easily proved, by exposing chloride of silver to light, out of the body. The corrosive chloride of mercury or ezrrosive sublimate some- times undergoes a conversion of great interest to the toxic jlogist. It may happen that a person has been poisoned by the corrosive chloride, and yet there may be no evidence of the presence oi any thing, except the mild chloride or calomel. In such case, how are we to know, whether the mild chloride be the result cf the de aim- position cf the corrosive chloride, or whether the person may not Lave taken the mild chloride a short time prior to dissolution. 82 ACTION OF MEDICINES When the corrosive chloride meets with albuminous matters, it is decomposed by them, and is converted into mild chloride ; but, in such case, the mild chloride is intimately united with them, and if the decomposition has been produced by the animal matter of the coats of the intestines, it will be intimately united with these tunics; whilst, if the mild chloride has been taken prior to dissolution, it may be observed lying upon the mucous surface, and in no way amalgamated with it. Sometimes it would seem, after an article has passed into the circulation, it is decomposed, either in the blood, or in some of the organs. If we force mercury through the skin, we can affect the salivary glands, and whilst the system is pervaded by the mercury, a gold watch exhibits, by its white coating, that the mercury is ex- haled by the cutaneous surface. In like manner, if blue pill, or calomel, be administered in adequate quantity internally, the watch will be equally coated by the mercury. We do not know the exact condition of the exhaled metal in these cases; whether, in the case of the mercurial ointment and blue pill, it be still oxide,— in the state of calomel, still mild chloride; — or whether, in all these in- stances, it be not decomposed, and given off in the form of mercu- rial vapour. The fact, that metallic mercury has been detected in the bodies of such as have died under its influence, leads us to pre- sume, that the metal may be reduced, and exhaled in the form of vapour, so as to occasion the coating in question. When substances enter the blood by absorption, if they can che- mically combine with any of the principles of that fluid, they probably do so ; but this is not accomplished so readily, as might have been presumed, owing to the quantity of organic matter, which frequently interferes largely with inorganic affinities. Out of the body, we have full opportunity for witnessing the changes induced by the gases, and by various agents, on the blood prior to coagulation, and whilst still endowed with vitality. They are signal; and similar changes would, doubtless, be produced, could the same agents be applied, in the same state of concentration, to the blood whilst cir- culating in the vessels. Numerous experiments have shown, that when certain substances have been given for a long time, the blood is rendered much thinner; whilst directly contrary effects are ob- served to follow the use of others ; — the coagulum being firmer, and the blood of a deep, or dark colour. As the pabulum, therefore, of the different nutritive processes is modified, we can readily compre- hend, that the functions of secretion and nutrition may be import- antly modified also. The difference in the rapidity with which the absorption of me- dicinal agents is accomplished is great. It is dependent upon the de- gree of distention of the vessels, and on the existence or absence of erethism in the part. If polysemia or vascular fulness exists, absorp- tion is tardily effected; but if blood-letting be premised, the sub- stance speedily passes through the coats of the blood-vessels, and THROUGE REVULSION. S3 enters the circulation. In some experiments by Magendie, in which water was injectel into the vesses. so as to produce a state of arti- ficial plethora, and a fluid was thrown into a serous cavity, it was found, that whilst the state of plethora existed, none of the fluid entered the circulation: but when blood was drawn from a vein. — as it was abstracted, the fluid in the serous cavity rapidly dtsan- peared under the eye cf the observer, by staking through the :::-.ts of the vessels, and entering the circulatory current. Hence it is. that in thrse active effusions or transudations into sortus cavities. which constitute dropsies, bloodletting is a most philosophical and energetic remedy. It has been said, that the activity- of absorption is greatly de- per.der.': upon the existence or absence cf erethism in the part. If the lining membrane of the intestinal canal be in a state of g-eat irritate! n or inflammation, the digestive, and ether absrr tarns, are no longer accomplished. This is strikingly the case in malignant cholera, which usually consists of a peculiar excitation in the car 11- laries of the intestinal mucous membrane. Under this excitarltn. the watery portions of the blood are exhaled, until that fluid is. in many cases, left so thick, as to be unable to pass along tne vessels ; and this, nttwithstauding nutritive fluids may have been constantly and freely administered. It is. on this account, also, that there is frequently so much difficulty in affecting gastrt-enteriti: patients with mercury. In the last stages of many of the bilious and ty- phoid forms of fever, the absorbent timet! on ef the intestines is almost annihilated, in consequence cf the irritation in the mucins membrane of the digestive tube. C. TH30UGH REVULSION. There is yet another, and a most important mode, in which medi- cinal agents exert their efficacy. v;z.. by revulsion, or derivation. It is a general rule, in the animal eccnomv. that two diseased actions do not readilv g on at the same time with the like degree of in- tensity. This has been the subject cf remark for ages, and tor all ages: and many popular remedies have been suggested by a know- ledge of the fact. When any morbid action is going on in the sys- tem, and a new source of irritation is artificially excited, it rten happens, that the new irritation, by attracting the nervous and vas- cular afflux to it. detract5^ or derives from the internal morbid action, so as to diminish, or wholly remove it. It is in this way that mis- ters, and tine various counter-irritants, issues, setens. moxas. ice. produce their beneficial effects, not z-j the discharge which tney oc- casion. Hence it is, t::. that g:: a results from a popular remedy,— the application of a garlic poultice to the thumb in cases of tooth- ache. But these are only marked examples of revulsion. It results. likewise, from the action of every local stimulant. It follows the use of cathartic^, and is the way in which their chief remedial agency is, in mauv cases, exerted. In head affections, especially ir. apt- 84 ACTION OF MEDICINES plexy, a revulsion, thus effected, is often most salutary; and for this purpose, when deglutition is impracticable, and even when not, powerfully stimulating enemata are thrown into the rectum with de- cided advantage. In like manner, the milder cathartics may be productive of benefit in gastro-enteritic affections by the succession of sympathies, which they induce, in passing over the different tracts of the intestinal canal. Diuretics, and in short, as already remarked, all local stimulants owe a part of their efficacy to revulsion; and some of the most valuable agents we possess in the treatment of protracted disease, — as mercury and iodine, — are often employed with no other view. The avowed object of the practitioner is to excite a new action; or in other words to produce, artificially, a new condition of the system of nutrition, which may remove that, which has been so long existing. The doctrine of revulsion reposes on the received belief, that diseases are cured by remedies that are counter to them, — " con- traria contrariis medentur ;" but an imposing medical sect has at- tempted, and is attempting, to overthrow this doctrine, and to set up the opposite,— " similia similibus medentur." The Homceopathists, as they are termed, maintain, that there are remedial agents, which can produce symptoms similar to those of disease, and that every dynamic affection of the living organism can be destroyed by an- other of still greater intensity, and permanence, that strongly re- sembles it. They maintain, indeed, that the curative virtues of me- dicines are solely dependent upon the resemblance their symptoms bear to those of the disease. There are but three modes, they affirm, of applying medicines in disease ; first, the homoeopathic; secondly, the allopathic or heteropathic, — the method in general use, which is said by them never to regard that which is really diseased in the body, but to attack parts that are sound, in order to draw off the malady from another quarter, and direct it towards the latter ; and thirdly, the antipathic, enantiopathic, or palliative : by which method they affirm, physicians have, till the present time, succeeded in affording apparent relief, and gained the confidence of their pa- tients, by deluding them with a temporary suspension of their suf- ferings. Upwards of a quarter of a century ago, Samuel Hahnemann — the founder of the "homoeopathic medical doctrine," — first propounded his opinions in the authoritative form of the " Organon der rationellen Heilkunde" — " Organum of rational medical science." The book was issued from the Dresden press, but did not at first attract, in a marked manner, the attention of physicians. In 1819, a second edition appeared, under its present title, — the epithet rationellen, or rational, having been omitted. Since that time, it has passed through different editions, and the English reader, who is not a German scholar, is now enabled to peruse it through the medium of a trans- lation by Mr. Devrient, with notes by Dr. Stratten, of Dublin. It is not the author's intention to inquire into the principles and THROUGH REVULSION. eO merits of this fantastic doctrine at length ; but a few observations may be made upon it. Cinchona appears to have been the first drug experimented with by Hahnemann. Whilst occupied in translating the Materia Medica of Cuilen into his own tongue, he was dissatisfied with the explanation of the febrifuge powers of that drug, and deter- mined t o make trials upon himself. He took it in consiuerable quan- tity, while in perfect health, and found it produced symptoms like those of ague. Hence, he inferred, that intermittents are removed bv cinch :ua. in consequence of its exciting in the svstem a morbid condition, similar to ti.atfor the removal o: which it is administered. Again, say the homceopathists. — mercurial preparatims. when ad- ministered internally, produce symptoms — local and constitutional — so closely resemodng the symptoms of syphilis, that medical orao- titioneis. who have spent years in the investigation of syphilis, hr.d it difficult, and in some instances impossible, to distinguish one disease from the other. If the venereal poison produces pustules, scales and tubercls. mercury does the same. If syphilis is attended with inflammation of the periosteum and caries of the bones; so is the action of mercury. *• Inflammation oi the iris from lues,"" says Dr. St ten. •• is an every d?y occurrence : the same disease is a very frequent consequence of mercurv. Llceration of the throat is a com- mon symptom of syphilis: the same affection results from mercurv. Ulcers on the organs of reproduction are the result of both the poison and the remedy: and furnish another proof of the doctrine simili" similibus. Nitric acid is generally recommended in cutaneous dis- eases : the internal use of this remedv. in a very dilute form, produces scalv eruptions over the surface oi the body : and the external ap- plication of a solution, in the proportion of one part acid to one hundred and twenty-eight pans water, will produce inflammatlin and ulceration of the skin. These observations would lead to th? conclusion, that nitric acid cures cutaneous diseases, by the facility it possesses of producing a similar disease of the skin. Nitrate oi potash, administered internally, in sraail doses, produces a ire quern desire to pass water, accompanied with, pain and heat. When this sta*e of the urinarv sv-ma exists as a consequence of disease, or the application of a 1 list :, a verv dilute solution of the same remedy has been found beneficial. The ordinary effects of hyescyamus niger are vertigo, delirium, stupefaction, and somnolency. Wnere one or other of these diseased states exists, it yields to small doses of the tincture of this plant. The internal use oi hyescyamus is followed by mental aberration, the leading features of which are jealousy and irascibility. When these hallucinations exist, this remedy is indi- cated. Opium in general causes drowsiness, torpor, and deep sleep ; and vet this remedy, in small doses, removes these symptoms when thev occur in disease. Sulphur is a specific against itch : notwith- standing which, when it is administered to healthy individuals, it frequently excites a pustular eruption resembling itch in every par- ticular." VOL. I.—S 86 ACTION OF MEDICINES Dr. Stratten asserts, that these deductions are drawn from actual experiment; and so, we are told, are all the positions advanced by the homceopathists. The doses of medicines, administered by them are infinitesimally small; the decillionth degree of dilution is not uncommon. The following extract from Hahnemann's treatise on chronic diseases, will show to what an extent the farce is carried. " Of homoeopathic medicines, take one grain of those which are solid, (mercury being included in the number,) or one drop of those which are liquid ; put this small quantity on about the third part of a hundred grains of pulverised sugar of milk in a porcelain capsule that is not glazed ; then mix the medicine and the sugar of milk together for a moment, with a spatula of bone or horn, and pound the whole strongly during six minutes. The mass is then detached from the bottom of the capsule and pestle during four minutes, in order that it maybe perfectly homogeneous, and then rub down afresh during six minutes with equal force. Collect the whole of the pow- der into a body during four minutes, then add the second third por- tion of the sugar of milk, and mix the whole for an instant with a spatula ; then triturate with force during six minutes. , This is to be once more scraped-together during four minutes, and rubbed again for six minutes. Stir the whole together during four minutes, and add the last third portion of the sugar of milk, which is to be mixed by turning it about with the spatula ; then triturate the mass powerfully during six minutes, scrape it together during four minutes, and the whole is finally to be rubbed down for six minutes. After the powder has been carefully detached from the capsule and pestle, put it into a phial, and let it be corked and labelled with the name of the substance, and the mark Too, which shows that the substance is in the hundredth degree of attenuation. To carry the medicine to the ten thousandth degree of attenuation, take one grain of the powder marked Too, prepared as above, add the same to the third part of an hundred grains of pulverised sugar of milk, mix the whole in the capsule, and proceed in such manner, that after having tritu- rated each third portion with force during six minutes, scrape the mass together during a space of four minutes. The powder, when thus prepared, is put into a well corked bottle with the figures fo,000 marked on the exterior, which will point out its degree of attenua- tion. The same method is observed when this second powder marked 10,000 is to be carried to the millionth degree of attenua- tion," &c, &c. The homoeopathic method can only be regarded as a branch of the expectant stem ; and it is liable to every objection that applies to the latter. The homceopathists argue, however, that inasmuch as very small portions of a chemical substance can be detected in a solution, so may minute portions be capable of impressing the organism. For example — say they — one grain of nitrate of silver, dissolved in one thousand five hundred and sixty grains of distilled THROUGH REVULSION. -7 water, will yield an evident gray precipitate — perceptible in every part cf the fluid — when two grains of muriatic acid are added to it: — and again.— when one grain of iodine is dissolved in a drachm of alcohol, and mixed in the same quantity of distilled water as in the last case, and to this two grains of starch, dissolved in an ounce of water, are added, an evident blue tint is produced in the solution. In these experiments:, consequently, the grain of the nit-ate of silver and iodine must have been divided into on-dtteeu thousand two hundred and sixtieth of a grain. These experiments, however, are in no wise elucidative of the position:—for although such minute portions of chemical agents may be detected by the senses, it by no means follows, that they can exert a remedial action. Accordingly, it is affirmed byM. Andral, that when the homoeopathic system has a eea impartially tried, it has not been found to succeed in the manner asserted by its supporters. Like the expectant method in general, it is totally inefficient in acute cases: but. like it, where a ivantage is t^ be derived from trusting to that recuperative power, which, we have Seen, is seated in all living oodles, and is too much neglected, its adoption is beneficial. This is one of the useful less oris, which the system aids in teaching. Another, perl: an s. is. — the propriety, now universally admitted, of simplicity in our prescriptions.— in consequence of the greater or less uncertainty that must often exist — where two or more agents are thrown together—whether tl.ev may not mutually modify each others action. The homceopathists believe, that every disease carries with it a greater susceptibility for tne proper medicine : and accordingly, they lay down the rule, that only one simple medicine should be administered to the sick a* a time. One of the strangest of the assertions of Hahnemann and his f 1- lowers is — that homoeopathic medicines acquire at each division or dilution a new degree of power, by the rubbing or shaking to which they are subjected, •• a means." savs Hahnemann. :' of developing the inherent virtues of homoeopath! medicines that was unknown till mv time : and which is so energetic, that latterly I have been forced. by experience, to reduce the number of shakes to two. of which I for- merly prescribed ten to each dilution'' !! * Srch are the chief modes in which medicinal agents exert their influence on the human economy. I. Their agency may be altogether direct or local. II. It may be general — through local influence. 1. By means of the nerves. -. By absorption. 3. By revulsion. *■ Hahnemann's words are. u dass ieh in den letxem Jah-en ju-ch uberzengende E" .hranp- 0. 88 ACTION OF MEDICINES. 2. CLASSIFICATION OF MEDICINES. The unbounded credulity, which at one time prevailed regarding the effects of drugs, and which so long disfigured the science of me- dicine, has now almost passed away, and we observe less and less of the old feeling of confidence in the adaptation of particular drugs to particular cases of disease. The practice has become more ra- tional ; and efficacious agents are now mainly relied on. Still many superfluities exist in the lists of the materia medica, which might, with much propriety, be dispensed with ; and time will accomplish this. The plan now is, — to discover the seat and nature of the diseased action, and to adapt a remedy, whose properties are known, to the exigency; — locally or generally, as the case may require. We have no agents, that are possessed of specific properties, which are exerted with unvarying uniformity on disease. Their action is modified by numerous circumstances. A cathartic may, in one case, excite emesis in place of catharsis ; and, in another, an emetic may excite catharsis rather than emesis ; whilst the words febrifuge, an- tispasmodic, &c, are mere terms to express the secondary result of some agent on the vital solid. It is in consequence of medicines possessing no specific r— no uniform — influence, that so much skill and attention are required in the treatment of disease. At one time, it was supposed that certain drugs are specifically adapted to com- bat certain morbid conditions, but the belief, except with the homceopathists, is now exploded, and even mercury — the panacea of some— is denied to possess any such power, and its action is more rationally accounted for. From what has been said, it will appear, that although we may be perfectly acquainted with the ordi- nary medicinal properties of a drug, and although these properties may be essentially the same, the agency, exerted by it, may be dif- ferent according to the precise character of the disease, and accord- ing to the age, sex, temperament, &c, of the patient. Were these points determinate, we could always calculate with certainty what would be the precise action of any medicinal agent. With regard to the parts of the frame on which medicines act, we may affirm, that they are capable of affecting every tissue and every function — directly or indirectly. Like other influences, which sur- round the body, and are perpetually impressing it in some mode or other, remedial agents can act upon the living organs so as to mo- dify every function. Ultimately, however, they must all affect the same great vital property of contractility, irritability, incitability, or excitability, whichsoever we may term it, which is seated in every living tissue. Under the influence of this vital property, kept in action by appropriate stimuli, all the functions are accomplished, and when these stimuli are at a certain degree, they are accom- plished in health ; but if, from any cause, the vital force becomes exalted or depressed beyond the healthy standard, disease results; and such disease is a disease of increased or of diminished action. CLASSIFICATION OF MEDICINES. All medicinal agents, which, in this way. exalt the vital activity of the body, are excitants; and such as diminish it are sedatives; and we may, consequently, with propriety, class all agents, that are use- ful, or that are not wholly inert, either as excitants or as sedatives. The subject of the classification of medicinal agents will, however, require a little farther consideration. The advantages of classification in science are obvious. The re- lations of articles to each other are, in this way, exhibited, so as to impress the memory, and to facilitate the investigations of the stu- dent ; but in no branch of science is it applicable under more diffi- culties than in Therapeutics, provided we are desirous of establish- ing such classification on tile precise operation of medicinal agents : whilst nothing is more easy than to form a natural classification of them, founded simply on the three great kingdoms of nature to which they may belong. Both these modes of classification, termed respectively the Therapeutical and the Natural Historical, have been detailed in all their varieties in recent works on Ma- teria Medica and Therapeutics. The classifications of medicinal agents, based on their operation, are numerous, and, at the same time, most unsatisfactory. Immense labour, and, of course, valua- ble time, have been spent upon the subject, without any rich fruit. It has been already said, that all remedial aftnts, which are pos- sessed of activity, must belong to one of two classes, — stimulants or excitants, and sedatives: we must except, however, certain agents. whose effects are purely chemical or mechanical, or which are not employed to effect any changes in the living tissue. Perhaps the best of all classifications would be one founded upon the agency exerted on the different tissues ; but this arrangement, in the present state of science, is by no means easy; and, moreover, the action of medicines is so associated with certain terms, — as narcotics, tonics, sedatives, &c., employed to denote certain operations, which they are esteemed capable of producing, that, to abandon them, would be to throw obstacles in the path of the student, without the ultimate advan- tage accruing to him, of possessing a better knowledge of the modus operandi of medicines, than when a classification, somewhat resembling those usually embraced, is adopted. The classification of M. Barbier is founded upon the tissues affected, but it is extremely in- complete, and unsatisfactory, and, in consequence of the imprac- ticabdity experienced by him in grouping the various agents under appropriate heads, his last unmeaning division is. of course, a large one. 90 CLASSIFICATION OF MEDICINES. BARRIER S CLASSIFICATION. ' Which strengthen the tissue of ] organs, - - 1 Which stimulate the 1. Tonics. 5. 6. 7. Temper ants. JYarcotics. Purgatives. 8. Emetics. 9. Laxatives. |> 10. Incertasedis. tissue of ) 2. Excitants. organs, - ) 3. Diffusibles. Which relax the tissue of organs, 4. Emollients. Which moderate too great ac- ~> tivity of organs, - - 5 Which diminish cerebral life, Which irritate the inner surface ) Medicines-{ of the intestines, - ) Which irritate the gastro-duo- ) denal surface especially, ) Which disturb the natural move- } ments of the intestines, 5 Whose modus operandi is not ] determined, or which cannot be included in the preceding classes, - One of the most rjcent classifications — and the notice of any- more would be unprorMtble -—is that of Dr. A. T. Thomson, founded upon the classifications of Dr. Thomas Young, and Dr. Murray. It, also, is liable to the objections, which must apply to all attempts to reduce the multitude of medicinal agents to any thing like a scientific arrangement, as well as to others, which appertain to it exclusively. It is as follows : r. vital agents. a. Influencing the body generally ; a- — By operating directly upon the nervous system. * Increasing action, .... Excitants. 'Primarily, Sedatives J' ( fveingerants. Secondarily, S Narcotics. a' ( Antispasmodics. b.— On the Muscular and Sanguiferous systems: Tonics. Astringents. c.— On the Secerning system : Errhines. Sialagogues. Expectorants. Emetics. Cathartics. Diuretics. Emmenagogues. Diaphoretics. Diminishing action^ CLASSIFICATION OF MEDICINES. Q\ b.— Influencing the body solelv by their action on the part to which they are applied. Epispastics. a. Rubefacients. b. Vesicants. c. Actual cauterants. n. chemical agents. a.— Inn aencing the state of the body, or its con- tents, by their chemical properties. " Acting on the surface, - Escharctics. a. Potential caiUrcn's. Antacids. Antalkalies. a. Antiseptics. Antilithics. On the contents of cavities. < III. MLXHAXICAL AGENTS. Demulcents. Diluents. To the three great divisions of Dr. Thomson no objection need be urged; but when the different subdivisions, and the ascribed modus operandi of many of the classes are considered much room is found for difference of sentiment. It may be observed by anticipation, that there is no adequate ground for placing Excitants among those agents that operate directly on the nervous system; and~7b/i<'c? amongst those that act on the muscular and sanguiferous svstems: nor is it readily seen, how Epispastics can be regarded as the onlv agents. that influence the body solely by their action on the part to which they are applied. The class of Anthelmintics, which could not have fallen conveniently under any of Dr. Thomson's subdi- visions — with the views, which he probably entertains of the mode. in which their therapeutical agency is exerted — has been wholly omitted : and although anthelmintic virtues are assigned to the ordi- nary medicinal agents, that are conceived to possess such virtues.— when these agents are referred to under other heads.— it is singular. that the class is neither mentioned in the table, nor in the bodv of the work. It seems to have altogether escaped Dr. Thomson's at- tention. To the following classifications of the author, objections mav doubtless be urged. He has already said, that it is impracticable to form any. which can be altogether unobjectionable. It has been more than once remarked, that all agents, capable of affecting the vital tissue so as t: modify its functions etfectively, mav be classed under the head of excitants, or of sedatives. But, in addition to these — what may be called — *; vital agents.''' there are some other classes of medicines, which, in consequence of their eflect being almost purely chemical, without modifying the condition of the living 92 CLASSIFICATION OF MEDICINES. tissue, may be appropriately designated chemical agents ; and, again, there is one other class equally without direct influence on the vital manifestations, and acting simply or chiefly on the mass of humours — which may be properly ranked under the denomination of mechanical agents. This is probably as simple a classification as can be made, and one altogether intelligible to the student. It does not involve questions connected with the intimate modus operandi, which must necessarily engage attention in considering the different classes, whilst it embraces some classes not admitted into the arrangement of Thomson, and which, it will be seen, comprise some of our most useful medicinal agents. The class of Anthelmintics — in the sense of—"medicines, which prevent the generation of entozoa within the body," is placed next to the class of tonics; because the predis- ponent cause of their unusual multiplication is a want of tone of the system generally, and of the stomach in particular ; and if we con- fine our attention to the destruction of these parasites by true anthel- mintics, or, in other words, by agents directly destructive to entozoic life, we do but little, — the most important step being to remove the predisposition to fresh generation. As, in the case of intermit- tent fever, the main object of the practitioner is less directed to the condition of the patient during the paroxysms, than to the preven- tion of their recurrence. CLASSIFICATION OF THERAPEUTICAL AGENTS. Excitants. i. Vital Agents. Sedatives. increasing ac- tion generally, < or locally, or both. I diminishing action directly or indirectly. Excitants proper. Tonics. Anthelmintics. Astringents. Emetics. Cathartics. Emmenagogues. Abortives. Diaphoretics. Errhines. Sialagogues. Diuretics. Expectorants. Sorbefacients. Revellents. Antispasmodics. Sedativesproper. Narcotics. Refrigerants. Nauseants. CLASSIFICATION OF MEIICINE5. 93 f Antacids. ■ Antalkalies. n. Chemical Agents. \ Antilithics. [ Disinfectants. •»r » \ Demulcents. in. Mechanical Agents. - - - ( D.iuents. This was the classincation adopted by the author in the flrst edi- tion of his ,; General Therapeutics" ; but he finds it more convenient t" embrace one that harmonises more with the arrangement adopted in his "Practice of Medicine." The different classes of therapeutical agents, and the agents themselves, will be investigateu in the fol- lowing order: 1. Agents that affect prominently the alimentary V r> , *' ! - - • Cathartics.. canal or its contents. - - - > , A, i • • , f Anthelmintics. ■2. Agents that affect prominently the respiratory \ y oc\^ organs, - - - - - - , / P- -- orants. f Errhines. Sialag: gates. 3. Agents that aafeet prominently the follicular or \ Diuretics. glandular organs, .... j Antilithics. [ Diaphoretics. ' \-~ --*ics 4. Agents that aflect prorninentlv the nervous^ r„""L ." r • tetanies. system. - - - - - - >.,- :■ f Antispasmodics. 5. Agents that atfect prominently the organs of \ Emmenagogues. reproduction. ----- / Parturifacients. Excitants. Tonics. Astringents. •j. Agents that atieet various organs, ■{ Sedatives. Reirigerants. , Reved.ents. [ Eutropnics. y Antacids. 7. Agents whose action is prominendy chemical, Antalkalies. £ Dismiectants. S. Agents whose action is prominently mecha- \ Demulcents. meal......" - / Diluents. 94 EMETICS. SECTION I. AGENTS THAT AFFECT PROMINENTLY THE ALIMENTARY CANAL, OR ITS CONTENTS. I. EMETICS. Synon. Vomitoria. Definition of Emetics — Nauseants—Their modus operandi — Therapeutical application — Physiology of vomiting— Modus operandi of emetics —Effects on the stomach, and general system — Evils of their too frequent employment — Therapeutical appli- cation of emetics — Special emetics. Emetics have been defined by M. Schroff, " agents, which, by the excitant effect they produce upon the stomach, give occasion to vomiting;" but this definition is meager and unsatisfactory. That of Dr. Paris is to be preferred: — " Substances which excite vomiting, independently of any effect arising from the stimulus of quantity, or of that occasioned by any nauseous taste or flavour." The physiology of vomiting has, of late years more especially, engaged the attention of some of the most accurate anatomists, and physiologists. At one time, it was universally conceived, that the stomach is the main — indeed, the sole — agent; whilst, at an after period, the opposite view was maintained, and the stomach was denied any agency whatever in the result. The intimate consider- ation of this topic of physiology has been gone into, in another work; and it is not necessary to repeat it here. It may be observed, how- ever, that the former of the theories referred to, which prevailed of old, is full of error, and ought to be discarded; and that, as often happens, when exclusive and hostile views are maintained, the truth probably lies between them, or may consist of a combination of both. From a careful examination of what has been said on both sides of the question, it appears, that we are justified in inferring, that the stomach, of all the organs concerned, is the one whose action is least energetic and indispensable; that the pressure, exerted on its parietes by the diaphragm, and abdominal muscles, is the most powerful cause: as, it is found, that the more or less complete paralysis of the diaphragm, or the destruction of the abdominal muscles, renders vomiting much more feeble, and more slow in manifesting itself. When an emetic has been taken in a sufficient dose, a train of phenomena makes its appearance contrasting greatly with those that follow. An indescribable sensation is first of all experienced, which is chiefly referred to the region of the stomach, and consists of a feeling of anxiety and of circumgyration, which extends also to the head; a copious flow of saliva and of sweat takes place, with pale- ness of the surface, and, indeed, every sign of diminished nervous and vascular action. This state of "nausea," as it is termed, is manifestly one of debility, or of diminution of the vital powers; and, when it has continued for any length of time, is usually succeeded NAUSEANTS. 95 by a very different condition of the functions: the diaphragm and abdominal muscles are t.v"n into violent c: .faction: an inverted action of the muscular ecu. of the stomach is produced; and. under these combined actions, the c ".tents oi the stomach are ejected. During this state of excited action, the pulse assumes iresh vigour: the skin becomes dorid. especially that of the race: a copious, warm perspiration takes the place of the cold, clammy sweat of nausea. and ah is energy where depression previously prevailed. It is obvious, then, that the therapeutical effects of substances. capable of txcting emesis. mast vary according as they are adminis- tered to keep up nausea, or given in doses saahcient to induce emesis: and, again, that emetics may differ amongst themselves according as their operation is preceded or not by more or less nausea. YShere the nauseant operation is alone induced, the effects ci the reme.:y are so different as to demand a separate consideration. I. XAUSSANTS. The state of nausea being one of reduced action, it can be readilv understood, that a sedative ager.ov, thus induced, and kept up for a sufficient length of time, may succeed in subduing indammation. and the morbid exaltation of organic actions which constitutes ordinary fever. These effects can be accomplished by nauseating remedies properly administered. From the effects, then, which nauseants are capable of inducing, their therapeutical application will be sufficiently obvious, and, ac- cordingly, but little ditficulty is experienced by the practitioner in laving down his indications, or in carrying them into eriect. by some one or more o: the numerous nauseants. which are contained in the catalogues of the materia medica. With regard to the condition of the functions under the influence of a nauseant, — when pushed to the extent of inducing marked nausea, -»- there can be no difference of opinion : but it has been a quest! n. whether, if these same agents be given so as to fall short oi inducing nausea, or any sensible evidences of their action. — in alterative doses, in other words,— they may not modify the functions in the same manner as full nauseants. but to a less degree. A gr at deal may be said in favour of the affirmative view of this question, but it is one obviously not easv of demonstration. W ere we, indeed, to deny the position altogether, it would be uihicu.t to account satisfactorily for the operation of antimonials. or of many other reputed diaphoretics in small doses, which are emetic in larger. All admit, that when the tartrate of antimony and potassa is given si as to produce nausea, it is a decided sedative and diaphoretic. — diaphoretic because sedative. The state of nausea being, as already remarked, one of dimished action, — the exalted vital manitestatins, constituting fever, are reduced bv it : and diaphoresis, which had been checked by the febrile irritation, is restored. In this case, the antimonial, — like every diaphoretic.— is an indirect agent only. 96 EMETIC3. But if the tartrate of antimony and potassa be given in doses some- what smaller than are requisite to induce nausea, it can still be con- ceived, that an action of sedation may be exerted, although, it must be confessed, that we have no sensible evidence of such an effect except the result; and, it must be equally confessed, that, in our uncertainty, we ought scarcely to place that confidence in those agents, which is occasionally reposed in them by practitioners. Fortunately, however, — as remarked under another section, in re- gard to antimonials especially, — this very confidence is, at times, followed by negatively beneficial results. It prevents the partisans of the perturbating treatment of fever by means of violent and re- peated cathartics from causing as much irritation as they might other- wise do, and gives the patient a little of that quietude and absence from disturbance, which is so important in the management of all febrile cases, and especially of such as are accompanied by erethism in the mucous membrane of the intestines. Therapeutical application of JYauseants. Internal inflammation. — In all internal inflammations, nauseants are obviously proper, as well as in every kind of active hemorrhage ; whenever, indeed, it is desirable to diminish the force and velocity of the circulatory movements. In such cases, they are amongst our most valuable therapeutical means, and, if the system can be kept, for any length of time, sufficiently under their influence, the local hyperemia will often yield, after it has resisted other agencies. In a case of pericarditis, which fell under the author's care, and which threatened fatal results, the acetate of morphia was administered in a full sedative dose ; — this salt being preferred to opium in con- sequence of the latter disagreeing in the particular case. The nau- sea, caused by it, was intense ; but the symptoms were so much ame- liorated, that the dose was repeated : in this way, the nausea was kept up for forty-eight hours, and, during the condition of sedation, the inflammatory signs disappeared, and the patient doubtless owed her safety mainly to the nauseant agency. Constipation. — In constipation, a union of nauseants with cathar- tics becomes occasionally advisable, and at times effectual, after cathartics alone have been unsuccessfully employed. If the con- stipation be dependent upon any irritated condition of the exhalants of the canal, the use of debilitants, — such as those now under con- sideration,— reduces the erethism, and facilitates the operation of the purgative. Whenever, too, it is desirous to break in upon a morbid chain, and especially in the neuroses, nauseants may be beneficially administered: but, in these cases, the revulsion, induced by a nauseating emetic, is generally preferred, in consequence of the more powerful impression which it makes on the nervous system. This subject will, however, be fully canvassed, under the heads of Emetics, and Revellents respectively. The practitioner has, in all NAUSEANTS. 97 cases, to reflect, whether the state of the organic acti.us be such as to require the cebilitant agency, which nauseants are capable of exerting ; and it is not generally difficult to arrive at a correct con- clusion. Perhaps, in all cases, the tartrate of antimony and potassa is capable of fulfilling every desire of the phvsician : but. :: asin- ahy, other articles are selected : — ipecacuanha bv some : squih — particularly when the affection is seated in the air passages — bv ethers: but there is not sufficient reason for the belief, that any nau- seant is preferable to the tartrate of antimony and potassa : and. moreover.—being devoid of anv stimulating property,— it can be administered in many cases, in which the exciting emetics would be obviously improper. Sj'gical cases. — With similar views to those that impress the physician, the surgeon has recourse to nauseants. Whenever it is desirable to depress the energies of the svstem. and to induce re- laxation of constricted parts, thev are advantageously employed. In strangulated nerma. tobacco sou ike, or tobacco infusion is thrown into the rectum : but, as will be shown hereafter, the use of tobacco. even in this form, is not devoid oi danger: and. ; erhaps. there is no relaxant effect produced by it, which might not be eauallv produced by the nauseants above mentioned. When a luxated limb has t: be reduced, the force of contraction 01' the muscles is diminished during the existence of nausea : and if the surgeon, at the time, employs his manoeuvres dexterously, he may succeed in effecting the reduction. Obstetrical cases.—To the obstetrical practitioner nauseants are not less useful. Wnen tartar emetic is given so as to impress the system, it removes rigidity of the os uten : and in violent or irrita- ble labour the inordinate activity oi the uterus is allayed bv it, whilst the ddatation of the mouth of the organ is facilitated. Dr. Kennedy, of Dublin, has drawn the attention of practitioners to these cases, as well as to the value oi nauseants in puerperal con- vulsions, in obstructed and inrlamed mamma?, and in puerperal ma- nia : bu* it is needless to attemnt :o point out every affection, in which nauseants may be employed with advantage. By bearing in mind the sedative influence thev are capable 01 exerting, the pi - titioner can meet with little diffliulty in deciding upon the cases in which their exhibition may be noxious or salutary. n. Eoizrics. In order that an emetic shall produce its effect upon the stoma:n. it must nrst of all affect the brain. Should it irritate tie nerves of the stomach, that irritation must be appreciated by the brain, and a reflex action be exerted upon the st.mach. before it can discharge its contents. It is not necessary, however, that the impression should vol. 1.—9 98 EMETICS. be first made on the gastric nerves. Certain sources of irritation, seated elsewhere, may impress the brain by their irradiations, and produce the same effect. Various circumstances affecting the nerves of the stomach may excite vomiting; — for example, the administration of substances belonging to the class of emetics ; over-distention of the organ; offensive character of food ; morbid secretions from the supra-dia- phragmatic portion of the alimentary canal, or from the stomach itself; reflux of bile into the stomach, &c. &c. In these cases, the impression is made upon the nerves of the stomach ; thence it passes to the brain, which appreciates the sensation, and calls upon the dif- ferent organs, concerned in vomiting, to execute their functions. But numerous cases present themselves, in which the impression is first received on other parts than the stomach, and where it equally proceeds to the brain, which then calls for the action of the appro- priate organs. Thus, the stomach sympathises with an organ, that has been long suffering under chronic irritation: there is, indeed, scarcely an organ in the body, which, when affected with protracted suffering, does not disorder the functions of the stomach, and in- duce vomiting. The irritation of the uvula, when elongated ; and the presence of tenacious phlegm in the posterior nares, bring on a kind of " gagging," which is occasionally followed by full vomiting. We have examples, also, in which the nervous impression is even more remotely connected with the effects than in those selected. The sight of a disgusting object will " turn the stomach" of many. The same may be said of nauseous smells, and flavours; of riding, sailing—especially at sea, swinging, &c. In all these cases, the impression is made on the nerves,— the great nervous centres being primarily or secondarily affected. Did it indeed admit of the slightest question, that the encephalon must always be implicated in the act of vomiting, the circumstance, that if its impressibility be blunted by narcotics, it is excessively difficult to excite vomiting, — a fact which has to be borne in mind when the therapeutist is called upon to act in cases, where narcotics have been taken as poison, — would tend to establish the affirmative. In many cases, the effect of an emetic agency — although appa- rently produced with inconceivable rapidity — must be the result of a very complex and reflex operation. When, for instance, pain in a distant organ sickens, the brain must accomplish the sensation ; thence a reflex action must take place to every part of the surface of relation, and the gastric nerves be specially impressed, and call on the brain, to send the nervous influx to the organs particularly con- cerned in the act of vomiting. When vomiting has continued for some time, accompanied by vio- lent retching, more or less bile is always evacuated ; — the inverted action of the stomach being extended to the duodenum; and the irritation produced in the alimentary canal, being propagated along the biliary ducts to the liver, so that the secretion from it becomes GENERAL EFFECTS. 99 augmented. It is a common belief, that where bile is discharged during vomiting, excited in this orin any other way, it is a proof, that the person is — what is termed — *• bilious," but, for the reasons that have just been assigned, it may be no more than an evidence that emesis has taken place with retching. At times, in violent mis- chief affecting the intestinal canal— as in cases of colica ileus —the inverted action extends even as low down as the large intestine ; the faeces are made to clear the ileo-caecal valve, and are discharged by the mouth, giving rise to the alarming phenomenon of stercoraceous vomiting ; but this never occurs from the administration of any emetic. It is always an index of serious lesion or obstruction of the intestinal tube. The action of an emetic is local as regards the stomach, but it ex- tends to almost every organ of the body. It has been already said, that its effect is that of an excitant to the nervous and sanguiferous systems, causing the blood to circulate more freely through the capil- lary" vessels ; and in this way trifling obstructions may be removed ; but if the obstruction amounts to hyperatmia. and especially if this latter condition exists to any great extent, it may be increased by it. In all the varieties of hyperasmia, that characterise local inflammation, there is, as the author has attempted to show, an over-distended and atonic condition of the extreme vessels, induced by the blood having been sent into them, under some source of irritation, in undue quan- tity. I his over-distended state of capillaries gives occasion to re- mora of blood in them, and excites the vessels, communicating with tnem. to inordinate action : and it is obvious, that if, in such a state, a remedial agent be administered, whose effect is to hurry the circu- latory fluid towards the affected parts, the hyperaemia may be aug- mented. Accordingly, it might be supposed, that emetics would act injuriously, when any of the internal organs are labouring under in- flammation. This would seem, indeed, to be a general principle of therapeutics, and to be especially applicable to inflammation of those viscera, which are more particularly affected in a mechanical manner during the operation of vomiting: but exceptions can be readily imagined, or rather, there may be modifying circumstances, which may be urged against its universality. In active inflammation, for example, there is more or less concentration of the vital energy to- wards the inflamed part; but the effect of the operation of an emetic is to propel the blood towards every organ of the body, and thus to equalise the circulation. There is, too, another effect of emetics, which enables us to produce positively beneficial results in internal inflammations of organs not immediately concerned in the act of vomiting : this is the revulsive — one oi the most important, indeed, of therapeutical agencies. The stomach, and the organs more immediately concerned, are, in this wav, made the centre of an artiheial fluxion, which detracts from that existing in some other portion of the organism. Under this joint equalising and revulsive agency, emetics are beneficially employed 100 EMETICS. in certain inflammatory affections, notwithstanding their tendency to add to the hyperaemic condition ; — the good, effected by the equalis- ation and revulsion, largely preponderating over the injurious ten- dency in question. During the efforts of vomiting, the abdominal viscera are com- pressed by the contraction of the diaphragm and abdominal muscles; hence the different secretions, which take place from them, are aug- mented ; and a tendency to displacement is communicated, so that hernial protrusions may be produced, — or increased, if already exist- ing. The different procidentiae, too, of the pelvic viscera are inju- riously affected by the pressure, and if the female be impregnated, abortion may be occasioned : indeed, there are certain obstetrical physiologists, who think, that the extrusion of the child, in parturi- tion, is altogether accomplished by the contraction of the abdominal muscles, — a position, which would not appear to be tenable. By placing the hand on the abdomen during one of the violent throes of labour, that viscus can be felt contracting energetically ; can be seen, indeed, to do so, where, —as in France,— the clothes are thrown up about the termination of labour, in order that the eleves may have an opportunity of inspecting the phenomena connected with man's ingress into the world. Were it otherwise, there would seem to be no necessity for the development of muscular fibres, which is found to take place as the uterus becomes distended in utero-gestation. In the efforts of vomiting, the circulation, as above remarked, be- £omes hurried, so that evil might result in those, who are labouring ander aneurismal or other serious lesions of the heart and arteries ; and instances are on record, where the vessels have given way during retching. The circulation through the lungs, as in every other part of the frame, becomes augmented in velocity; the secretions from the bronchial tubes are rendered more copious, and hence an emetic becomes an expectorant — an agent whose 'modus operandi will be inquired into hereafter. This effect is not facilitated in the man- ner mentioned only. An additional force is invoked. The succussion communicated to the lungs, by the repeated contraction and relaxa- tion of the diaphragm during vomiting, not only increases the secre- tion, but dislodges it when secreted, so that it becomes loose and more readily expelled by coughing. Hence it happens, that a hard, and dry cough is converted into one that is loose, and free. In the accelerated action of the larger organs of circulation, pro- duced by vomiting, the capillary vessels participate ; and a copious and warm perspiration usually supervenes, contrasting singularly with the cold, clammy perspiration of nausea. Hence emetics be- come diaphoretics. As to their effect on the stomach itself, they may simply evacuate its contents, which may consist of food taken in, with the secretions from the supra-diaphragmatic portion of the tube as well as from the stomach itself. At times, these last secretions are morbid, and unless they are removed, they may become the source of irritation. This is GENERAL EFFECT?. 101 especially the case in diseases accompanied with great erethism of the dermoid tissue. Whenever the cutaneous surface is extensively excited, — as indicated by great heat or by efflorescence, — the mu- cous membrane lining the stomach is apt to participate in the irrita- tion, so that secretions of a morbid character take place from it: these secretions can be readily removed by the action of a gentle emetic. It is easy to see, however, that, under the stimulation produced by emetics of powerful action, the lining membrane of the stomach must be more or less excited, and hence, a copious secretion of the mu- cous fluid takes place : mucus is observed to be mixed with the rejected matters, and. for the reasons already assigned, bile is gene- rally present. But, if substances too irritating, or too violent in their action, be administered, the membrane may become innamed and true gastro-enteritis result. It has been properly remarked by M. Broussais, that the specific character of emetics and purgatives is merely stimulation, which may terminate, if the dose be very large, in innammation and ulceration of the digestive mucous membrane. The same author has well said, too, that the long-continued employ- ment of stimulants— as emetics — greatly exalts the sensibility of the stomach, rendering the treatment protracteu and difficult, and laying the foundation for repeated relapses. •• Emetics." he remarks, '■ may unhesitatingly be placed at the head of the causes, which most promptly produce it," [exaltation of the sensibility of the st - mach.] *' We have collected some very remarkable examples of this kind of lesion in persons, who had been made to vomit for many hours by incessantly repeated doses of tartar emetic, or to whom this remedy had been administered for many cays in succession. It is seldom after such errors, that the physician does not observe in his patients a permanent exaltation of the sensibility", and irritability of the stomach. We have at present under our care, (Aagust, 1S-6.) a lady, who was subjected in 1513, by her physician, to emesis for three consecutive days, to cure a supposed gastric oppression. In the excess of his zeal, he th ught it his duty t remain constantly with his patient, to make her take, at stated peiious. doses of tartar emetic, which he had carefully put up himself. The very next day, symptoms of disorder in the hypochondriac region manifested them- selves, with which the lady had never before been affected ; and, irom that period, it has been impossible, by any means, to calm the irritability of the stomach, or to blunt the painful sympathies, which accompany digestion. We have also attended numerous other neu: i - pathic patients, who dated their disorders from repeated emetics, ad- ministered to them by the same physician, one of the greatest eme- tisers we know.v Full vomiting, accompanied with much retching, or nervous con- centration on the stomach, promotes both exhalation and absorption. The cutaneous transpiration is augmented, as it is in the precursory state of nausea : but the perspiration, induced at these two periods. is essentially different. In the former case, it is tne healthy, ener- 9* 102 EMETICS. getic action of vessels, similar to that which takes place in rude health under the agency of exercise or external warmth: in the lat- ter, the whole system is labouring under temporary debility; and the cold clammy exudation sufficiently exhibits the diminished ac- tivity of the vital forces. Absorption is affected by the same class of agents; but, with regard to the precise mode in which the result is produced thera- peutists differ. It cannot be because of the augmented secretion which takes place from the lining membrane of the stomach, for that is to a trifling amount; — so trifling, indeed, that it could not be expected from this cause, that any unusual demand would be made upon the absorbents of any part of the system. We can account for absorption being more energetically exerted, in cases of dropsy, for example, after the administration of agents, ashydragogue cathartics, which occasion a greater separation of the watery parts of the blood, or after blood has been taken from the vessels ; because here the quantity of circulating fluid being diminished a more ready imbibi- tion of the fluid of dropsy is effected ; but this explanation does not well apply to the operation of emetics. It will be shown hereafter, that the nervous system is largely concerned in the operation of cer- tain agents that modify the function of nutrition, and this is probably the case in vomiting. The powerful nervous concentration on the stomach, and the different organs concerned in vomiting, interferes probably with the functions of nutrition and secretion in other parts of the organism, so that less fluid maybe exhaled, whilst that, which has already been deposited, passes readily through the coats of the blood-vessels by imbibition, and gains the fluid of the circulation. This modification of nutrition is exemplified in the disappearance of morbid growths under the touch of royalty, the wand of the magi- cian, and the incantations of the impostor. From what has been said, it will be readily inferred, that emetics,' like local stimulants in general, are valuable revellents, although, owing to the powerful effects they produce on the whole vascular and nervous system, they may not be susceptible of such useful applica- tion as cathartics, whose operation is more circumscribed. In head affections, for example, whilst cathartics are of great advantage by deriving from the encephalon, and occasioning a salutary excitation in the lining membrane of the bowels, emetics may be of doubtful propriety, owing to the violence of their operation forcing the blood toward the encephalon, and endangering the augmentation of any hyperaemic condition, that may be existent there. Still, in the opi- nion of many, no mischief, — but rather advantage, — accrues in those very cases from the use of emetics. Emetics differ greatly in the period that elapses between their ad- ministration and operation, and also in the degrees in which they induce nausea. The sulphates of zinc and copper, for example, act speedily ; whilst the tartrate of antimony and potassa, or ipecacuanha, requires fifteen or twenty minutes. This fact has given rise to a di- GENERAL EFFECTS. 103 vision of emetics into direct and indirect, or in other words, into such as are conceived to act by impressing the nerves of the stomach ::!- marily : and such as exert their agency, in the first instance, on the great nervous centres themselves. An agent of the hrst class is presumed to excite such a disagree- able impression upon the nerves of the mucous coat of the stomach, that the brain immediately calls for the assistance of the different muscles concerned in vomiting, and the contents of the stomach are at once evacuated : or repeated efforts are instantaneously established to effect their expulsion. On the other hand, an agent of the latter class is presumed to ex- cite no immediately disagreeable impression upon the gastric nerves, but gives occasion to the act oi emesis bv passing into the circula- tory apparatus of the stomach; impressing the nerves distributed to the lining membrane of the blood-vessels: or reaching the brain. and making its first impression upon that organ : and the fact that many substances,—as the tartrate of antimony and potassa, — which, as regards its agency on the stomach, is equally soluble with the sulphates of zinc or copper, — require such a length oi time before their effects are produced, compared with those last salts, is favour- able to the latter opinion : only one other view could indeed be indulged, and it is sufficiently difficult of comprehension ;— that the tartarised antimony requires to make a more protracted impression on the gastric nerves, than the salt of zinc : yet how this can be effected by a solution, capable of such ready absorption, is by no means clear. The rapid emetics, as a general rule, excite the least nausea, and their action is soonest over. The vegetable emetics are generally attended with more nausea than the mineral; although the tartrate of antimony and potassa, which requires about the same time before its operation commences, is considerably nauseant, and is more fre- quently employed to excite nausea, where such agency is demanded, than any other substance belonging to the class. The effects of sub- stances, which require time for action, supervene more gradually, and continue longer. As a general rule, too. the rapid emetics are not productive of much retching, when compared with the others; and hence a judicious selection of a particular emetic for a special morbid condition, or to fulfil a certain indication, may be important. Where the object is simply to evacuate the contents of the stomach, a rapid emetic, and one that is neither accompanied in its action with nausea nor retching, is indicated. On the other hand, where a powerful nervous impression has to be made, one of an opposite cha- racter is demanded. Hence it is. that if a noxious substance be taken into the stomach, recourse is had to the sulphate of zinc or the sulphate of copper ; whilst, in an attack of intermittent, where we are desirous of powerfully impressing the nervous svstem, the tartarised antimony, or ipecacuanha, or a combination of both, is selected. 104 EMETICS When an emetic is given for the purpose of simply evacuating the contents of the stomach in disease, fluid — as warm water, or warm chamomile tea, or mustard and water, or a few drops of solution of ammonia in water — may be used, especially after each act of vomiting, for the purpose of preventing retching. The fluid must, however, be allowed in moderation, and, where a soluble poisonous article has been taken, but little should be permitted, unless it can be removed from the stomach by the stomach-pump immediately after it has been swallowed, or is likely to be evacuated at once under the action of an emetic. Hence, dry vomiting is advised in such cases. Where the tartrate of antimony and potassa is adminis- tered to children as an emetic, it may be well to allow the child to suck or drink before the operation comes on, as the salt, it is asserted, has been found to produce poisonous effects, when taken on an empty stomach. Occasionally, the emetic acts longer, or more severely, than is desirable. In such case, a few drops of laudanum, or of laudanum and ether ; or a teaspoonful of brandy ; or a drop of creasote, may be prescribed. A teaspoonful of magnesia in a glass of sherry wine has been advised with the same object. These ex- citants are not often, however, needed. Frequently a mustard plas- ter to the pit of the stomach is adequate to the emergency. If the object of the practitioner be to excite a new nervous im- pression, the greater the amount of retching, within due limits, the better. At times, emetics not only produce emesis, but they excite violent catharsis ; or they may induce the latter effect without the former. In such cases, a few drops of laudanum have succeeded in restricting their operation to the stomach. In very irritable indi- viduals, too, the emesis may go to an inordinate extent, so as to ex- haust by the repeated retching and vomiting. Carbonic acid, — as contained in soda water, or as given off by the union of tartaric acid and carbonate of soda, — or opium, or some rubefacient to the epigastric region, may be required to check it. Reference has been made to the evils resulting from the repeated employment of emetics as regards the gastric functions, as well as to the mischief they may induce in particular states of the system. One other inconvenience resulting from them, — or rather, said to result from them, but of which the author has not seen an example, — is that of inflammation of the extremities, followed by gangrene. M. Barbier — an eminent French writer on therapeutics — has cited the following case. —A woman, of a constipated habit, had used many means for producing catharsis, but ineffectually, when a sur- geon to whom she applied administered a violent preparation, which operated both upwards and downwards. Cramps, convulsions of the limbs, and great anguish supervened. Immediately afterwards she was attacked with severe lancinating pains of the extremities, and ecchymoses appeared on different parts of the body. Gangrene attacked the cartilaginous portion of the nose, the lower lip, the skin of the chin, the points of two toes of the right foot, and the great toe IN INTERMITTENT FEVER. 105 of *he left, all of which successively dropped off. To this case Barbier adds one of his own. A woman, of the Faubourg d'Amiens, having procured a cathartic remedy from an herbalist, was attacked. after taking it, with incessant vomiting and purging, which rapidly reduced her strength. Sue was taken to the Hotel-Dieu. Next dav *ae point of the nose, the ears, and the cheeks became oi a deep violet hue. and soon afterwards the same colour spread over the feet and the hands, and gangrene rapidly attacked all these parts. She lost one oi her feet, and several toes of the other. These cases do not seem t^ prove incontestablv, that the gangrene was dependent upon the use of emetics. The effects mav have been coincident, instead of consecuent: and if any such evil were to be apprehended from them, we ought assuredly to possess a greater num- ber of examples. Therapeutical Application of Emetics. After this full investigation of the general effects consequent on the administration of emetics, their therapeutical application to par- ticular diseases will be intelligible. I terrnittent fevers.— In intermittent fevers, they are employed with two objects.— either to excite a powerful nervous impression, or to simply evacuate the contents of the stomach, and, according as the practitioner has one or other of these objects in view, he selects his particular emetic accordingly. For exciting a powerful nervous impression, one which produces much nausea and vomiting is. as already inculcated, to be preferred: whilst if simple evacuation be desirable, it matters not how trivial the nausea or disorder mav be. Practitioners, however, generally have recourse to the nitrate of antimony and potassa, and ipecacu- anha, singly or combined. The iatter is perhaps the more certain agent: and it has the advantage, that no verv great attention is re- quired to the dose.— sixty grains not usually producing more effect than thirty. Where the object is to arrest the paroxysm of an intermittent, the emetic should be exhibited a short time before the cold stage is ex- pected ; and should it even not have the effect oi completely pre- venting the fit. it may essentially mitigate it. The first impression, made by an emetic of antimony, or of ipecacuanha, is one of diminished action ; the second is one of equalis- ation : so that although the former operation might appear inappro- priate in a case of diminished action, like that oi the cold stage of an intermittent, the latter might be decidedly advantageous: and this latter, it would seem, predominates over the former, inasmuch as no evil is found to result from the employment of emetics in the cold stage. Even in those pernicious intermittents.— thefebres c.lsridtf, as thev have been termed,— in which reaction, if established at all, is so with difficulty, they have been found decidedly useful. In 106 EMETICS such cases, emetics, which produce the equalisation without the de- pression, are obviously indicated — as sulphate of zinc, or sulphate 7. And, again, '• Emetics, purgatives, and tonics, which act by revulsion, affect only temporary cures in chronic gastritis and gastro-enteritis, and render the radical cure more difficult." Prop. 349; — "propo- sitions," which must be regarded as mere assertions emanating from a distinguished mind, but not on that account to be received as authority, in the absence of evidence. It need scarcely be said, that in the course of continued fever, morbid secretions must take place from the lining of the alimentary tube as in remittents and intermittents, but as these can generally be evacuated by cathartics, they are usually employed to the exclusion of emetics. Inflammations. — In the different phlegmasia?, emetics are much used. In some, however, thev are more effective than in others. In la, i l. -tracheitis or croup, they are given in very different stages of the disease, to fulfil different indications, and with equal pro- priety. At the commencement of an attack, both of spasmodic and inflammatory croup, an emetic, by exciting a salutary revulsion, and equalising the circulation, frequently puts an end to the afiec- tion ; and even if the disease has made some progress,it is a valuable agent, after blood-letting. Accordingly, it is one of the remedies most employed in the early stages of croup. It is equally indicated after the plastic secretion has been thrown out from the membrane ; but it must obviously be a matter of extreme difficulty, bv any agency, to cause the detachment of the false membrane, and its expulsion through the narrow chink consti- tuting the rima glottidis, when it has formed in the trachea ; yet the best expectorant agency that can be exerted, is effected by the suc- cussion, which the action of an emetic occasions. The same remarks apply equally to the inflammation of the lining membrane of the larynx, that constitutes laryngitis. In amygdalitis or inflammation of the tonsils, as well as in pharyn- gitis and oesophagitis, the same good effects are produced by the revellent and equalising agency of emetics ; and when suppuration has supervened, and the abscess is seated so low down in the pharynx 108 EMETICS or oesophagus, that it cannot be reached by the instrument of the surgeon, the operation of an emetic may cause it to break. With this view, one of the direct emetics maybe prescribed. No great impression on the nervous system is needed. The expulsive efforts are alone required; and the sulphate of zinc, or the sulphate of copper, is capable of fulfilling every indication. In the malignant varieties of cynanche, which so often accompany scarlatina, emetics are frequently administered. Much curative influence cannot, how- ever, be expected from them, except at the very commencement of these affections ; but at a subsequent period, they may be given with the view of removing the viscid secretions, which excite so much annoyance. Diseases of the chest. — Emetics are much employed in different diseases of the chest. In pneumonia, they are not often used before the activity of vessels has been diminished by the proper antiphlo- gistic remedies; but when the inflammation has been somewhat subdued, their equalising and revulsive influence becomes strikingly apparent. They favour the discharge of the bronchial secretions, by the succussion they communicate to the lungs ; and, for this reason, they are employed with considerable benefit in chronic bronchitis. They are, likewise, extremely beneficial in nervous cough, hooping- cough, and asthma. These diseases appear to be dependent upon a morbid condition of the nerves of the respiratory organs— thepneumo- gastric especially — which modifies the contractility of the muscular fibres, that surround the minute bronchial ramifications ; and this state of the nerves is generally perhaps connected with more or less derangement of the parts of the cerebro-spinal axis, whence they originate. Hence, the utility of producing a revulsive effect by means of these or other agents. Expectoration is also favoured by them in the manner just mentioned, and it has been long remarked, that those children suffer least from hooping-cough, who eject the contents of the stomach during each fit of coughing. Diseases of the encephalon. — It is in head affections that the use of emetics might seem most doubtful. In encephalitis, they are gene- rally esteemed inadmissible ; and, as the pain in the head is almost intolerable, their operation can hardly fail to aggravate the symptoms, notwithstanding their revellent and equalising tendency. The same remarks are applicable to their employment in apoplexy. The violent efforts, forcing the blood with greater impetus to the head by the arteries, and retarding its return by the veins, appear inappropri- ate in cases in which hyperaemia already exists in the encephalon, yet their revellent properties would seem to have rendered them useful in ophthalmia, when blood-letting, counter-irritants, &c, had been prescribed, and the disease had, notwithstanding, remained stationary. In these very cases, the same substances, employed so that their operation may be confined to exciting nausea, are amongst IN BUBO AND ORCHITIS. 109 our most valuable remedies, and not in these affections only but in every variety of phlegmasia. Amaurosis. — Amaurosis is said to have been beneficially treated by emetics, but much reliance obviously cannot be reposed on them, when the retina, or the optic nerve, or the part of the brain in which the optic nerve arises, is affected with paralysis. Impaired or de- praved vision often occurs sympathetically from disorder of the diges- tive functions; at other times, it is owing to lesion of the eye itself, or of the cerebral part of the organ of vision ; hence the affection termed myodesopsia or musae volitantes is symptomatic of one or other of these morbid conditions ; and hence the various hallucina- tions, illusions or waking dreams, which occur in diseases of the encephalon, — as mania and hypochondriasis, but which are often pro- duced in persons of sound mind, whose nervous systems are unu- sually impressible, and easily acted upon by irritations in the stomach, or elsewhere. Where the primary mischief in such affections is in the stomach or intestines, emetics are more likely to afford relief than when the depravation is seated originally in the encephalon. Bubo and orchitis. — In certain local affections — as bubo and orchitis — the revellent action of an emetic is often most beneficial. The inflammation may have been vigorously attacked by the proper antiphlogistic measures, yet the swelling may remain stationary. Ii a powerfully revellent nervous impression be now made, by exciting emesis, the swelling will frequently disappear. In the very early stages of orchitis, or bubo, the revulsion, thus produced, is by no means as efficacious. The excited state of ves- sels generally predominates too much to be broken in upon by any impression upon the nervous system. The state of vessels must be reduced by antiphlogistics, and then emetics may be had recourse to with full advantage. Phthisis pulmonalis. — In phthisis pulmonalis, emetics were at one time considered the best remedies : and, according to one writer. Dr. Young, a majority of the cures of phthisis have been effected by them or by nauseating agents. This idea probably originated from the good effects observed to follow a sea voyage, which is usually accompanied by sea-sickness: but the fallacy, in this case, consists, in referring that to the nausea, which may be produced by the greater equability of temperature at sea, and by the new impressions made upon the mind and nervous system of the voyager, through the altered barometrical, hygrometrical. thermometrical, electrical and other conditions of the atmosphere, and by the new scenes in which the patient is placed. Even in the early stages of phthisis, when alone any course of medication can be expected to be effective, emetics are, at the present day, but rarely had recourse to. In the later periods of the disease, they are not only useless, but add to the existing irritation and debility. Diseases of the alimentary canal. — In gastritis, and enteritis, erne- VOL. II. —10 110 EMETICS. tics are manifestly not needed, and would probably be injurious ; nor would they appear to be indicated in spontaneous vomiting ; but, as diarrhoea is often kept up by irritations in the intestinal canal, and requires the administration of a cathartic to remove them, so vomit- ing may suggest the use of an emetic ; and even when the spontane- ous vomiting has persisted after the contents of the stomach have been evacuated, the new action, induced by an emetic, may break in upon the disorder of function, and remedy the evil. In dyspepsia, emetics are occasionally prescribed, but they must be employed with caution. A gentle emetic removes indigestible matters and morbid secretions, and produces an excitation in the stomach which may be salutary; but repeated emetics, as has been previously shown, injure the tone of the organ, develope its sensi- bility, and augment the very affection for the removal of which they were administered. In cholera — both of the indigenous, and foreign variety — gentle emetics are prescribed by some practitioners, and as means for the removal of morbid secretions they may be useful; but it is not clear, that they ought to be regarded as of much efficacy in affections that are dependent upon an irritated or excited state of the gastrointes- tinal mucous membrane, and which yield with the subsidence of the inflammatory irritation,— or terminate unfavourably, when the morbid affection of the membrane in general, and of the exhalants in particu- lar, is excessive. In cases of malignant cholera, the stimulating emetics—as mus- tard — have been most frequently employed, — the inflammatory irri- tation of the raucous membrane in these malignant cases being occasionally diminished by gentle excitants, as we have seen it may be in affections of the mucous membranes in general, when the over- distended state of extreme vessels is the prominent pathological lesion. A main part of the benefit, however, accruing in such cases, is probably derived from their revulsive operation, — the chief patho- logical mischief being usually situate lower down in the tube. It has, indeed, been a question, with some therapeutists, whether ad- vantage might not be derived, in these unfortunate cases, from reme- dies that might even inflame the lining membrane of the stomach ; but such a harsh plan of revellent treatment could, of course, be scarcely admissible. In diarrhoea and dysentery, where the irritation is seated lower down in the tube, an emetic may produce good effects as a revulsive ; but, in the latter disease, the violence of the. inflammation must be previously subdued by appropriate agents. It would seem, too, that in certain cases of constipation, accompanied with spasmodic con- striction of the muscular coat of the intestines, emetics, administered after blood-letting, have relaxed the spasm, so that the bowels have been relieved, or gentle cathartics have afterwards been sufficient. In dysentery the seat of which is chiefly in the lining membrane of the large intestine, the revellent and equalising effects of emetics are beneficially manifested. IN HEMORRHAGES. Ill Rheumatism and sout.— In acute rheumatism and gout, emetics are not much used, although occasionally their operation — as revel- lents and equalisers — may be advantageously exerted. In the latter disease, connected as it is with considerable gastric disorder, their use might seem to be more especially indicated ; and in both diseases they may be demanded for the removal of morbid secretions, r of undigested matters from the tube,— a result, which can generally, however, be accomplished by the use of gentle cathartics. Hemorrhages.— After what has been said of the general mode of action of emetics, and of their application to the ordinary phlegmasiae, their agency in hemorrhages will be apparent. In epistaxis, they cannot be required, and their employment in apoplexy,— it has been already seen,— is a more than questionable measure. The same, i: has been thought, may be said of hamoptysis. Although their equa- lising and revulsive operation might act advantageously, it has been conceived, that the activity they occasion in the vascular movements, might more than compensate for their salutary agency. Yet, it has not been found, that haemoptysis, symptomatic of phthisis, has re- curred, or been increased at sea during the reohing of sea-sickness. In such cases, nauseating doses are recommended, which, as before shown, produce an effect of a directly opposite character, so as to give occasion to their being classed amongst agents that diminish action. In harmatemesis, emetics have been recommended by some, with the view of removing the accumulations of blood, which form in the stomach; and, in this respect, they may be of service. The hemor- rhage, in these cases, is generally venous, and takes place by dia- pedesis or transudation, — often owing to visceral engorgement, which prevents the blood from circulating freely in the engorged organ, and occasions irregular congestions in other parts. In such cases, emetics ought to be administered with caution. In the wards of the Philadelphia Almshouse, we annually meet with cases of haema- ternesis, melaena, and epistaxis, occasioned by engorgement and in- duration of the liver or spleen, especially the latter, acquired in malarious districts. The proper treatment of the hemorrhage neces- sarily merges in that of the primary affection on which it is de- pendent. In cases of simple haematemesis, the action of the stomach, induced by an emetic, may occasion the removal of the venous congestion, and the pressure of the muscular coat of the viscus on the vessels exhaling the blood may tend to contract their dimensions, and to arrest the flow, somewhat, perhaps, in the manner that the hemor- rhage is arrested in the next variety to be considered. Uterine hemorrhase may occur prior to, during, and subsequent to, the delivery of the child. In all cases, it is produced by a discharge from the uterine vessels. The old idea, universally entertainei, was,— that the vessels of the mother pass directly to the placenta, and pour their blood, by open mouths, into the maternal portion of 112 EMETICS that organ. Under this view of the subject, hemorrhage would be produced by a rupture of the maternal vessels. Some observers have satisfied themselves, that there is no direct communication be- tween the uterine vessels and the placenta, but that these vessels coast along the uterine parietes in a direction parallel to the placenta,— having, however, portions scooped out of their sides, which portions are closed, either directly or indirectly, by the placenta. Under this view, there can of course be no maternal and foetal portions of the placenta; the wrhole is foetal, and hemorrhage arises from the de- tachment of the decidua or of the placenta from the apertures in the uterine vessels. Whatever, therefore, induces contraction of the uterus, occasions the reapplication of the placenta, or of the body of the child to the vessels whence the hemorrhage proceeds, and arrests it. These remarks apply, of course, only to hemorrhage occurring prior to, or during delivery, and then only to cases in which the placenta is situate elsewhere than over the os uteri. In uterine hemorrhage following the delivery of the ovum, the hemorrhage is arrested by causing the uterus to contract upon itself, and thus to obliterate, as it were, the maternal vessels ; and emetics, which call into action the abdominal muscles, facilitate this result, although they are but rarely had recourse to, seeing, that the ob- stetrical practitioner has more effectual means for attaining his object. Jaundice. — In jaundice, dependent — as it often is — on some impediment to the flow of bile along the biliary ducts into the duo- dedum, and especially when produced by a gallstone, the inverted action and the succussion, induced by the operation of an emetic, are often beneficial, and the same remark holds good in cases of cholelithus or gallstone without jaundice. Here, an emetic should be selected, whose operation is preceded by nausea—as tartar emetic or ipecacuanha—the relaxing influence of which is first felt, and this is immediately succeeded by the propulsory efforts, which are, at times, successful in causing the calculus to clear the biliary passages. It has been properly remarked, however, that emetics are more advantageous and safe in the early than in the later periods of jaundice, when there is reason to believe in the existence of organic disease of the liver ; and also, that they should be used with caution, when there is evidence of distention of the gall-bladder,— indicated by a tumour felt on pressing the right hypochondrium. Under such circumstances, the operation of an emetic has been known to occasion rupture of the gall-bladder and fatal peritonitis. JYeuroses. — In mental alienation, emetics were at one time much advised, and some of the most noted remedies possessed properties of this kind. They are not given at the present day, unless symp- toms should arise in the course of the disease to indicate their ad- ministration. In the cases in which they are presumed to have everted a salutary agency, this was probably accomplished less by IN DROPSY. 113 their acting as evacuants, or through modifications induced in the circulation, than by the new impression made by them upon the nervous svstem. Hence, they are occasionally used in mania to interrupt intense abstractions. When the insane obstinately deter- mines to retain his urine and faeces, an emetic often succeeds in breaking in upon the determination ; and the same applies to thrse who are affected with delirium tremens, in which disease emetics have been wholly relied on by some. (For the author's views on this subject see his Practice of Medicine. 2d. edit, ii., 274, Phila- delphia, 1S44.) In all such cases, emetics have to be given in larger doses than usual. The encephalon being in a state of excite- ment, and employed in its own acts, is less affected by impressions made on other organs, and, consequently, requires a larger amount of the impressing agent; but if the energy of the system be first re- duced by a copious abstraction of blood, then the ordinary dose of the emetic may produce its accustomed effects. In hypochondriasis, which is an encephalic disorder, accompanied generally with much gastric derangement, an occasional emetic often acts beneficially, by exciting a new action in the nervous system, and giving an impulse to functions carried on with unusual torpor. In epilepsy, and in the convulsions of children, emetics are not only excellent prophylactics, but valuable curative agents. Where organic mischief does not exist, these diseases are usually induced by great mobility, or impressibdity of the encephalon, developed by irritation in some other part oi the system, and especially in the digestive tube. Often, this is produced by indigestible diet, or by morbid secretions, and when the prodromic or premonitory symp- toms of the attack are present, a timely emetic may prevent the paroxysm, by removing the cause, and exciting a new nervous im- pression, as in the case of intermittents. The same kind of revulsion is, at times, salutary in hysteria, as well as in the different forms of neuralgia. The impression of the emetic is powerfully exerted on the stomach, and thence irradi- ates to every part of the nervous system, and, by equalising the nervous distribution or influx, detracts from its intensity in any given point. Dropsy. — Lastly, emetics have been frequently exhibited in the different varieties of dropsy, and they are calculated to act as pro- moters of absorption in such cases ; — not so much in consequence of any increased action of the exhalants of the lining membrane of the stomach, which they may occasion, as by their revulsive opera- tion. Dropsies, as will be seen, have been known to disappear under powerful mental emotions, and not only dropsies, but deposi- tions of solid materials, and we can, therefore, understand, that these affections may diminish under the nervous derivation excited by an emetic. Thev cannot, however, be repeated sufficiently often tj 10* 114 SPECIAL EMETICS. produce much salutary influence, for fear of injuring the tone of the stomach ; and accordingly they are but rarely employed in the treat- ment of hydropical affections. Such are the diseased conditions in which emetics are especially serviceable. It is obviously impossible to specify every variety of organic lesion in which they may be salutary. Enough has been said of their general properties, and particular applications, to suggest the cases in which their administration may be indicated. SPECIAL EMETICS. a. Direct Emetics. 1. ZINCI SULPHAS. —SULPHATE OF ZINC. Sulphate of zinc occurs in commerce in an impure state, under the name of White Vitriol, by which, indeed, it was long known in medicine. The salt, however, always contains iron, and commonly copper and lead ; and therefore, for pharmaceutical purposes, it is directed to be prepared by the union of oxide of zinc and sulphuric acid. Sulphate of zinc is in colourless crystals, which effloresce on ex- posure to the air. It is wholly dissolved by water, by 2^0 of its weight of cold water, and by less than its own weight of boiling water. It is insoluble in alcohol. The solution in water affords'with am- monia a white precipitate, which is redissolved by the alkali in ex- cess. It also yields white precipitates with chloride of barium, fer- rocyanuret of potassium, and sulphohydrate of ammonia. Sulphate of zinc, which is tonic in small doses, is a rapid and safe emetic ; and hence is given, when it is desirable to evacuate the contents of the stomach speedily, as when poison has been taken. The dose for this purpose is from ten to thirty grains. In excessive doses it acts as an irritant poison. 2. CUPRI SULPHAS. — SULPHATE OF COPPER. Sulphate of Copper, Roman or Blue Vitriol, or Blue-stone, used in the United States, is formed by a direct combination between old scrap copper and sulphuric acid. This is always made on the large scale ; and hence it is not in the list of preparations of the Pharma- copoeia of the United States, but in that of the materia medica. It occurs in rich blue crystals, which are wholly soluble in water, and slightly efflorescent in the air. It is insoluble in alcohol. Ammonia throws down, from a solution of the salt in water, a precipitate, which is entirely redissolved when the ammonia is added in excess. ANTIMONII ET POT AS SUE TARTRAS. H5 It dissolves in about four parts of water at 60°, and two parts of boil- ing water. Likt sulphate of zinc, sulphate of copper is, in very small doses, a tonic ; and in larger an emetic. It is, however, much more active, and in considerable doses is a highly acrid and corrosive poison. Its dose, as an emetic, is from wo to five grains, given in water; but it is less safe than the sulphate oi zinc. b. Indirect Emetics. 1 A>TIMOaNII ET POTAS ?ra TARTKA-—TARTRATE OF ANTIMONY AND.POTAi* oA. Tartrate of Antimony and Potassa. Tar'tarised antimony, Emefic Tartar, Tartar Emefic — in the Southern states of the Union erro- neously termed Tartar — is, perhaps, more frequently used as an emetic than any other agent. In the Pharmacopceia of the United States (1S42 it is directed to be formed as follows:—Take oi .>'..■/ buret of Ajitimoni1. in fine powder, si v. : M riafic Acid, .^xxv. : Altric .icid. ^ip : Water, a gallon. To the acids mixed in a glass vessel, add gradually the sulphuret of antimony, and digest the mixture with a gradually in- creasing heat till effervescence ceases ; then boil for an hour. Filter the liquor when it has become cool, and pour it into the water. Wash the precipitated powder frequently with water, till it is wholly freed from acid, and then dry it. Take of this powder, oij.: Bitar- trate or Potassa, in very fine powder, siiss.; Distilled water, f. sxviih Boil the water in a glass vessel: add tie powders previously mixefi together, and boil for an hour ; filter the liquor whilst hot, and set it aside to crystallise. By further evaporation, the liquor may be made to yield an additional quantity oi crystals, which should be purified by a second crystallisation. Tartrate oi antimony and potassa consists of tartrate of antimony and tartrate of potassa ; and the object of the above process is first to form sesquioxide of antimony, and then to saturate the excess of acid in the bitartrate oi potassa with it. It is in transparent crystals, which become Opaque and white on exposure to the air. As met with in the shops, it is generally in powder, and, when pure, is per- fectly white. Dr. Pereira, however, remarks, that some ignorant druggists prefer a yellowish-white powder: and he was informed bv a manufacturer cf the salt, that he was obliged to keep two varie- ties, — one white, the other yellowish-white. — to meet the demands ci his customers. The yellow hue is owing to the presence of iron. It is often adulterated with bitartrate of potassa : and it has been found that it may contain 10 per cent, of it. and yet dissolve in the proper quantify of water. It. is wholly soluble in 14 or 15 parts oi water, according to Dr. Pereira; — according to the Pharmacopceia of the United States, in 20, at 60r Fahr. Uncombined bitartrate of 116 SPECIAL EMETICS. potassa is detected by adding a few drops of a solution of carbonate of soda to a boiling solution of the antimonial salt. This causes a precipitate, which is immediately redissolved, if bitartrate of potassa be present. When tartrate of antimony and potassa is taken in very large doses, it acts as a powerful irritant poison, causing direct inflammation of the stomach and intestines. It is likewise an irritant when applied to the cutaneous surface. Its nauseant and emetic properties alone fall under consideration in this place. As a nauseant, it is constantly given in febrile and inflammatory affections, in such doses as to keep up the action of sedation suffi- ciently long to break in upon the chain of morbid associations. For this purpose, it is prescribed in the dose of from |- to \ a grain every two or three hours ; carefully regulating the quantity and the periods so as to prevent the supervention of vomiting. As an emetic, it may be given alone, orin union with ipecacuanha — one or two grains of the tartrate to fifteen or twenty grains of the latter. When administered alone, it should be in divided doses ; — six grains, for example, being dissolved in four ounces of water, and a fourth part given every fifteen minutes until it operates ; — the action, in this case, as in that of every other emetic, where it is de- sirable to evacuate the contents of the stomach freely, and there is no danger of dissolving any noxious matter that may be contained in it, being aided by drinking freely of warm water, or of warm chamo- mile tea. For reasons already assigned, it is rarely prescribed, how- ever, where any poisonous agent has been taken, — recourse being then had to direct emetics. Being devoid of taste, it is a very convenient emetic in the dis- eases of infancy, in which it is advisable to give it in divided doses until vomiting is induced ; and it is doubtless the main agent in some of the nauseating and emetic preparations so commonly used in such cases in domestic practice. VIl\OI ANTiMO'MI, ANTMONIAL WINE.— (Antim. etPotass. Tartrat.d'y. Vini, f. ^x.) Each ounce of the wine contains two grains of the tartrate. Antimonial wine is commonly kept in families, and it has the advantage, which a watery solution has not, of keeping well. It is readily taken by children as wine. It is not well adapted, how- ever, as an emetic, for the adult. If we regard the ordinary dose of the tartrate of antimony and potassa to be two grains, it would re- quire one ounce of the wine, which might be injurious, and in no circumstances could offer advantages over the aqueous solution. Ac- cordingly, it is rarely prescribed to adults. To children, under five years of age, the vinum antimonii is generally given in the dose of a tea-spoonful, repeated every fifteen or twenty minutes until it acts. 2. IPECACUAN'HA. Ipecacuanha is the root of Cephai'lis Ipecacuan'ha; Sex. Syst. ECACCANIiA. 11* Penlandria Mntwuia; Nat. Ord. R - biacea-"-. — Cinchonaceae Lindley): a small shrubby plant, which grows in Brazil, in moist, shady situations, between the 5th and 20th parallels oi south latitude. It is said. also, to occur in New Granada, and in some cf the West India islands. The roots are gathered at all seasons of the year, but especially from January to March inclusive. The amount on which duty wa s paid in Oiid England, in 1541. was 9.623 lbs. : but a singular nnctuation as to quantity is rre- ■iT*" sented by the table of imnorts for the last CrrdidOsIrec few years, which is as follows : Pereira ■. Ln 1534. 9.035 lbs. In 1535. 12.426 1535, 7.469 1539. 7.453 1536! 11.437 1540. 6.453 1S37. 11,435 1541. 9,623 As imparted, ipecacuanha root cpnsists of the proper knotty root: the thinner, woody cylindrical portion by which it is attached to the stem, and frequently a part of the trailing portion of the stem also. The annulated or ringed portion—Radix Ipecacuanha annula'tee fasccz, of continental writers — is the most active part, and, therefore, ought alone to be used by the apothecary. The root — as we meet with it — is of about the thickness of a small gooseanill. and oi a length varying from two inches to seven : contorted, and presenting numerous annular grooves, which give it a characteristic, knotted or ringed appearance. The colour varies, from brownish, redd! sh-br-v:.. grayish-brawn to gray. Its substance consists oi two parts — the one constituted oi the bark, the other of the meuitullium, — the prcnorrlon. in 100 parts of good ipecacuanha, being 50 of the former to 20 of the latter. The meditullium is nearly inert, and as it is pnlverisable with more difficulty than the cortical portion, when the pulverisation is effected in a mcrtar, it may happen, that the portion which may re- main last in the mcrtar, possesses scarcely any medicinal property. Cjeneraily. however, at the vreSeut day. it is reduced to powder, on a large scale, by grinding, so that this separation is n Brown Tp «. Rinz--. p-r: tion without ri observable. 118 SPECIAL EMETICS. The powder of ipecacuanha has a nauseous odour, and on some persons produces a peculiar effect, giving rise to sneezing, cough, dyspnoea, and all the symptoms of catarrhus cestivus or hay asthma, as it has been termed. These symptoms pass off after a time, and generally with a copious secretion from the bronchial tubes. It would appear, that small particles of the powder inhaled with the air induce bronchitis, and at the same time affect, in a peculiar manner, the ramifications of the pneumogastric nerves, so as to give occasion to this disorder. A friend of the author suffered excessively when- ever he had occasion to handle the powder, and especially if he were present whilst the pulverisation was going on. Its taste is bitter, subacrid, mucilaginous, and very nauseous. Ipecacuanha yields its virtues to water, and still more to alcohol, pure or diluted. The stronger wines equally extract them, and hence most of the pharmacopoeias have a wine of ipecacuanha. The virtues reside essentially in an active principle, which was first sepa- rated by M. Pelletier in 1817, to which he gave the name Emetine — now often termed Emetia. Pelletier's analysis was as follows. Brown Annulated Ipecacuanha. Red do. Cortex. Meditullium. Cortex. Emetia, 16 1.15 14 Odorous fatty matter, 2 traces 2 Wax, 6 Gum, 10 5.00 16 Starch, 42 20. 18 Ligneous matter, 20 66.60 48 Non-emetic extractive, — 2.45 — Loss, 4 4.80 2 100 100.00 100 The emetia in this analysis is, however, the impure, and it was subsequently found by Pelletier, that the root contains only about 1 per cent, of the pure. Such are the characters of the officinal ipecacuanha. Other ipe- cacuanhas have, however, been described, and it is not surprising, that many roots should have been substituted for the officinal variety. It would appear, however, that they are but little known in the trade of this countty or of Europe. It is, consequently, not necessary to dwell upon them. IPECACUANHA. 119 Striated Ipecacuanha Root. ri>C'U ^Pereira) Stri'ated ipecacuanha, black Fig- 3- ipecacuanha, is from psycho'tria emetica, a native of Peru, which was, at one time, supposed to be the source of the true ipe- cacuanha. This would appear to be sometimes imported into continental Europe, and to be confounded with the dark speci- mens of the true ipecacuanha. Its joints however, are longer ; and the surface is striated longi- tudinally. Pelletier found it, on analysis, to yield 9 per cent. of an emetic extract, similar to impure emetia. Undulated. W:dte or amy lace- ous ipecacuanha is obtained from different species of Richard- so'nia, which inhabit open plains in Brazil. It resembles most the true root, but is distinguished , , r . ,-,, o. An old r.-ot. with a well- by having fewer and shallower marked intersection annular fissures, larger joints, * Conlon and the central woody portion being proportionally much thicker. Pelletier found it tO Cn:uate4 Ipecacuanha contain 5 or 6 per cent, of an P™,„f n k. * . c Root of Richards:: la emetic extract, like impure scabra. , ,' •r c b. Root of a Rirhard- emetia, and a iarge quantity oi s -,a. {Pereira starch. Another variety of white ipecacuanha is obtained in Brazil from iomd'ium ipecacuanha, or viola ipecacuanha It is much thicker than the true ipeca- cuanha, being sometimes as large as the little finger, having only a few transverse fissures, distinct joints or knots, and a thick woody interior. Pelletier found this root to contain about 5 per cent, of emetic extract similar to impure emetia. As an emetic, ipecacuanha acts like tartrate of antimony and pct- assa. It is perhaps the safest and most certain of the indirect emetic>. and although it is supposed to be — in large doses — an acr: -narcotic poison, the author has never known a case, in which such symptoms have presented themselves. Emetia, when injected into the venous system of a dos, excites vomiting in the first instance, and afterwards coma, which ends fatally. To produce lull emesis, it is often associated with tartrate of anti- mony and potass, as remarked under that article : but it is frequenty given alone. Tne common mode is to administer about twenty 120 SPECIAL EMETICS. grains of the powder in warm water; and to repeat this quantity every fifteen or twenty minutes until it ope- rates ; drinking freely of warm water or of warm chamomile tea. When the object is to excite nausea, from one to three grains may be prescribed at such intervals as may be deemed advisable. This dose will generally be sufficient as an emetic for children of two or three years old. When it does not operate on the stomach, both it and other emetics are apt to affect the bowels ; and not unfrequently they all have an emeto- cathartic operation. VMM IPECACUANHA, IPECACUAN'HA WINE. — (Ipecac, contus. ^ij ; Vini, Oij.) This prepa- ration may be used in the same cases as the antimonial wine, and there may be cases in which it may be proper when the former is not; for example, the antimonial wine, in particular persons, may produce griping and intestinal irritation, whilst the wine of ipecac- cuanha may not; and conversely. It is a very safe emetic for children. The dose to the adult is one fluid ounce ; to the child of from one to two years of age a tea-spoonful or a fluidrachm. Ionidium Ipecacuanha Root. (Pereira.) SYR'UPUS IPECACUANHA, SYRUP OF IPECACUANHA. — (Ipecac, in pulv. crass; ^j ; Alcohol, dilut. Oj ; Syrup, Oij. Prepared either by ma- ceration or by the process of displacement.) From f. ^j to f. ^ij of this preparation will act as an emetic, but it is not much used. It is more convenient for children, on whom it operates in the dose of from f.3j to f. 3ij. EMET'lA. Emet'ia, Emeti'na, Em'eta — as already remarked — is the active principle of Ipecacuanha, which was first separated from it in 1817 by Pelletier, of Paris. It is not officinal in the Pharmacopoeias of Great Britain, or in that of the United States, but has been received into many continental Pharmacopoeias, — as the Parisian, Batavian, Hannoverian, &c. There are two varieties of the active principle, which, according to Magendie, bear the same relation to each other as moist sugar does to the crystallised. One of these is termed the impure, the other the pure. To obtain the former, powdered ipeca- cuanha is digested with ether to dissolve the fatty matter, whence it derives its disagreeable odour, and which possesses no emetic virtue. Wbhen the powder yields nothing more to the ether, it is exhausted by means of alcohol; the alcohol is then evaporated in a water-bath, GILLEXIA. 1C1 and the resilue dissolved in cold water. It thus leses some of the wax, and a iittle of the fatty matter that still adhered to it. It is then mixed with carbonate of magnesia, whereby it loses its gallic acid. is reu:si~lved in alcohol, and evaprrate! to dryness. To obtain pure emetia. magnesia is substituted for the carbonate as-a in the process rust cescrme-.. in such quantity, mat the acid existing in the liquiu may be neutralised, and that which is asst- ciated with the emetia be separate u from it. The precipitate of mag- nesia and emetia must now be washed with cold water to remove the colouring matter, which is art combined with, the magnesia ; and after b-l-r carefully dried it must be treated with alcohol, which dis- solves the emetia. The emetia obtained bv the evaporation of the alc~>hcl must then be dissolved in a dilute acid, and treated with pure animal charcoal. After this purification it must be precipitated by a salifiable base. Impure emetia is in the form oi reddish bro^n. transparent scales : is almost inodorous, and oi a hirer taste. It is verv deliu/uescea-. and soluble in water. Pare emetia has a white, and frequent, v somewhat yellowish appearance, is pulverulent, and does not deli- quesce like the impure. It is but little soluble in cold water : m re so in warm. It dissolves readilv in ether and alcohol. With the acids it forms orystaldsafie compounds, from which it may be pre- cipitated by galls, which are the test agents for touating its edbt- in an ever a ose. Emetia — the impure especially —has been orcr osed as a sabsirute for ipecacuanha, and with this view formulae for ooholual prepara- tions of it have been received into manv of the Pharmacopoeias of continental Europe. It would not seem, how-rer, that much advan- tage would result from its use. and it certainly is far more expensive than ipecacuanha in anv of its forms of preparation. Tne dose of the impure emetia is a grain or a grain and a halt. given at intervals of fifteen or twenty minutes unth it vomits; of the mure emetia. from a quarter to half a grain. 3. GILLE'.VIA. GiFenia is the root cf G.lle'ria trifoliate, Soiree a trifolia'ta, lndi :■•■. Physic. Amr'ican Ixcacuan'ha. Beaurn.nt Root; Sitx. Syst. Icos- a:idriaPc.a>tagynla : Nat. Oao. Rosacea?; — an in -ige nous herbaceous plant, which grows throughout the United States to the east of the Alleghanies from Florida to Canada, in light sods and in shady ana moist situations; and .lowers in Jane arm Jmlv. The root is garner- ed in S ptember. In the valley of the Mississippi, Gille'nia stipAa cec grows. It> root is luce that of me eastern species, and is saic to pessess the same propert.es. As met with in the shops, the root is oi the size ct a small g: : se- quel, wrinkled lo.agir.rnma..\, with cocas.onal transve-se fissm-es. VOL. I.--11 122 SPECIAL EMETICS. and in the thicker pieces having a somewhat knotty appearance, owing to indentations on one side corresponding with prominences on the other. The chief Fig. 5. properties are in the corti- cal portion, which has a bitter disagreeable taste. Its virtues are extracted by the same menstrua as ipe- cacuanha. As one of its names im- ports, its medical virtues resemble those of ipeca- cuanha, for which it is substituted by some. It is not, however, much used, although said to be a mild and satisfactory emetic. The dose of the powder is from 20 to 30 grains, repeated like ipecacuanha at intervals of 15 or 20 minutes until it operates. 4. 8CILLA. —SQUILL Squill is the bulb of Scilla or Squilla marit'ima, Sea on'ion; Sex. Syst. Hexandria Monogynia; Nat. Ord. Liliacea>; which grows on the shores of the Mediterranean — viz. Spain, France, Italy, Sicily, Greece and Africa. It is imported, both in the fresh and dried state, but much more commonly in the latter ; an incentive to which is, that in England, and we believe in this country also, the duty on Giiienia stipuiacca. the dried bulb is no higher than that on the fresh. The fresh bulb is pear-shaped, and consists of concentric lamella?, the outer ones of which are thin, membranous, and of a brownish-red colour, whilst those within are whitish, thick, fleshy and juicy. In English pharmacy, two kinds of squill are met with, — the white and the red, the former of which is preferred. The average SCILLA. 123 weight of the bulb is from half a pound to four pounds, but they have been seen weighing ten pounds and a half. The fresh bulb is kept in dry sand : and before drying it. the dry rind is removed : after which the bulb is cut transversely into thin slices, and dried as quickly as possible with a gentle heat. The dried squill of the shops is in yellowish- white, or white,slightly diaphanous pieces, which are brittle when dry, but generally flexible, owing to their high hygrometric property ; on which account, it ought to be kept in a dry place, or in well stopped hordes. Dried squill is inodorous: and of a bitter, nauseous, extremely acrid taste. It yields its virtues to water, alcohol and vinegar. Its best solvents are dilute alcohol and vinegar, which are consequently useu in various officinal formula?. S 11 1 has been subjected to analysis by different chemists : but the results have not been satisfactory, and it is not aumitted, that the active principle has been isolated. In large doses, souill belongs to the a:ro-narcotic class of vege- table poisons. When given to a less extent, it operates as an emetic, generally producing catharsis also. As an emetic, it is rarely prescribed, exoert in aoibctions of the respiratory organs : over which — as will be shown under the head of Expectorants — it is conceived to exert some special agency. It is rarely, however. given, except in croup, to such an extent as to produce emesis : it is exceedingly uncertain in its action, and the vomiting inuuced bv it is. at rimes, of the most harsh and uisagreeao.e kind. The dose of the powdered squill, as an emetic, is from six to twelve grains : but it is scarcely ever prescribed in this form to the adult; and to children one of the following preparations is selected. If it be desirable to nauseate bv it. one or two grains may be given three or four times a dav. gradually increasing me uose until the effect is induced. TKCTTBA SCULL TIXCTUBE OF ViMl. — (Scill. = iv : Alcohol, dilut. Oij. Prepared either by maceiuau »n or by the process of displace- ment.'. As a nauseant. this tincture mav be given in the d:sr of 30 or 40 drops, two or three times a day. It is rarely, however, pre- s riocu with this view, being generally added to expectorant mix- tures. It is not administered as an emetic. ACE7i.il SCULL VINEGAR OF SQUILL. — {ScilL ©on:. =iv : Acet. de- stillat. Oij.; Alcohol, f. sj. Prepared either by maceration or by the process of displacement.^ Two fluidrachms will usually in- duce nausea. The alcohol is added to prevent decomposition. OITML SCILIE. OIOEL OF SO.riLL— Mel. despumat. ^-riij : Acet. Scillce, Oij. Reduce to the specific gravity 1.32.) Tills prepara- tion is occasionally given to children labouring under croup or o^l- 124 SPECIAL EMETICS. monary catarrh, and repeated so as to induce vomiting. The dose for this purpose is a tea-spoonful given every fifteen or twenty minutes. SYRUPCS SCILLE, SYRUP OF SQUILL. — (^ce^. Scillce, Oj ; Sacchar. ftij.) Given as a nauseant and emetic in the same cases and doses as the last. SYR'UPUS SCILLjE COMPOS'ITUS, COMPOUND SYRUP OF SQUILL — The Mel. Scillce Compositum, or Compound Honey of Squill of the former Pharmacopoeias of the United States. (Scill. cont. ; Senegce cont. aa 3IV. Fig. 10. Antimon.et Potass. Tartrat.gr. xlviij.; Aquce Oiv ; Sacchar. j^iiiss. The water is poured upon the squill and senega. It is then boiled to one-half, and strained; the sugar is added, and the whole evaporated to three pints. Whilst hot, the tartrate of antimony and potasss is dissolved in it. It may also be prepared by the process of displacement.) This prepara- tion is commonly known under the name of Hive Syrup ; and as a formula of the kind was ori- ginally proposed by Prof. J. R. Coxe, it bears the name of Coxe's Hive Syrup. It is much used in domestic practice, and is a fa- vourite remedy in croup and every form of pulmonary ca- tarrh in children. The dose is from ten drops to a fluidrachm, according to the age of the child, repeated every fifteen or twenty minutes until it operates. It is doubtful, however, as else- where remarked, whether this sy- rup have any virtues as an eme- tic not possessed by tartrate of antimony and potassa, or ipeca- cuanha. 5. LOBE'LIA. Lobe'lia Infla'ta, Indian To- badco, or Erne1 tic Weed; Sex. Syst. Pentandria Monogynia: Lobelia inflata. Nat. Order, Lobeliacese ; is an indigenous plant, which is a common weed throughout the United SI>'APIS. 125 States, beginning to flower about the end of Julv and terminating on the occurrence of frost. The plant is collected in August or Sep- tember. "When chewed it produces the same effects as tobacco. Like it, to, it appears to contain an essential oil on which its odour depends, and an acrid or alkaline principle, to which its effects on the system have been considered to be ascribable. To this acrid principle. Mr. Procter, of Philadelphia, who separated it. gave the name Lobelina. He found that the seeds contained at least twice as much in proportion as the whole plant, which yielded only one part in 500. Lobelia imnarts its virtues to the same menstrua as ipecacu- anha. It is a powerful acrc-uarcotic, and has, therefore, to be ad- ministered with caution. On this ac ount it is not often given, in regular practice, as an emetic. The dose of the powder is trom nvc grains to twenty, repeated until it operates. TOCTUR1 LOBE Ul. Tl.XCTTRE OF LOBELIA. {Label. 5iv : Alcohol, dilut. Oij ; prepared either by maceration or bv the process oi displace- ment.) The fal! dose of the tincture, as an emetic, is about half a fluid ounce : but it is sometimes prescribed as an emetic and nar- < otic in asthmatic cases, in the dose off. ?u or f. 3 j, until vomiting is induced. 6. SIX A ?:?.— MO'STARD. Mustard is the seed of S'.na'pis nigra, and o>. alba; Sex. Svst. Tetradynamia siliauosa : Nat. Ord. Cructterae : plants which are in iigeiious in Europe ; but cultivated there as well as in this country, and which rlower in June. It is kept in the shops, b :th in seed, and in fine powder, as prepared, on me large scale, for co i- narv purposes. Black mustard seed are small and roundish : of a reddish or blackish-brown colour externally, and yellow interna.ly. V\ nen en- tire, they are inodorous: but when bruised, the oolour is very pun- gent: taste, bitterish and acrid. The seeds of white mustard are larger, and of a somewhat less pungent taste. Both varieties affbrd a vellow powder, of a somewhat unctions apoearance. When bruised or powdered, the. communicate meir active properties to water, but only slightly to alcohol. Both black and white mustard seeds have been repeated.y sub- jected to chemical analysis, and the results are interesting to the organic chemist, but very little so to the therapeutist. Y\ aen black mustard seed are subjected m pressure, about d> per cent, of rixed oil is obtained, which has a faint smell of mustard, and a mild oily taste, and which has been used as a cathartic anu anthelmintic. On distillation with water, a volatile oil is obtained, which is exceed- ingly acrid, and contains a portion of salpnur. This oil, it appears, 11* 126 SPECIAL EMETICS. does not pre-exist in the seeds, but is produced by the action of water. White mustard seeds contain more fixed oil than the black, but they cannot be made to yield any volatile oil. Their activity ap- pears to be owing to a non-volatile acrid substance, which does not exist ready formed in the seeds, but is readily formed in them under certain conditions. It was affirmed many years ago, by MM. Trou- peau and Blanc, that the irritating property of black mustard is dimi- nished by the addition of vinegar, which is very often used in form- ing sinapisms ; and that a mixture of concentrated acetic acid in certain proportions with black mustard powder is wholly inert, although either one or the other would act as a powerful excitant, if used — the former with water, and the latter undiluted. The vine- gar and acetic acid, in these cases, have the effect of preventing the development of the acrid volatile oil. Some interesting expe- riments have been made on this subject, by two recent writers on therapeutics and materia medica, — MM. Trousseau and Pidoux, who found : First. That there was no notable difference between mustard pounded eight days before it was used, and that which had been pounded five months before. Secondly. That a sinapism prepared with hot water, acts more rapidly than one prepared with cold water ; but at the end of a few minutes this difference no longer exists. Thirdly. That mustard mixed with water acts with greater energy than that which is mixed with common vinegar, weak acetic acid, and concentrated acetic acid; and that reciprocally, acetic acid, mixed with mustard, loses of its activity. These gentlemen add, that the admixture with vinegar appeared to have no effect on En- glish mustard — a discrepancy which they express themselves unable to explain. It has been suggested, however, by Dr. Pereira, that this may perhaps be referable to the fact that common English flour of mustard contains pod pepper, the active principle of which (cap- saicin) is soluble in vinegar. It does not appear that the same dete- riorating influences are exerted on white mustard. The medical properties of mustard, are those of an acrid excitant. When it meets with water — as already remarked — volatile oil is developed, which is the occasion of the acrid vapour, that arises when flour of mustard and hot water are mixed together. Mustard seeds bruised, or the powder in the dose of a large tea- spoonful, will generally operate as an emetic, and have been es- teemed useful, where it has been considered advisable to rouse the sensibility of the stomach,— as when narcotic poisons have been taken in malignant cholera, and in certain forms of paralysis. It is more frequently, however, diffused in warm water, and administered to aid the operation of other emetics. 7. TAB'ACUM. — TOBAC/CO. The leaves of JVicotia'na Tab'acum — Sex. Syst. Pentandria Mo- nogynia ; Nat. Ord. Solanese or Solanaceao. — are the officinal por- TABACCM. 127 tion of the plant, so well known owing to its extensive cultivation in this country, and to its employment in most parts of the globe. It imparts its properties to both water and alcohol : but long boilina destroys them, and, accordingly, the extract is devoid of all the virtues of the plant. Tobacco has been subjected to analysis by many chemists; the result of which would seem to show, that the two main active prin- ciples are — a peculiar oily-like alkaloid, called dMcoti'na, cr d\?C0'- tia ; and a camphoraceous volatile oil termed S\lco'tianin, Concrete volatile oil of tobacco, and Tobacco camphor. INicotia belongs to the same class of principles as conia, and closely resembles it in chemi- cal properties. It appears to be the most active of the constituents. When tobacco is distilled at a higher temperature than that of boiling water, an empyreumatic oil is formed, under new combina- tions, which is most virulently poisonous. This od is formed in the pipe of the smoker, and is associated with nicotia. In large doses, tobacco is one of the most violent acro-narcotic poisons. In smaller, it occasions vomiting accompanied by the most deadly sickness and sedation. Hence, its use in cases where great relaxation is necessary. Its powerful nauseant and emetic operation, as well as its effect on the nervous system, is well seen in those who attempt to chew or to smoke it for the first time. Even when given in glyster, or applied to abraded surfaces, it has caused death ; and a tobacco cataplasm applied to the pit of the stomach has succeeded in inducing nausea and vomiting : more especially where other emetics have been taken previously. As a nauseant, and^ therefore relaxant, it has been employed in various forms of colic, constipation and strangulated hernia ; and its operation is generally attended with nausea and giddiness. In these cases, it is thrown into the rectum either in the form of infusion, or of smoke ; and in strangulated hernia especially, it has proved effec- tive, after blood-letting, tartrate of antimony and potassa, and other sedative relaxants had been used in vain. In like manner it has been prescribed in retention of urine, tetanus and other spasmodic diseases, — wherever, in short, it is important to produce powerful sedation, or to relax spasms. Still the fatal results, occasionally supervening on its employment, must be borne in mind, and it must not be used except in cases which have resisted other means. This is probably the cause, why both the physician and the surgeon pre- scribe it rarely. Tobacco has been given as an emetic, in the form of snuff. —five or six grains constituting a sufficient dose; but it is rarely prescribed in this shape. LNFrsni TAB ACT, INFUSION OF TOBAC CO —(Tabac. X\. ■ Ague? bul- lient. Oj.) This is never used except as an enema to produce re- laxation. It is safer to inject only one half; and if the relaxant effects be not induced in half an hour, to throw up the remainder. 128 SPECIAL EMETICS. It must be borne in mind, that a smaller quantity than half a drachm has proved fatal. TAB'ACI, WINE OF TOBAC'CO.—(Tabac. concis. gj.; Vim. Oj.) This preparation has been more frequently employed as a diuretic, but it is capable, in repeated doses of thirty or forty drops, of inducing nausea. A cataplasm is sometimes made of common snuff and ce- rate, and has been applied to the throat and breast in cases of croup; and Dr. Wood states, that one of the worst cases of spasm of the rima glottidis which he had seen, and which had resisted powerful depletion by the lancet, yielded to the application of a tobacco cata- plasm to the throat. The infusion of tobacco has, likewise, been employed with advantage as a bath in tetan- ic and similar neuropathic affections, and also the cigar in the case of those who have been unaccustomed to its use. 8. SANGUINA'RIA. — BLOOD- ROOT. Fig. 7. Sanguinaria Canadensis. Sanguinaria is the root of Sanguina'ria Canadensis, Blood-root, Puccoon, Indian Paint, Tur'meric; Sex. Syst. Polyandria Monogynia; Nat. Ord. Papaveracese; an herba- ceous perennial plant, which flowers early in spring, and grows abundantly in every part of the United States. The root, which is the only officinal portion, when dried, is in flattened pieces, much wrinkled and contorted. The fracture is spongy and une- ven, — its surface being at first bright orange, but becoming, by exposure, of a dull brown colour. It has a bitterish acrid taste, and imparts its virtues to water and alcohol. An active principle — Sanguina- rine—has been obtained from it, which is alkaline, and con- sidered to possess all the vir- tues of the root. It is said to lose its virtues rapidly by keeping. ANTHEMIS. 129 Bloodroot is an acrid emetic : and, in large doses, belongs to the class of acro-narcotic poisons. It is not often employed as an emetic. The cose of the powder, with this view, is from ten to twenty grains. It is recommended, that it should be taken in pill by preference, in consequence of the great irritation of the throat produced bv the powder when swailoweu. Wood and Bache.) It may also be pre- scribed in infusion. (Smguinarice =ss ; Aq. fervent. Oj.) of which the dose may be a tame-so xinful or two. _ TlNCTTBi SANGCNA'RLIfh TINCTURE OF BLOODROOT. — !&nguinar. cont. ."-.-.-: Alcohol, dilut. Oij. Prepared by maceration or bv the process of displacement.) The dose as an emetic is f. ^iij. to f. "iv. but it ^ not often administered as such. 9. ANTHEM IS.—CHAM'OMILE. Chamomile is the flower of An'themis nofbUis; Sax. Syst. Svn- genesia Polygamia Superrlua; Nat. Orb. Ccunpositae Corvmbiferao, a plant which is indigenous almost everywhere in temperate Europe. The flowers become double by cultivation; and hence those which are tound in the shops, and which are imported from Germany and England, are of this character. It is cultivated largely around London for the market of that citv. With the view of producing emesis. hut one preparation of cha- 130 SPECIAL EMETICS. momile is ever given, — the tepid infusion ; and it is rarely pre- scribed except with the view of aiding the action of other emetics, or m cases where there is a disposition in the stomach to relieve itself spontaneously. INFU'SUM ANTHEM'IDIS, INFU'SION OF CHAMOMILE, (Anthemid. ^ss ; Aqua bullient. Oj. Dose, as an emetic, f. giv. The infusion—Chamo- mile tea — is generally, however, made extemporaneously in domestic practice. 10. HYDRAR'GYRI SULPHAS FLAVUS —YELLOW SULPHATE OF MER'CURY. This salt of Mercury, called also Subsulph'ate of Mer'cury and Tur- Fig. 9. pcth Mine'ral, is ob- tained by throwing a sulphate of mercury into boiling water. It is a lemon-yellow powder, almost inso- luble in water ; dis- solving in about 2000 parts of cold water, and in about 600 parts of boiling wa- ter. Yellow sulphate of mercury is in large doses a violent cor- rosive poison. It is occasionally, but rare- ly, given as an eme- tic ; its operation be- ing very severe, and at times followed by ptyalism. Exciting greatnausea and pow- erful retching,it would be much employed in cases in wh ich a strong revulsion is indicat- ed, were it not that its action is so harsh, and unmanageable. The dose as an eme- tic is from two to five Erythronium Americanum. grains. EUPHORBIA COROLLATA. 131 U. SO'DII CHLO'RIDUM — CHLORIDE OF SODIUM. When common salt — whose properties are described under the head of Cathartics—is taken in the dose of a table-spoonful or more, it excites vomiting ; and during the visitations of epidemic cholera, it was preferred by some practitioners to other emetics. It has also been given in cases of narcotic poisoning, where neither the stomach-pump nor other emetics were at hand. A few other indigenous substances that act as emetics have been admitted into the secondary list of the Pharmacopceia of the United States, viz: 12. Apoc'yxum axdros^vmifo 'lium, Dogsba ne : Sex. Syst. Pen- tandria Digynia ; Nat. Ord. Apocynaceae; a plant which flourishes in every part of the Union, flowering in June and July, and is emetic in the dose of thirty grains of the dried root. 13. Ascle'pias Ixcarxa'ta, Flesh coloured Asclepi'as•; Sex. Syst. Pentandria Digynia ; Nat. Ord. Asciepia- f i? 10. daceae; flowering from June to August. The root has been used as an emetic and cathar- tic. 14. Erythro'xioi, Dog's Tooth Violet; Sex. Syst. Hexandria Monogynia; Nat. Ord. Liliaceae: which grows throughout the Northern and Middle states; flowering in April and May : the root and herb being officinal. Dose, as an emetic, twenty or thirty grains of the recent bulb. 15. Euphor'biaC - rolla'ta, Blooming or Lo.rjc flowering N/m/g-. Milk weed; Ska. S\ :>t. Douecan- dria Trigvnia: Nat. •BiBiiojojsiq.iGqdoa Ord. Euphorfiaceoe; which grows in various parts of the United ■v7t i. •*• 132 CATHARTICS. States, flowering in July and August; and the dried root of which is emetic in the dose of from ten to fifteen grains. 16. Euphor'bia Ipecacuan'ha, Ipecacuanha Spurge, American Ipecacuanha, which flourishes in the Middle and Southern states, blooming from May to August; and the dried root of which is emetic in the dose of from ten to fifteen grains. 17. Phytolac'cje Radix, Poke root — the root of Phytolacca Decan'dra; Sex. Syst. Decandria Decagynia; Nat. Ord. Phytolaceee; which is emetic in the dose of from ten to thirty grains; but is slow and protracted in its operation, apt to act upon the bowels, and in very large doses to induce symptoms of acro-narcosis. It is there- fore not often used. II. CATHARTICS. Syttox. Dejectoria, Eccathartica, Hypactica, Lapaclica, Jlpocathartica, Coprocritica. Definition of cathartics—Effects they are capable of inducing—Organs on which they act—Divided into laxatives and purgatives—Drastics—Abuse of cathartics—Glys- ters—Suppositories—Therapeutical application—In fevers—In inflammatory disor- ders—In hemorrhage—In the neuroses—In dropsies, &c. Special cathartics. The simplest definition of cathartics is—"agents that increase the number of alvine evacuations." Certain writers on Therapeutics have endeavoured to incorporate in the definition their modus oper- andi; and, in a modern work, the definition is still farther, and with less propriety, extended, — so as to include other effects which they may or may not induce. Thus, the Messrs. Schroff define them to be;—" Medicines, which, by augmenting the secretion and pe- ristole of the intestinal tube, occasion the evacuation by the anus of ac- cumulated and noxious matters:" but it is obviously not necessary for the induction of catharsis, that there should be any accumula- tion — physiological, pathological, or noxious— in the bowels. The definition is, consequently, faulty. There is no class of medicinal agents possessed of more valuable properties, and none more abused. Exposed, as the digestive or- gans are, to the most heterogeneous and often irritating substances, and liable to have their tone injured by alternations of stimulation, and the opposite condition, accumulations of food as well as of secre- tions are apt to occur, which demand the use of cathartics: their effect, too, is not confined to the mucous membrane of the alimentary tube : through the nerves, it is propagated elsewhere, so as to re-act on'organs, situate at a distance from the seat of the impression. To fully comprehend the effects which cathartics are capable of CATHARTICS. 133 inducing, it may be well to consider briefly the organs and tissues on which their operation is immediately exerted. The mucous coat of the small and large intestines is an extension of that of the stomach, and, with some modification, of that of the supra-diaphragmatic portion of the digestive tube ; and this, again, may be looked upon as an extension of the cutaneous envelope of the body. Like the mucous lining of the stomach, that of the small intestines is a part of the surface of relation, and impressions made upon it are probably conveyed, with equal facility", to the great nervous centres. Hence it is, that it has been regarded by M. Broussais as the seat of many important diseases, of a febrile charac- ter especially. In the mucous coat are situate many of those mucous follicles, which, in consequence of their having been described by Brunner, Peyer, and Lieberkuhn, have been called after those observers. Their function is to secrete mucus for lubricating the mucous mem- brane ; but, of late, their importance in the economy has been ex- aggerated by some : and. as has been previously remarked, they have been looked upon as the seat of many of those ataxic and adynamic fevers, which Broussais refers to the mucous membrane generally. It does not appear probable, that these small follicles can be so inti- mately associated, in their morbid derangements, with the great vital organs, as to give occasion to the diseases, that have been ascribed to them. Their function seems to be similar to that of the sebaceous follicles of the cutaneous envelope, and they have not perhaps any great agency in the causation of disease. Frequently, on dissection, they are found considerably enlarged, and this is. doubtless, often owing to their forming part of the lining of the tube, as Broussais has suggested. At other times, they are enlarged and ulcerated, and thus become one of the expressions of typhoid fever, but not the essence of it; as the eruption of measles or scarlatina is only one of the expressions or manifestations of those diseases. The mucous membrane, besides the secretion from the follicles, exhales the ordinary halitus of the mucous membranes, and the two together are to a considerable amount. The daily quantity, indeed, of the liquor entericus or succus intestinalis, as it has been called, was estimated by Haller at probably far beyond the truth. In addition to this humour, the upper part of the small intestine receives the secretions from two important organs.—which, from their presumed agency in chylosis. have been termed assistant chylo- poietic viscera, — the liver, and the pancreas, whose ducts open to- gether. From the upper portion of the small intestine more especially, the chvliferous vessels arise :—this part of the tube must therefore be regarded as the great seat of chylosis or chylification. It is not until the fa?ces have attained the lower part of the small intestine, or the commencement of the large, that they attain the full vol. i.—12 134 CATHARTICS. faecal odour. This is not produced altogether by the reaction of the elements of the food upon each other, but by a peculiar secretion ; so that alvine discharges, possessed of the faecal odour, may take place, even when little or no food has been taken ; and, in the course of febrile affections, it becomes important to remove those, should constipation arise, as they are capable of inducing as much irritation as if they were the product of the digestion of alimentary matter. So long as life persists, secretions are poured into the ali- mentary tube throughout its whole extent from the lining mem- brane, as well as from the liver and pancreas; and if these are per- mitted to remain in the canal, they become the foyers of irritation, and mischief. The argument, often urged, — that it is not neces- sary for the bowels to be kept open in morbid cases, because no food has been taken, — is therefore erroneous. Although in the upper portion of the small intestines an arrange- ment of the mucous coat exists, calculated to detain somewhat the aliment in its course downwards, and to extend the surface for the origin of chyliferous vessels, in no part of its extent does it pre- sent the character of a reservoir. The opposite to this is the case with the large intestine. Its saccated arrangement clearly shows it to be destined for the detention of the faecal matters, until they have accumulated to such an extent as to give rise to the necessity for the act of defecation. In these saccated portions, the faeces are occasionally retarded, become indurated, and adhere to the mucous membrane, so as to excite irritation; and, when evacuated, they are in the form of small rounded masses, to which the name scybala has been given. The whole of the intestinal canal is more or less endowed with the vermicular, oscillatory motion, which has been called peristole, or peristaltic action. This motion is under the influence of the ganglionic nerves, through which the muscular coat of the tube is excited to contraction, and the degree in which contraction occurs is greatly connected with the mode in which the function of diges- tion is accomplished. Lastly, it is important to keep in view, that various organs are contiguous to the alimentary tube, whose functions are susceptible of modification by agents that affect it. Reference has already been made to the liver, and pancreas ; and it will be found, that the uterus can, in this way, be considerably modified in its actions. As regards the effects of cathartics on the intestinal canal, much difference exists according to the nature of the agent, and the dose in which it is exhibited. When the lining membrane is but slightly stimulated, chylosis may be augmented, and a laxative tendency be induced ; if it be more stimulated, the exhalation from it may be increased, and the irritation be extended by the sympathy of contiguity to the muscular DIGESTIVE APPARATUS. 135 coat, so that there may be a slight increase in the peristole; and it the specific stimulation be yet greater, both the exhalation and the peristole may be largely augmented. The effect of a mild cathartic may be almost wholly restricted to the evacuation of the tube, and but litde etfect be exerted on other organs, or on the general system. The first evacuations which re- sult from its operation consist merely of the contents of the intes- tines : those that follow are mixed with the secretions of the canal. and of the liver and pancreas, with the drinks that have been taken : and at times, fluids — as soups—maybe readdy detected in the discharges. Yet, as the appearance of an unusual quantity oi bile, in the matters ejected by vomiting, may merely be an evidence that the excitement accompanying emesis has caused a greater secretion of bile, so — it must be borne in mind — the alvine discharges may assume an unhealthy bilious character under the operation of a cathartic, owing solely to the irritation it induces in the various se- cretorv organs of the digestive apparatus. When the mild chloride of mercurv, for example, is administered as a cathartic, it irritates the lining membrane of the duodenum, and this irritation extends along the biliary ducts to the liver, the secretion from which is aug- mented. At the same time, it irritates the different follicles of the canal, and the exhalants generally, so that evacuations are occa- sionally induced by it, which resemble chopped spinach, and which are regarded by some as indicating that it has succeeded in in- ducing a new action in the mucous lining of the digestive tube. It can, hence, be understood, that after the operation of calomel, or of any purgative, whose action is chiefly exerted on the upper portion of the intestines, there may be a greater quantity of bile in the eva- cuations, without our being justified in inferring, that the individual is bilious; and that the increased flow of bile is occasioned by the purgative mav be proved bv discontinuing its use for some days. when the signs of bile in the evacuations will cease, and be repro- duced, when it is resumed. It has been mentioned, that the mild chloride of mercury affects the upper part of the intestinal canal; and the same may be said of rhubarb, colocynth, inc. There is, indeed, a singular preference on the part of different cathartics for different portions of the tube ; some, — as the articles enumerated, — acting on the upper part ; others, — as aloes, — on the large intestines, and especially on the colon and rectum ; and others,—as the saline and oily,— affecting the whole tract of the intestines. Accordingly, a selection may be made so as to suit the particular view of the practitioner. At times, too, it is desirable to at on other organs through the intestinal canal, by means of sympathy ; as wben we wish to affect the liver or pan- creas. — in which case cathartics are chosen, that act upon the part of the tube into which their ducts enter. — or the uterus, when one is selected that acts by preference on the lower portion of the tube. and affects the uterus by sympathy of contiguity. It is in this wav, indeed, that aloes has acquired its reputation as an emmenagogue. 136 CATHARTICS. Cathartics act not only on the bowels but on parts at a distance. Every portion of the organism is capable of being impressed by them. They are amongst the most generally useful, and applicable revel- lents that we possess ; and, when given to such an extent as to cause hypercatharsis, they rapidly reduce the powers of the system, — less, perhaps, by the copious exhalation of the serous portions of the blood, which they cause from the lining membrane of the intes- tines, than by the sympathy that exists between them and the vital organs. Reference has been made more than once to the destruc- tive influence exerted on those organs by irritation — often unmarked by prominent symptoms — in the intestinal tube. It is by their mixed depletive and revulsive action that they become useful sorbe- facients in hydropic affections, and cases of rapid disappearance of dropsical effusions under their operation are often witnessed. Cathartics differ greatly from each other in their mode of operating. Some gripe much ; others not at all. Some operate many times, others rarely more than once ; although much, in this respect, de- pends upon the individual. Pharmacologists have generally divided them, — according to the intensity of their operation, — into laxatives, purgatives, and drastics, under which all the articles may be arranged. To these may be appended another division — that of enemata. The ancient humorists, who considered, that most diseases were produced by the predominance of some particular humour, which needed evacuation, and that particular cathartics were eminently endowed with the power of fulfilling these objects, divided them'into hydra- gogues, phlegmagogues, cholagogues, and pantagogues or panchyma- gogues, according as their operation was exerted more especially upon the watery portions of the blood, on phlegm, on bile, or on the whole of the secretions from the tube collectively. The division of cathartics into laxatives and purgatives is con- venient, and not inappropriate. Laxatives gently stimulate the mu- cous coat of the intestines, and augment the peristole but little : hence, they are well adapted for cases in which the sole indication is to unload the bowels of their contents. Some of them produce their effects entirely in a mechanical manner. Corn bread, for ex- ample, proves laxative, in consequence of the mechanical attrition of the particles of husk left mixed with it on the mucous membrane. In the same manner, bread, made of unbolted flour, is laxative, and becomes proper, in the way of diet, when there is torpor of the diges- tive function ; hence it has attained the name " dyspeptic bread" Other laxatives, again, are special local stimulants, or affect the mu- cous membrane by their medicinal properties, — as sulphur, mag- nesia, &c. These, when given in a much larger dose than usual, may still be but laxative. They do not induce full catharsis ; and are, therefore, separable, with propriety, from the division of purga- tives, many of which cannot, in the most minute dose, be made to act as laxatives. Purgatives produce their effects like laxatives, but their operation is more powerful. They excite a copious exhalation from the mu- GENERAL EFFECTS. 137 cous Itning of the intestines, and augment the peristaltic action to a greater degree. It is in consequence of the evacuation of warerv matters, produced bv the operation of purgatives, that thev are used as depletives in febrile, and inflammatory affections : ana. from the excitation they occasion in the abdominal nerves, they are energetic revellents. This excitation is often shown in the tormina and irrita- tion that precede and accompany their operation. The more violent purgatives have been termed drastics. They produce a greater degree of irritation in the lining membrane of the intestines, and occasionally act upon the nerves ot the stomach so as to induce nausea, and even vomiting. They belong generally to the resinous or resino-extractive substances, and one reason, why they excite such violent tormina, appears to be. that they are sparingly soluble, and adhere to the mucous coat, from which they are tardily detached. This view is corroborated by the circumstance, that if we add any substance to them, which aids their solubility, the grip- ing may generally be prevented, or considerably mitigated. After all, however, the division of cathartics into laxatives and purgatives, although generally convenient, and not inappropriate, is not always so. Much depends upon the individual, and hence a laxa- tive may purge drastically, whilst a drastic may scarcely purge at all. Still, these are exceptions. Cathartics usually produce their full effect without being absorbed: they are altogether local stimulants to the mucous membrane of the intestines, and through it to the muscular coat. Yet, they can act by the way of the circulation, and the fact is another instance of the singular preference, exerted by medicinal agents for certain parts of the organism, rather than for others. When a respectable physician, Dr. Hale, of B^-on, injected castor oil into his veins, he speedily felt an oily taste in his mouth, which continued for a length of time, and the medicine acted powerfully as a cathartic. Croton oil, when placed on the tongue of an apoplectic, in whom deglutition is im- practicable, produces its ordinary cathartic operation. Rhubarb exerts the same agency when applied to the skin; and the milk cf a wet-nurse, who has taken infusion of senna, rhubarb or other cathar- tics, may ac* upon the intestinal canal of the child. As a general rule, the action of cathartics is in a direct ratio with the dose within certain limits. S::ne. however, are so potent, that it is almost impracticable to reduce them to the point at which they are simple laxatives. Elaterium is one of these. On the other hand, there are agents, whose operation is altogether so gentle, that if given to any amount, they will not be drastics. Such is the case ~.mth manna, magnesia, sugar, and olive oil. Their operation is always that of gentle cathartics or laxatives. There are substances, again, i-'f this class, whose operation in a full dose is more violent than that which is considered to characterise the action of laxatives, and which, when given in a much larger quantity, exert no mere energy. Such is the general fact with calomel, castor cil. and rh-ioarb. ihe 1:2* 138 CATHARTICS. effect of these cathartics is commonly, indeed, but little understood, or, if understood, but little attended to. A tea-spoonful or two of castor oil is often sufficient to evacuate the bowels, not only in health, but in chronic febrile and other affections,— where the object is simply to produce such evacuation. Exceptions, indeed, occur to this, but the rule is not the less general; and it is important to bear it in mind, inasmuch as the stomach is often extremely irritable, and but little adapted, in those affections, for the reception of a consider- able quantity of indigestible oleaginous matter. Given in these small doses, it is one of the best cathartics we possess for keeping the alimentary canal clear, when there is irritation of the gastro-enteric mucous membrane, as in gastric and other fevers. It has been main- tained, indeed, by Rasori and others, that the action of all cathartics increases in a direct ratio with the dose within certain limits only, and that beyond these, the opposite is the fact,— the evacuant power being, in other words, directly as the dose up to a certain point, and inversely as the dose beyond that point; that in the latter case they may act as sedatives without producing any cathartic effect what- ever; and that, consequently, most purgative medicines maybe con- sidered not only as simple evacuants, but as antiphlogistics or se- datives. To this subject, however, reference will have to be made under the individual articles of the class, and especially under Calo- mel, where the difference of action according to the dose is more strongly marked perhaps than in the case of any other cathartic. Substances, when largely divided, so that fresh and fresh portions come into contact with the lining membrane of the digestive tube, generally act with more efficiency, than when they are given in such form, that the cathartic touches in bulk the surface on which it has to operate. Thus, an ounce of the sulphate of magnesia, dissolved in half a pint of water, and taken by tea-spoonfuls, at short intervals, will induce a greater action than if the whole solution were swallowed at once. This fact is elucidated by a case, which the late Dr. James Gregory, of Edinburgh, was in the habit of relating in his lectures. A boy was directed to take an ounce of Epsom salts, but, having a strong objection to the taste of the cathartic, he resolved to form it into pills with crumb of bread. On making the pills of an appro- priate size, he found they amounted to three hundred and sixty, a number corresponding so nearly with that of the days of the year, that he determined to make it correspond entirely. Accordingly, he divided them into three hundred and sixty-five portions, and took them one after the other. The effect was extraordinary. The most violent hypercatharsis was induced so as to endanger his life. This was owing probably to the gradual and successive breaking down of the pills in the stomach, so that particle after particle came in con- tact with the mucous membrane, and exerted its specific effect. We can thus understand, that a saline cathartic, dissolved in a large quantity of water, may act more powerfully than if the quantity of the solvent were less. In many of the saline mineral waters, GENERAL EFFECTS. 139 which are employed as cathartics, the quantity of saline ingredients is extremely small. A pint of Seltzer water is found to con- tain but five grains of carbonate of magnesia and seventeen of chlo- ride of sodium. The same measure of Spa water contains nine and a half grains of carbonate of magnesia, and one quarter of a grain of chloride of sodium. The Aix-la-Chapelle water has five grains of chloride of sodium to the pint ; the Balston, five grains of carbonate of magnesia, and eighteen of chloride of sodium : the Bedford, one and a half grain oi chloride of sodium, and ten grains of sulphate of magnesia ; and the Congress spring, at Saratoga, twelve grains of carbonate of magnesia, and fortv-eight grains of chloride of sodium. Many of the resinous purgatives excite much griping during their action, — apparently — as observed above — by adhering to the mucous lining, and acting as violent irritants ; hence corrigents are required to remove the disagreeable accompaniments of their ordinary operation. These may consist, — either of substances, which add to their solubility ; — of agents, which, by augmenting the peristole of the canal, hurry on the cathartic, so that it does not remain, for any length of time, in contact with any one portion of the mucous mem- brane ; — or of such as shield the intestinal canal against its irritating influence. As a general rule, the soluble cathartics act more speedily than the others ; yet, the cathartic oils are exceptions to this, for they are scarcely, if at all, soluble, — undergoing little or no change in the stomach. Castor oil becomes mixed with the various secretions and substances in the alimentary canal, and is divided into small filaments, so as occasionally to deceive the practitioner. Some years ago, J. P. Frank was requested to see a prince, who had been attacked with epilepsy. His physician, a respectable old practitioner, assured Frank, that he could at pleasure make his patient void thousands of filiform worms. As he was neither able to define the genus, nor species of these worms, the quantity of which, from his account, was prodil'ATA. Cathartics may, likewise, be exhibited to act on the lower part of the intestinal tube bv direct application. In this form, they are termed cathartic clysters, enemata, or lavemens. When thrown in contact with the lining membrane of the rectum they irritate it: and. by sympathy oi continuity, their influence is extended to the upper portion of the tube. Hence, thev may be administered with auvan- tage. when cathartics cannot be easily given by the mouth, as where deglutition is impracticable. Accordingly, in apoplexy, trismus, ice. this is a mode of exhibiting purgative and other remedies often had recourse to. It is obvious, too, that glvsters may be given with ad- vantage to aid the operation of cathartics ; and. in cases oi extreme debility, in which apprehension is entertained, that cathartics, ad- ministered in the ordinary mode, may act too powerfully, glvsters can be advantageously substituted. Thev are most valuable agents, and. until of late, have been too little employed in this country, as well as in Great Britain ; but, on the continent of Europe, they form a part of the boudoir of every female, and are regarued indispensable to cleanliness and to health. In the M:?.:de Lnaginaire of Moliere, Argan enters on the stage, reading his apothecary:s bill, — in which the clyster and its adaptation occur over and over again,— without any feeling of outraged delicacy on the part of toe auditors ; whilst with us the slightest allusion to the operation or the instrument cannot be mentioned to ears polite. Even cold water, thrown into the rectum, excites the peristole oi* the intestines, and produces a salutary effect in inflammation of the lining membrane: — the cooling influence being propagated, upwards, by virtue of the extensive sympathy that exists between every part of the capillary surface. In the same manner, warmth can be applied so as not only to act as a fomentation to the parts with which the material of the glyster comes in contact, but to have the southing effect extended to parts above ; and, by means of contiguous sym- pathy, to organs seated in the vicinity of the lower portions of the tube. With both these views enemata are administered, but they 144 CATHARTICS. are chiefly used for the purpose of stimulating the canal, so as to occasion the evacuation of its contents. For this purpose, warm water, soap and water, salt and water, molasses and water, or gruel with the addition of salt or castor oil, are generally the selected vehi- cles ; and if the desire be to excite considerable revulsion in the rec- tum, oil of turpentine may be added, either formed into an emulsion with the yolk of egg, or simply mixed with the gruel or other con- stituents of the enema. At times, where the idea exists, that consti- pation is the effect of spasm in some part of the canal, the tobacco glyster is administered. This may be given either in the way of infusion or of smoke, which latter may be thrown up through an or- dinary tobacco-pipe ; — the tobacco being placed in the bulb. It is then ignited, and the bulb being put into the mouth, the smoke can be readily forced into the intestinal canal, by blowing through the tube. The exhibition of tobacco, in either mode, is attended, how- ever, with danger, and therefore it ought only to be had recourse to with great caution. Cases, as elsewhere remarked, are on record of fatal results from an infusion of the strength directed in the pharma- copoeias. When glysters are administered by the ordinary bag and pipe, they rarely go farther than the rectum, and may therefore fail altogether in their operation. The syringe, employed of recent date, is capable of propelling the enema farther; but, at times, it also fails, especially where there is any obstruction at the termination of the sigmoid flexure of the colon, as is not unfrequently the case. Dr. O'Beirne has very properly directed attention to this point in the pathology of defecation, and has advised, that an elastic gum tube, like the ordi- nary stomach tube, should be gently insinuated through the narrow portion at the sigmoid flexure, until it has entered the colon ; in this way, liquid faeces or flatus are occasionally brought away after every ordinary remedy has failed ; and by attaching the external extremity of the tube to the stomach pump, an enema may be projected into the colon, and prove effectual, when the ordinary enemata, as usually exhibited, may have been administered in vain. Some years before the appearance of Dr. O'Beirne's observations, the author had an interesting case of obstruction of the bowels, in an aged individual, who, for almost the whole period of his existence, had held an honourable situation in his country's service. In this case, the colon appeared to be much distended by flatus. Injection after injection was thrown up by the only means at hand — the bag and pipe—but no relief was obtained. The symptoms became more and more urgent. Under these circumstances, the idea oc- curred, that if a hollow instrument could be passed up until it reached the part of the colon above the seat of the constriction, relief might be obtained. Accordingly, a large sized elastic-gum male catheter was passed, with some difficulty, through the sigmoid flexure, and as soon as its extremity attained the colon, a considerable discharge of fetid gas took place, and relief was instantaneous. This agency suppositories. 145 would probably be completely successful in affording relief, in those cases in which it has been recently advised to force air into the in- testines for the removal of colic occasioned by the presence of air in the intestines; — a plan of treatment, by the way, which is minutely described by Swift, and the invention assigned to a medical philo- sopher of the Academy of Lagado. The quantity of fluid to be administered in the way of enema must vary according to age, and other circumstances. For an in- fant, a few ounces may be sufficient; for an adult, from a pint to a quart; but if the desire be to wash out the colon, a considerable quantity may be necessary. In all cases, when given to produce a cathartic operation, the fluid ought not to be sent in too rapidly, as it is apt to excite the rectum to action, so as to occasion its imme- diate return, bringing along with it only the contents of that gut. The enema ought to stay long enough to excite, by sympathy, the whole tract of the large intestines at least: and, therefore, if it comes away in a few minutes — and especially if the discharge has but little faecal matter mixed with it — it ought to be repeated. StTPPOS'lTORIES. It has been already remarked, that glvsters are excellent revel- lents, when composed of materials possessed of excitant properties. The same may be said of suppositories, which are special excitants, or ordinary excitants, according to the ingredients of which they are composed. In early infancy, they are often employed to open the bowels, and are usually composed of turpentine soap, — a small conical piece, moistened, being forced up into the rectum, and left there, when it generally produces a free evacuation of the lower part of the canal. At times, the soap is smeared over with castor oil; at others, with turpentine, to add to the cathartic effect. In this way. as well as by glyster. any medicinal agent may be brought to affect the rectum ; and accordingly, cathartics, opiates, &c, are often so administered. It has been proposed to introduce a kind of galvanic suppository, made of two metals — zinc and copper — into the rectum, for the removal of constipation, and this has been attended, in some cases, with good effects: not, probably, in consequence of any speciuc ex- citation oi the nerves of the rectum by galvanism, but by its acting as an ordinary excitant to the nerves of the mucous membrane. Another mode of employing the galvanic excitation is by forming a connection between two different metals ; one being introduced into the mouth, the other into the rectum ; but this apparatus is net possessed of more energy than the first, and both are perhaps largely indebted for their action to the local excitation which their presence in the rectum engenders. The public and even the profession have been amused by various instruments, invented for the application of galvanism to different parts of the body : and if their efhcacv on the 146 CATHARTICS frame have not been well marked, they have not failed to minister to the pockets of their inventors. Dr. A. T. Thomson remarks, that the peristaltic action of the in- testines may be increased by various external means; and, of these, he instances the electrical aura as highly useful in " simple torpor of the gut;" and the dashing of cold water on the lower extremities, which has succeeded in procuring the immediate evacuation of the intestines " in obstinate costiveness, particularly in the case of ileus, when all other means have failed." Both these agents produce their effect less as special excitants, than by modifying the nervous distri- bution. We have already seen, that there are many nervous modi- fications,— those through the influence of the mind especially,— which act upon the intestinal canal, so as to produce catharsis. Therapeutical Application of Cathartics. The therapeutical application of cathartics will now be intelligi- ble. They may, of course, be employed with various objects: — either to act as simple evacuants, as depleting agents, or as revel- lents. Fever. — In the disordered state of functions, constituting gene- ral fever — whatever may be its variety — their use is, throughout the disease, more or less indicated. In the state of erethism that exists in every portion of the dermoid structure, morbid secretions are necessarily formed, which, if not removed, act as fomites and induce irritation ; yet although cathartics of a mild kind are needed to keep the intestinal canal free, it is — as has been before observ- ed— a great mistake to irritate the lining membrane of the intes- tines by drastics, in diseased conditions in which the absence of all irritation — mental as well as corporeal — ought to be inculcated ; and this remark applies especially to fevers, which are apt to be ac- companied by unusual irritation in the mucous membrane of the sto- mach, and small intestines. The plan to be pursued in such cases seems to be clearly indicated, — to attack the local inflammation, and the general increased action, by bleeding—general and local — and by the use of refrigerants; to keep the canal free by cathartics of the mildest kind,—as a tea-spoonful of the oleum ricini, repeated at intervals if necessary; — and, under this system, the issue is, ac- cording to the author's experience, far more fortunate than where much irritation is kept up in the intestinal canal. Reflection, in- deed, suggests, at a glance, the impropriety and inconsistency of any irritating plan of medication in fever. We carefully employ seda- tive agents; recommend the most careful abstraction of light, and sound, and the avoidance of all irritation, except that which we offi- ciously excite in a part of the system, which, as Broussais has pro- perly maintained, possesses intimate sympathetic relations with every other part of the organism ; and, under this mode of management, many cases of continued and remittent fever, doubtless, run their IX FEVER. 147 course to a fatal termination, which, under a better system of treat- ment, would have terminated in health. It must be borne in mind, that, in these cases, the objection is not to cathartics in the abstract. The employment of mild cathartics to keep the alimentary tube en- tirely free from all morbid secretions must be regarded as one of the most important points in the management of fevers, that are even accompanied with an unusual degree of erethism of the gastroente- ric mucous membrane. It is the powerfully irritating cathartic — that excites evacuation after evacuation, and exhausts the patient by irritation — which is so objectionable. The author is satisfied, that many cases of continued and remittent fever have arrived at a happy termination by the treatment above recommended, which might have eventuated unfortunately, had the irritating cathartic agency, so strongly inculcated by several distinguished teachers and authors, within so late a period as the last fifty years, been adopted. If we cast our eyes over the periodicals which are daily emanating from the press, we find that such agency is beginning to be less and less invoked, although the attention of the practitioner is equally directed to the gentle removal of all offending matters from the intestinal canal. Laxatives, or gentle cathartics — in other words—have taken the place of the more violent, and the improvement has been signal. In fevers of the synochal or inflammatory kind, unaccompanied by much gastro-enteric irritation, more powerful cathartics may be employed, the object being to use them as depleting agents, as well as for the purpose of evacuating offending matters. In such cases, recourse is had, more commonly, to saline cathartics, which, by exciting the action of the exhalants of the mucous membrane generally, occasion the evacuation of a portion of the more watery parts of the blood. It has been generally inculcated, that whenever the evacuations are fetid or ill-conditioned, it is necessary to repeat the cathartic, until their natural healthy character is restored ; but if the alimentary canal be kept clear from the commencement of the disease, it can rarely happen, that this fetid character will be marked, or to such an extent as to demand much attention. Besides, it must be recol- lected, that they may be rendered ill-conditioned by the employment of these very agents. When the mild chloride of mercury, for ex- ample, is exhibited for some time, it modifies the secretion from the different grandular and follicular organs, and gives occasion, as before mentioned, to green or dark coloured evacuations— calomel stools — very much resembling chopped spinach. This has, of course, to be borne in mind, as under the idea just mentioned, which prevails largely amongst those who do not reflect, the cathartic might be re- peated, with the view of removing the very condition which it has induced. Professor Chapman has recommended, that, in obstinate remittent and intermittent autumnal fevers, cathartics should be con* tinued until dark, tarry, fetid stools are discharged. This dark ap- 148 CATHARTICS pearauce, he conceives to be a glutinous matter, which adheres to the intestines, and requires cathartics for its removal; but it appears by no means clear, that it may not be, in part, the effect of the repeated employment of cathartics deteriorating the intestinal secretions, in the manner referred to. From what has already been said, it will obviously be improper to administer violent cathartics in yellow fever ; which, like malig- nant remittents, is accompanied by malignant gastritis or gastro-en- teritis. Intermittents. — In intermittents, cathartics are rarely employed for cutting short the disease. The impression they make upon the nervous system is not sufficiently- intense to break in upon the mor- bid catenation. They are generally employed in such cases for the purpose of removing the contents of the alimentary tube, so as to prepare the way for the administration of cinchona, or of some of its preparations, or of other antiperiodics ; and in the progress of the affec- tion, they are had recourse to — as in other maladies— for removing morbid secretions, or whenever the bowels are in such a condition as to require their employment. In all cases, where a doubt may exist as to the propriety of pre- scribing cathartics, there may be none as to the exhibition of ene- mata. They are, indeed, invaluable agents, where the powers of life are so much reduced, that a rational fear is entertained as regards the administration of cathartics by the mouth. Even when food has not been taken, the canal must be kept free ; as the vitiated secretions, and the product of the digestion of the different sub- stances poured into the digestive tube cannot fail, by their reten- tion, to add to the irritation. Eruptive fevers.— In all the exanthemata, the employment of gentle cathartics is indispensable to their judicious management. In small-pox, measles, scarlatina, &c,— where the cutaneous surface is affected with erethism,— the extension of the skin, constituting the mucous membranes, and especially the gastro-intestinal, cannot fail to participate in the general morbid condition; to have its secretions depraved; and, consequently, to require the administration of eva- cuants. With regard to the kind of cathartic best adapted for febrile affec- tions in general, there is none perhaps so available as the oleum ricini. Next to this, the different salines, especially the sulphate of magnesia; and, if stronger cathartics are required,— which, as has been remarked, happens far more rarely than has been imagined — the pulvis jalapa compositus — which consists of jalap and bitartrate of potassa; or combinations of jalap and calomel, or of rhubarb and calomel, may be administered. Where the object is, as in fever, to remove all offending matters daily from the alimentary canal, and not to excite a powerful revulsion, or a copious exhalation from the IN THORACIC AND ABDOMINAL INFLAMMATION*. 149 mucous membrane, the most unirritating agents ought obviously to be chosen, and of these, the oleum ricini is decidedly the best. Thoracic and abdominal inflammation.— Cases of thoracic inflam- mation do not exhibit any signal advantage from the employment of cathartics. These can act only by virtue of their depletory or revul- sive properties, and their administration must be guided by general principles; but, in inflammatory affections of the contents of the ab- domen, or of its lining membrane, great care and discrimination are required to decide upon their utility, or the contrary. In peritonitis■, whether implicating the peritoneum proper, or its extensions investing the intestines, cathartics have to be employed with caution, for fear the irritation excited, during their operation, should add to the inflammation. In such cases, Dr. William Saun- ders was in the habit of saying, that the best mode of opening the bowels — in enteritis especially, which is usually attended with con- stipation — is the use of the lancet; and if this be followed up by a full sedative dose of opium, the bowels will often respond without the aid of any cathartic. The constipation is, in such cases, depend- ent upon the inflammation, and when this — the cause — is removed, the effect yields also. Where the enteritis is seated in the mucous coat, irritating purgatives should be given with extreme care. A case, indeed, can scarcely be imagined, in which they can be indi- cated ; yet the exhibition of a gentle cathartic,— simply with the view of keeping the canal free from morbid secretions, and morbific mat- ters, which cannot fail to be present in such a diseased condition of the lining membrane,— is amongst our most valuable means of medi- cation. This is signally the case in dysentery,— in which the in- flammation is chiefly seated in the lower portion of the intestinal tube,— and in the early stages of cholera, common as well as spas* modic. In diarrhoea, which arises from irritation of the lining membrane of the intestines, it was at one time the custom to employ no agents of any kind. The disease — as already remarked — was looked upon as an effort of nature not to be interfered with ; whilst by others, an opposite view has been maintained, and astringents have been ad- vised from the commencement. Of the two views, the latter is more markedly erroneous, and mischievous in its consequences. The dis- ease is one of irritation, and the exciting cause is often seated in the intestines themselves: accordingly, it may be maintained, as an aimost universal rule, that gentle cathartics should be exhibited in the flrst instance, and be repeated if necessary : and that astringents should not be used, unless an asthenic condition should supervene,-^ like the gleet, which generally succeeds to acute inflammation of other mucous membranes. If the propriety of the use oi gentle cathartics in the case of diar- rhoea affecting adults be admitted, the remark must apply a fortiori to the diarrhoea of infants, who are extremely liable to erethism of 13* 150 CATHARTICS the dermoid tissue, and to the formation of acid in the primae viae, which has often, probably, considerable agency in the development of the disease ; hence the acid smell of the evacuations. Often, too, accompanying this state, there are manifest indications of an inflamed condition of the gastro-enteric mucous membrane. Dyspepsia.— In the variety of dyspepsia, which consists of an irritated condition of the lining membrane of the stomach, violent cathartics are improper; but laxatives may be,— and usually are,— indicated. Indeed, in atonic dyspepsia, the same system is advis- able, and an occasional brisk cathartic maybe exhibited with advan- tage. When employed in this manner, a fillip is given to the digestive function, which is often salutary ; whilst if the cathartic be often repeated, a degree of sensibility and irritability may be induced in the bowels, which cannot fail to add to the mischief. Hepatic diseases. — In hepatic phlegmasia, engorgement, or torpor, cathartics have been regarded as eminently useful, by acting imme- diately on the radicles of the portal veins, and thus diminishing the quantity of fluid, that passes to the liver by the vena porta. From what has been remarked, regarding the use of emetics in jaundice, and in cholelithus or gallstone, it will be understood, that cathartics may have a beneficial agency, by stimulating the intestinal tube, — the excitation being conveyed by continuous sympathy to the liver and its accessaries ; but where there is organic mischief, as happens in most of the protracted cases, especially such as occur in those of broken down constitutions, they must be given with caution. Constipation. — Of the utility of cathartics in constipation we have already treated. They ought not — as there stated — to be administered in such doses as to act as powerful local stimulants, on account of the depression which always succeeds to the superexcita- tion. The proper mode is to prescribe them in small doses, often repeated, accompanying them by a properly regulated diet. A brisk cathartic may obviate the constipation for the time, but no perma- nent cure can be effected, without striking at the root of the evil, by a proper and protracted laxative treatment and regimen. Colic. — In the different varieties of colic, cathartics have been much employed. The intestinal pain is generally caused by over- distention of the coats by flatus, or by accumulated or irritating ali- ments ; and the method usually adopted for removing the disease is to excite the peristaltic action of the intestines, so as to diffuse the flatus over a larger surface, or to remove the source of irritation. This may often be effected by a union of cathartics with aromatics, or, when the pain is extremely violent, by the substitution of an opiate for the aromatic, to allay the spasm, which forms a part of the disease. Perhaps in all cases of colic, the best course is to premise IN HEMORRHAGE. 151 a full dose of an opiate, and afterwards to administer a cathartic bv the mouth or rectum, should this be necessary. Hemorrhage. — The rules that guide us in the administration of cathartics in hemorrhage, vary according as it is of the active or pas- sive kind. In the former they may be proper ; in the latter not. In apoplexy, they are employed both as depletives and revellents; but more for the latter purpose than the former. During the apoplectic seizure, one of the best revellents is a stimulating enema, and this can be administered when deglutition is impracticable. Croton oil is also given under similar circumstances. If a drop of this be put upon the tongue, it passes by imbibition into the blood-vessels, and seeks out the intestinal canal for its operation, by virtue of that sin- gular action of preference, of which there Eire so many marked ex- amples. In the epistaxis, that occurs about the period of puberty, the deple- tion and revulsion produced by a common dose of sulphate of mag- nesia are often sufficient to put a stop to it; and, whenever signs of vascular activity exist, — as in other hemorrhages, — cathartics are clearly suggested. The same may be said of their employment in cases of haemoptysis, although mental and corporeal quiet are abso- lutely necessary during the attack, and for some time afterwards; but, in the interval, no doubt can arise as to the propriety of their administration. The saline cathartics, which operate upon the whole of the intestinal canal, and augment the exhalation from the mucous membrane, ought to be selected. In haematemesis or vomiting of blood, whilst cathartics have been strongly recommended by some, they have been as warmly repro- bated by others. The German practitioners generally object to them; vet the objection does not appear to be well founded. A saline ca- thartic, bv acting upon the whole of the intestinal canal, developes a succession of sympathies, during its operation, that derives greatiy from the concentration of vital activity towards the stomach, which is present in active haematemesis. Besides, certain of the saline pre- parations— as before shown, — are somewhat astringent: the super- sulphate of magnesia, of potassa, or of soda, for example, — which may be formed extemporaneously, by adding the elixir of vitriol, or the dilute sulphuric acid, to a solution oi sulphate oi magnesia, of sulphate of soda, or of sulphate of potassa, — comes in contact with the vessels pouring out the blood by rhexis or diapedesis, and by its directly astringent properties arrests the hemorrhage, whilst the agency of the cathartic may prevent its recurrence. It has been stated, elsewhere, that many cases of haematemesis are dependent upon obstruction in some other organ than the stomach, — and espe- cially in the uterus ; and where there is torpor of this last viscus — such as exists in many, if not in most cases of amenorrhoea—the action of the cathartic is well adapted for communicating a salutary excitation to the uterine functions, through contiguous sympathy. 152 CATHARTICS In menorrhagia, care has to be taken in the administration of ca- thartics, owing to the fact just mentioned,— that they excite the action of the uterus by the sympathy of contiguity; but in hematu- ria, such cathartics as are not accompanied with a diuretic operation may be beneficially employed, — the derivation of nervous and vas- cular influx from the urinary organs being attended with good effects. With this view, the oleum ricini is had recourse to with much ad- vantage. Hemorrhoids. — In hemorrhoids, the mildest kinds of cathartics are serviceable, while the more violent are injurious. Obviously, too, such cathartics should be avoided as act upon the lower portion of the alimentary tube, unless some addition be made to them, which rids them of their objectionable features. Accordingly, when aloes is given, it is generally in small doses, and with the addition of some narcotic, — as hyoscyamus. The mild chloride of mercury is a cathartic, which generally acts more energetically upon the upper portion of the intestines; but, with some, it irritates the rectum, and, consequently, such individuals should avoid its use when affected with hemorrhoids or any disease of the rectum. Castor oil, and sulphur, are the best laxatives in such cases. These remarks apply equally to procidentia, in which drastic cathartics could not fail to do mischief. Pregnancy. —In pregnancy, powerful cathartics must be avoided, for reasons that have been previously assigned. Head affections. — In various head affections, and especially in en- cephalitis, whether involving the brain or its membranes, or both, — cathartics would clearly be advantageous, by virtue of the revulsion they effect, did not the inconvenience, to which the patient is sub- jected by the motion necessarily attendant on their operation, often preclude their employment. In mania, they are, at times, absolutely required, in consequence of the torpor, that occasionally exists in the intestinal tube. Owing to this cause, an accumulation sometimes takes place in the large in- testines to a surprising extent, and the use of the scoop is required to remove the indurated faeces that have collected in the rectum ; after which, injections of cold water may be thrown into the large intes- tine to restore its tone. Owing to the torpor of the nerves of the tube, or rather to the cerebral abstraction and excitation, which prevent the usual sensi- tive impressions from being duly appreciated, the most violent dras- tics are occasionally demanded — as oleum tiglii, or elaterium — and even these are often ineffectual, unless blood-letting be premised, which, by reducing the nervous energy, enables smaller doses to produce the wished-for operation. Sometimes, considerable diffi- culty is experienced by the administration of any remedy by the mouth, — the patient obstinately closing the jaws, and resisting IN NErROSES. 153 every effort to separate them. This determination mav frequently be broken in upon—especially after blood-letting—bv pressing strongly on the parotid gland, which occasions so much pain, that the maniac yields, and the jaw is depressed. .Yeuroses. — In all the neuroses, it is important to keep the intes- tinal tube free ; as irritations, seated there, re-act upon the cerebri - spinal axis, and add to the mischief. Hysteria, which is ranked, though improperly, by Pinel, in ac- cordance with antiquated notions, as a nevrose de la generation, is often associated with this condition of the bowels; and therefore requires the use of cathartics. Great nervous torpor of the whole system is also present in many cases of this protean malady, re- quiring the administration of cathartics as revellents, both by the mouth, and rectum. Under the head of emetics it was remarked, that irritations of the stomach and bowels, produced by improper diet or by morbid secre- tions, are a grand exciting cause of epilepsy, as well as oi infantile convulsions. Cathartics are, therefore, almost universally proper in these alarming attacks : but care must be taken not to repeat them sufficiently often to develope the sensibility of the tube, as they might react on the cerebro-spinal axis, and augment the very mis- chief which they were administered to remove. Chorea—a disease of the nervous centres, accompanied with great torpor of the digestive function — requires a union of tonics with cathartics for its removal. Dr Hamflton, of Edinburgh, — an authority, who has been the cause of much valuable use, and at the same time, of much abuse of the cathartic medication, — places his main reliance on cathartics, in the cure of this singular affection. One of the varieties of trismus — the trismus nascentium — or " lockjaw of the new-born," is often dependent upon irritations seated in the intestinal canal, and is occasionally removable by gentle cathartics, as the oleum ricini. In this part of the globe, it is rarely witnessed ; but in the warmer regions, it is a fatal malady. At the Havana, according to Don Ramon de la Sagra, of one hundred chil- dren dying under ten years of age, nineteen per cent, amongst the whites perish of it within the first seven days, and twenty-four per cent, amongst the infants of color. There, the affection is called the " disease oi the seven davs" (mal de los siete dias.) In violent cases of tetanus in the adult, cathartics constitute one of the agents to which recourse is almost invariably had, along with other, and more essential remedies, —as narcotics. When swallow- ing is impracticable, stimulating enemata are often administered, with the view of exciting a new impression by revulsion ; or opium is given in the same manner, where the object of the practitioner is to endeavour to overpower, by sedatives, the inordinate erethism of the cerebro-spinal axis. When deglutition can be effected, a union of cathartics and opiates is often employed to fulfil similar views. The 154 CATHARTICS. oleum tiglii is, in these cases, a useful cathartic, both when deglu- tition exists, and when it is impracticable. Dropsies. — Cathartics are among the most valued, and valuable agents in the treatment of dropsies, especially when these are of an active kind. In the passive, they must necessarily be used with more caution. The division of cathartics, to which recourse is had, is that of drastics, such of those especially as produce copious watery discharges, — or which, in other words, act powerfully on the secre- tory apparatus of the mucous membrane of the alimentary canal. Elaterium is one ; but it must be cautiously administered, on account of the difficulty that exists in regulating its operation. Calomel, and gamboge are often selected for this agency. These hydragogues — as before mentioned — act in two ways in the curation of dropsy ; first, they diminish the amount of circulating fluid, and thus add to the activity of imbibition ; and secondly, they excite a powerful re- vulsion, which gives rise, indirectly, to a sorbefacient agency. Intestinal worms. — Cathartics are often employed as anthelmin- tics ; but their main effect can only be the removal of existing worms ; they do not prevent their re-formation ; besides, if often given, they may debilitate the system generally, and the digestive function in particular, and thus favour the predisposition to the development of those parasites ; but, on the other hand, an occasional brisk cathartic may give rather than diminish tone, by breaking in upon the mono- tonous execution of functions, and exerting a salutary impression of excitation. Such are the chief disorders and purposes for which cathartics are administered. It is obviously almost as impracticable, as it is un- necessary, to refer to every case, in which their employment may seem to be indicated. Their main effects on the general system are, — depletion and revulsion ; and a wise discrimination will suggest the particular cases, in which such agency is demanded. Their im- mediate effects upon the parts with which they come in contact are obvious ; and a very slight degree of reflection — after the patholo- gical lesion has been correctly appreciated — will enable the practi- tioner to decide as to the propriety of their administration. SPECIAL CATHARTICS — MANNA. 155 SPECIAL CATHARTICS. I. Laxatives or Mild Cathartics. 1. MANNA. Manna is the concrete juice of Ornus Europe!a. Frax'inus Ornus, or Flowering Ash; Sex. Syst. Diandria Monogynia ; Nat. Ord. Oleaceae (Lindley ; a native of the south of Europe, especially of Calabria and Sicily. It is chiefly obtained by making incisions in the stem. It also issues in part spontaneously from fissures, and in part from punctures made by an insect, the Tettigo'nia Orni or Cica'da Orni, The juice, as it issues, is nearly colourless, and some- what viscid ; but it soon concretes in the sun into a yellowish opaque substance. Some of it is permitted to fall on the ground, or on leaves placed to receive it, or to trickle down the trunk ; but where care is taken the leaves of the ornus are stuck into the bark below the incisions, which guide it to receptacles formed of leaves of the Cactus Opun'tia or Indian Fig : and straws and twigs are inserted into the incisions so that the juice concretes in the form of stalactites, and is readily detached clear from the bark. The collection of manna commences in July, and continues till October, — the best kind being obtained during the month of August, or in the height of the season ; and the inferior qualities towards the close. Manna is imported chiefly from Palermo and Messina, but likewise from various parts of Italy and Sicily. The quantity, on which duty was paid in England, in 1S39, according to Dr. Pereira, was 13,493 pounds. There are several varieties of manna met with in commerce. The one which is the purest, is Flake Manna— Manna Cannula'ta — which is in irregularly shaped pieces resembling stalactites, and ob- tained in the manner above mentioned. It is light, brittle, of a white or pale yellowish white colour; has a faint, rather pleasant odour, and a sweet somewhat peculiar taste, becoming ultimately rather acrid. When broken, flake manna has a crystalline or granular structure. Manx a ix sorts or Common Manna consists of whitish or yellowish fragments similar to the last variety, but smaller, and mixed with a soft, viscid, uncrystallised brownish mass, like that which constitutes the commonest variety — the fat or fatty maxxa, which is in the form of a soft viscous mass, of a dirtv yellowish-brown colour, con- taining few crystalline fragments, and full of impurities. Under the name Sicilian Tolfa Manna, Dr. Pereira describes an inferior kind, corresponding to the manna in sorts. It is thought by him to cor- 156 SPECIAL CATHARTICS. respond in quality to Tolfa Manna, produced near Civita Vecchia, which is but little valued. Manna has frequently been subjected to analysis, and been found to contain about 60 per cent, of a peculiar sweet principle called mannite ; a little common sugar, partly crystalline and partly uncrys- tallisable ; extractive matter, and about 32 per cent, of moisture. The extractive matter, which is nauseous, has been regarded as the laxative principle; yet mannite would seem to be as laxative as manna itself. Manna, like sugar, is nutritive ; but, it is not used with us on account of this property. It is a gentle laxative, but does not always act without inducing tormina. By females ^ and children it is occasionally taken alone ; but more frequently it is prescribed as an adjunct to other remedies of the same class, as senna, and sulphate of magnesia, whose taste it somewhat conceals, whilst it adds to their cathartic agency. According to the author's taste, however, the addition of the manna is no improvement. The dose of manna, for an adult, is from one to two ounces; for children from one to three drachms. In the case of the former it may be eaten ; of the latter, it may be taken dissolved in water, simple or aromatic, or in tea or coffee. Mannite. — Mannite has been brought forward as one of the " new remedies." It is obtained by treating manna in tears with boiling alcohol; then filtering and suffering it to crystallise ; by rest and refrigeration mannite is precipitated in small, beautiful, white needles. It is used under the same circumstances as manna, and the dose is much the same. 2. SULPHUR. Sulphur, of the Pharmacopceia of the United States, is the sub- limed sulphur of some other pharmacopoeias. It is found both in the inorganic and the organised kingdom. In the former, it occurs either imbedded in rocks — common native sulphur; or produced by volcanic action — by sublimation — volcanic sulphur. In the or- ganised kingdom, it is found in many plants; in the liliaceae, for example, in garlic ; in the cruciferae, in mustard; and in assafce- tida of the umbelliferae. It is also found in certain animal sub- stances, as eggs, urine, &c. In combination, in the state of sulphuric acid, it occurs extensively. Sulphur may be procured by purifying native sulphur, or by de- composing the native sulphurets ; but the sulphur of commerce is generally obtained in the former way. It is brought chiefly from Italy and Sicily. During the year 1834, according to McCulloch, not less than 507,808 cwt. of rough brimstone were imported into England, of which 485,756 cwt. were from Italy, or rather Sicily. SULPHUR. 137 Native sulphur is met with in small quantities in different parts of the United States. Crude sulphur is prepared from native sulphur, either by being subjected to a rude process of fusion, or by a process of distilla- tion in earthen pots. In this state, it is imported and purified. The process, formerly adopted, was to submit it to fusion in an iron caldron ; when the earthy impurities subsided, and the liquid sul- phur was ladled out and cast into moulds, so as to form the roll sulphur or roll brimstone. The improved method of purification is to distil it in an iron still, the sulphur being allowed to pass into a chamber, on the walls of which it is deposited, in the form offlowers of sulphur. If, instead of permitting the sulphur to enter the sulphur chamber, it be made to pass into an appropriate receiver, the sulphur distils over, and condenses into a liquid, which, when solidified, constitutes the refined sulphur oi commerce. If this be cast in wooden moulds, it forms the stick or roll or cane sulphur, or brim- stone. Flowers of sulphur, or solid sulphur, may be prepared from the metallic sulphurets, by similar processes. The dregs that remain after the purification of sulphur constitute sulphur vivum, formerly used externally ; but now never employed excep* by the veterinary surgeon. It has hence obtained the name of horse brimstone. Sublimed sulphur, prepared by any of these methods, contains more or less sulphuric acid, owing to some of it undergoing com- bustion. This can be removed by washing, after which we have the sulphur sublimatum lotum of certain nf the pharmacopoeias, and of the United States Pharmacopceia of 1S30. In the last edition, however. Sulphur means the sublimed article ; and Sulphur lotum or washed sulphur, sublimed sulphur thoroughly washed with water. As met with in the shops, it is in fine powder, of a bright yellow colour, and of a peculiar smell and taste. It is insoluble in water, but soluble in alcohol, ether, and the oils. — both fixed and volatile. It is whcllv volatilised by heat, and ought not to change the colour of litmus paper. Sulphur is one of the gentlest laxatives; producing scarcely any augmented secretion from the follicles and exhalants of the intes- tines. Being so mild in its action, it has been given in cases of pregnant females : and is a common laxative in hemorrhoidal affec- tions. When it is necessary to add to its cathartic agency, mag- nesia, or bitartrate of potassa may form the adjunct. The great ob- jection to sulphur is, that even its internal use occasions the patient to exhale a disagreeable sulphurous odour, owing to the formation of sulphuretted hydrogen. Sulphur in combination with bitartrate of potassa, or alone, mixed with molasses, has long been a favourite " purifier oi the blood," and is often given, spring and fall, as a domestic remedy. Its dose, as a cathartic, is from 5J to 55s. 158 SPECIAL CATHARTICS. It may be given, as before remarked, in molasses, or diffused in milk. SULPHDR PRJECIPITA'TUM, PRECIPITATED SULPHUR or lac sulph'uris, pre- pared by decomposing a sulphuret of lime, by means of chlorohydric acid, was officinal in the British Pharmacopoeias, and is still so in that of the United States. It possesses no advantages over sulphur lotum. It is much whiter, and in a state of fine division. It is said to be exceedingly liable to adulteration, and, on this account, has been left out of the British Pharmacopoeias. According to Dr. Pereira, in the preparation of nearly the whole of the precipitated sulphur, sul- phuric acid is substituted for the chlorohydric, by which the product contains about two-thirds of its weight of sulphate of lime ; and he adds, that he was informed by an extensive manufacturer of the arti- cle, that a firm, whose name he mentions, was almost the only one that bought the pure kind. Pure precipitated sulphur, like sublimed sulphur, is wholly vola- tilised by heat. 3. MAGNE'SIA.— MAGNE'SIA. Magne'sia, calcined or burnt magne'sia, is prepared by exposing car- bonate of magnesia to a red heat in an earthen vessel, until the car- bonic acid is wholly expelled, and the protoxide of magnesium re- mains. It is a light, white powder, devoid of smell, and almost tasteless- Its specific gravity is 2.3. When moistened with water, it exhibits an alkaline reaction. It is very sparingly soluble in water, and less so in boiling water than in cold. It absorbs carbonic acid ; and, therefore, should be kept from contact with air. The tests of its purity, as given in the Pharmacopoeia of the United States, (1842,) are,— that it should dissolve wholly without efferves- cence in dilute chlorohydric acid, which would prove the absence of carbonate of magnesia, with which it is often mixed, and that the solution in dilute chlorohydric acid should yield no precipitate with oxalate of ammonia, or chloride of barium, — proving the absence of lime and of sulphates. Magnesia is a gentle laxative, and as such is employed in preg- nancy, affections of the rectum, &c, where mild aperients are need- ed. It is especially valuable where constipation is attended with car- dialgia from too great a secretion of the gastric acids ; and in chil- dren it forms an admirable laxative, owing to the great predominance of acid with them. It is also readily taken by them, when mixed with milk, and sweetened. It is an excellent adjunct to carminative mixtures, where it is advisable to increase the peristole of the bowels ; and is often prescribed for this purpose to children. (Magnes. gr. xv ; 01. anisi, seu 01. carui gtt. iij ; Aqua f. I] ; Sacchar. 3L M. Dose, a tea-spoonful occasionally.) W here diarrhoea is attended with acidity, as it often is, magnesia FICUS, 159 may be needed to facilitate the removal from the bowels of the re- dundant acid ; but where it is desirable to neutralise the acid, and at the same time to induce a constipating effect, prepared chalk should be prescribed. The dose of magnesia as a cathartic, to an adult, is from a scruple to a drachm : to infants from two to eight or ten grains. Occasion- ally it does not operate, owing to its not meeting with acid in the sto- mach : its action, in such cases, may be facilitated by drinking le- monade, which forms a citrate of magnesia that acts as a mild aperient. It is proper to remark, that where magnesia has been taken for a long time, and in large quantities, it has occasionally accumulated in the bowels, and given rise to unpleasant effects. 4. MAGNESLE CAR'BONAS. —CARBONATE OF MAGNE'SIA. Carbonate of magnesia, subcarbonate of magnesia, or magnesia alba, occurs, although not in great abundance, as a mineral; but that of the shops is prepared on a large scale bvdecomposing sulphate of mag- nesia by an alkaline carbonate ; the consequence of which is the pre- cipitation of carbonate of magnesia. As it is prepared by the whcde- sale chemist, no formula for it is given in the Pharmacopoeia of the United States. The greater part of that which is used in this coun- try is imported from Scotland. In New England, it is prepared from the bittern of the salt works, which consists chiefly of sulphate and muriate of magnesia : and in Baltimore, it is made from the sulphate of magnesia extensively prepared there. Carbonate of magnesia is a light, white, inodorous, and almost insipid powder. It is nearly insoluble in water, but readily dissolves in aerated or carbonic acid wnter. It i< distinguishable from pure magnesia by effervescing with acids. Its adulterations are the same as those of magnesia, and may be detected nearly in the same manner. The therapeutical properties of carbonate of magesia are almost the same as those of magnesia. As, however, it contains carbonic acid, this is set at liberty, when the salt meets with acid in the sto- mach, and is apt excite flatulence. Its dose, as a laxative, is from half a drachm to a drachm, given in milk, with which neither it nor magnesia mixes well without great care. Its admixture is facilitated by first rubbing it with svrup. A fluid magnesia has been much recommended of late by Sir James Murray, and Mr. Dinneford. The preparation of the latter is said to contain from 17 to 19 grains of carbonate of magnesia in every duidounce. It is a condensed solution of magnesia m carbo- nated water. 5. FICUS.—FIGS Figs, in the Pharmacopoeia of the United States, mean fk«» drWj 160 SPECIAL CATHARTICS. Fig. ll. fruit of Ficus Ca'rica, the Fig Tree, which is a native of Asia and Southern Europe, but cultivated in the gardens of this country. The figs, when ripe, are dried in the sun or in ovens, and are afterwards packed in drums, bas- kets or boxes. They are chiefly brought to the United States from Smyrna ; and the Turkey or Smyrna figs are the largest and sweetest; and therefore the best. Dried figs form a very consider- able article of commerce in Provence, Italy and Spain, besides affording, as in the east, a principal article of suste- Ficus carica. nance for the population. The annual importation into Great Britain has been estimated at about 20,000 cwt. The chief constituents of figs are mucilage and sugar of figs, which greatly resembles the sugar of the grape. Like other saccharine articles, figs are laxative; and, by virtue of their mucilage, they are demulcent likewise. They are eaten in cases of habitual torpor of the bowels; and they enter into the com- position of the Confectio Sennce of the Pharmacopceia. The split fig retains heat well, and is, therefore, occasionally ap- plied to inflammatory tumours to promote suppuration. 6. CAS'SIA FIS'TULA—PURGING CAS'SIA. Cassia Fistula is the fruit of Cas'sia Fis'tula, Cathartocar'pus Fis'- tula, Pudding pipe tree or Purging Cassia; Sex. Syst. Decandria Monogynia; Nat. Ord. Leguminosae, which is supposed to have been originally a native of Upper Egypt and India, whence it has spread to various places. It is now found abundantly in Hindusthan, China, the East India and West India Islands, and in South America. The fruit — the officinal portion — as imported from the East and West Indies and South America — is in pods, from nine inches to two feet in length, which are cylindrical, slightly curved, and of a dark brown, nearly black colour. Internally, the pod is divided into numerous thin transverse partitions,— and each of these contains a hard, flattened, oval-shaped seed, surrounded by a soft, black pulp resembling an extract. CAS'SLE FIS'TM PULPA, PULP OF PURGING CASSIA, is separated by pour- ing boiling water on the bruised pods to soften the pulp ; then strain- ing first through a coarse sieve, and afterwards through a hair one, and boiling down to a proper consistence. When subjected to analysis, the common or African variety yielded 61 per cent, of sugar; the American 69 per cent. PRUNUM. 161 Cassia pulp is a laxative in a small dose : in a larger it is purga- tive, but it does not act kindly : being apt to induce nausea, and tor- mina. It is rarelv presented alone,— never perhaps in this country : but it enters as one of the laxative ingredients into the Confectio Senna of the Pharmacopceia of the United States. Its dose as a mild laxative is stated to be 5j. to 3;.j: as a purgative, 31 . to 5;. 7. TAMARLVDUS.— TAM AKINDS. Tamarind is the preserved fruit of Tamarin'dus In'dica; Sex. Syst. Monodelphia Triandria : Nat. Ord. Leguminosae. a tree which is indigenous in the East and West Indies. The fruit is a pod from two to six inches long, which consists of a ligneous husk, enclosing a pulpy texture, which is traversed by numerous branching fibrils. within which one or more seeds are imbedded. The officinal part is the pulp between the seeds and husk. It is usually imported along with the seeds and preserved in sugar. Tamarinds are brought to this country from the West Indies. When siibiected to analysis, the pulp yields citric, tartaric and malic acids; bitartrate of potassa : sugar, gum, vegetable jelly, paren- chyma and water. It has an agreeable, sweetish acid taste, and readily imparts its properties to water. Tamarinds are gently laxative, but they are rarely given alone. They were formerly prescribed with other cathartics, as with infusion of senna; but they have been considered — probably on insufficient grounds — to diminish the operation both of it and cf the resinous cathartics. Thev form part of the Confectio Senna oi the Puarma- copoeia of the United States; for which purpose they are digested with a small quantity of water, until they become of uniform consist- ence ; after which the seeds and hiaments are separated by pressing through a hair-sieve. This is the TAMARINDI PUPA or Pulp of Tama- rinds of the Pharmacopceia. 5. PRUNUM —PRUNES. Prunes are the dried fruit of Prunus domes'tica. the Plum-tree; S-.x. Syst. Icosandria Monogynia: Nat. Ord. Rosacea?; which is cultivated in temperate regions every where; but is suppose*: to be a native of Syria, especially near Damascus. The dried traits are called Prunes or French plums. They are chiefly imported from the south of France, and are derived from the Saint Julien variety ; the table prunes being obtained from the larger kinds of plum — as the Saint Catharine and the Reine-Claude "r green-gage. The fresh ripe front, according to M. Berard, contains about twenty per cent, of solid matter, of which upwarcs of eleven per cent, is sugar, and five gum. —the remainder being constituted of the malic and pectic acids, albumen and ligneous fibre. The proportion of 14* 162 SPECIAL CATHARTICS. sugar, is increased in the process of drying; but this matter has not been investigated. Prunes are laxative, and when taken in the evening are sufficient, with many, to cause the evacuation of the bowels on the following morning. Generally, they are taken stewed, as diet, in cases of costiveness, or in febrile and other diseases in which it is desirable to keep the intestinal canal gently free. The sugar and mucilage, which they contain, renders them also nutritious. They are some- times added to cathartic infusions and decoctions to improve their taste and increase their effect. The Pulp of prunes, Pruni Pulpa, is made by softening the prunes in the vapour of boiling water, and having separated the stones, beating the remainder in a marble mortar and pressing it through a hair sieve. It enters into the composition of the Confectio Senna. 9. SINA'PIS. —MUSTARD. The seeds of Wliite mustard, Sina'pis alba, unbruised, have been long recommended, in the dose of a table-spoonful, in cases of torpor of the digestive function. They had almost fallen into disuse, how- ever, when Sir John Sinclair—the author of a " Code of Health and Longevity," published an article in a periodical, strongly recommend- ing them to the aged, as a means of preserving their health, by stimulating the digestive function to greater activity, and at the same time keeping the action of the intestinal canal free. They may be taken three or four times a day, mixed with molasses. It would seem, however, that their use in such large quantities, in torpid habits, is not totally devoid of danger. They have been known to accumulate in the caecum and appendix caoci, and are said to have induced fatal inflammation of the stomach and bowels. Besides the above officinal laxatives, there are some, which are occasionally used as such, but whose prominent effects are of a different nature. These will require but a passing notice. 10. O'letjm amyg'daljE, Oil of almonds; and O'leum Oli'vue, Olive oil. The properties of these oils are described elsewhere. Both of them are mild laxatives in the dose of f. 3ss. to f. 3j; although not often used as such. When prescribed, it is generally in affections of the alimentary canal, or of the genito-urinary apparatus, when it may be desirable to give laxatives, that will not enter into the blood- vessels, and irritate the kidneys or urinary passages. A common laxative for new-born children, in England, is a mixture of equal parts of Oil of almonds and Syrup of violets, or Syrup of Roses — the dose of which is a tea-spoonful; but olive oil and simple syrup are equally effective. OLEUM RICINI. 163 II. Purgatives, or Brisk Cathartics. O'LEUM RIC INI.— CASTOR OIL. The Castor oil plant. Ric"inus commu'nis or Fig. 12. Palma Christi; Sox. Sv^m Mon 0 ia M na iel- phia; Nat. Ord. Euphorbiaceae, is probably a native of the East Indies. Greece and Africa, whence it was introduced into the West Indies and the American continent. It is now largely cultivated in many parts of the United States. In India, it is said to attain the height of fifteen or twenty feet; but in this country" it does not exceed a few feet. The seeds ripen succes- Kici: ^comir—s-. sively in August and September. They are of an oval shape, some- what compressed, and about the size of a small bean. Externally they are smooth and shining, and of a pale grey colour, marbled with reddish-brown spots and stripes. In their general appearance, they have been likened to a tick, whence the name Ricinus. The husk, which constitutes 24 per cent, of the seed, is chiefly composed of ligneous fibre, with a little gum, resin, and extractive matter. The nucleus or kernel, which has been found to amount to 69 per cent, of the seed when dry, contains 46.2 of fixed oil, 2.4 of gum, 0.5 of soluble albumen and 20 of coagulated albumen. The fixed oil is the Oleum Ricini. The quantity of castor oil used almost exceeds belief. Of 490. 558 lbs. imported into England in 1S30. 441,267 lbs., according to M'Culloch, came from the East Indies ; 39.40S lbs. from the British Northern Colonies of America; 5,139 lbs. from the United States; and 4,7IS lbs. from the British West Indies. A large proportion of that used to the east of the Alleghanies comes by way of New Or- leans from Illinois and the neighbouring States, where it is so abun- dant as to be sometimes burnt in lamps. (Wood ic Bache). The mode in which castor oil is prepared in this country is as fol- lows :— The seeds, being cleansed from all extraneous matters, are put into a shallow iron reservoir, and submitted to a gentle heat, not greater than can be readily borne by the band ; the oi ;ect of which is, to render the oil sufficiently liquid to be easily expressed. They are then introduced into a powerful screw-press, by which process a whitish oily liquid is obtained, which is transferred to clean iron boilers, supplied with a considerable quantity of water. The mix- ture is boiled for some time, and the impurities being skimmed erf, a clear oil is left on the top of the water, the mucilage and starch being dissolved in the water, and the albumen coagulated. The clear off is removed, and the process completed by boiling it with a small pro- portion of water, continuing the application of heat till aqueous vapour ceases to rise, and till a small portion of the liquid, taken out in a vial, is perfectly transparent when it cools. The effect of this last operation is said to be — t clarify it. and render it less irritating by driving off the acrid volatile matter. If tie heat be carried too 164 SPECIAL CATHARTICS. far, the oil acquires a brownish hue, and an acrid taste, similar to the West India oil. One bushel of good seeds yields five or six quarts, or about 25 per cent, of the best oil. (Wood & Bache). Castor oil, which is obtained by expression without heat, is called cold-drawn castor oil. Recently prepared castor oil, or oil, as it is often called, is inodor- ous and nearly insipid; colourless, or of a pale straw colour; thick, but perfectly transparent. It is lighter than water; grows rancid by keeping; thickens, and its colour becomes of a reddish-brown. It has a hot nauseous taste ; is completely soluble in absolute alcohol, and in pure sulphuric ether, differing, in this respect, from all the ordinary fixed oils, except palm oil. Hence, alcohol is lecommended in the Edinburgh Pharmacopceia to test its purity. In this country, however, the oil is so common, that there is no inducement to adul- terate it. It has often been examined by the chemist, but the source of its cathartic powers has not been discovered. Castor oil seeds are possessed of acrid cathartic properties, and are said to have proved fatal when taken to the extent of 20 at once. The acrid principle is considered to be dissipated by the heat of boiling water; but it is more probable that it exists in the covering of the kernal, inasmuch as the cold-drawn castor oil does not appear to be more active than that which is prepared by heat. It has been seen, indeed, that long continued heat developes acridity. Castor oil is one of the most valuable of the mild cathartics, ope- rating by virtue of a special affinity for the mucous membrane of the bowels ; for when injected into the veins — as was done by a respect- able physician of this country, (page 137), it produced griping and purging, and what was more surprising, the taste of castor oil was experienced. It is one of the most speedy in its operation, and, ac- cordingly, is well adapted for all cases in which it is desirable to evacuate rapidly the contents of the bowels. It is apt, however, to induce nausea and vomiting, and this sometimes renders it inappli- cable. As elsewhere remarked, its cathartic action is not by any means in a ratio with the dose ; hence, in cases in which it is merely desirous to evacuate gently the bowels, a tea-spoonful or two will often operate as effectually as a larger quantity, and, of course, with less proba- bility of exciting nausea. The author is constantly in the habit of giving it in tea-spoonful doses, especially where there is erethism of the mucous membrane of the bowels, and the dose is generally suffi- cient. For children, it is unquestionably one of our most satisfactory cathartics, and is in constant use in domestic practice, — the only ob- jection being its nauseous taste. The ordinary dose of castor oil is considered to be a fluidounce, or about two table-spoonfuls ; rarely, however, can more than a table- spoonful be needed. For children, the ordinary dose is a tea-spoonful. It is so exceedingly disagreeable to many persons, that they can scarcely be prevailed upon to take it ; and, under such circumstances, if it reaches the stomach, it is apt to be rejected. As in other cases, RHEUM. 165 however, if the dose be repeated immediately, it may be retained. To obviate its unpleasant taste, it may be dropped on a little aromatic water, spirit and water, hot coffee, or hot milk, and the mouth may be rinsed with some of the vehicle before it is swallowed. Dr. R. E. Griffith, of Philadelphia, says the most effectual mode of dis- guising its taste is to mix it with the froth of porter. It is not un- frequentlv made into an emulsion with the volk of egz or mucilage and some aromatic water. (01. ricini, f.5yj ; vitell. avi, seu rnucilag. acac. f.|ss ; aqua mentha pip. L5V. — Dose, a fourth part every two hours until it operates. Oil of turpentine aids its action materially, but renders it still more disagreeable. Should it be indicated, two drachms may be added to the above mixture. Where nausea and vomiting are anticipated, or intestinal irritation exists at the same time, ten drops of laudanum may be added to the dose of oil. RHEUM—RHUBARB. Rheum Palmatam. Eh:JT. Cotnpactam. The chief varieties of rhubarb root met with in commerce are the Chinese. Russian, and the European. Dr. Pereira, however, states, that he is acquainted* with sis kinds —the Russian, the Dutc'.-trim- med, the C*f o . the Himalayan, the English, and the French. The Chinks:-:, or East India Rhubarb, constitutes the largest por- tion of that which is used in this country. It is brought either directly from Canton, or by Singapore and other ports of the East Indies. As 166 SPECIAL CATHARTICS. we meet with it, it is either in round or flattened pieces ; seems smooth, as if it had been scraped ; and is generally perforated with holes, in many of which are found pieces of the cords by which they had been suspended. It is more heavy and compact than the Rus- sian variety ; the smell, too, is much less powerful, and the colour of the powder of a more dull yellow or brownish cast. The Russian, Turkey, Moscow, Bucha'rian or Sibe'rian Rhubarb, is imported from St. Petersburg ; and is said to have been formerly shipped from the Turkish ports, to which it was brought from Tar- tary, by caravans, through Persia and Natolia. Hence, it was often called Turkey Rhubarb. The Bucharian merchants have entered into a contract with the Russian government to supply it with rhubarb in exchange for furs. It is carried by them to Kiachta, a frontier town, where it is inspected by a Russian apothecary, employed there for the purpose. The worm-eaten portions are rejected, and the others are bored to ascertain their soundness. The portions which do not pass examination are burned, and the rest is sent on to the Russian capitol. The size and shape of the pieces are various, — the external appear- ance seeming to show, that the cortical portion had not been scraped as in the Chinese Rhubarb, but had been cut off longitudinally by the knife ; hence the angular appearance of the surface. The smell and taste are essentially those of the Chinese variety, excepting that it is somewhat more aromatic. The aroma is considered, however, to be so delicate, that, according to Dr. Pereira, in all wholesale drug houses, a pair of gloves is kept in the Russian rhubarb drawer with which to handle the pieces. When chewed, both it and the Chinese variety feel gritty under the teeth, owing to the presence of numerous crystals of oxalate of lime. The colour of the powder is a bright yellow, without the orange tinge of the Chinese. As the Russian is much more expensive than the Chinese variety, the latter is sometimes cut so as to resemble it; but the fraud may be detected by attention. Dr. Wood states, that he has seen parcels of very good rhubarb imported from Canton, which were evidently prepared so as to resemble the Russian ; but in most, if not all, of the pieces which came under his notice, the small perforating hole was found, which characterises the Chinese rhubarb, although in some instances it had been filled with the powdered root so as to conceal it. This was probably the Dutch-trimmed, or Bata'vian Rhubarb, which, according to Dr. Pereira, is imported from Canton and Singa- pore. Sometimes the worm-eaten pieces are made to resemble the sound by filling up the holes with a mixture of powdered rhubarb and mucilage, and covering over the surface with the powder; but, by removing this, the fraud is detected. At times, too, the eastern varieties are mixed with the European; the last of which is easily distinguishable by its weaker aroma, and want of grittiness when chewed. It is not easy, however, to detect the admixture, if the rhubarb be in a state of powder, and the adul- terating article be in small quantity. RHEUM. 167 The Europe'an Rhubarb is much inferior to that which is brought from Russia and China. In England two kinds are met with in the shops under the name of English Rhubarb, one dressed or trimmed, so as to resemble the Russian: the other, sometimes called stick rhubarb. It is raised in various parts of England, but chiefly near Banbury in Oxfordshire, and is distinguished from the Asiatic varie- ties by being externally of a reddish hue, and having brownish spots of adhering bark, and internally a looser, sorter, spongy texture, with occasional cavities, especially in the centre. It is pasty under the pestle. In taste and smell, it resembles the Asiatic rhubarb ; but is more mucilaginous, and does not, like it, feel gritty under the teeth. The stick rhubarb is in irregular pieces, about five or six inches long, and an inch thick. Its taste is astringent, but very mu- cilaginous. Both varieties of English rhubarb are said to be exten- sively employed by druggists to adulterate the powder of Asiatic rhubarb. Rhubarb is likewise cultivated largely in France, especially at an establishment called Rheumpole, near the port of Lorient. The quantity of rhubarb consumed is very great. In the year 1S31, according to McCulloch, there were imported into England from Russia 6,901 lbs.; from the East Indies. 133,462 lbs. : of this quantity, 40,124 lbs. were retained for home consumption. The medical virtues of rhubarb are yielded wholly to water and to alcohol. It has been repeatedly subjected to chemical analysis, but the results have not been of much pharmacological interest. They show that it contains, along with its cathartic constituents, a bitter principle, and astringent matter, consisting of tannic and gallic acids, to which a portion of its medical virtues is referable. Rhubarb is one of the most valuable cathartics, seeming to act upon the whole tract of the intestines, and not causing any very copious secretion from the lining membrane. It is, consequently, one of the mildest of the class. Owing to its containing tannic and gallic acids, it is somewhat astringent, and the common opinion is, that it is first an evacuant to the bowels, and afterwards an astrin- gent. Its bitter principle, too, gives it tonic properties, and hence, in small doses it is prescribed whenever a joint tonic and laxative agency is needed. Like many other cathartics, its action is often accompanied by tormina, which may be obviated bv the addition of some aromatic. Associated with other cathartics it forms one of the most common prescriptions of the physician. It is often given, especially in in- fancy, combined with magnesia or its carbonate, which is said to re- move the constipating influence, that rhubarb, given alone, exerts after it has acted as a cathartic. United with the mild chloride of mercury, and an appropriate corrigent, it is an active cathartic, and one very commonly prescribed. (Pulv. rhei gr. xv. ; hydrarg. chlo- rid. mif.pulv. zingib. aa gr. v. M. By roasting rhubarb, its cathartic power is diminished, and its as- 168 SPECIAL CATHARTICS. tringency —it has been supposed — increased ; hence, it is not un- frequently employed in diarrhoea and dysentery. The dose of rhubarb, to produce a full operation, is from twenty to thirty grains ; in smaller doses, it acts as a laxative. The Euro- pean varieties require to be given in twice the quantity. Its nausea and bitter taste, according to Dr. A. T. Thomson, is completely co- vered, when mixed with milk, if the mixture be taken directly ; but if not taken immediately the medicine soon communicates its taste to the milk. When not given in this form, one of the following officinal pre- parations may be prescribed: INFU'SUM RHEI, INFU'SION OF RHUBARB. (Rhei, cont. 3J. ; Aqua bullient. Oss.) The dose of this infusion, as a laxative, is f. gj. or f. gij.; but it is rarely given alone. It is commonly used as a vehicle for other cathartics or tonics, or for magnesia, when used as an antacid. PIL'fflJERHEI, PILLS OF RHUBARB- (Rhei, in pulv. 31}.; sapon. 3ij. ; di- vide in pil. cxx.) Generally taken at bedtime as a laxative. Dose, two or three, repeated on the following morning if necessary. P1LM RHEI COMPOSTLE, COMPOUND PILLS OF RHUBARB. {Rhei, pulv. 3j.; Aloes, pulv. gvj. ; Myrrh, pulv. gss.; ol. menth. piperit. f. 3ss. ; Syrup, aurant. q. s. ut fiant pil. cclx.) The aloes adds to the activity of the rhubarb ; but it is not easy to see what can be the effect of the myrrh ; the oil of peppermint is a corrigent, which pre- vents the cathartics from griping. It is a good laxative pill, in the dose of two to four taken at bedtime. SYR'UPUS RHEI, SYRUP OF RHUBARB. (Rhei contus. gij.; Aqua bul- lient. Oj.; Sacchar. fbij. made into a syrup.) Given in the dose of a teaspoonful or two to infants as a laxative. It is not so frequently administered, however, as the following: SYRUPUS RHEI AROMAT'ICUS, AROMATIC SYRUP OF RHUBARB. {Rhei, con- tus. gnss. ; Caryophyll. contus. Cinnam. contus. aa |ss.; Myristic. cont. 5ij- ; Alcohol, dilut. Oij. ; Syrup. Ovj. made into a syrup. It may be prepared also by the process of displacement. See the Phar- macopoeia of the United States, 1842.) This is much used in do- mestic practice, under the name of spiced syrup of rhubarb, in the bowel affections of children, especially in those that occur during the summer and autumnal months. The aromatics and the alcohol impart excitant properties to it, and render it carminative and laxa- tive. The dose for an infant is a teaspoonful or two. TINCTU'RA RHEI, TINCTURE OF RHUBARB. (Rhei, cont. 3iij.; Cardam. cont. 5ss. ; Alcohol, dilut. Oij. It may be prepared also by the pro- cess of displacement.) The cardamoms are added as a corrigent. ALOE. 169 In the dose of f. 55s. to f. 5J. it proves cathartic. In lesser doses, it is sometimes taken as a stomachic and laxative. TINCTU'RA RHEI ET ALOES. TINCTURE OF RHUBARB AND ALOES. (Rhei. cont. ^x. ; Aloes, pulv. jvj.; Cardam. cont. 53s.: Alcohol, dilut. Oij.) This is the relic of the ancient Elixir sacrum. It combines the ca- thartic virtues of both rhubarb and aloes. The dose, as a cathartic, is from f. jss. to f. gj. TLNCTURA RHEI ET GENUA NX TINCTURE OF RHUBARB AND GEXTIA5. (RJiei, cont. ^ij ; Gentian, cont. ^ss. : Alcohol, dilut. Oij. It may also be made by the process of displacement.) By combining the tonic virtues of the gentian, this tincture is employed as a tonic and laxative, in doses of from f. 5i. tof. 5SS. ; in larger doses, f. 5L to f. Jij. it is cathartic. TINCTU'RA RHEI ET SENNE. TTNCTURE OF RHUBARB AND SENNA. (Rhei, cont. 5j : Senna, 31J ; Coriandr. cont.; Foenicul. cont. aa 5j ; Santal. rasur. ,-ij ; Croci, Glycyrrhiz. aa 35s ; Uvar passar. demptis acinis, ft>ss ; Alcohol, dilut. Oiij.) This polypharmacal production is an imitation of Warners Gout Cordial. The rhubarb and senna are cathartics ; the coriander and fennelseed excitants, and therefore cor- rigents ; the red saunders and saffron are mere colouring matters ; the liquorice and raisins communicate sweetness to the tincture. It is an agreeable stomachic and laxative, especially in the flatulence of the gouty, and such as have been addicted to the use of wine or spirituous liquors. The dose is f. ~ss. to f. 51J. YTNOI RHEI, WINE OF RHUBARB. (Rhei, contus. =ij ; Canellx, contus. 3J; Alcohol, dilut. f. =ij ; Vini, Oj.) Canella is an excitant and corri- gent ; and the wine is applicable to the same cases as the Tinctura Rhei. The dose is from f. oiij. to f. 5J. 13. ALOE.—ALOES. il'oe spica'ta, and Fis. 15. '"'ft) Aloes is the inspissated juice of the leaves of other species of aloe; Sex. Syst. Hexandria Monogynia ; Nat. Order, Liliaceae. The Lon- don Pharmacopoeia refers it to Aloe spicata aloDe ; the United States Pharmacopoeia (1S42), with more propriety, to that as well as other spe- cies. It is generally believed, indeed, that three species furnish the different kinds in the market,—Aloi' spica'ta, A. vulga'ris, and.?. Soco- tori'na, and it is considered probable, that at least two other species are employed, — A. Com- meli'ni of Willdenow, and A. linguseform'is of Thunberg. The information, which we possess as to the sources of aloes, is still unprecise. Within a few years, the drug has beer* imported into England from Bombay, vol. 1.—15 170 SPECIAL CATHARTICS. Arabia, Socotora, Madagascar, the Cape of Good Hope, the Le- vant, and the West Indies, and it would seem, that the aloes of British commerce is derived more or less from most, if not all of these places, directly or indirectly. The finest aloes is obtained by inspissating the juice, which flows spontaneously from transverse incisions made in the leaves. If pressure be used, the juice becomes mixed with the mucilaginous liquids of the leaves, and an inferior kind of aloes is the result. A still inferior kind is prepared by boiling the leaves, after the juice has escaped, in water. In England, no less than seven varieties of aloes are met with —the Soc'otrine, Hepat'ic, Barba'does, Cape, Mocha, Cab1alline, and Indian, (Pereira.) In this country, we rarely see more than three, the So- cotrine, the Cape of Good Hope, and the Hepatic. (Wood and Bache.) Socotrine Aloes ought to be obtained from the Island of Soco- tora, in the Straits of Babelmandeb, but much that is sold under that name is procured from other places. It would appear that in 1833 the quantity exported from that island was two tons. The name Socotrine Aloes is often given to the best specimens of aloes, no matter whence obtained. Both in Spain and the West Indies, according to Wood and Bache, the juice, inspissated in the sun, bears this name. It would appear, however, that the commer- cial value of the real Socotrine aloes is now below that of Barbadoes aloes, than which it is perhaps inferior in activity. Socotrine aloes is of a yellowish or reddish-brown colour, which becomes deepened by exposure to air. The fracture is smooth, glassy, conchoidal; yet, even when of excellent quality, it often breaks with a roughish fracture. The powder is of a golden yellow colour. The odour of fresh broken pieces, especially when breathed on, is fragrant according to some ; it is certainly peculiar, and perhaps, to the mass, not unpleasant. The taste, like that of all the aloes, is in- * tensely and enduringly bitter, but perhaps it is somewhat less disa- greeable than the other varieties. Cape of Good Hope or Cape Aloes, is imported, as its name shows, from the Cape of Good Hope into Great Britain, whence it is again imported into the United States, and is the variety chiefly used in this country. It differs materially in its appearance from the So- cotrine aloes, having a shining resinous aspect, whence its name of Al'oe lu'cida with the Germans. It is of a deep-brown colour, ap- proaching to black, and has a glossy or resinous fracture. "When held up to the light its edges appear translucent, and have a yel- lowish-red or ruby colour. The powder is of a greenish-yellowcolour. Its odour is stronger and more disagreeable than that of the preced- ing variety. Hepatic or Barbadoes Aloes is imported from Barbadoes or Jamaica in gourds. Its colour varies from a dark-brown or black to ALOE. 1:1 a reddish-brown or liver colour. The fracture is sometimes dull; at others, glossy. The powder is of a dull olive-yellow colour. The odour, especially when breathed upon, is exceedingly uisagreeaoie and nauseous. It is known that this variety is obtained from the Al'oe vulgc. ris. It is but little used in this country, except for horses. A variety of aloes, called Genuine Hepatic Aloes, Liver-co- loured Socotrine Aloes, is exported from Bombay, and would appear to be an inferior variety of the Socotrine. The two are sometimes, indeed, intermixed. The composition of aloes has been investigated by many distin- guished chemists, Trommsdorff, Bouillon-Lagrange. N ogel, Bracon- not, and Winkler. It was for a considerable period regarded as a gum-resin, but it is questionable, whether it contain strictly either gum or resin. Its most important constituent is a bitter extractive matter, termed aloesin, which, according to TrornnisdorrT. forms 75 per cent, of SDCotrine aloes, and Si.25 of Barbadoes aloes. Some specimens of the latter did not, however, contain more than 52 per cent. There is, in addition to this, a resinoid substance, the pro- portion of which varies from 6.25 to 42 per cent.— which has been considered oxidised extractive. The most important point, in a pharmacological point of view, is, that aloes yields its medical virtues to cold water: a dark-brown substance, however, being left, which is dissolved by boiling water, but is deposited again as the water cools. Tbis is the resinoid sub- stance. Its best solvent is dilute alcohol. Aloes is more extensively used than any other vegetable cathartic. It forms the basis of most cathartic pills. Its action appears to be exerted on every portion of the canal, but especially on the large intestines. Even when placed in contact with an abraded surface, it exerts its wonted effect on the bowels ; affording an example of that special affinity between particular therapeutical agents and par- ticular portions of the economy of which we have so many exam- ples. In large doses it is apt to irritate the rectum, and is therefore improper for those who are suffering under piles, and in pregnancy. When, however, it is associated with hyoscyamus, its injurious agency, in the latter condition especially, is obviated. {Aloe's pulv. 5J : Ext. hyoscyam. 3j.— M. et divide in pilulas xx.— Dose, two at bedtime.) In its operation, aloes does not stimulate greatly the cutaneous exhalants, and hence the evacuations are not as watery as those pro- duced by many other cathartics. It is rarely, however, given alone: being usually associated with other cathartics, and with some essen- tial oil or other excitant, to prevent the griping, which it is so apt to occasion. It is affirmed, too, that certain substances, although not pos- sessed of any cathartic property, increase the cathartic action of aloes. Several vegetable bitters, especially sulphate of quinia, and likewise sulphate of iron, have been considered to act in this manner. Dr. 172 SPECIAL CATHARTICS. Christison states, that he has not been able to remark the property m sulphate of quinia, but that it is undoubtedly possessed by sulphate of iron,— one grain of aloes with two or three grains of that salt producing as much effect as two or three grains of aloes alone, and with much less tendency to irritate the rectum. The attention of the author has been drawn to this point, but he has not been able to speak so positively as Dr. Christison. It can be understood, how- ever, that any tonic combined with a laxative may have the effect of aiding the operation of the latter, by the greater energy it com- municates to the digestive operations. The bitter extractive of aloes renders it at the same time tonic, and hence its usual association in " dinner pills" with tonics, where it is advisable to have a joint tonic and laxative action. Aloes is rarely given where a speedy action on the canal is needed. Its operation is gradual, and hence, as well as by reason of its ex- ceedingly nauseous taste, it is generally given in the form of pill. Its action is by no means in proportion to the dose ; and, accordingly, it may be prescribed with impunity even to children in very large doses. The author was first induced to employ aloes so largely from the very high eulogiums he had heard pronounced upon it by Dr. Hamilton, late Professor of Midwifery in the University of Edin- burgh, to whom the idea of administering it freely in diseases of children was suggested by observing, in an apothecary's shop, where he had been placed by his father for the purpose of being practically instructed in Pharmacy, that the Syrup of buckthorn — so called — which they were in the habit of vending to mothers oi families to be given to their children, was usually formed extempo- raneously of aloes dissolved in treacle or molasses ; and upon making inquiries of those who had purchased it, he found that no bad effects had resulted from its administration; he, consequently, formed the determination of trying it in his own practice, when he found it to be not only a successful agent after other means had failed, but also, that it was rarely rejected by the stomach, acted mildly, was per- fectly safe, and but seldom objected to by young infants. The author has elsewhere detailed cases in his own practice, as well as in that of others, in which two drachms of oowdered aloes were taken in this form in two successive days, without any griping or unpleasant symptom, and writh full relief to the constipation. (Commentaries on Diseases of the Stomach and Bowels of Children, p. 92, Lond. 1824.) The dose of aloes, as a purgative, is from five to ten grains or more; as a laxative, two or three grains in the form of pill. PIL'UM ALOES, ALOET'IC mU —(Aloes pulv., Sapon. aa gij. Divide in pil. ccxl.) The soap is added with the view of assisting the solu- tion of the aloes, so as to cause it to act on the whole intestinal tract, rather than on the rectum. Five pills contain ten grains of aloes ; so that two at bedtime will usually pioduce a laxative effect on the following day. ALOE. 173 Ptt'ILE ALOES ET ASSAFOZ TIDE. PILLS OF Al'OES AND ASSAFETTDA.—(Aloes pulv.. Assafoetid., Saponis, aa 5ss. ; divide in pdulas clxxx.) The assafetida is added as an excitant; and the pill is given in constipation accompanied by flatulence, and impaired tone of the stomach and intestines. Dose, two to five. PILULE ALOES ET 5TTRRHE, PUIS OF AL'OES AND MYRRH, — {Aloes pulv. sij : Myrrh, pulv. =j : Croci, =ss ; Syrup, q. s. ut fiant pil. cccclxxx.) These are the old Pilules Rufi or Ruf us's pills. They are frequently used by females labouring under catamenial obstruc- tion, which is generaDy attended bv more or less atony and consti- pation ; the myrrh being regarded as an emmenagogue. The dose is from three to six. PULYIS AL'OES ET CANEL LE POWDER OF Al'OES AND CANELLA. — {Aloes, ffcj ; Canellce, =iij.) This is the old Hiera picra or '• holy bitter," which has long been much used in domestic practice as an emmen- agogue. The canella is excitant, and therefore prevents the griping tendency of the aloes: but like the last preparation, this is no more emmenagogue than any of the other combinations of aloes: all of which — as elsewhere remarked — affect the uterus only by contigu- ous sympathy, through their action on the lower part of the intesti- nal canal. TLNCTrRA ALOES. TINCTURE OF ALOES. — (Aloes pulv. §j; Glycyrrhiz. = iij ; Alcohol. Oss ; Aq. destillat. Oiss.) The same objection ap- plies to the tincture of aloes as to the powder, and indeed to every form of administration except the pill. It is in the highest degree nauseous, and the liquorice renders it scarcely less so. Its dose, as a cathartic, is from f. =ss. to f. 5 iss. TINCTU RA ALOES ET MrRRELE, TDCTURE OF ALOES AND MYRRH. (Aloe's pulv. 31:1 : Croci, 5J ; Tinct. Myrrh. Oij.) This is a relic of the Elixir Pr n -ietatis of Paracelsus. It possesses the same medical properties as the Pilulas Aloes et Myrrhae, — the saffron being a mere colouring ingredient. Its dose is from f. 5J. to f. 51J. or more. VLNUM ALOES. WINE OP ALOES. (Aloes pulv. =j : Cardam. cont., Zingib. cont. aa 5J : Vini, Oj.) The wine of aloes is used in the same cases as the tincture ; — the cardamom and ginger acting as corrigents. Aloes likewise enters into other officinal formulae, as the Extrac- tum Colocynthidis compositum ; the Pilula Rhei composite, the Tinc- tura Benzoini composite, and the Tinctura Rhei et Aloes—which are described elsewhere. 15* 174 SPECIAL CATHARTICS. Fig. 16. Fig. 17. 14. SENNA. In the Pharmacopceia of the United States (1842), Senna is defined to be "the leaflets of Cassia acutifo'lia (Delile), Cassia obova'ta (De Candolle) and Cassia elonga'ta (Lemaire Journ. de Pharm.,\n. 345.)" These plants belong, in the Sexual System, to Decandria Mono- gynia ; Nat. Ord. Leguminosse. Confusion, however, still exists as to the'precise species that yield the senna leaves of commerce. The leaflets of Cas'sia obova'ta, which is a native of Egypt, Nubia, Syria, In- dia, &c, and has been cultivated in Italy, Spain, and the West In- dies, are said to form Alep'po, Senegal' and Ital'ic Senna, and to be one of the constituents of Alexandrian senna. Those of Cas'sia acu- tifo'lia, which is a native of Egypt, in the valleys of the desert to the south and east of Assouan, are collected by the Arabs, and sold to the merchants, who convey it to Cairo. This is said to be the species that furnishes the Trip'oli Senna, and the greater part of the variety, known in commerce under the name of Alexan'drian Senna. Dr. Pereira, however, refers the Tripoli senna, which he thinks he has detected in Alexandrian senna, to Cas'sia JEthiop'ica, which grows in Nubia, Fezzan to the south of Tripoli, and probably in Ethiopia. The leaflets of Cassia elongata, which grows in India, are said to yield the Tinnevell'y and Mecca Sennas. The consumption of senna is considerable. The quantity on which duty was paid in England, in 1838 and 1839 was, according to Dr. Pereira, as follows ; from the East Indies, in 1838, 72,576 lbs. ; in 1839, 110,409 lbs. ; from other places, in 1838, 69,538, lbs. ; in 1839, 63,766 lbs. The Mediterranean senna is brought chiefly to this country from Marseilles ; the Indian variety comes either from Bombay or Calcutta, — directly, or by the way of London, where it is purchased at the East Indian Company's sales. (Wood & Bache.) The varieties that are brought to this country are the Alexandrian, the Tripoli and the Indian. Legnme and leaflet of Acute leaved Alexandrian Senna. Legume and leaflet of C obovata. (Pereira.) SENNA 175 Alexandrian Senna is an admixture of the leaflets of the species of cassia referred to in the Pharmacopoeia of the United States. It is sold by compulsion to the Egyptian government, who resell it. It is collected in Nubia and upper Egypt, and is sent down the Nde to the great depot oi Boulak, near Cairo. It is oi a greyish green colour ; of a smell somewhat resembling that of tea, and of a viscid taste. It has a broken appearance, and contains various ex- traneous matters, which are separated from it. — when it becomes what is termed picked Alexandrian senna. Tripoli Senna resembles, in appearance, the Alexandrian, than which it is much cheaper. It is more broken up, however: and, although very active, is less esteemed. The common opinion is. that it is carried to Tripoli in caravans from Fezzan; but, under the belief that the leaflets are furnished by Cassia aeutioolia, which differ, however, in some respects, from those in the Alexandrian senna, and taking into consideration the greater cheapness of the Tripoli senna. Dr. NVood is of opinion, that it grows upon the Mediterranean coast of Africa, in the vicinity of Tripoli. Of the Indian Senna, there are two varieties ; 1, the Ttwevf.t.t.v Senna, or the finest East Indian Senna, which is cultivated at Tinne- velly in the southern part of India. It is a fine unmixed senna, is extensively employed, and brings a good price. It consists of large unbroken leaders, of a fine green colour, from one to two inches or more long, and at times half an inch broad at their widest part. 2. An inferior or second East Indian senna, the Mecca Senna, or Pike Senna, which is cultivated in Arabia, and finds its way to Bombay. It is in long leaflets. narrower than those of Tinnevelly senna, and of a yellowish colour, some of the learlets bring brownish or even blackish, and is occasionally mixed with pods, and with stalks and dust. Different adult-r- ations of senna have been pointed out by pharmacological writers, but they do not appear to apply to the sennas of this country, which are sufficiently pure. I M :>enna yields its virtues to water — Tlnnevellv ~- «.Ler :^r *. Lr-rt :yle.) dilute : hence water and in officinal preparations. warm or cold ; and to alcohol — pure or dilute alcohol are the menstrua employed It has, 1, an odorous principle—volatile oil of senna — which cf course is lost by boiling. This has a nauseous odour and taste : and appears to possess some cathartic power, — the distilled water acting as a mild cathartic : — d. a purgative principle, to which the name cathartin has been given, three grains of which cause nausea, griping and purging. The active principle is precipitated by infusion of galls, and pro- 176 SPECIAL CATHARTICS. bably by other astringents, as well as by a solution of subacetate of lead ; but these substances could scarcely be combined in the same prescription. Senna has a special affinity for the lining membrane of the intes- tines ; for its infusion proves cathartic when injected into the veins ; and the infant at the breast is purged by it, after the mother has taken it; hence it must have passed into the circulation of the latter. It might, therefore, operate both by direct contact, and indirectly through the circulation. It is a safe, active, and rapid cathartic ; hence its value, alone, or associated with other articles, that act speedily, where such action is desirable. The objection to it is its nauseous taste, and tendency to induce vomiting, and especially severe griping. The corrigents, generally used to obviate these objectionable quali- ties, are aromatics and saccharine matters, which last have been con- sidered the best of all. They appear, too, to be modified by com- bining it with certain other cathartics. Like other cathartics, too, its purgative effect seems to be increased by a combination with tonics, yet the combination is rarely necessary, and therefore not often made, on account of the disagreeable character of the com- pound. Senna is rarely given in powder, partly on account of the quantity necessary to produce the effect. From jss to 3ij is the average dose. Black tea and coffee have been advised to cover its disagreeable flavour. INFU'SUI SENN1, LNFU'SION OF SENNA. (Senna, fij ; Coriandr. cont. |j; Aqua bullient. Oj.) The coriander is added as a corrigent. Senna tea is a common domestic remedy, especially as a purgative for children, sweetened with sugar. It is most commonly, however, used as a vehicle for other cathartics, of the saline class, especially. The well known Haustus niger or black draught, or black dose — the terror of the invalid, by reason of its nauseous character — is a com- pound of this nature. It may be made as follows : — Infus. Senna, f. ^v ; aq. cinnam. f. ^j ; manna, 5iv ; magnes. sulphat. 3yj. Dose, an ounce and a half or more. The dose of the Infusum Senna is f. |iv. According to Dr. A. T. Thomson, the disagreeable taste of senna is considerably less when the infusion is made with cold water, al- though it does not lessen the activity of the drug. The taste of the ordinary infusion of senna is covered by the addition of a few grains of cream of tartar, or by admixture with black tea. _ TINCTU'RA SENN.H ET JALAPS, TINCTURE OF SENNA AND JALAP. (Senna, 5"j ; jdap. pulv. §g coriandr. cont. ; carui, cont. aa jjss ; cardamom. cont. 3ij ; sacchar. Jiv ; alcohol, dilut. Oiij. It may be made, also, by the process of displacement.) This is one form of the old elixir salutis. The jalap is a cathartic adjuvant; and the aromatics, sac- CASSIA MARILANDICA. 177 charine matter, and the menstruum itself act as corrigents. It is a carminative cathartic, and is employed occasionally, like the tinc- ture of rhubarb, in costiveness attended with flatulence, especially in persons of the gouty diathesis. It is more commonly used, however, as an adjunct and adjuvantjo the infusion of senna. Its dose, as a cathartic, is from f. ^ss to 5J. SYRTPUS SENN.E. SYRUP OF SENNA. (Sennce, =ij; Fcenic. cont. =j ; aqua bullient. Oj ; sacchar. 5XV.) The syrup may be added to the infusion of senna, as an adjuvant and corrigent. It is well adapted. also, as a cathartic for chddren. Dose, f. 5j to f- 5iij- _ CONFECTIO SENNE. CONFEC HON OF oiv; glycyrrhiz. cont. oiij: Fie. Lb j; pulp. prun.; pulp, tama- rind. ; pulp, cassia fistul. aa tfess; sac- char. tfeiiss; aqua Oiv. Make into an electuary.) This is one of the forms of the lenitive electuary, long used as a laxa- tive, especially in cases of pregnant fe- males, in affections of the rectum, and when- ever a gentie effect on the bowels is needed. The c ori- ander and the sac- charine matters act as corrigents to the senna; whilst the liquorice,rigs.prunes, tamarinds, and pulp of cassia are, at the same time, laxative. The dose is from -ij to oiv, taken at bed- time. S^nna likewise en- ters into other offi- cinal preparations, as the tinctura rhei et SENNA. (Senna, oviij; coriandr. Fig. Ii. Cassia Marilanuiea. senna and syrupus rhei et senna of the Pharmacopoeia of the Inited States. 178 SPECIAL CATHARTICS. 15. CAS'SIA MARILANDICA. — AMERICAN SENNA. This is an indigenous perennial plant, Sex. Syst. Decandria Monogynia; Nat. Ord. Leguminosse, from three to six feet high, with flowers of a beautiful golden yellow colour, which is very common in every part of the United States to the south of New York, growing most abundantly in flat ground on the margins of rivers and ponds. It is sometimes cultivated in the gardens for medical use. The leaves of wild senna — as it is often termed — are collected in August or the beginning of September, and carefully dried. It is in full bloom in the months of July and August. In the shops of this country, the leaves are often met with in compressed cakes, prepared by the Shakers; they have a feeble smell, and a disagreeable taste, somewhat resembling that of senna. They would appear to contain an active principle, similar to the cathartin of senna; and they yield their virtues to both water and alcohol. The medical virtues of American senna are similar to those of the imported article; but it is not so active, requiring to be given in a dose about one-third larger. It may be prescribed, like senna, in the form of infusion. 16. JUGLANS. —BUT'TERNUT. Butternut is the inner bark of the root of Juglans ciner'ea, an in- digenous forest tree known not only under the name of butternut, but also of oilnut and white walnut; Sex. Syst. Monoecia Polyandria; Nat. Ord. Terebinthacese; —Juglandese, (Lindley.) It grows in the Canadas, and in the northern, eastern, and western parts of the United States ; flowering in May, and the fruit ripening in September. The inner bark of the root, which is the officinal portion, is collected in May or June. It is a gentle cathartic, resembling rhubarb in its operation, and was much used in the army of the United States during the revo- lutionary war. It is rarely, however, prescribed in the cities. It yields its virtues to water, and may, therefore, be given either in the form of decoction or of extract. The latter is officinal. Juglans itself is rarely if ever prescribed in substance. EXTRACT!! JUGLAN'DIS, EXTRACT OP BUT'TERNUT, (Prepared by evapo- rating the decoction of the inner bark of the root in coarse powder, or by the process of displacement.) The extract often found in the shops is prepared, by the country people, from a decoction of the bark of the branches, and it is said even from the branches themselves. This, as suggested by Dr. Wood, may account for the uncertainty of its action. The dose is 20 or 30 grains. PODOPHYLLUM. 179 17. PODOPHYLLUM.— MAY APPLE. Podophyllum, of the Pharmacopoeia oi the Udnited States, is the rhizoma of Podophyl lum pelta'tum; Sex. Syst. Polyandria Mono- gynia : Nat. Ord. Ranunculaces ; — Podophyllese, (Jussieu , Ber- benciaceaj. Y\s. -0, (Torrey i>' Gray), an indigenous herbaceous plant, grow- ing exten- sively thro1 the United States, in moist shady places, and in low marshy grounds, & common- ly known under the name of May apple or Ma7i- drake. It flowers about the end of May or the be- ginning of June, and the fruit, which is sometimes preserved, ripensinthe F,c:Payoum. latter part of September. The root is collected after the leaves have fallen off. As met with in the shops, it is in pieces about two lines thick, with broad flattened joints at short intervals; is wrinkled longitudi- nally, and of a reddish or yellowisb-brown colour externally. In- ternally, it is of a whitish colour. Its taste is at first sweetish, after- wards "bitter, nauseous, and slightly acrid. It yields its virtues both to water and alcohol. The powdered root resembles jalap in its action, and may be used. 180 SPECIAL CATHARTICS. in the same cases and forms of combination. Its dose is about 20 grains. EXTRAC'TUM PODOPHTL'LI, EXTRACT OF MAY APPLE. (This extract is direct- ed to be prepared in the same manner as the Extractum Jalapa, for which it might be substituted.) Its dose as a cathartic is from five to fifteen grains; but neither it nor podophyllum is much used by the profession generally. 18. HYDRAR'GYRI CHLO'RIDUM MITE".—MILD CHLORIDE OF MER'- CURY. Mild Chloride ofMer'cury, Submu'riate of Mer'cury or Calomel, is usually prepared by sublimation. According to the Pharmacopceia of theUnited States, a sulphate of mercury is first formed by boiling two pounds of mercury in three pounds of sulphuric acid, until the salt is left dry. This is then rubbed, when cold, with the remainder of the mercury, until they are thoroughly mixed. A pound and a half of chloride of sodium is now rubbed with the other ingredients till all the globules disappear. The mild chloride is then sublimed, and afterwards reduced to powder, and washed frequently with boil- ing distilled water, till the washings afford no precipitate upon the addition of solution of ammonia. If no metallic mercury were added in this process, the sublimate would be corrosive chloride. As prepared in the above way, there is always some corrosive sub- limate mixed with the mild chloride, which is removed by the wash- ing directed in the process. NVith the same view, and to obtain it in a state of minute division, the mild chloride in vapour is made to come in contact with steam in the subliming vessel by which it is condensed. Calomel is also occasionally made by precipitation from a solu- tion of mercury in nitric acid, as much as possible in the state of pro- toxide, and adding to it chloride of sodium. By this process, it is obtained in a state of very fine division. "When well prepared, the two calomels are essentially alike in therapeutical properties ; but the one by sublimation is generally pre- ferred. Neither one nor the other is made by the ordinary apothe- cary, but by the manufacturing chemist on a large scale. Calomel, prepared in the ordinary mode by sublimation, forms a crystalline cake, the shape of which is dependent upon that of the subliming vessel. The crystals are square prisms. As seen, how- ever, in the shops, it is in fine powder, devoid of taste and smell, and of a light buff colour. That, which results from the vapour being condensed by steam, is perfectly white. It is wholly volatilised by heat, and is insoluble in water, alcohol and ether. By exposure to light it becomes darker coloured, and hence ought to be kept in a bottle coated with black paper, orbe paint- ed black. By the alkalies or alkaline earths, it is immediately HYDRARGVRI CHLORIDIM MITE. 181 blackened, owing to the formation of protoxide of mercury. Should it contain corrosive chloride, — when distilled water is boiled with it, a white precipitate will be caused on the addition of ammonia. Mild chloride of mercury is in much use as a cathartic, and per- haps nowhere more so than in the United States. It has been else- where remarked, that it is one of the cathartics that do not act in a direct ratio with the dose : indeed, it often happens, that whilst three or fo ir grains operate freely, twenty or thirty mav exert but little agency. In the latter quantity it has been advised to allay irrita- bility of the stomach or bowels in numerous diseases, and especially in spasmodic cholera, in which it has been administered in enormous quantities by some, under the idea that large doses act as a sedatiye. Yet this sedative influence — if it exist—must be confined withir certain limits, erherwise the immense doses occasionally given — amounting even to drachms — ought to be attended with fatal con- sequences. It has been already shown, that according to the idea of Rasori. all cathartics act best in moderate doses, and that when thev are given beyond a certain amount they trove sedative rather than cathartic. Calomel is essentially a cholagogue cathartic, acting upon the upper part of the intestines more especially, and by contiguous sym- pathy upon the liver ; hence its operation is often attended witb a copious discharge of bile, which, as already remarked, mav be no evidence that the individual is bilious, but merely that he has taken a cathartic, which acts upon the lining membrane of the duodenum, and thus augments the biliary secretion. The source of the green stools, or calomel stools which succeed to its repeated enrol youer.t. has been a subject of difference of opinion: they appear to be owing to a modified secretion of the whole glandular and follicular appara- tus connected with the intestinal canal, all of which it certainly ex- cites to greater action. With many persons — perhaps with most—when taken to the extent of inducing purging, calomel causes more or less nausea, and at times vomiting : and not unfrequentlv its action is accompanied by griping. Notwithstanding these inconveniences, however, it is an excellent cathartic, especially when taken at night in the form of pill, and followed up by some saline or other cathartic, of more gene- ral and speedy action, on the following morning. It is likewise an excellent adjunct to other cathartics, and hence — where there is no special objection to its employment — it is a common and effective ingredient in most active cathartic pills. It is also a very common cathartic for children, in consequence of the facility with which it can be administered. The only objection to it is. that inhabits which are very impressible to the action of mer- cury, it is apt to affect the mouth, even when every precaution has been taken : and. in children especially, to induce stomatitis, with foetor of the breath, increased flow of saliva, troublesome ulcerations, VOL. i. —16 182 SPECIAL cathartics. and, in rare cases, sloughing of the gums and cheeks, and even ne- crosis of the bones of the face. It is proper, however, to remark, that the author has noticed some cases in which these phenomena presented themselves where no mercury had been taken. Still, it must be admitted, that where a disposition exists to such stomatitis, it may be developed by the use of a calomel purge. The author has observed, that particular persons are unusually susceptible to mer- cury, and have the constitutional phenomena, pointed out elsewhere, induced by a very small quantity of it; and in public practice he has remarked, that at certain seasons or periods almost every patient in the wards of the hospital could be affected with mercury by the ex- hibition of a pill of a few grains of calomel, or even of the piluhe hydrargyri. This disagreeable result is less to be apprehended under the age of two years, — children at that early age resisting the action of mercury, to which they are so susceptible at an after period. Associated with opium, calomel is a valuable agent in many in- testinal affections accompanied with constipation, or in which it is desirable to gently excite the action of the canal, to remove scybala or irritating matters; for example, in various species of colic ; in enteritis after blood-letting — the opium acting as a sedative in the dose of two or three grains, and the same amount of calomel asso- ciated with it, then operating as a cathartic — and in diarrhoea, dy- sentery, &c. It is a cathartic often employed in cases of worms, appearing to act not simply by dislodging the parasites, but by proving, in some measure, anthelmintic. In Great Britain, the ordinary dose of calomel as a cathartic is from two to five grains ; and in France it is rarely given to this ex- tent, whilst in this country the average dose may be stated at from five to fifteen grains. As already remarked, its action does not aug- ment in a direct ratio with the dose. On the contrary, the author has instituted numerous experiments in public practice, and has found that, as a general rule, five grains are more certain in their opera- tion than twenty. In all cases, when calomel does not act upon the oowels, another cathartic should be administered, as its retention may induce the constitutional effects of the remedy. Children ge- nerally require almost as large a dose as adults, a child of two years of age requiring three to five grains ; — their intestinal canals not seeming to be more impressible to the action of this irritant than those of adults. The United States Pharmapopoaia has a form for the PIL'ULiE HYDRAR'GYRI CHLOR'IDI MITIS, or Pills of mild chloride of mercury, in which the calomel is made into pills of one grain each by means of gum arabic powder and syrup. Calomel pills are generally, how- ever, made extemporaneously with the same excipients or with con- fection of roses; and they have the advantage, that they separate more readily in the stomach ; whilst calomel pills, that have been long kept in the shops, have been known to pass through the whole tract of the intestines unchanged. PILULE HYDRARGYRI. 1S3 Mild chloride of mercury is employed in the formation of the Hy- drargyri Oxidum nigrum, and it is one of the ingredients of the Pilule Cathartica Composite of the Pharmacopoeia of the United States. PILUL.E HYDRAR'GYRI—MERCl KIAL PILLS. Mercurial pills or blue pills are formed by rubbing mercury with confection of roses, till all the globules disappear, and then adding liquorice powder, beating the whole into a mass. In the Pharma- copoeias of London and the Lhrited States, one grain of mercury is contained in three of the mass, — blue mass, as it is called from its colour. Even at the present day, after much attention has been paid to the subject, it is a matter of dispute as to what is the condition of the mercury contained in this preparation, as well as in others where it is divided by friction with substances not apparently adapted for exerting any chemical agency upon it, — as in the Unguentum Hy- drargyri, and the Hydrargyrum cum Cretd. Many distinguished chemists of the day are disposed to regard it as merely in a state of mechanical division. In the absence of chemical proofs, it would be an objection to this view, that metallic mercury is admitted to be wholly without action on the living economy. It has been found re- cently, however, that the vapour disengaged from mercury at atmo- spheric temperatures contains some oxide ; and it is affirmed by a distinguished pharmacological writer, Dr. Christison, that, during the last eight years, he has examined various samples of the Unguen- tum Hydrargyri, and has never failed to detect a sensible propor- tion of oxide in it; and wt although the same fact," he adds, "has not yet been proved of the pill and powders of mercury, there is not yet any conclusive evidence to the contrary." Although, therefore, the point is unsettled, it may be esteemed probable, that a portion at least of the divided mercury in the Pi- lulx Hydrargyri has undergone oxidation. It was under the idea, that the metal is in the state of protoxide, that Mr. Donovan pro- posed, that the protoxide should be introduced into the materia me- dica. This is the HYDRARGYRI OX EOUM NIGRUM of the Pharmacopoeia of the Udnited States; the Hydrargyri oxidum, of that of London, the Suboxide, Ash, Gray, or Black oxide of mercury. It is the precipitate thrown down from the mild chloride of mercury by means of potassa. It is rarely, however, used internally, and owing to the occasional pre- sence of the peroxide, is liable to operate harshly. Under another head, it will be seen, that it is employed externally as a mercurial revellent. NYhen the Pilulae Hydrargyri are given as a cathartic, the dose may be five grains at night, followed by a draught of senna and sulphate of magnesia, or sulphate of magnesia alone on the follow- ing morning. Of itself, it will rarely act satisfactorily as a cathartic. 184 special cathartics. The practice of administering it as above mentioned became com- mon and empirical, greatly owing to the frequent recommendations of it by the late Mr. Abernethy in disorders of the digestive func- tion ; and the author has seen many cases in which mischief was produced thereby. A constant repetition of such agents is, indeed, as elsewhere remarked, well adapted for inducing all the characters of bilious affections, which, in the generality of cases, are, in strict pathology, derangements of the stomach and intestines ; and it need scarcely be repeated, that too frequently a repetition of cathartics may give rise to the very evils, for the fancied removal of which they are administered. An intelligent writer has properly animadverted on the mischief resulting from the constant call for "a blue pill at night and a pot of faeces in the morning." saline' cathar'tics. As the saline cathartics act much alike, they may be classed toge- ther. They are generally given much diluted with water. When concentrated, they would seem, according to Liebig, to have a phy- sical, as well as a dynamic action. They extract water from the coats of the stomach and thence create thirst. Part of the solution becomes diluted in this way, and is absorbed ; but the greater part passes into the intestines, dilutes the solid matters, and acts as a cathartic. 20. MAGNE'SLE SULPHAS.—SULPHATE OF MAGNE'SIA. Sulphate of magnesia is the common Epsom salts, or Bitter purg- ing salts. It is a constituent of sea water, and of many mineral springs ; and is found in some soils, sometimes efflorescing in capil- lary crystals ; and in this country is met with abundantly in many of the caverns on the west of the Alleghany mountains. Formerly, Epsom salts were prepared exclusively from the Epsom waters by evaporation and crystallisation, and the salt is still pre- pared from the springs of Seidlitz and Seydschiitz. In Great Britain it is made either from Dolomite or Magnesian limestone, by con- verting the carbonate of magnesia into a sulphate ; or from the bit- tern left after the preparation of common salt, from which it is ob- tained by simple evaporation and crystallisation. In Baltimore, it is extensively manufactured from magnesite — the siliceous hydrate of magnesia, which abounds in the neighbourhood of that city. It contains less lime than dolomite. These works supply the United States. Sulphate of magnesia is always prepared by the manufac- turing chemist, and the quantity annually consumed, in the forma- tion of magnesia, and as a therapeutical agent, is enormous. Sulphate of magnesia — as met with in the shops— is sufficiently pure for medicinal purposes. It is in small acicular crystals ; but by solution, and re-crystallisation, tolerably large rhombic prisms, often truncated on the obtuse edges, and terminated by two or four S0D.E SULPHAS. 1S5 converging planes, are obtained. The crystals are colourless, trans- parent, without smell, but of a bitter, disagreeable taste. The pure sulphate effloresces, but, owing to an admixture of muriate of mag- nesia, it occasionally deliquesces. It dissolves in its own weight of water at 60" Fahr., and three-fourths of its weight of boiling water. It is insoluble in alcohol. Sulphate of magnesia possesses the characters of the whole class of saline cathartics, acting upon the entire tract of the intestinal canal, and increasing the secretion from the lining membrane, and at the same time the peristaltic action : so that the evacuations are numerous and watery. The great objection to it is its nau- seous taste, yet it often remains on the stomach when other cathar- tics would be rejected. This is especially the case with a mixture of the sulphate of magnesia and the carbonate as in the following form: — Magnes. sulphat. ^vj ; Magnes. carbonat. ^ij ; Aqua mentha piperit. 5iiss. M. Dose, one half, to be repeated if necessary. Alone, or associated with infusion of senna, it is one of the most common cathartics, both with the professional and the unprofessional. Like all the saline cathartic^, (as elsewhere remarked.^ it operates best when dissolved in a large quantity of water. The ordinary dose is one ounce ; but in cases of constipation it is best to aummister a small quantity — as a drachm — every morning, until the sensibility of the mucous membrane is developed to the necessary degree, which it generally will be sooner or later. The addition of diluted sulphuric acid, or of elixir of vitriol, so as to form a supersulphate of magnesia, adapts it as an excellent laxative and local stimulant in cases of hemorrhage from the stomach and intestines. In the dose of an ounce or two, it is prescribed as an adjunct to cathartic enemata. Chloride of magnesium, or Muriate of Magxesia.—Magxe sti chlo'ridum, Magxe sue*me'rias, has been recommended as a saline cathartic by Dr. Lebert. It is said to exert no injurious effect on the stomach; and to produce less inconvenience than most other cathar- tics. Its purgative action is said to be followed by improvement of the appetite. The mean dose for an adult is an ounce : and half that quantity for one from ten to fourteen years of age. 21. S0OD.E SULPHAS.-—SULPHATE OF SODA. Sulphate of soda, commonly called Glauber's salts, is contained in many mineral springs, and is produced artificially in several chemi- cal processes. It is rarely, or never, prepared by the ap'tr.ecary, being manufactured on a verv extensive scale by the who.esa.e che- mist. It is made from the salt remaining after the preparation of chlorohydric or muriatic acid; which is sulphate of soda, usually with the addition of free sulphuric acid. To neutralise this, the London College directs carbonate of soda; the Edinburgh College, 16* 186 SPECIAL CATHARTICS. carbonate of lime. The latter is more economical. It would appear, too, that in consequence of the enormous consumption of sulphate of soda, in the manufacture of carbonate of soda, the sulphate is some- times made directly by the addition of sulphuric acid to chloride of sodium. In some of the Northern States, particularly in Massachu- setts, a portion of Glauber's salt is procured from sea-water in the winter season. During the prevalence of very cold weather, sulphate of soda, being the least soluble salt, that can be formed of the acids and bases present, separates in the form of crystals. (Wood and Bache.) Sulphate of soda is in colourless crystals, having the same crys- talline form as sulphate of magnesia and sulphate of zinc, which it resembles in general appearance. It rapidly effloresces on exposure to the air, and ultimately falls into a white powder. It dissolves in three parts of water at 60°, and in one part at 212° ; and is insoluble in alcohol. Its taste is cooling, but bitter and very nauseous, which is the great objection to it as an internal medicine. Owing to its cheapness, it is not subject to adulteration, and as met with in the shops, is adapted for all therapeutical purposes. In its medical properties, sulphate of soda is similar to sulphate of magnesia, which has now taken its place. NVhen the author was a pupil in the North of England, the sulphate of soda being somewhat cheaper than the sulphate of magnesia was the common purgative with the people ; whilst the latter, being somewhat less disagreeable, was used by the better classes. An ordinary dose of salts is one ounce : this may be taken dissolved in water, to which a little dilute sulphuric acid, bitartrate of potassa, or lemon-juice has been added; or in mint water, which masks, in some degree, its disagreeable taste. If in an effloresced state, or dried so that its water of crystallisation is expelled, half the quantity will be a sufficient dose. 22. SOD^E ET POTAS'S^E TARTRAS.—TARTRATE OF POTAS'SA AND SODA. This salt, formerly called Seignette's salt, and still not unfrequently termed Rochelle salt, is made by neutralising bitartrate of potassa with carbonate of soda,—the excess of acid in the bitartrate being saturated by the soda of the carbonate, whilst the carbonic acid is disengaged. It is in colourless, transparent crystals, which are prisms or halves of prisms, presenting six, eight or ten sides, and the primitive form of which is the right rhombic prism. It effloresces slightly in dry air, and is wholly and readily dissolved in five parts of boiling water. Its taste is saline and slightly bitter. It is not liable to adulteration. Tartrate of potassa and soda is a mild refrigerant cathartic,— less disagreeable to the taste than the neutral salts generally em- ployed. It is a constituent of the Seidlitz powders—so called — P0TA<=S.E TARTRAS. 1S7 which consist of a mixture of two drachms of this salt, and two scruples of bicarbonate of soda, put up in a white paper: and of thirty-five grains of tartaric acid in a blue paper. These are dissolved separately in water, and taken in the state of effervescence. The dose of tartrate of potassa and soda is from 55s. to 5J. 23. SOD.E PHOSPHAS.—PHOSPHATE OF SODA. This salt, sometimes called tasteless purging salts, is prepared from bone earth. A formula is given in the Pharmacopceia of the United States. In this, sulphuric acid is made to act upon bone ash, which consii-ts of phosphate of lime united with some carbonate. In this manner, sulphate and superphosphate of lime result; the latter of which remains in solution.— the former being mainly precipitated. Carbonate of soda is then added; phosphate of lime is precipitated, and carbonic acid disengaged. The formation of crystals of phos- phate of soda is promoted by a slight excess of carbonate of soda. Phosphate of soda is in colourless transparent crystals, which speedily effloresce on exposure to the air. and are in oblique rhombic prisms. It has a mild saline taste, resembling that of common salt; has an alkaline reaction, and yields a yellow precipitate with nitrate of silver, which is soluble both in nitric acid and ammonia. It dis- solves in four times its weight of cold, and twice its weight of hot water, and is almost insoluble in alcohol. Phosphate of soda possesses the same virtues as the other saline cathartics, with this advantage, that its taste is far more agreeable. It may be given in soup or gruel, to which it communicates a taste like that of common salt It may be given also to children more easily than any other cathartic of the class. By those, who considered it desirable to restore to the blood the saline matter, which it had lost in spasmodic cholera, the phosphate of soda was often selected as the saline agent. The dose as a cathartic is from ^j. to 5ij. 24. POTAS S.E TARTRAS. —TARTRATE OF POTASSA. Tartrate of potassa or soluble tartar is made by neutralising the excess of acid in the bitartrate of potassa by the addition of a boiling solution of carbonate of potassa. The tartaric acid unites with the potassa, and the carbonic acid is disengaged, after which some in- soluble tartrate of lime is separated by filtration: and the liquor is evaporated so that the tartrate may crystallise on cooling. When properly prepared, it is in white crystals, which are some- what deliquescent, or become moist in damp air; and are entirely soluble in their own weight of water. Its taste is saline, and some- what bitter: most commonly, it is in a granular state, owing to the solution being evaporated to dryness. Tartrate of potassa is a mild cathartic; but is rarely given alone. It is sometimes added to other cathartics, as the infusion of senna, the 188 SPECIAL CATHARTICS. griping effects of which it is said to correct like the saline cathartics in general. It is occasionally administered as a refrigerant laxative in febrile affections. The dose, as a laxative, is a drachm or two; as a purgative, §ss. t05J- 25. POTAS'S^E BITAR'TRAS. —BITART'RATE OF POTAS'SA. Bitartrate of potassa; supertartrate of potassa, acidulous tartrate of potassa or cream of tartar is the crude tartar, argol or impure super- tartrate of potassa purified. Tartar exists in grape juice, but as it is very slightly soluble in alcohol and water, it is deposited when alcohol is produced, and forms an incrustation on the sides of the wine casks. This is purified on a large scale, in France, by solution and crystallisation, and it is from that country, that we receive it. The purest salt is obtained, according to Dr. Christison, by dissolving that which has been purified, gradually evaporating the solution, and removing the crust of bitartrate, which forms on the surface, and which has given the name cream of tartar to the salt. As met with in the shops, it has either the form of white crystalline crusts, which are gritty under the teeth, or, what is more common, of a fine white powder. It is devoid of smell, but has an acidulous and not disagreeable taste. It is soluble in 90 parts according to some — 60 according to others — of cold water; and in about 15 of boiling wrater ; and is insoluble in alcohol. It is liable to be adul- terated by white mineral and other powders, and usually contains from 2 to 5 per cent, of tartrate of lime, which does not, however, interfere much with it in a medical point of view. When pure, it is wholly soluble in boiling water; and if impure, the extraneous matters remain undissolved. Should it be adulterated by either alum or bisulphate of potassa, the fraud will be detected by the chloride of barium, which throws down white sulphate of baryta, insoluble in nitric acid. In small doses, bitartrate of potassa is a gentle laxative, and, associated with sulphur, is a common domestic remedy for preserving the health of children in spring and autumn. In larger doses, it acts more powerfully, and is often given along with jalap, senna, and other cathartics to exert a hydragogue effect. NVhen prescribed as an aperient, it may be in the dose of a drachm or two ; as a hydra- gogue cathartic, from half an ounce to an ounce ; and as good a vehicle as any is molasses. NVhen associated with sulphate of mag- nesia, its acidity masks the disagreeable taste of the latter ; and a solution, formed of the two, makes an excellent aperient in habitual constipation. (See page 141.) Bitartrate of potassa is employed in the preparation of the anti- monii et potassa tartras, the ferri et potassa tartras, the potassa tartras, the pulvis jalapa compositus, and the soda et potassa tartras of the Pharmacopceia of the United States, POTASSA SULPHAS. 189 26. POTASS.E SULPHAS—SULPHATE OF POTASSA. Sulphate of potassa, — of old, sal poiychrest or salt of many virtues, — is found in both kingdoms of nature, but that which is used as a medicine is prepared artificially. It is made on the large *cale from the salt, which remains after the distillation oi nitric acid from nitrate of potassa. This has an excess of sulphuric acid, which may be neutralised — as directed by the Dublin College, — by carbonate of potassa. The London College ignites the salt in a crucible, until the excess of sulphuric acid is entirely expelled : whilst the Edinburgh College neutralises it with carbonate of lime. Both of these processes are more economical than that of the Dublin College. As we meet with it, sulphate of potassa has usually the shape of sin- gle or double six-sided pyramids. The crystals are of a white colour, very hard and permanent in the air : devoid of smell, and oi a bitter saline taste. They require sixteen times their weight of water at 60~ to dissolve them, and five times their weight of boiling water ; and are insoluble in alcohol. Sulphate of potassa is a mild cathartic, operating without any un- pleasant concomitants ; but it is rarely employed. As a laxative, it might be given in the dose of 20 or 30 grains : as a purge, in doses oi 4 or 5 drachms. It is sometimes, but not often, combined with rhu- barb, in dyspeptic cases, and in gastro-intestinal affections of chil- dren, which are accompanied with constipation- It enters into the composition of the pulvis ipecacuanhas compositus, or Dover's powder, — not on account of its medical virtues, but be- cause — by reason of its hardness— it facilitates the division of the opium. Cases have been recently published, in which large doses of the salt — an ounce and upwards—given as a cathartic, have proved fatal. It would seem, that the salt is constantly employed in France as a domestic remedy by nurses, to diminish or stop the flow of milk in puerperal females; and it is supposed, both in that country and in England, to have the power of inducing abortion. It is very diffi- cult to pulverise : and a portion of its irritating properties may be dependent upon mechanical excitation of the mucous surfaces with which it comes in contact. Bisulph'ate or supersulphate ofpotas'sa, Pot as s^: bisul'phas, is officinal in the British Pharmacopoeias. The London and Edinburgh Colleges direct it to be made, by adding sulphuric acid to a solution ot the salt that remains after the distillation of nitric acid. It is a white salt ; has a very acid taste and reaction, and is soluble in twice its weight of water at 60°. Bisulphate of potassa may be given in the same cases as sulphate of magnesia, with excess of sulphuric acid. Like the sulphate of potassa it is laxative, and has the advantage of being more soluble ; but cannot alwavs be substituted for it. It ca^es of want of tone of 190 SPECIAL CATHARTICS. the digestive organs, accompanied by diminished secretion of acid, the acid acts beneficially as a tonic; and in hemorrhage from the bowels, good may result from the local astringent influence of the acid on the vessels concerned, whilst the salt may carry off the blood that has been effused. It is not, however, much prescribed at the present day, and perhaps not at all on this side of the Atlantic. 27. POTAS'S^E ACE'TAS. —ACETATE OF POTAS'SA. This salt may be formed by the direct combination of acetic acid and carbonate of potassa ; evaporating and crystallising. The acid unites with the potassa of the carbonate, and carbonic acid is disen- gaged. As met with in the shops, it has a white, fohaceous, satiny ap- pearance ; is soapy to the feel, inodorous, and has a strong saline, warm, and rather acrid taste. It is extremely deliquescent, and therefore requires to be excluded carefully from the air. At 60° Fahr., according to Dr. Pereira, 100 parts dissolve in 102 of water. It is very soluble likewise in alcohol. When pnre, it is perfectly neu- tral, and does not change the colour of litmus or turmeric. It is rarely adulterated, and never perhaps so as to interfere with its medi- cinal use. The Pharmacopoeias of London and the United States lay down certain tests of its purity; but the Edinburgh considers them unnecessary. Acetate of potassa is a mild cathartic ; but it has been more cele- brated as a diuretic, whence its old name sal diureticus. Owing to its affecting both the intestines and kidneys, it has been prescribed as a cathartic and diuretic in dropsy. To produce the former effect, it should be given in the dose of 5\j to 3iij- 28- SO'DII CHLO'RIDUM — CHLORIDE OF SO'DIUM. Mu'riate of soda or common salt is extensively met with in the inorganic kingdom, and in both plants and animals. Its source, however, as an article of commerce, is in the water of salt springs, and in that of the sea. It occurs, too, in mines in various parts of the world. In this country, the chief saline springs are in New York, and Virginia ; the salt works at Kenawha, in the latter state, being estimated to have yielded two million bushels of salt in the year 1835. (Wood & Bache.) Salt, dug from the earth, is sold in the crude state under the name of rock salt. It is purified by solution, and crystallisation. From sea-water, it is made in the same manner, the evaporation being either accomplished spontaneously, or by heat. Sea water contains about 2.25 per cent, of it. The salt, which is obtained spontane- ously, is the bay salt : it is in large grains. The ordinary saltis pro- cured by artificial evaporation. It is in small white, irregular grains ; and is the form in common use. Basket salt, is common salt dis- solved and recrystallised, and is so called from being often sold in baskets. This and the bay salt are the best qualities. JALAPA. 191 The crystals of common salt are white cubes, and, when pure, they undergo no change in the air: as, however, it generally contains more or less chloride of magnesium, it is slightly deliquescent. At 60°, it requires about two and a half times its weight of water to dissolve it; and is scarcely more soluble in boiling water than in cold. It is sparingly soluble in rectified spirit, and scarcely at all so in absolute alcohol. Chloride of sodium is rarely given as a cathartic, although in large doses it acts not only as such, but as an emetic. It probably aids the action of the other cathartics in mineral waters. It is a very common addition to cathartic enemata. As a cathartic, it ope- rates in the dose of ^ss to ^ij. To clysters it is generally added in the quantity of a table-spoonful or two. According to Sir George Lefevre, chloride of sodium, in the form of brine, in which cucumbers are preserved, is a most popular ape- rient in Russia. A small watery, seedy cucumber is preserved in salt and water, to which a very small proportion of vinegar, and some leaves of the black currant tree, are added. Thousands of barrels are so prepared annually, and serve as salad, for rich and poor, during winter. The liquor, impregnated with the rind of the cucumber, and the leaves of the black currant tree, is drunk in doses of a tumblerful, and seldom fails to produce the desired effect. Chloride of sodium is used in the preparation of the Hydrargyri Chloridum mite of the Pharmacopceia of the United States. 20. MANGANESII SULPHAS. — SULPHATE OF MAN'GANESE. This beautiful, rose-coloured, and very soluble salt, which is iso- morphous with sulphate of magnesia, is prepared on a large scale for the use of the dyer. It has been recently recommended by Mr. A. Ure as a cholagogue cathartic. If a "drachm of it, he says, be dissolved in about half a pint of water, and swallowed before breakfast, it will generally occasion, after the lapse of an hour or so, one or more liquid stools. Infusion of senna forms a good adjunct in special cases. More recently, Dr. Goolden has confirmed the ob- servations of Mr. Ure. In one case, the immediate effects of the salt were clearly marked in producing a copious flow of bile, which calomel had failed to do. III. Drastic Cathartics. 30. JALA'PA. —JALAP. Jalap root, the botanical origin of which was long uncertain, is now referred to Ipomse'a jala'pa, or Ipoma'a purga; Sex. Svst. Pentandria Monogynia ; Nat. Ord. Convolvulaceae ; a plant, which grows on the mountainous land around Chicanquiaco, not far from Xalapa or Jalapa, on the eastern slope of the Andes, at an eleva- tion of about 6000 feet. Xalapa is the only market for the drug, 192 SPECIAL CATHARTICS. whence it is exported through Vera Cruz. According to McCulloch, the entries of jalap into England for home consumption amounted at an average, in 1831 and 1832, to 47,816 pounds a year. Jalap root of commerce is in roundish or pyriform masses, rarely exceeding a pound in weight, and varying in size from that of the fist to that of a hat. The tubers are often, however, cut into pieces or sliced. They are of a dark brown colour, rough and wrinkled externally; heavy, hard, and pulverisable with difficulty, and — when broken — of a grayish colour, with concentric darker circles, in which the matter is denser and harder. Jalap is liable to be worm-eaten, but it has been found, that the insect eats only the amylaceous portion, so that what remains is stronger, weight for weight, than that which has not been touched by it. The ,powder—in which state it is generally seen in the shops — is of a pale grayish-brown colour, and a very disagreeable taste. The active properties of jalap appear to reside in a resinous sub- stance, which exists in the proportion of from 9 to 13.5 per cent. ; hence water takes up from it chiefly amylaceous and mucilaginous extractive matter, and little of the cathartic principle, whilst alcohol dissolves the resin. A light or fusiform jalap, called in Mexico, male jalap, and Said to be the produce of Ipomse'a Orizaben'sis, is sometimes im- ported into this country, mixed with the true jalap ; or alone, and sold for the latter. The genuine drug, may, however, be known by the characters above described : whenever it is light, of a whitish colour externally, of a dull fracture, and spongy or friable, it ought to be rejected. (Wood & Bache.) Jalap is one of our most common and effective cathartics. It is said to have proved fatal by the violent inflammation it induced in the gastro-enteric mucous membrane, but the author has never met with such a case. It augments the secretion from the lining mem- brane of the bowels, and, at the same time, greatly increases the peristaltic action ; to a less extent, however, than gamboge. It is given, however, in the same cases, alone or associated with other articles, where it is desirable to exert a considerable revellent and depletive agency on the intestinal canal, as in dropsy, encephalic affections, &c. Whenever, indeed, a brisk cathartic is needed, jalap fulfils the indication. It is apt, however, to excite nausea or tormina, and hence a corrigent, as ginger or some other excitant, is generally added to it; or another cathartic, which may modify its operation. Jalap, associated with mild chloride of mercury, is one of the most com- mon cathartics. (Jalap, pulv. gr. xv. ; Hydrarg. chlorid. mit.; Pulv. Zingib. aa gr. v. — M.) The dose of powdered jalap is from fifteen to thirty grains. Its special affinity for the mucous membrane of the bowels is exhibited by the fact, that it purges, when applied to a wound. To children, it is sometimes given in cakes of ginger- bread, the jalap being incorporated with the paste. COLOCYNTHIS. 193 pulv. ^j. ; potass, bitart. pulv. ^ij.) The dose of this powder — which is a common hydragogue cathartic prescribed in dropsy, and used whenever an active cathartic is demanded — is from ^j. to 5j- TINCTU'RA JALA'PJE, TINCTURE OF JALAP. — (Jalap, pulv. gviij; Alcohol. dilut. Oij. Prepared either by maceration or by the process of dis- placement.) This is not often prescribed alone. It is usually added to cathartic mixtures to quicken their operation. As a purgative, it will act in the dose of f. gij. to f. £ss. EXTRAC'TUM JALATJE, EXTRACT OP JALAP. —Jalap, in pulv. crass, ftj; Alcohol. Oiv.; Aqua, q. s. — made into an extract by the process of displacement.) The extract may be given in doses of ten grains as a cathartic ; but it is rarely used alone.- It is an ingredient of the Pilula cathartica composita. Jalap-root is one of the bases of the Tinctura Senna et Jalapa of the Pharmacopceia of the United States. 31. COLOCYN'THIS. — COL'OCYNTH. The colocynth of the shops is the fruit of Cucu' mis Colocyn'this, or bitter cu'cumber; Sex Syst. Monoecia Syngenesia; Nat. Onn. Cucurbitacese — deprived of its rind. It is a native of Japan, Coro- mandel, Cape of Good Hope, Syria, Nubia, Egypt, Turkey, and the Islands of the Grecian Archipelago, and is cultivated in Spain, whence it is imported, as well as from the Levant, Mogadore, &c. The quantity, on which duty was paid in England, in the year 1839, according to Dr. Pereira, was 10,417 lbs. The fruit, commonly called Coloquin'tida, or bitter apple, is gathered in autumn, when it begins to assume a yellow colour, and is peeled and dried quickly either in the sun or in a stove. It is generally imported into this country peeled, but sometimes unpeeled — the Turkey colocynth of commerce being usually peeled — the Mogadore unpeeled. (Pereira.) The colocynth of the shops is in whitish balls of about the size of a small orange. These are very light and spongy; the seeds, which are inert, constituting three-fourths of their weight. The pith is the officinal portion. It has not much smell, but its taste is intensely and enduringly bitter and nauseous. It has been subjected to analysis, and found to contain a bitter or purgative principle — Colocynth'in or Colocynth'ite — which is obtained by digesting the watery extract in alcohol, and evaporating the tincture thus formed. It is a bitter resinoid matter. The pulp of colocynth is not readily pulverisable. It yields its virtues to water and to alcohol. It would seem, however, that cold water takes up only 16 per cent., whilst boiling water takes up 45 per cent. Colocynth is a powerful irritant to the mucous membrane of the intestines, exciting, in large doses, fatal inflammation, and, as one of the results of its violence of action, occasioning, at times, abor- VOL. i. —17 194 SPECIAL CATHARTICS. tion ; hence it has been used to induce criminal abortion, which — like other agents—it never accomplishes except through the violence it does to the system of the mother. Even in small doses, when given alone, its operation is often very harsh, and hence it is usually com- bined with other articles of the class. It seems to exert its ac- tion on every part of the intestinal canal, and, unlike aloes, excites the organs of" secretion of the mucous membrane to unwonted ac- tion, and thus becomes hydragogue : as such, it is not unfrequently prescribed in dropsy. The dose of powdered colocynth is from five to ten grains, intimately mixed with powdered gum arabic or starch; but it is rarely given in this state. The form of preparation, most com- monly prescribed, is the following. EXTRAC'TUM COLOCYN'THIMS COMPOS'ITUM, COMPOUND EXTRACT OF COLOCYNTH. (Colocynth. ^vj ; aloes, pulv. ^xij ; scammon. pulv. ^iv ; cardamom. pulv. 5j; saponis, ^iij ; alcohol, dilut. cong.) The aloes and scam- mony are added to modify the violent action of the colocynth ; the cardamom corrects the griping tendency of the cathartics ; and the soap is supposed to aid their solubility. It likewise adds to the con- sistency of the mass. Compound extract of colocynth or cathartic extract is an excellent and powerful cathartic, forming, like aloes, the basis of many extemporaneous cathartic pills. It is very often associated with the mild chloride of mercury, and forms an excellent cathartic (Ext. Colocynth. comp. gj ; hydrarg. chlorid. mit. £)j. —M. et divide in pil. xx. Dose, two or more, at bedtime.) The ordinary dose of compound extract of colocynth as a cathartic is from five to thirty grains. PIL'ULjE CATHARTIC! COMPOS'ITjE, COMPOUND CATHARTIC PILLS. {Ext. colocynth. comp. pulv. ^ss; extract, jalap, pulv. ; hydrarg. chlorid. mit. aa 3 i ij ; gambog. pulv. gij. — M.) This combination acts effectively in the dose of three pills. Forms for cathar- tic pills might, however, be multiplied almost indefinitely. 32. GAMBO'GIA. —GAMBOGE. Gamboge or Gamboge — although so well known as a pigment and a drug — Hebradendron cambogioides. . . r. o ^"k """■ " ul"5 a. Male flowehne branch. 1. Back is the concrete juice of a tree not yet ST^cSyhr-coi^Wta ascertained. Two kinds of gamboge stamens, b. Fruit hearing branch, are described by writers, the &m and 3. bection of fruit with its four .inii.-. i i i i seeds. the Leylon, but it would seem that the former only is known in commerce. Although uncertainty hangs on the precise tree or trees that furnish 21. SCAMMONIUM. 195 the gamboge, it has been thought to be obtained from Hebraden'dron Cambogioides, Cambo'gia Gutta or Stalagmi'tis Cambogioides, Sex. Syst. Monoecia Monadelphia; Nat. Ord. Guttiferse, a tree of moderate size, which is a native of Ceylon ; and it is inferred, that in Siam it is procured from the same tree. Three varieties of Siam gamboge are met with in commerce ; 1. the pipe, so called in consequence of its being in cylinders, often hollow ; this is the purest; 2. the lump or cake, in masses of several pounds weight, containing generally fragments of wood, twigs, and air cells ; and 3. the coarse, which differs from the other in contain- ing more impurities. Pure gamboge is devoid of smell, and has not much taste; but after it has remained some time in the mouth, an acrid sensation is experienced in the fauces. The colour of its fragments is orange yellow, but when the surface is rubbed with water, it becomes a bright yellow, —to produce which it is extensively employed as a pigment. It is brittle, and has a smooth glassy conchoidal fracture. Gamboge has been carefully analysed by Dr. Christison, who found the composition of the pipe variety, according to two analyses of different samples, to be as follows : — Resin, 74.2, — 71.6 ; arabin or soluble gum, 21.8, — 24.0; moisture 4.8 in both instances: total — 100.8, — 100.4. It contained no trace of volatile oil. The effect of gamboge on the economy is like that of elaterium, than which, however, it is much less active ; and, like it, it is used whenever a hydragogue cathartic is needed, as in dropsies, encephalic diseases, &c. It is rarely given alone, but is usually associated with other cathartics, which mutually temper each other's action. Owing to its tendency to induce nausea and vomiting, it should be prescribed in small doses, — from one to three or four grains, in the form of pill, repeated every four or five hours. It is one of the ingredients of the Pilula Catharticce Composita of the Pharmacopceia of the United States. In large doses, it is an acrid poison, inducing violent in- flammation of the lining membrane of the stomach and bowels; and the deaths which have followed the use of a celebrated nostrum, Morrison^s Pills, have been ascribed to it. It has, indeed, been de- tected in them. 33. SCAMMO'NIUM—SCAM'MONY. Scam'mony is the concrete juice of the root of Convolvulus Scam- mo'nia or Scammo'nea ; Sex. Syst. Pentandria Monogynia; Nat. Ord. Convolvulaceee; a native of Greece and the Levant. It is obtained by cutting the root across near its crown, and sticking shells into it to catch the juice that exudes. The root is very large, gene- rally three or four inches in diameter, and as many feet long ; but a single root yields only a few drachms of scammony. The juice is milky as it exudes, and soon concretes under exposure to air, and evaporation. Scammony is usually exported from Smyrna ; occasionally, it goes 196 SPECIAL CATHARTICS. by way of Trieste, and, still more rarely, is shipped from Alexandria. The finest kind is called Virgin or Lach'ryma Scammony ; other varieties are termed seconds and thirds. Formerly, it would seem, the term Aleppo Scammony was applied to the finer, and that of Smyrna Scammony to the inferior kinds, but no such distinction, it is said, is now known in British commerce. In 1839, the quantity of scammony on which duty was paid in England amounted, accord- ing to Dr. Pereira, to 8551 lbs. Scammony is said to be so generally adulterated that it is not easy to fix the characters of the genuine article. It is affirmed, indeed, that there is no article of the Materia Medica, which is sophisticated so often, or which it is so difficult to find pure, even in mere speci- mens for scientific examination. Dr. Christison remarks, that spurious scammonies are so very common, the pure drug so rare, and the characters of the two qualities so very different, that he has known well informed retail-druggists who could not tell what the pure arti- cle was. The following have been laid down as the characters of good scammony by an accurate and practised observer, Dr. Pereira. It readily fractures between the fingers, or by the pressure of the nail; its specific gravity is about 1.2; its fracture dark, glistening, and resinous ; the fractured surface should not effervesce on the addition of chlorohydric acid, which it would do if chalk were present; the decoction of the powder, filtered and cooled, is not rendered blue by tincture of iodine, which it would be if starch were present. One hundred grains, incinerated with nitrate of ammonia, yield about three grains of ashes ; and sulphuric ether separates at least 78 per cent, of resin (principally), dried at 280° F. Such, too, are mainly the tests of purity laid down in the last Edinburgh Pharmacopceia. The following tabular view of various spurious samples of scammony has been given by Dr. Christison. Calcareous. Amylaceous. Calc. Am. Resin, 64.6 56.6 43.3 37.0 62.0 42.4 Gum, 6.8 5.0 8.2 9.0 7.2 7.8 Chalk, 17.6 25.0 31.6 18.6 Fecula, 1.9 4.0 20.0 10.4 13.2 Lignin and Sand, 5.2 7.1 7.8 22.2 13.4 9.4 Water, 6.4 5.2 6.4 12.0 7.5 10.4 Total, 100.6 100.8 101.3 100.2 100.5 101.8 Some concrete pieces, obtained from various species of convol- vulus, and from certain species of the Apocynaceee, are described by writers ; as the Montpel'ier Scammony, from Cynan'chum Monspel'ia- cum; the Bourbon Scammony from Periplo'ca Mauritia'na; and the Germany Scammony, from Convolvulus Se'pium ; but they do not appear to be known in the British or American markets. OLEUM tiglii. 197 Pure scammony is a gum-resin, containing, however, but a small proportion of gum. According to Dr. Christison, the analysis of two distinct specimens gave 81.8 and 83.0 per cent, of resin ; 6.0 and 8.0 of gum ; 1.0 and 0.0 of starch ; 3.5 and 3.2 of fibre and sand ; and 7.7 and 7.2 of water. When pure, it is almost wholly soluble in boiling dilute alcohol; and sulphuric ether takes up at least 77 per cent., and even 82 or 83 per cent., if the specimen be tolerably dry. The resin is the cathartic principle, and is separated in the form of the Resina seu Extractum Scammonii of the Edinburgh Pharmacopceia. Scammony is a drastic cathartic, and applicable to all cases in which medicines of the class are needed. It is so liable to adultera- tion, however, and so uncertain, withal, in its operation, sometimes acting with great harshness, that it is not much used in this country, and when it is so, it is usually in combination with other cathartics, whose action it augments, whilst its own is mitigated. It is an ex- pensive article, costing in England thirty-two shillings, or about seven dollars per pound, wholesale. The ordinary dose of the scammony of the shops is from five to twenty grains. It is occasionally prescribed to children in combina- tion with mild chloride of mercury, and an aromatic excitant to ob- viate its griping tendency. (Scammon. pulv. gr. iv. ; Hydrarg. chlorid. mit. gr. ij. ; Zingib. pulv. gr. iij. M.) It maybe made into an emulsion with milk, which diminishes its excitant and irritating qualities. Scammony enters into the composition of the Extractum colocyn- thidis compositum, and the Pilula catharticce composita of the Phar- macopceia of the United States. 34. O'LEUM TIG'LIL — CROTON OIL. Croton oil is the expressed oil of the seeds of Croton Tig'lium or Purging Croton: Sex. Syst. Monoecia Monadelphia : Nat. Ord. Euphorbiacese, a native of the continent of India, and of the islands forming the Indian Archipelago and Ceylon. The seeds, formerly called Grana tiglii, G. tilii, G. Moluc'ca, &c, are in size and shape similar to those of the castor oil plant. The shell is covered with a yellowish epidermis, beneath which the surface is dark brown or blackish. The kernel is of a yellowish brown colour, and forms about 64 per cent, of the seed. The seeds are imported with the view of obtaining the oil from them, of which they yield about 50 per cent, under strong pressure. They have been repeatedly sub- jected to analysis, but no important pharmaceutical information has accrued from it. The oil is obtained from the seeds in the same manner as the Oleum Ricini from the seeds of Ricinus Communis. It would seem, likewise, to be obtained from the seeds of Croton Pava'na, a native of Ava ; and Dr. Burrough, who was for some time in India, in- formed Dr. Wood, that much of the oil, prepared there for exporta- tion, is derived from the seeds of a plant entirely different from croton 17* 198 SPECIAL CATHARTICS. tiglium. A parcel of these seeds was planted by Dr. R. E. Griffith, who succeeded in raising a plant, which proved to be Ja'tropha Curcas, the seeds of which are known by the name of Barbadoes Nuts. This oil is weaker than the real croton oil, but is said by Dr. Burrough to be an efficient cathartic in the dose of three or four drops. Croton oil is a thickish fluid, of a honey-yellow colour, disagree- able smell, and very acrid taste, exciting inflammation of the tongue and fauces. It has a very acrid matter associated with it, possessing acid qualities — the crotonic acid — which is identical with the jatro- phic. In ether and turpentine it is wholly soluble ; in alcohol par- tially so. It is occasionally adulterated with castor oil, which may be de- tected by treating it with absolute alcohol, which dissolves the castor oil, and thus lessens the volume of the oil, whilst no perceptible effect is produced on pure croton oil. Croton Seeds, like the seeds of the castor oil plant, are highly acrid and cathartic. In India they are prepared for medical use by being slightly torrefied, by which the shell is more readily separable, and the activity of the acrid property thought to be diminished. Even then the kernel acts powerfully as a cathartic in the dose of one or two grains. Croton Oil is a drastic cathartic, very valuable in one respect — that it can be given in small doses. In many cases of great tor- por of the intestines, its action has proved very certain. Even a drop commonly produces eight or ten fluid evacuations ; but at times it has been necessary to give as many as four or five drops in the course of ten or twelve hours. Like most of the drastic cathartics, it occa- sions tormina, but these are less distressing than the burning sensa- tion which it commonly causes in the fauces. Not unfrequently, also, it induces nausea and vomiting. It is one of the most speedy ca- thartics in its operation, and being active in a small dose, it is adapted for cases in which deglutition is effected with difficulty or is imprac- ticable, as in apoplexy, paralysis, &c, in which cases it may be dropped on the tongue. It may likewise be employed when a re- vellent action on the bowels is needed, or in obstinate constipation where other remedies have failed. The ordinary dose is stated to be one or two drops ; but it will generally operate in smaller quantity than this, even in one-fourth or one-half a drop, repeated every hour or two. It is usually given in the form of pill. (Olei tiglii, gtt. iv ; Mica panis q. s. ut ft. pil. viij. Dose, one, two, or more.) It has also been given in the form of emulsion, the objection to which is the acrid sensation it induces in the throat. Hufeland recommended it as a substitute for castor oil, advising that a drop of it should be added to an ounce of oil of poppies, and that the mixture should be called O'leum Ric"ini ojficina'le. ELATERIUM. 199 A soap of Croton oil, composed of two parts of the oil to one part of liquor potassee, has been recommended, of which two or three grains prove cathartic. A Tincture of the seeds has likewise been proposed, formed of two ounces of the seeds from which the rinds have been removed, and one ounce of alcohol. This acts as a cathartic in the dose of 20 drops. Croton oil — as will be seen under another head — is likewise a valuable counter-irritant; and it is affirmed, that a few drops, ap- plied externally by way of friction around the umbilicus, have ex- erted a cathartic effect. In obstinate cases, or where the stomach will not readily receive this or other purgatives, it may be tried in this manner. In another work, (New Remedies, 4th edit. p. 468. Philad. 1843), the author has given various forms for administering the croton oil, many of which, however, are employed by individuals rather than by the mass of the profession. 35. O'LEUM EUPHOR'BLE LATHYRTDIS. — OIL OF CAPER SPURGE. Euphor'bia Lath'yris, Garden Spurge, Caper Spurge, Caper plant or Mole plant ; Sex. Syst. Dodecandria Trigynia ; Nat. Ord. Euphorbiacese, is indigenous in France. Although not a native of this country, it is sometimes met with in situations where it has the appearance of growing wild. It is easily cultivated, and in some parts of New Jersey is found in abundance. The oil is obtained from the seeds in the same manner as castor oil from the castor oil seeds. It resembles, in colour, the Oleum Ricini, but is less dense. It has no odour when newly prepared, and no perceptible taste; but it speedily becomes rancid and acquires great acrimony. It is solu- ble in sulphuric ether; insoluble in alcohol, and forms a soap with alkalies. About forty or forty-four parts of oil are obtained by expression from one hundred parts of the seeds. The oil, prepared in Europe, acts as a cathartic in the dose of from four to eight drops, without occasioning tormina or tenesmus, but that obtained from beans raised in this country is not as mild an article. Even when administered with aromatic oils, and made into a soap with alkalies, it produced, in numerous instances, nausea and vomiting. It would seem, however, that when given in small quantities, and repeated at intervals of half an hour or an hour, it operates freely as a cathartic without inducing much nausea. It may be given in the form of pill with crumb of bread, or made into an emulsion with mucilage of gum arabic, sugar, and water. 36. ELATE'RIUM. Elaterium is a substance deposited by the juice of the fruit of 200 SPECIAL CATHARTICS. Momor'dica Elate'rium, Wild or Squirting Cu'cumber ; Sex. Syst. Fig 22 MoncEcia Syngenesia; Nat. Ord. Cucurbitaceae, a native of the South of Europe, and common on rubbish in the villages of Greece, and the Archipelago. It is cultivated in Great Britain for medical use. It was found by Dr. Clutter- buck, that the seat of elaterium is entirely in the juice around the seeds, obtained without expres- sion. When the cucumber is sliced and placed upon a sieve, a colourless juice flows out, which soon becomes turbid, and in a few hours deposites a sediment. This is the true elaterium, which Dr. Clutterbuck found to purge in the dose of one-eighth of a grain. The quantity, however, obtained in this way, is very small, not more than six grains having been got from forty cu- cumbers. The process recom- mended in the British Pharmaco- poeias is to slice ripe wild cucum- bers and strain the juice, very gently expressed, through a very fine hair-sieve, it is then set by for some hours, until the thicker part has subsided. The thinner supernatant part being rejected, the thicker is dried with a gentle heat. It would appear, however, that the process, actually followed at Apothecaries' Hall, London, is the following : — The fruits are cut longitudinally in halves by women, and are then placed in a hempen cloth, and put into a screw-press ; apparently, a tolerable pressure is applied, but for a few minutes only, being removed before all the juice has ceased to run out. When the fruits are taken out of the press, they are but very slightly crushed, so that the pressure cannot have been great. The juice— as it runs from the press—falls into a hair-sieve, through which it flows into a cylindrical-lipped glass jar. Here it is allowed to remain for about two hours, in which time a greenish fecula is deposited. The supernatant liquor is then carefully poured off, and the thicker liquid at the bottom is placed on a paper filter sup- ported by a cloth one, stretched on a wooden frame ; a bitter, yel- lowish-brown liquor runs through, and a green mass is left on the filter. The latter is then carefully dried by a stove, and constitutes Momordica Elaterium. a. Pepo expelling its seeds ; i Transverse section of the pepo. . Stalk ; e. (Pereira.) ELATERIUM. 201 the finest elaterium. The mother liquid, which was poured off from the deposit, is placed in shallow brown pans, and there lets fall a fresh deposit, which, when separated and dried, forms a paler elate- rium. Elaterium of commerce appears to consist essentially of the active matter, to which the name elaterin has been given, with the green colouring matter, cellular tissue, and starch expressed from the fruit, and mixed with the residue obtained by drying the bitter liquor, with which the tissues and elaterin were moistened. It is in light, thin, friable cakes or segments, which bear frequently the marks of the muslin or paper on which they were dried. The colour is of a pale greenish gray, which becomes yellowish by exposure. Its taste is acrid and bitter. Some inferior kinds are met with, which are much curled, gummy, and of a brown, or olive green colour. They are supposed to be prepared from the juice after the finest elaterium has been separated. A variety of elaterium is imported into England from Malta, which is in much larger flakes than the best English elaterium, and has frequently some paper adherent to it on which it was dried. It is not seen, so far as the author knows, in this country. So active a substance, and one so liable to variation in strength, not so much from adulteration as from errors in the time of collecting or mode of preparation, has necessarily attracted to it the attention of the chemical analyst. Dr. Paris found 100 parts to contain 26 per cent, of extractive ; 28 of starch; 5 of gluten ; 25 of woody matter ; 4 of water, and 12 of a green, resinoid and bitter matter, to which he gave the name Elatin ; and as he ascertained, that it possessed all the properties of the elaterium, he considered it to be the active principle. Since then, however, this elatin has been shown to consist of chlorophylle or green colouring matter, with a colourless crystallisable substance, to which the name Elaterin has been given. The following table, from Pereira, exhibits the different strength of various specimens of elaterium : 100 parts of Elaterium. Quantity of Elaterin. Prepared according to the London College, (Hennell,) ----- 44 Best British Elaterium, (Morries,) - - 26 Worst do., (Morries,) 15 French Elaterium, (Morries,) - - - 5 or 6 Elaterium, (Edinburgh Pharmacopoeia,) - - 14, 3 to 25 Best specimens, (Balmer,) - - - 33 Fine sample, prepared at Apothecaries' Hall in 1839, and dried by steam heat, (Pereira,) - 26 Elaterium, in an over-dose, is a violent acrid poison, producing inflammation of the lining membrane of the stomach and bowels. In 202 SPECIAL CATHARTICS. Fig 23. smaller doses, it is a drastic cathartic, causing a copious secretion from the follicles and exhalants of the intestines, and being the most active of the hydragogue cathartics. On this account it is employed in dropsy; and, where there has been no important lesion of the ab- dominal viscera, its revellent and depletive influence, exerted in this manner, has succeeded in cases of active dropsy, after other remedies had failed. By its revellent action; it is likewise well adapted for encephalic affections, such as apoplexy, mania, &c, in which there is usually great torpor of the intestines. On account of the uncertainty of the strength of commercial elate- rium, and the occasional harshness of its operation, it is not much employed, and when it is, it should be given in divided doses, and be repeated until it operates. Half a grain, united with three grains of the extract of gentian as a constituent, may be given every hour or two, until it operates. Even in this quantity, it may excite nausea and vomiting. Not un- frequently, it acts on the bowels in the dose of one-eighth and even of one-sixteenth of a grain. The ordinary dose of good ela- terium may, indeed, be so stated, yet we rarely meet with it of such a strength. Dr. Pe- reira affirms, that he has repeat- edly employed, and seen others employ, elaterium, and has al- ways observed, that a quarter of a grain of good elaterium acted very powerfully, some- times bringing away several pints of fluid ; and that half a grain usually occasioned vomit- ing as well as violent purging. As the active part of elate- rium, the elaterin is soluble in rectified spirit, it has been pro- posed to administer it in the form of tincture, made of one grain of elaterin, a fluidounce of alcohol, and four drops of ni- tric acid. Between thirty and forty minims seldom fail to act freely. The dose of the elaterium of Clutterbuck is always fixed at elaterin at one-sixteenth to one- Apocynuin cannabinum. one-eighth of a grain; that of the twelfth of a grain. ELATERIUM. 203 Some other indigenous articles that act as cathartics have been admitted into the secondary list of the Pharmacopceia of the United States ; for example : 37. Apoc"ynum cannab'inum, Indian Hemp : Sex. Syst. Pentandria Digynia ; Nat. Ord. Apocynacese: the root of which is officinal, and which is powerfully emetic and cathartic. It has been used as a hy- dragogue cathartic in dropsy. From fifteen to thirty grains of the pow- dered root generally induce vomiting. It is most commonly given in decoction. (Apocyn. cannab. giss ; Aquae, Oiss ; coque ad Oj. — Dose, f. ^j. to ^ij.) 38. Convol'vulus pandura'tus, Wildpota'to, Sex. Syst. Pentan- dria Monogynia; Nat. Ord. Convolvulaeese, which grows in every part of the United States, flowering from June to August. The root, which is the officinal portion, has been proposed as a sub- stitute for jalap in the dose of forty grains, but it is rarely employed. 39. Iris versicolor, Blue flag: Sex. Syst. Tri- andria Monogynia; Nat. Ord. Iridaceae ; found in all parts of the United States, flowering in June; the root of which — the officinal portion — has been used as a cathartic ; but it is apt to be followed by distressing nausea and prostration. The dose is from twenty to thirty grains, but it is scarcely ever employed. 40. Trios'teum, Fever- root. This is the root of Trios'teum perfolia'tum; Fever-root, Feverwort or Wild Ip'ecac; Sex. Syst. Pentandria Monogynia; Nat. Ord. Capri- foliacese ; which is found in most parts of the United States; flowering in June. The root is cathartic ; andin large doses emetic. The dose of the bark of the root — the part usually employed — is twenty or thirty grains; alone or combined with other cathartics, as calomel. Fig. 24. 204 ANTHELMINTICS. III. ANTHELMINTICS. Synox. Anlithelmintica, Antiscolica, Anliverminosa, Vermifuges. Definition of anthelmintics—Experiments on worms, out of the body—Different kinds of anthelmintics—True anthelmintics—Mechanical anthelmintics—Anthelmintics that expel worms by acting on the intestinal canal—Anthelmintics that prevent the formation of worms—Ectozoa—Special anthelmintics. This class of medicinal agents ought to embrace not only medi- cines, which prevent the generation of entozoa within the body, but such as destroy or expel them, when already existing there. The common definition of anthelmintics is—"remedies which de- stroy or expel worms situate in any part of the alimentary canal." Murray and Paris restrict it to " remedies, which expel worms ;"— but this is an unimportant part of their operation^ The great object is to get rid of the predisposition to their generation. The anthel- mintics, that destroy or expel, merely remove the parasites already present in the alimentary tube ; but, unless the pathological condition that gives occasion to their reproduction is removed, the evil will constantly recur. Whilst this pathological condition was disregarded, attempts were altogether restricted to the discovery of such agents as appeared to be detrimental to entozoic existence, or of such as might most ef- fectually dislodge the parasites; and the number, brought forward with such pretensions, has been prodigious ; yet but few are em- ployed at the present day, and this partly — indeed chiefly—be- cause the main object of the practitioner is properly considered to be to prevent their fresh generation. Numerous experiments have been instituted on worms, that have been voided,— under an expectation, that some light might, in this way, be thrown on the agents that would probably be most detrimental to them whilst in the body. Redi undertook several experiments on the ascarides lumbricoi'des, of which the following is a partial sum- mary : — in cold water, they lived from sixty to seventy hours; in an infusion of coralline, more than sixty hours; more than thirty in water rendered bitter by aloes; in water saturated with salt, they died speedily; in brandy, still more speedily; in syrup — and the experiment was often repeated—within three or four hours. In wine, one lived twenty-four, another forty, and a third seventy-four hours. It has been a question, whether the fatty oils be noxious to worms. They who believe, that, like insects, they are furnished with spira- cula, have thought, that, by pouring oil upon, or anointing them, the spiracula would become obstructed, and hence the animal would die. Human entozoa are not, however furnished with spiracula, nor do experiments prove the noxious agency of oils. Coulet affirms, that he found the taenia solium live as long in oil of almonds as in any other fluid. Arnemann, found that human ascarides lumbricoi'des, TRUE ANTHELMINTICS. 205 as well as those of the swine, lived several days in oil, when kept in a warm situation. They were in all cases, however, affected with restlessness and contortions ; but their bodies became gradually languid and lax ; their movements were executed with difficulty, and, as it appeared, painfully, and the skin was contracted into rugae. In oil of sweet almonds, a lumbricus of the hog lived twenty-seven hours ; another thirty ; human lumbrici, from forty-six to fifty-three. In oil of bitter almonds, the lumbrici of the hog lived eighteen, twenty-four, and thirty-nine hours ; whilst the human died within thirty-four. In castor oil, those of the hog lived fifty-six ; the human, from forty-four to forty-eight; the distoma hepaticum, eight. In lin- seed oil, those of the swine from eighteen to twenty ; the human from twenty-three to twenty-six. In oil of walnuts, those of the swine, twenty-two ; the human, twenty to twenty-five. In oil of the hazel- nut, those of the hog, nineteen ; the human, twenty-six. In oil of poppy, those of the hog, twenty ; the human, seventeen, twenty-two, and twenty-seven. In oil of elder, those of the hog, twenty-eight; the human, two and three. In oil of hyoscyamus, those of the hog, eighteen and twenty-two ; the human, twenty-seven. In oil of beech, those of the hog from twenty-nine to thirty-two ; the human, forty to forty-six. In oil of hemp, those of the hog, sixteen and twenty- three ; the human, twenty-seven. In oil of mustard, both those of the hog, and man, thirty-six. In rape oil, those of the hog, twenty- one to twenty-six ; the human, twenty-eight; and in oil ofbehen the human lived twenty-six hours. None of these experiments, however, were as satisfactory as those instituted by Chabert with his empyreumatic oil, which consists of one part of the fetid or empyreumatic oil of hartshorn, and three of the essential oil of turpentine, subjected to distillation. Every kind of worm, immersed in it, was killed either immediately, or after the lapse of a few minutes. The preparations of turpentine are, indeed, amongst the most detrimental to entozoic existence of the substances with which we are acquainted. Anthelmintics, according to the definition generally given of them at the present day, may be divided into four classes. First, — True anthelmintics. Secondly, — Mechanical anthelmin- tics. Thirdly, — Anthelmintics, that expel worms by acting on the intestinal canal. Fourthly, — Anthelmintics, that prevent their for- mation. 1. True Anthelmintics. Of those anthelmintics, that prove destructive to entozoic life by virtue of some principle, poisonous to them, which they contain, there are but few employed in ordinary practice ; yet the lists of the materia medica supply us with a host of such remedies. The pre- parations of turpentine, especially the oil, united, or not, with the empyreumatic animal oil obtained during the distillation of harts- horn, are decidedly the best; but the improvident employment of VOL. i. —18 206 ANTHELMINTICS. these and other excitant agents is liable to induce that debility of tne digestive function and of the system, which is the great predis- ponent of worms. If the proper administration of these remedies fails to destroy the parasites, little dependence can be placed upon the others. It is singular, that M. H. Cloquet should put the aqueous decoction of hydrargyrum purificatum at the head of his list of anthelmintics. He observes, also, that he has seen the ascarides lumbricoides eva- cuated in a state of torpor, after the abdomen of the patient had been rubbed with a mixture of ox's gall, and common soap, with oil of tansy, or oil of chamomile, strongly impregnated with camphor, and garlic; or with milk, holding aloes in solution, impregnated writh the bitter principle of the colocynth, and camphor ; or with a maceratum of bruised garlic in camphorated sulphuric ether. A like effect, he says, is produced by a plaster composed of yellow wax, litharge, assafetida, and galbanum. He also recommends an application, which is neither the most elegant, nor readily attainable;—assafetida dissolved in the gastric juice! " or, what is more simple, in the saliva!" Other external applications have been recommended by Laennec, Barton, &c: their action, however, may in all cases be explained in one of two ways. The terebinthinate, alliaceous, or highly odorous agents may be absorbed into the system, and, in this way come in contact with the entozoa, but it is not probable, that they can affect them, in a state of sufficient concentration, to be detrimental. This explanation will not, however, apply to others. There is every reason for believing, that frictions, cataplasms &c, act as indirect anthelmintics only, by improving the activity of the gastric and intestinal operations, and thus removing the grand pre- disposition. 2. Mechanical Anthelmintics. Of these, two only are now in general use. In the United States, indeed, neither of these is much employed, but in Great Britain they have by no means outlived favour. These two are the filings of tin or granular tin, and mucuna or cowhage. The mode in which they act is described hereafter. 3. Anthelmintics that expel worms by acting on the intestinal canal. The substances that operate in this manner belong to the class of cathartics ; but these should not be of a violent character, or often repeated, owing to the debility they are likely to induce in the di- gestive organs. The occasional exhibition of a brisk cathartic is often a valuable agency not only in removing the worms, but in sti- mulating the gastric function to a more healthy action, and thus re- moving the predisposition. By exciting, too, the intestines to throw off the retained faeces, and secretions, — in which the worms are often enveloped, and find a nidus favourable for their generation,— they enable those anthelmintics, which may be prescribed, to come more ANTHELMINTICS. 207 immediately into contact with the parasites, and should, consequently, be made to precede the use of those remedies. Nor is it alone prior to the administration of anthelmintics that cathartics are useful. When the former have been prescribed for a few days, and there is reason to hope that they have occasioned the death of the worms, a brisk cathartic may be advantageously given for the purpose of re- moving any accumulation of dead animal matter that may have taken place, and thus of diminishing the tendency to a fresh generation. The cathartics that have been chiefly used for this purpose, are oleum ricini, oleum tiglii, gamboge, scammony, jalap, aloes, and calo- mel, — singly or combined. 4. Anthelmintics that prevent the formation of worms. This class of agents is, after all, the most important. The great predisposition to invermination consists in want of tone generally, and of the gastro-enteric organs especially. Accordingly, agents that are found to aid chylosis, prove most valuable. Charcoal has long had a character for being anthelmintic, and it is well known, that it has been, and is, constantly mixed with the food employed for fattening fowls for the markets of large towns. The charcoal contains no soluble matter, but by grating over the mucous mem- brane of the stomach and intestines, it stimulates the organs con- cerned in digestion, to greater activity, and enables a larger quantity of chyle to be separated from the food taken along with it than could be accomplished without its agency. Such is the fact, likewise, with regard to salt— the condiment of condiments, as it has been, not improperly, termed. Where children are not allowed a proper quantity with their meals, they have been observed to be extremely liable to the generation of these parasites ; and therefore a due allowance is always to be permitted, and recom- mended. The agriculturist administers it liberally for the prevention of invermination in his cattle ; and it is occasionally given to both animals and man as a true anthelmintic. Fortunately, it is much liked by children, who have apparently a natural taste for it, as is the case with the individuals of the animal kingdom, — the buffalo of our own country daily frequenting the salt licks of the west to enjoy the treat; and all our domestic cattle lick it with the greatest delight. In the twenty-ninth volume of the London Medical and Physical Journal, Mr. Marshall has published the case of a lady who had a natural antipathy to salt — which is rare — and who was dreadfully infested with worms during the whole of her life. In Ireland, ac- cording to Dr. Paris, where, from the bad quality of the food, the lower classes are very subject to worms, a draught of salt and water is a popular and efficacious anthelmintic, and Lord Somerville, in his address to the English Board of Agriculture, refers to the effects of a punishment which formerly existed in Holland. " The ancient laws of the country," says his lordship, " ordained men to be kept 208 SPECIAL ANTHELMINTICS. on bread alone, unmixed with salt, as the severest punishment that could be inflicted upon them in their moist climate. The effect was horrible ; these wretched criminals are said to have been devoured by worms engendered in their own stomachs." Where the practitioner is desirous to destroy worms, the manage- ment may have to be somewhat modified by the particular variety ; but, as the symptoms, which distinguish these from each other, are by no means unequivocal, the treatment must be obscure also. This is, however, of the less consequence, as all entozoa are induced by the same causes, and more or less affected by the same vermifuges. As the ascarides or oxyures vermiculares occupy the lower part of the bowels, and occasion a troublesome itching within the rectum, their presence may be suspected, and medicines can be introduced to act upon them immediately, by the way of injection ; aided, or not, by anthelmintics, administered by the mouth. In all cases, per- haps, it would be better that they should be placed, in this way, be- tween two fires, as it were, as they have been found even in the upper part of the alimentary tube, whence they have been ejected by vomiting ; and it is not by any means improbable, that the an- noyance occasioned by a clyster might induce them to migrate, for the purpose of seeking quiet in the higher portions of the intestines, or at least of getting rid of the irritation to which they may have been exposed in the lower portion. In all cases it will be necessary to investigate the condition of the system, that favours the unusual generation of worms, and to treat it accordingly ; but the considera- tion of this subject belongs more particularly to Special Therapeutics. SPECIAL ANTHELMINTICS. 1. True Anthelmintics. O'LEUM TEREBIN'THINiE — OIL OF TUR'PEiNTINE. Oil of turpentine— whose general properties are described else- where — singly, or combined with other agents, is the most powerful of the direct anthelmintics, destroying worms rapidly which may be immersed in it out of the body. It is likewise — as elsewhere shown — a cathartic, so that it is rarely necessary to administer any other cathartic afterwards, as is the case with many of the anthelmintics. Should it not act on the bowels, however, it may be advisable either to associate with it castor oil, or to follow it up in the course of a few hours by a dose of this oil, inasmuch as when it does not pass off, it may, according to Dr. Copland, by being absorbed, give rise to encephalic mischief, and occasionally to nephritic symptoms. It CHENOPODIUM. 209 is applicable to every variety of intestinal worms, and has proved very efficacious in cases of taenia. It may be given in the dose of f. ^ij to f. ^ss and more, in mo- lasses ; or made into an emulsion with the yolk of egg or mucilage —(01. terebinth, f. J^ss ; vitell. ovi, seumucilag. acac. f. ^yj ; Aqua mentha piperit. f. £ss — M.) Dr. Pereira states, that he has fre- quently administered f. |iss, and sometimes f. |ij, and in no instance has he seen any ill effects from it. In cases of the oxyures or ascarides vermiculares, oil of turpentine may be made to come in contact with them in the form of enema. 2. O'LEUM ANIMA'LE. —ANIMAL OIL. Animal oil, or Dippel's oil— O'leum anima'le Dippel'ii — is ob- tained by subjecting animal substances — as bone — to destructive distillation. The commercial article is derived from the manufacture of bone black, and is identical with the Oleum cornu cervi or Oil of hartshorn of the older Pharmacopoeias. It is thick, brown, viscid, and has a most disgusting odour. The oil has been highly extolled as an anthelmintic — by the Germans more especially, and it is, unquestionably, very effective even in cases of taenia; but it is so inexpressibly nauseous, that but few stomachs can retain it. Its virtues have been ascribed to the creasote which it contains, and they are, doubtless, dependent in part upon that constituent. The dose is tt\,v. to rr^xx. in mo- lasses, given for three mornings in succession, and followed by a cathartic. The Empyreumat'ic Oil of Chabert, made—as before remark- ed—by adding one part of animal oil to three parts of oil of tur- pentine, leaving them to combine for four days, and then distilling three parts, has been greatly extolled. It, also, is very nauseous. It combines the anthelmintic virtues of its constituents, and may be given in the dose of a tea-spoonful three times a day. It is a very effective vermifuge. 3. CHENOPO'DIUM.—WORMSEED. The wormseed of the United States is the fruit of Chenopo'dium Anthelmin'ticum or Jeru'salem Oak: Sex. Syst. Pentandria Digynia: Nat. Ord. Chenopodiaceae, — the wormseed of Europe being the fruit of Artemis'ia Snnton'ica, (Dublin College,) or of a variety of A. Marit'ima. Dr. Pereira, however, affirms, that the substance sold in Great Britain under the name of" wormseed," does not consist of seeds, but of broken peduncles, mixed with the calyx and flower- buds. Chenopodium anthelminticum is an indigenous plant, which grows in almost every part of the United States, but especially to the sou h,— being found in the vicinity of rubbish, along fences ; flowering from July to September, the seeds ripening in autumn. These are small, roundish, light, of a very bitter pecu iar .as;e, and of a disagreeable 18* 210 SPECIAL ANTHELMINTICS. odour, which is possessed by the whole plant. Their properties are dependent upon a volatile oil separable by distillation with water. Fig. 25. Chenopo'dium ambrosio'ides, an indigenous plant, is said to be used indiscriminately for it. The seed of the chenopo- dium is one of the most po- pular anthelmintics in use in the United States ; and the common mode of prescribing it to a child three or four years old is to mix one or two scruples of the powder with molasses ; administering this for three nights in suc- cession, and then prescribing a cathartic on the following morning. 0LEUM CHENOPODII or oil of wormseed, Wormseed oil, is offi- cinal in the Pharmacopoeia of the United States. It is of a bright yellow colour when freshly distilled, but becomes darker by age. It is admi- nistered in the same manner as the powder, in the dose of four to eight drops. It may be mixed with sugar or mo- Chenopodium Anthelminticum. lasses. 4. SPIGE'LIA. —PINKROOT. Spigelia is the root of Spige'lia Mariland'ica, Indian Pinh, Ca- rolina Pink or Peren'nial Wormgrass. Sex. Syst. Pentandria Mono- gynia; Nat. Ord. Gentianaceae; —Spigeliaceae (Martius), an indige- nous plant of the States south of the Potomac, which grows in rich soils on the edges of woods, and flowers from May to July. It is collected in quantities by the Creeks and Cherdkees, by whom it is packed in casks, or, more frequently, in large bales, weighing from 300 to 350 lbs. ; — that in the casks being preferred as less likely to be damp and mouldy. (Wood & Bache.) The dried root, as met with in the shops, consists of numerous, slender, branching, crooked and wrinkled fibres, issuing from a short rhizoma. These fibres are from three to six inches long. Its odour is faint; and taste sweetish and slightly bitter. Its activity has been assigned by Feneulle to a brown bitter extractive, similar to I SPIGELIA. 211 that of the cathartic Leguminosae, which, when taken internally causes vertigo and a kind of Fis- 26- intoxication. The virtues of spigelia are imparted to boil- ing water. The roots are sometimes mixed with those of a small creeping plant, which twines round the stem. These are much smaller and lighter co- loured, and should be sepa- rated before the spigelia is dried. Pinkroot is much used in the United States as an an- thelmintic, and although cases are related in which it is said to have proved acro-narcotic, and even to have caused death, it is very extensively prescribed, and with entire impunity. Still, it is well to bear in mind, that such cases have been recorded, as well as the statement, that the acro-narcotic effects are less apt to occur when the medi- cine acts on the bowels, or is combined with cathartics. Dr. Wood affirms, that in the United States, it stands at the head of the anthelmintics. It certainly is highly esteemed by many, but others have equal confidence in the che- nopodium,and much more in the oil Of turpentine and its Spigelia Marilandica. combinations. It is scarcely used in Great Britain, although it is offi- cinal in the Pharmacopoeias of London, Edinburgh, and Dublin. The dose of the powdered root, for a child a few years old, is from ten to twenty grains, and for an adult from one to two drachms. This may be given every night, or every night and morning, for three successive days, and then be followed by a brisk cathartic. Or it may be associated with calomel, jalap, or any of the cathartic powders. 1NFUSU.1I SPIGE'IM, INFUSION OF PM-ROOT. (Sj/igel. §ss ; Aqua bul- lient. Oj. The dose of this infusion, for a child a few years old, is f. ^ss. to f. ^1; for an adult, f. ^iv. to f. ^viii, given in the same manner as directed for the powdered root, or an equal quantity of > 212 SPECIAL ANTHELMINTICS. senna may be added to the infusion. A preparation is generally kept in the shops, which is said to be much prescribed by physicians under the name of worm-tea, and which consists of pink-root, senna, manna and savine, mixed together in various proportions to suit the views of the prescriber. (Wood & Bache.) The author has never used it, nor seen it used. 5. FILIX MAS.—MALE FERN. Filix Mas, of the secondary list of the Pharmacopceia of the United States, is the rhizoma of Aspid'ium Filix Mas or Nephro'dium Filix Mas; Sex. Syst. Cryptogamia Filices; Nat. Ord. Filices; a plant which is indigenous in this country in shady pine forests, from New Jersey to Virginia, as well as in those of Europe, Asia, and Africa. The rhizoma should be collected in the months of July, August, or September. The sound parts are to be carefully dried and reduced to powder. When dried, its odour is weak, taste sweet, and mucilaginous, slightly bitter and austere. It is generally brought to this country from Europe. Fig. 27. Npphrodium Filix mas. A. Pinnule with nine sori. a.) B. Magnified portion of pinnule with the sporangia. a. Stomata. b,b, Sporangia partially covered by c. the indusium. C. Magnified sporangium. a. Stalk, b. Ring. c. Membranous sac.. D. Ruptured Sporangium with the sporule escaping.—(Pereira.) As met with in the shops, it consists of fragments of the dried thickened bases of the footstalks, to which small portions of the rhi- zoma are found adhering, and of the root fibres. It is recommended, that the stock of the apothecary should be renewed annually, as in two years the best article becomes useless. Filix mas has been analysed by various individuals, and it is pro- bable, that the anthelmintic virtues reside in volatile oil, which exists in it to the amount of about 7 per cent. It contains, likewise, tannic and gallic acids, which communicate to it its astringent properties. The root of the male fern has only been used as an anthelmintic. It was the basis of Madame Nouffer's celebrated remedy for tignja, which was purchased by Louis XVI., in 1775, for 18,000 francs. The dose of the powdered root is one to three drachms, given in molasses for three nights in succession, and followed by a brisk ca- thartic in the morning. The plan adopted — and successfully, in GRANATI RADICES CORTEX. 213 many cases,— by Madame Nouffer, was to give two or three drachms of the powder in from four to six ounces of water, in the morning fasting, and two hours afterwards, a purgative bolus composed often grains of calomel, ten of scammony, and six or seven of gamboge. But the most effectual preparation would seem to be that proposed by M. Peschier of Geneva — the ethereal extract, which has been called also O'leum Fi'licis, and Extrac'tum Fi'licis ^the'reum, which contains not only the volatile oil, but also a fixed oil, tannic, gallic, and acetic acids, a muco-saccharine matter, green and red colouring matter, and a semi-resinous substance. It is made by digesting, in the cold, the root, cut small, for ten or twelve days, in a sufficient quantity of sulphuric ether ; after which the strained liquor is evaporated until the ether is removed. Peschier had known it to be successful in 150 cases, when he wrote ; Ullersberger had used it in 60 cases, and a medical friend of his in 200 cases, with invariable success. It is affirmed to have been found more success- ful against the Bothrioj&phalus latus than the Tcenia solium; and a part of the discrepancy of results has been ascribed "to mis cause. For example, it has not been found as effectual in the treatment of taenia at Paris, and the entozoon most common is the Taenia Solium. The dose of the ethereal extract is from twelve to twenty-four grains. It may be given in the form of pill or in molasses, for two or three nights in succession, and then be followed by a brisk ca- thartic. The Ethereal Tincture of the Buds of the Male Fern (one part of the buds to eight of ether) has been used with advantage as an anthelmintic ; and a decoction in the proportion of an ounce of the rhizoma to a pint of water has been occasionally prescribed. 6. GRANA'TI RADI'CIS CORTEX.— BARK OF POMEGRAN'ATE ROOT. Pu'nica Grana!turn or Pomegran'ate; Sex. Syst. Icosandria Mo- nogynia; Nat. Ord. Myrtaceae; — Granateae (Don,) appears to be a native of northern Fig. 28. Africa, whence it was transported to Italy at the time of the Carthaginian wars. It is also indigenous in Bengal, China, and Persia. The bark of the root — which is the part used as an anthelmintic— is usually in small fragments, in quills or portions of quills, of a yellowish, or ash-grey colour externally ; and yellow within. It is brittle and not stringy, and has a faint peculiar smell, and an astringent taste. It has often been sub- jected to analysis ; and has been found, by M. Latour de Trie, to contain, 1, a mat- ter, which was considered to be peculiar, Funics granatum. and to which the name of Gran'adin or Gren'adin was given, but which has been shown to be mannite. 214 SPECIAL ANTHELMINTICS. 2. Tannic acid, to which — as well as to a small portion of gallic acid — its astringency is owing ; and 3. Resin. The analysis sheds no light on its anthelmintic properties. It yields its virtues freely to water. Pomegranate root bark is rarely employed at the present day ex- cept as an anthelmintic, and not often with that view. It is said, when given in full doses, to induce nausea, vomiting and purging, and occasionally giddiness and faintness, which would seem to show that it possesses acro-narcotic properties, on which its anthelmintic virtues may be dependent. The testimony in favour of the bark as an anthelmintic has been discordant. It is especially in cases of taenia that it has been em- ployed ; and numerous trials have been made with it in England, France, Germany, and Italy ; yet in extensive experiments at the Polyclinical Institute of Berlin it proved of no value; but this failure was referred to some imperfection in the drug. The fresh bark possesses far more virtue than the dried : the latter has, indeed, been regarded as inert. It is almost always given in decoction, which may be prepared with two ounces of the bark, boiled in a quart of water down to a pint and a half. Of this, the dose is f. ^ij, every half hour until the whole is taken. The formula, cited by Paris from Ainslie's " Materia Medica of Hindusthan," di- rects it to be prepared with ^ij of the fresh bark, boiled in a pint and a half of water, until only three quarters of a pint remain. An alcoholic extract of the bark of the root is recommended by Deslandes. 7. AZED'ARACH. —AZED'ARACH. The bark of the root of Me'lia Azed'arach ; Sex. Syst. Decandria Monogynia ; Nat. Ord. Meliaceae ; is in the secondary list of the Pharmacopoeia of the United States. The tree, termed PHde of China, Pride of India, Bead Tree, and Poisonberry Tree, is a native of oriental countries ; but is cultivated as an ornament in various parts of the world. It is very common in the Southern states, but does not flourish farther north than Virginia. The berries are reputed to be poisonous, yet they are said to be eaten by children at the south without inconvenience, and are con- sidered to be anthelmintic. The bark of the root — the officinal portion — has a bitter nauseous taste. Its virtues are imparted to boiling water. It is regarded by many as one of the most valuable anthelmintics ; and when given in large doses is unquestionably acro-narcotic. It is usually prescribed in decoction. (Azedarach. recent, ^iv ; Aqua, Oij: cocque ad Oj, et cola. Dose, f. ^ss. every two or three hours, till it exhibits its effects on the stomach or bowels.) TANACETUM. 215 8. FUCUS HELMINTHOCOR'TON. Fucus Helminthocor'ton, Helminthocor'ton or Cor'sican Wormweed; Nat. Ord. Algae; — Algaceae (Lindley), is a marine plant, which grows on the coast of the Mediterranean, and especially of the Island of Corsica. The whole plant is employed as an anthelmintic in Europe ; but it is not used in this country. The American editors of the Manual of Materia Medica and Pharmacy, by Edwards and Vavasseur, affirm that it is the best vermifuge with which they are acquainted, and that they witnessed in Corsica the most astonishing effects from it. The dose of the powder is from gr. x. to 3ij. mixed with molasses. It is also given in infusion and decoction, and it is affirmed by Dr. James Johnson, that when thrown into the rectum it " destroys any worms domiciliating there as effectually as choke-damp would destroy the life of a miner." Yet its effects on the economy are scarcely appreciable ; and chemical analvsi's sheds no light in regard to its anthelmintic principle or principles. 9. SO'DII CHLORIDUM. —CHLORIDE OF SO'DIUM. The value of common salt — whose general properties are de- scribed under Cathartics—as a condiment in the prevention of worms, has already been mentioned, (p. 207.) It was also re- marked, that experiments have shown it to be detrimental to those entozoa when out of the body. Hence it has been administered as a true anthelmintic. Its cathartic agency might entitle it to be placed also under another of the divisions of anthelmintics. When given as a true anthelmintic, it is generally in large doses from ^ss. to ^j ; and in cases of oxyures or ascarides vermiculares, it may be thrown into the rectum in strong solution. 10. TAMACE'TUM. — TANSY. The herb Tanace'tum vulga're or Tansy: Sex. Syst. Syngenesia Polygamia superflua; Nat. Ord. Compositae Corymbiferae; is an herbaceous plant, indigenous in Europe, but introduced into this country, where it grows wild on the road-sides, and is cultivated in the gardens. It flowers from July to September. The whole herb has a strong, peculiar and disagreeable odour, and a nauseous, bitter, and aromatic taste. It has been subjected to analysis, and found to be essentially composed of volatile oil__ Oleum Tanace'ti—which has the peculiar smell of the plant, and a warm bitter taste ; and of a bitter matter, which is usually de- nominated extractive, but has been regarded as partly resinous. Still, the main properties are extracted by water, and all, probably, by alcohol. Tansy is chiefly used as an anthelmintic in domestic practice. It is rarely prescribed by the physician, and is therefore placed in the secondary list of the Pharmacopoeia of the United States. Its an- thelmintic virtues are probably dependent both on the bitter princi- 216 SPECIAL ANTHELMINTICS. pie and the volatile oil; the latter of which is more destructive to the parasites, whilst the former, like bitters in general, is adapted for giving tone to the digestive function and to the system in gene- ral ; yet the seeds, which contain the largest proportion of the bitter principle, and the smallest of volatile oil, are said to be most effec- tive. It is generally given in infusion — Tansy Tea ; prepared by infusing ^ij. of the herb in Oj. of boiling water, the dose being from f. I), to f. §iij. The seeds might be given in powder, in the dose of from gr. xxx. to 3J ; or a few drops of the oil might be administered in molasses. 1 11. CREASO'TON. —CRE'ASOTE. {For its general properties, see Excitants). Several portions of tapeworm having been observed to be dis- charged during the administration of creasote, it was prescribed, in such cases, zrs a true anthelmintic. From five to eight drops may be given to adults in an ordinary dose of oleum ricini. It has likewise been associated with oleum tiglii. II. Mechanical Anthelmintics. MUCU'NA.— COWHAGE. Mucuna, in the language of the Pharmacopceia of the United States, is the " bristles of the pods of Mucu'na. pru'riens, Dol'ichos pru'riens, Stizolo'bium pru'riens, Cowhage or Cowitch." Sex. Syst. Diadelphia Decandria ; Nat. Ord. Leguminosae — a climbing plant indigenous in the West Indies. The pod or legume — as met with in the shops — is of a brownish colour, shaped like the italic s, contain- ing four to six seeds, and covered with a pubes of stinging hairs__ seta — which, when placed on the skin, pierce it, and give rise to intense itching, and, in some persons, to cutaneous inflammation. The best application, in such cases, is oil. Rubbing the part always increases the local phenomena. Mucuna has long been celebrated as a mechanical anthelmintic. That its action is mechanical is, indeed, proved by the circum- stances, long ago observed, that worms, under its use, are discharged alive. When experiments, too, have been made on entozoa out of the body, the setae have been observed sticking in them and the animals twisting about evidently in great torture. That an anthel- mintic effect is produced upon them by cowhage within the human body appears to be well supported. The testimony in favour thereof has been satisfactory, and the author himself has repeatedly seen its exhibition followed by the evacuation of entozoa after other an- thelmintics had been given fruitlessly. The difficulty has been to understand how it could act upon the PULVIS STANNI. 217 worms, and not equally irritate the lining membrane of the intes- tines ; hence the efficacy of the medicine has been discredited. It is impossible, however, to set aside the numerous facts that have been adduced in its favour; and it would seem, that the mucus, which covers the membrane, may prevent the setae from penetrating it as it does the worms. Mucuna has been considered best adapted for the removal of Ascarides lumbrico'ides or the long round worm, and Oxyures vermi- culares or the small thread worm. The latter are, however, so low down in the intestinal canal, that its influence can scarcely be so powerful on them. It may be given in the form of electuary, the pods being dipped in molasses, and the seta? scraped off until the mixture has attained the consistence of thick honey. Of this, a table-spoonful is a dose for an adult; a tea-spoonful for a child three or four years old. This may be administered for three nights in succession; and the following morning, a brisk cathartic may be given. It is not much used in this country ; and the framers of the last edition of the Pharmacopoeia of the United States have transferred it from the primary to the secondary list. 13. COR'YLUS ROSTRATA. —BEAKED HAZEL. Beaked Hazel is a shrub two or three feet high, of the Nat. Ord. Amentaceae ; Sub. Ord. Cupuliferae ; Sex. Syst. Monoecia Polyandria, which grows in the mountainous regions of North America. The nut which it produces is of an ovate shape, surrounded by a cori- aceous and scaly involucre or cupula, terminating in a tube an inch and a half long, covered with short and thick bristles, very similar to those of mucuna. These have been found by Dr. Heubener, of Bethlehem, Pennsylvania, to possess similar anthelmintic virtues with mucuna, and to be equal to it in all respects. It may be given, like mucuna, in syrup, molasses or other con- sistent vehicle, and in the same doses. 14. PULVIS STANNI. —POWDER OF TIN. Powder of Tin, Gran'ulated or Gran'ular Tin, is prepared by melting tin in an iron vessel over the fire, and, whilst it is cooling, stirring it until it is reduced to a powder, after which it is passed through a sieve. Tin may also be reduced to powder by shaking it, when melted, in a wooden box, the inside of which has been rubbed with chalk. The testimonials in favour of this mechanical anthelmintic have been numerous. It has been strongly recommended not only in Ascarides lumbrico'ides, but also in Tania solium. It was at one time conceived, that its good effects might be owing to its combi- nation with arsenic, but this supposition has been negatived by the equal success following its use in a pure state. In all probability, it acts by the incessant annoyance occasioned by the friction of the vol. i.—19 218 EXPECTORANTS. particles of the tin, which renders the situation of the entozoa un- comfortable to them, and induces them to migrate ; whilst the same friction on the mucous coat of the intestines increases their peristaltic action, and favours the object; or, if it fail to do this, it augments chylosis, and improves the general tone of the digestive system. _ The dose to children is from 3ss. to 5ij. and more; to adults gss. and more, in molasses, every night, for three nights. On the follow- ing morning a brisk cathartic may be given. SECTION II. AGENTS THAT AFFECT PROMINENTLY THE RESPIRATORY ORGANS. B X P E C ' T O R A N T S. Synon. Anacathartics. Definition of expectorants — Organs on which they act — Modus operandi — Are indi- rect agents only — Inhalations — Special Expectorants. Expectorants are usually defined to be — " Agents that promote the excretion of mucus and other fluids from the lungs and air passages." To understand whether we be possessed of any substances that exert a special action of this kind, it is necessary to inquire into the anatomical constitution of the bronchial tubes, and into the mode in which reputed expectorants may affect them. The whole of the larynx, the trachea, and probably the bronchial tubes, are lined by a mucous membrane, whose office it is to secrete mucus, and to serve the purpose of the mucous membranes in general. From this membrane it is, that the humour of expectoration is secreted. Surrounding the air tubes, probably even in their minutest divisions, is a contractile coat, which has an important agency in the phenomena of expectoration. In the trachea, an obvious muscular structure exists in its posterior third, where the cartilages are wanting. It consists of a thin, muscular plane, the fibres of which pass transversely between the interrupted extremities of the cartilaginous rings of the trachea and the bronchia. The use of this muscular tissue, as sug- gested by Dr. Physick, and, since him, by Cruveilhier, Sir Charles Bell, and others, is to diminish the calibre of the air tubes in ex- pectoration ; so that the air, having to pass through the contracted portion with greater velocity, its momentum, in coughing, may re- move the secretions, that are adherent to the mucous membrane. The phenomena of asthma, as Laennec has correctly observed, occasionally exhibit a manifest temporary constriction of the minute bronchial ramifications, affording, indeed, every evidence of a spas- modic attack, — the essential cause being probably seated in the ramifications of the pneumogastric nerves distributed to the bronchial tubes, whilst, at other times, the phenomena indicate rather a para- lysed than a spasmodic condition of the muscular fibres. MODUS OPERANDI. 219 The quantity, and facility with which the matter of expectoration is secreted, must depend upon the condition of the mucous mem- brane. Occasionally, indeed, the sputum is derived from the breaking down of tubercles, or from positive abscesses in the lungs, but these are not the most common cases in which expectorants are employed ; — such, at least, as are regarded to exert a specific agency on the lining membrane of the air-passages, when taken into the stomach, or introduced, in any manner, into the circulation. If the bronchial mucous membrane be inflamed, as in acute bronchitis, the secretion from it may be wholly arrested for a time, after which it may become augmented, as in cases of inflammation of the mu- cous membranes in general; or, if the inflammation be to a less ex- tent, and protracted, a profuse secretion may take place from it, at- tended with every symptom of general asthenia, as in some of the cases of winter-cough or chronic bronchitis of old people. In these different conditions of the mucous membrane, a different condition of expectorant medication must be demanded. In the former, marked by every sign of internal inflammation, the antiphlogistic plan is im- periously required ; whilst in the latter, depletion is by no means in- dicated: on the other hand, general and local excitants maybe found advisable. These, however, are indirect expectorants — adapted for the removal of the condition of the system, which gives rise to thediminished or augmented secretion from the bronchial mu- cous membrane. Again, when the sputa are secreted, they often adhere to the mem- brane, and are expelled with difficulty ; at times, because the inflam- matory condition, above mentioned, does not admit of their ready de- tachment ; and, at others, owing to a want of due vigour in the system in general, and in the muscles, concerned in expectoration, in particular. In the former case, antiphlogistics, nauseants, &c. become indirect expectorants ; in the latter, substances, which, like ammoniacum, myrrh, and the different balsams, are excitants; or, again, agents, that are capable of inducing emesis, during the suc- cession accompying whose operation, the mucous becomes detached, and its expulsion favoured. In these cases, a nauseating emetic is most beneficial, if inflammatory irritation exists to any extent ; for, during the nausea, which precedes emesis, the secretion from the bronchial mucous membrane is favoured, and by the act of vomiting succeeding to the secretion the mucus is readily detached, and ex- pectorated. In this way, consequently, nauseants and emetics be- come expectorants. All these, however, are indirect agencies only, and it is important to inquire, whether there be such remedies as direct expectorants, or, in other words, any that act on the bronchial mucous membrane spe- cifically, or by preference, after having been received into the sto- mach, and entered the mass of blood ; for, it is manifest, that this is the only mode in which any internal expectorant can come into immediate contact with the seat of the mischief. The expectorant 220 EXPECTORANTS. whatever it may be, must be received into the circulation, either by imbibition through the coats of the gastro-enteric blood-vessels, or through the chyliferous vessels. In "either case, it must proceed to the heart, and pass with the blood of the bronchial artery to the bronchial mucous membrane; and although it cannot be de- nied, that many local excitants, when received into the blood- vessels, affect the particular parts of the frame on which they act by preference, we have no sufficient reason for the belief, that this is the case with any of the remedies, that are reputed to be expec- torants. None of them appear to affect the bronchial mucous mem- brane by preference : they exert upon it an indirect agency only. An attentive examination of the properties ascribed to the different agents, ranked under this division, can scarcely fail, indeed, to lead the intelligent therapeutist to the deductions of Dr. Paris. " If the term expectorant," he remarks, be intended to express a medicinal substance, which has the power of promoting the expulsion of fluid from the lungs, by some specific action on the parts concerned, we can have no hesitation in at once rejecting the word, and denying the existence of such remedies; if, however, the term be received conventionally, as comprehending all those substances, which are capable, according to the state of the system in each particular case, of producing expectoration, it will be extremely proper to recognise, and particularly useful to retain, such a class of medicinal agents." A still more recent writer, Dr. Spillan, has remarked, that " there pro- bably exists no class of medicines, which so fully establish the truth of the principle, that medicines are but relative agents, as the class now under consideration." These are the only views, that can be rationally maintained, and much careful discrimination, accordingly, becomes necessary to de- termine upon the precise kind of indirect agency that may be de- manded in any particular case : immense mischief has, indeed, been done by the promiscuous prescription of reputed expectorants, under circumstances contra-indicating their employment. The pathology of many of the varieties of cough has been but little attended to, until of late years. Its frequent identity with bronchitis was not sus- pected, or if suspected, disregarded. Expectorants, in such cases, were freely administered, —that is, substances considered to be pos- sessed of direct powers over the parts concerned in the formation of the matter of expectoration; and as almost all these remedies belonged to the class of excitants, it may be imagined, that J mischief frequently followed their administration. This every practitionerjmust have witnessed from the injudicious use of excitant cough mixtures, often administered when the system has been labouring under general febrile indisposition, connected with, or dependent upon, the bron- chitis, for which the expectorant was originally recommended. The judicious practitioner, in such cases, whilst he pays proper attention to the febrile and inflammatory symptoms, generally restricts himself, as far as may be, to the employment of demulcents. These, by pass- INHALATION. 221 ing over the top of the larynx, soothe the mucous membrane with which they come in contact, and, by contiguous sympathy, the soothing influence is propagated to the part of the bronchial mucous membrane labouring under irritation. Almost every division of medicinal agents may become expecto- rant, according to the precise condition of the system generally, or of the pulmonary organs particularly; and hence we find an expec- torant effect equally from depletives, and from tonics and excitants ; from narcotics and counter-irritants; and from nauseants and emetics. inhala'tions. But although the existence of any internal expectorant—acting through the stomach and the circulation on the lining membrane of the air passages — may be doubted, there is a mode of exhibiting remedies, so that they may come into immediate contact with the bronchial mucous membrane, so as to modify its functions effec- tively, — through the introduc- tion of different agents by inha- lation. In this way, soothing or relaxing vapours may be made to act upon the inflamed membrane, especially after the violence of inflammatory action has been previously somewhat subdued by appropriate anti- phlogistics ; accordingly, under such circumstances, the vapour Fig. 29. Fig. 30. Inhaling Bottles. of hot water is employed with much advantage, and, in cases of asthma, relief is occasionally obtained by the addition of some vola- tile oil, as by inhaling the vapour from a hot infusion of chamomile flowers. With the same view, ether is occasionally added. In some cases of asthma, there appears to be a condition of the pneumogas- tric nerves somewhat resembling paralysis, which excitants, intro- duced in the manner referred to, are as well adapted to remove as any other agents. The vapours of burning substances, as of tar and resin, are occasionally inhaled, and they may be employed with ad- vantage in chronic bronchitis, when the inflammation is of an asthe- nic character, or when the activity of the inflammation has passed away, and the copious secretion from the membrane is the most an- noying symptom. The vapours of boiling tar were, at one time, strongly recommended by Sir A. Crichton in consumption, but ex- perience has shown that not much reliance can be placed upon them in that fatal malady ; and many of the cases of benefit, derived from such inhalation, have probably been of the kind just referred to — cases of chronic bronchitis, 19* 222 SPECIAL EXPECTORANTS. The practice of smoking the roots of stramonium in asthma, and other pulmonary affections, has long existed, and frequently essential benefit is derived from it. There is something inexplicably capri- cious in this singular disease. Whilst one asthmatic cannot sleep in town, another cannot remain in the country. A friend of the author, a most respectable inhabitant of Baltimore, is unable to sleep at his country house, which is not more than a mile and a half from the centre of the town. He has tried the experiment frequently, and the result has been always the same. The author knows another indi- vidual, who cannot exist in the impure atmosphere of towns. Others, again, prefer a dry, whilst many breathe more freely in a moist atmosphere. The same thing, of course, applies to medicinal agents inhaled by the lungs. Tobacco relieves some, and aggra- vates the symptoms of others; but the smoke of stramonium agrees with a large majority of persons, and at times affords manifest re- lief. When suffering under a severe attack of the disease, the gen- tleman, above referred to — as unable to sleep in the country—has frequently made manifest to his medical attendant the relief he de- rives from its inhalation. For this purpose he employs the dried stalk. Others use the root, and others the leaves only. (For simi- lar cases, see the author's Practice of Medicine, 2d edit. ii. 328. Philad. 1844.) It is, too, in the way of inhalation, that the different gases have been used therapeutically. They were first proposed by the enthu- siastic Beddoes, and are certainly capable of affecting the frame — some as excitants, others as sedatives ; — but difficulties, connected with their efficient administration, and uncertainty in the results ob- tained, have led to their almost total abandonment. They pass through the bronchial tubes, penetrate the blood-vessels by imbibi- tion, and exert their appropriate agency, either on the nerves distri- buted to the blood-vessels, or affect the great nervous centres by reaching them through the circulatory current; but such agents can- not properly be ranked as expectorants. SPECIAL EXPECTORANTS. I. Excitant Expectorants. 1. SEN'EGA.—SEN'EKA. Sen'eka, Sen'eka snakeroot or Rattlesnake root, is the root of Polyg- ala Sen'ega ; Sex. Syst. Diadelphia Octandria ; Nat. Ord. Poly- galeae, an indigenous plant common in every part of the United States, but abounding especially in the Southern and Western portions, where it is collected for use. As met with in the shops, seneka is of different sizes, from that of SCILLA. 223 a writing quill, to that of the little finger, having a thick knotty head, which exhibits traces of the numerous stems. It is contorted, often marked by crowded annular eminences, with a projecting line run- ning along its whole length. The cortical portion is corrugated, cracked transversely, and of a yellowish-brown or greyish-brown colour. The smell is strong and peculiar in the fresh root, but faint in the dried ; and the taste is at first sweetish and mucilaginous, leaving a peculiar acrid sensation in the fauces. The whole of the virtues are resident in the cortical portion, the woody matter being inert, and therefore to be rejected, in re- ducing seneka to powder. These virtues are yielded to boiling water, and to alcohol, especially to dilute alcohol. They seem to be partly dependent upon a substance called Sen'egin, Polygalin and Polygalic acid, which has been esteemed by some to be an alkaloid ; by others an acid ; and which, when given to dogs, in the dose of 6 or 8 grains, has caused vomiting, difficult respiration, and death in three hours. Seneka has been regarded as one of the best of the excitant expec- torants ; and in the form of syrup of senega is largely used both in hospital and private practice, especially by those who prescribe ac- cording to a system of routine, and are guided by names rather than by phenomena. It is clearly excitant; -and, therefore, not adapted for facilitating expectoration in affections of the chest of an inflamma- tory character. Yet, like the squill, it forms part of a compound syrup — the Syrupus scilla compositus—associated with nauseating and emetic substances, which certainly fill contrary indications ; and — as elsewhere remarked—it is probable, that most, if not all of the benefit in many cases derived from the preparation, is due to the nauseants and emetics contained in it. Dr. Pereira assigns to seneka a sphere of action, which is inexpli- cable ; and to the author — who has employed it largely — incredi- ble. " In this country" (England) — he remarks — " senega is com- paratively little employed. It is an exceedingly valuable remedy in the latter stages ofbronchial or pulmonary inflammation, when this dis- ease occurs in aged, debilitated, and torpid constitutions, and when the use of depletives is no longer admissible. It appears to re-es- tablish a healthy condition of the secreting organs, to promote the resolution of the morbid deposits, and to give strength to the system. I usually administer it in combination with ammonia, which appears to me to promote its beneficial operation. Frequency of pulse, and a febrile condition of the system are by no means to be regarded as impediments to the use of this medicine." Seneka is rarely — if ever—given in powder. Should it be de- siied to administer it in this form, the dose may be from ten to twenty grains. DECOCTD! SEN'Ef.JE, DECOCTION OF SEN'EKA. (Senega, cont. sj ; Aqua Oiss. Boil to a pint.) This decoction is by no means as much used 224 SPECIAL EXPECTORANTS. as the syrup, the saccharine matter of which is itself demulcent, and therefore adapted for relieving cough and facilitating expectoration. Sugar, or liquorice root, or extract of liquorice, may, however, be added to it. SYRUPUS SENEGA, SYRUP OF SEN'EKA. (Seneg. cont. %\v ; ^qua Oj; Sacchar. tbj- Made into a syrup, either in the ordinary method or by displacement.) The dose as an expectorant is f. 3J to f. 3iij. It is a common adjunct to expectorant mixtures, and, in too many cases, for no other reason than because it bears the name of an ex- pectorant, without regard to the pathological condition, or its adap- tation to it. 2. SCILLA.—SQUILL. Squill—the general properties of which have been detailed, (p. 122) — is often prescribed both with excitant and sedative ex- pectorants ; yet the union with the latter, in the small doses in which it is usually exhibited, cannot be philosophical, inasmuch as it is unquestionably excitant; and, therefore, adapted for cases of pectoral disease, in which there is an absence of all febrile and inflammatory phenomena, and a demand rather for excitant expectorants in general. When given as an expectorant, in powder, which is rarely the case, it is usually in the dose of one grain, two or three times a day. As, however, it is a nauseant in a sufficient dose, it may be adapted, in a larger quantity, for affections in which sedatives are needed. In such cases, it must be pushed, until its influence on the stomach is exhibited. The Acetum Scilla (p. 123) is occasionally prescribed as an ex- pectorant, in the dose of f. 3ss. to f. 3j ; but by no means so frequently as the Oxymel (p. 123); and the syrups — simple and compound, (p. 123); the former in the dose of f". 3j to f. oij ; the Syrupus Scilla in the dose of a fluidrachm or two ; and the Syrupus Scilla Compo- situs or Hive Syrup, in the dose of twenty or thirty drops. The Tinctura Scilla (p. 123) is rarely given alone ; but is often added to pectoral mixtures. Its dose is from twenty drops to a drachm. PILULE SCILLA COMPOS'M, COMPOUND PILLS OF SQUILL. (Sail, in pulv. 3j 5 Pulv. Zingib.; Pulv. Ammoniac, aa 3ij; Saponis, priij ; Syrup, q. s. to be divided into 120 pills.) The dose of this is from 5 to 10 grains. AMMONTACUM.—AMMO'NIAC. The botanical history of ammoniacum has been a matter of uncer- tainty. Recently, however, owing to the researches of observers in India, it has been referred to Dore'ma Ammoniacum; Sex. Syst. Pentandria Digynia; Nat. Ord. Umbelliferae, a native of Persia, of which it is the concrete juice. The whole plant contains a large quantity of a milky juice, which oozes out, whenever punctures are AMM0NIACTJM. 225 made, even at the ends of the leaves. It would appear, however, that these are never made artificially, but that innumerable beetles pierce the plant in all directions ; and, when dry, the ammoniac is picked off, and collected. Dr. Pereira states, that he has, in his museum, the upper part of the apparently flowering stem, about ten inches long, with lumps of ammoniac sticking to it at the origin of every branch. Ammoniac, as met with in commerce, usually comes from Bom- bay, but sometimes frqjn the Levant. It is either in the state of tears, or in lump. The former is in more or less spheroidal tears, but often in larger pieces, of an irregular shape. Externally, they are of a yellowish colour, and whitish within. At ordinary tempera- tures, they possess considerable hardness, but soften under the heat of the hand. Lump ammoniac consists of whitish tears, imbedded in a sub- stance of a darker colour, and containing numerous extraneous mat- ters, — as seeds, fragments of vegetables, and dirt. The odour of both varieties is peculiar, and by no means agreeable; and the taste nauseous, bitter and somewhat acrid. Ammoniac is a gum-resin, which has been subjected to analysis by many chemists, and found to consist of about 70 per cent, of resin, and about 20 of gum. It contains also a volatile oil, which is sepa- rable by distillation with water. With this fluid, it forms a prepa- ration, which is officinal — the mistura ammoniaci. The alcoholic solution, which is transparent, becomes milky on the addition of water. Ammoniac has been long employed as an expectorant of the ex- citant class, and, consequently, in cases in which there was little or no inflammatory action. It would not seem, however, that its ex- citant properties are active, and, from the author's experience, it is not entitled to the credit that has been assigned it in chronic bron- chitis, and catarrhal affections in general. Such, indeed, appears to be the prevalent belief, if we judge by the much smaller employ- ment of the drug now than formerly. The dose of ammoniac is generally stated to be from ten grains to thirty, in pill. It is rarely given in this simple form, but in combi- nation with other reputed expectorants, as in the Pilula Scilla Composita of the Pharmacopoeias of Edinburgh and the United States, or the Pilula Ipecacuanha Composita of the London Pharmacopceia, (Pulv. Ipecac, comp. siij ; Scilla, recente exsiccat.. Ammoniac, aa jj; Mucilag. acacia, q. s. ut fiat massa. Dose, five grains to ten.). MISTURA AMMON'IACI, AMMO'NIAC MIXTURE. (Ammoniac. ?ij; Aqua, Oss.) This mixture was formerly called Lac Ammoni'aci, owing to its white appearance. The gum of the gum-resin forms a mucilage, by which the resinous portion is suspended. The greater part of re- sinous matter subsides, however, on standing. When given alone in pectoral affections, the ordinary dose is one or two table-spoon- fuls. It not unfrequently forms a vehicle for other agents, as Tincture of Opium, Syrup of Seneka, &c. 226 SPECIAL EXPECTORANTS. 4. MYROX'YLON. —BALSAM OF PERU. Balsam of Peru is the juice of Myrox'yIon Peruiferum, or Myro- sperm'um Peruiferum: Sex. Syst. Decandria Monogynia, Nat. Ord. Leguminosae, which is indigenous in Peru, New Grenada, Co- lumbia, and Mexico. In regard to its history, there is some uncertainty. It has been affirmed, that there are two modes of obtaining it—one by incisions made into the bark of the tree, and the other by boiling the branches and trunk in water ; — the former yielding a white liquid balsam; the latter a blackish-red liquid. The former, it is said, may be pre- served for years in the fluid state; but if deposited in calabashes, which is commonly done in the mountains of Tolu, after some time it condenses, and hardens into resin ; and is then termed dry white balsam or balsam of Tolu ; whilst the extract, made by boiling the bark in water, is blackish, remains liquid, and is known by the name of black Peruvian balsam. There seems still, however, to be a doubt, whether the black Peruvian balsam of the shops be prepared by coction. The quantity of balsam of Peru on which duty was paid in England, in the year 1839, was, according to Dr. Pereira, 825 lbs. Balsam of Peru is transparent, of a deep reddish-brown colour, and of the consistence of molasses. It has a fragrant aromatic odour ; and a hot and bitter taste. It is soluble in alcohol, and miscible with water by means of mucilage. Its specific gravity is variously stated, from 1.14 to 1.16. It is rarely adulterated. Wlien sub- jected to analysis, it yields 88 per cent, of resin, 12 of benzoic acid, and a trace of volatile oil. Prolonged boiling in water removes from it the benzoic acid, but nothing else. Balsam of Peru was at one time much used as an excitant, both in external and internal ulcerations; and hence it has been pre- scribed as an expectorant in phthisis ; also in chronic bronchitis, and wherever a gentle excitant is needed. The dose is f. 3ss. to f. 3i. dropped on sugar, mixed with molasses, or diffused in water by means of mucilage or yolk of egg. 5. TOLUTA/NUM.—BALSAM OF TOLU. Balsam of Tolu is now considered to be the juice of Myrox'ylon Toluif'erum; Sex. Syst. Decandria Monogynia: Nat. Ord. Legu- minosae, which is indigenous in the mountains of Tolu especially. It is obtained by making incisions into the trunk of the tree, collect- ing the juice as it exudes in appropriate vessels, and allowing it to concrete. It is commonly imported in little calabashes; and it does not appear to differ from the concrete white Peruvian balsam, which, indeed, as stated above, is termed balsam of Tolu. It is imported chiefly from Carthagena. >. When it first arrives in the country it is usually soft and tena- cious; but, when kept, becomes hard and brittle, somewhat like resin. It is transparent, of a yellowish-brown colour, has a highly STYRAX. 227 fragrant odour, and a sweetish, not disagreeable taste. It is very soluble in alcohol, ether, and the essential oils, and yields its benzoic acid to boiling water. Its chemical composition is similar to that of balsam of Peru. Balsam of Tolu is employed as an expectorant in the same cases as balsam of Peru, and is far more frequently prescribed. It has never appeared to the author to possess any special agency in chronic bronchitis, but it makes an agreeable adjunct to cough mixtures in the form of the Syrup of Tolu. In chronic catarrhal affections, the inhalation of the vapour of the ethereal solution is said to have been of benefit. The dose is from gr. x. to gr. xxx. repeated from time to time. It may be given in the form of an emulsion made with mucilage of gum arabic. (Tolutan. 3i; Mucilag. acacia f. 5ss. ; Syrupi f. 3iij ; Aqua f. |v. M.) TINCTU'RA TOLUTA'NI, TINCTURE OF TOLU. (Tolutan. |iij; Alcohol Oij.) It is sometimes added to pectoral mixtures, but is chiefly employed in the formation of the syrup. SYR'UPUS TOLUTA'NI, SYRUP OF TOLL (Tinct. Tolut. f. §i; Syrup. Oiss.) This is a very common adjunct to pectoral mixtures, to which it appears to communicate no virtues, but improves their flavour. Yet MM. Trousseau and Pidoux affirm, that they have cut short by it acute bronchitis, " which had reached the first septenary," and which, they think, would doubtless have gone on for a month or six weeks without the aid of this precious agent." In infants, it ap- peared to them of immense advantage in pulmonary catarrh, almost at the very onset of the affection, and still more " when the state of irritation, dryness and turgescence of the mucous membranes having been allayed, the catarrhal secretion began to be effected." Balsam of Tolu is an ingredient in the Tinctura Benzoini Composita of the Pharmacopceia of the United States. 6. STYRAX.—STORAX. Storax is the concrete juice of Styrax officina'le; Sex. Syst. De- candria Monogynia; Nat. Ord. Styraceae, (Lindley,) a small tree, which is indigenous in Asiatic Turkey and Greece, and is cultivated in the southern parts of Europe. From incisions made into the tree, or from the punctures of an insect, the storax exudes. No precise knowledge exists as to the mode in which it is procured ; as the natives of the country, who collect it, will not communicate their mode of procedure. It is imported into Great Britain from Trieste. Two varieties are met with in the shops; —common storax,—styrax calami'ta of some, and liquid storax. The former occurs in brittle cakes, several pounds in weight, of a reddish-brown colour, and having a fragrant, agreeable, balsamic odour, and an aromatic taste. It appears to be composed of saw-dust, cemented by a resinous mat- ter. It can be easily reduced to coarse powder, and in this state is often met with in the shops. The latter has been supposed to be 228 SPECIAL EXPECTORANTS. derived by decoction from Liquidam'bar styracif'lua; but Dr. Wood remarks, that some of the genuine juice of Liquidambar, brought from New Orleans, which he had an opportunity of inspecting, had an odour entirely distinct from that of Storax. Moreover, it has been recently affirmed, that the liquid storax, or storax oil, is ob- tained at Cos and Rhodes from styrax officinale. By means of lon- gitudinal incisions, the bark of the stems is removed in small narrow strips, which, when pressed together, readily adhere by means of their glutinous juice, and in this way, they are made up in bundles of about two pounds each. These are then subjected to pressure in warm presses, by which means a liquid storax is obtained, which, according to Landerer, cited by Pereira, has the consistence of but- ter, a gray colour, and an odour resembling that of vanilla. It is doubtful, however, whether this be the liquid storax of the shops, which is of a brown, almost black colour on the surface which is ex- posed to the air, but of a light greenish-grey colour within and of a smell somewhat resembling that of the Balsam of Peru. Dr. Pereira has described not less than ten varieties of storax, but the above are all that can concern the pharmacologist, — the others being rarely met with in commerce, and most of them never seen on this side the Atlantic. When subjected to analysis, storax yields a trace of volatile oil, about 50 per cent, of resin, and one or two per cent, of benzoic acid, the presence of which entitles it to a place among the balsams. It is so mixed — in the state in which it is met with in the shops — with extraneous matters, that it requires to be purified: this is done according to a process directed in the British and American Phar- macopoeias for STYRAX PURIFICA'TA, or pu'rified storax, which consists in dissolving the soluble matters in alcohol, straining the solution, and distilling off the alcohol, until the storax acquires the proper con- sistence. The volatile portion is not driven off by the heat of boil- ing alcohol, yet, as suggested by Dr. Christison, it may be well not to carry the concentration too far, in order that the fragrant principle may be better retained, and the extract be of a fitter consistence for forming pills. Storax, like some of the articles already mentioned, has been con- sidered to possess " stimulant properties, which are more particu- larly directed to the mucous surfaces, especially to the bronchial membrane;" but it may be doubted, whether either it or any of the articles referred to, be possessed of such powers. Like the other balsams, however, it is excitant, and might be employed in chronic catarrhal affections of the bronchia, in which excitant expectorants are needed. It is not often prescribed on this side the Atlantic, or indeed any where ; notwithstanding that the British colleges have a formula for the Pilula Styracis Composita, which consist essentially of strained storax and opium, and are occasionally given in chronic pulmonary affections to relieve cough ; but are more valuable, per- haps, as a means of administering opium to persons who are preju- BENZOINUM. 229 diced against it, the name and the balsamic character of the storax completely masking the narcotic. Should it be desired to administer storax, the dose may be ten to twenty grains two or three times a day, — or either the common, or the liquid storax may be suspended in water by means of mucilage of gum arabic. Storax enters into the composition of the Tinctura Benzoini Composita of the Pharmacopoeias. 7. BENZO'INUM.—BEN'ZOIN. Benzoin or Benjamin is the concrete juice of Styrax Benzoin; the Benjamin Tree; Sex. Syst. Decandria Monogynia; Nat. Ord. Styraceae, — a tall tree, indigenous in Sumatra, Borneo, Siam and Java. It is obtained in Sumatra, when the tree is about six years old, by making incisions in the bark, and allowing the juice to re- main for three months. Fresh incisions are made after the concrete juice has been removed, until the tree is exhausted, and usually dies. The juice which exudes at the first incision is the best, and said to be alone exported to Europe. Each tree yields about three pounds of Benzoin annually for ten or twelve years. Benzoin, which is met with in commerce, is usually imported into England from Singapore or Calcutta. In 1839, duty was paid there on 108 cwt. (Pereira.) It is of different degrees of fineness, and is sometimes distinguished into firsts, seconds, and thirds ; or more commonly, perhaps, into firsts and seconds, or fine and coarse; and sometimes the finer kinds are termed Siam Benzoin ; the commoner, Calctjt'ta Benzoin. The former contains white grains, which have the appearance of fragments of blanched almonds, that are seated in a deeper reddish-brown ground ; the latter is more uniform, and has a dark-reddish brown or almost black colour. Both are firm and pulverisable, of an agreeable, fragrant balsamic odour, and a slightly aromatic taste. Boiling water takes up a little benzoic acid; alcohol dissolves all except the impurities, and the solution is ren- dered milky by the addition of water. Its chief constituents are resin, benzoic acid, and a trace of vola- tile oil, —the amygdaloid benzoin containing 80.7 per cent, of resin, and 19.8 of benzoic acid ; the coarser or brown benzoin, 78.4 per cent, of resin, and 19.7 of benzoic acid. Benzoin had at one time a much higher reputation, as an internal remedy, than it has at present. Like the balsams and gum-resins, it was regarded as an excitant expectorant; and, as a relic of antiquity, it still holds its place in one or two formulae. Should it be prescribed at all, it ought to be in pulmonary affections, which are unaccompanied by febrile or inflammatory excitement. It will be seen afterwards, that it is employed as a topical expectorant in the form of fumigation ; and it is one of the ingredients of the fumi- gatory pastilles, which are largely used in oriental climes ; and of the fumigating compounds employed in the Romish church, vol. i.—20 230 SPECIAL EXPECTORANTS. Benzoin is scarcely ever — if ever—administered in substance. The dose of the powder may be from ten to thirty grains. TINCTU'RA BENZO'INI COMPOSTTI, COMPOUND TINCTURE OF BENZOIN.—(Ben- zoin. Jiij: Styracis puriUcat. |ij ; Tolutan. §j. Aloes, in pulv. £ss.; Alcohol. Oij.) The dose of this preparation, as an excitant expecto- rant, is f. 3ss. to f. 3ij. It is rarely, however, employed. As the resin is precipitated on the addition of water, it may be made into an emulsion by means of mucilage of gum arabic. It is chiefly used as an external excitant to ulcers. 8. AC'IDUM BENZOICUM. —BENZO'IC ACID. Benzoic acid, formerly termed Flowers of Benjamin, exists in the various balsamic substances, as benzoin, storax, tolu balsam, &c. It is also met with in the vanilla pod, and in certain animal sub- stances, as in the urine of children and of the herbivora under certain states of decomposition. In Pharmacy, it is obtained from benzoin by sublimation. Benzoin, in coarse powder, thoroughly mixed with an equal weight of fine sand, is put into a proper vessel, and, by means of a sand bath, with a gradually increasing heat, it is sublimed until vapours cease to rise. The sublimed matter is deprived of oil by pressure in bibulous paper, and is again sublimed. Benzoic acid, as met with in the shops, is in light white feathery crystals, of an agreeable odour, and an acrid feebly acid taste. It is fusible, and wholly volatilises if cautiously heated ; is soluble in about two hundred parts of cold water, and in about twenty-five parts of boiling water ; is very soluble in alcohol, and readily dissolves in solution of potassa, from which it is precipitated by chlorohydric acid. The therapeutical action of benzoic acid is, doubtless, excitant, and it has been imagined, by Dr. Pereira, and others, that its influ- ence is principally directed to the mucous surfaces, and, " especially to the aerian membrane." The author has not had the slightest reason for believing in this special affinity, and such would appear to be the general feeling of the profession, as it is now scarcely used except in one or two officinal preparations, in which it seems to be retained only from old prepossessions and associations. When given alone as an excitant expectorant, its dose is from ten to thirty grains; but the author has never administered it, or seen it administered, as such. It is occasionally used, as will be seen here- after, as a topical expectorant; and forms part of the Tinctura opii camphorata or Paregoric elixir, in which it probably exerts no bene- ficial agency. 9 COPA'IBA. Copaiba —=■ whose general properties are described under Exci- tants — has been much extolled by many respectable practitioners in cases of chronic bronchitis, and in every form of pulmonary affection, in which a gentle excitant is necessary. It is not adapted MYRRHA. 231 Fig. 31. for cases in which there is febrile or inflammatory action. Dr. La Roche, of Philadelphia, has adduced strong testimony in favour of it in diseases of the bronchial mucous membrane of the atonic kind, as well as in diseases of the mucous membranes in general. It may be given in the dose of twenty or thirty drops on sugar, or be made into an emulsion. (Copaib. f. jiss ; Mucilag. Acacia, f. ^vj ; Syrup. f. ^ss.; Aqua, f. ^ivss. — M. Dose, one fourth part four times a day.) 10. MYR'RHA. — MYRRH. Myrrh is the concrete juice of Balsamaden'dron Myrrha; Sex. Syst. Octandria Monogynia: Nat. Ord. Tere- binthaceae ; a small tree, which is indigenous in Gison, on the borders of Arabia Felix. It exudes from the bark of the tree, and con- cretes there. Formerly, the finest kind of myrrh was imported from Turkey, and an inferior variety from India; but it would seem that, at the present day, it almost all comes from the latter country. A considerable quantity of it is consumed; for, in the year 1839, according to Dr. Pereira, no less than 216 cwt. paid duty in England. The myrrh of the shops is in irregular pieces of various sizes, differing in colour, — the best pieces being of a reddish-yellow, and trans- lucent. It is brittle, and capable of reduction to powder, and has a peculiar, somewhat agreeable odour, and a bitter aromatic, but, in the author's opinion, disagreeable taste. The best myrrh should possess these qualities ; but other varieties are occasionally met with, — a second quality, which is in distinct small tears or grains, — and a third quality, which occurs in pieces of a darker colour than the best, and which, according to Dr. Pereira, are probably coarser myrrh mixed with impurities. Myrrh is only partially soluble in water, alcohol, and ether; the gum enables the water to suspend a part of the resin. Dilute alcohol dissolves some of the resin, and less of the gum ; whilst alcohol dis- solves the resin and volatile oil, leaving the greater part of the gum ; and as the two first are the active ingredients in myrrh, alcohol is generally used as the menstruum. The most recent analysis afforded 2.6 per cent, of volatile oil, 27.8 of resin, and 63.7 of gum. Myrrh has been employed as an expectorant. From its consti- tuents, it is obviously excitant, and, therefore, not adapted for any pulmonary affection in which there is vascular excitement. It has been occasionally prescribed in the same cases as the other excitant expectorants, but is not much used at the present day, and never, perhaps, except in combination. The dose is from gr. x. to gr. xxx. in the form of pill. It may also be made into an emulsion, but its taste is an objection to it in this form. Balsamadendron JVTyrrha. a. A leaf. b. The fruit. 232 special expectorants. TINCTU'RA MYRRHJ1, TINCTURE OF MYRRH. (Myrrh, contus. §iv; Alcohol. Oiij.) Tincture of myrrh possesses all the virtues of the drug, but it is scarcely ever prescribed internally. The dose, as an expectorant, is stated to be f. 3ss. to f. 3j. Myrrh enters into the composition of various officinal formulae, as of the Mistura Ferri Composita.; the Pilula Aloes et Myrrha ; the Pilula Ferri Composita ; and the Pilula Rhei Composita of the Phar- macopceia of the United States. 11. ASSAFCE'TTDA.—assafettda. Assafetida, — whose general properties are described under Anti- spasmodics— is excitant, and therefore adapted for cases in which there is a want of due innervation in the respiratory apparatus, and, at the same time, no febrile or inflammatory action. In hooping- cough, it has been regarded as beneficial; but the author has sub- jected it to extensive trials, and has not been able to say positively, that any markedly good effects have resulted from it. In this dis- ease, it doubtless acts by virtue of the new impression it makes on the nerves, and is more properly an antispasmodic. In old cases of chronic bronchitis, and of chronic cough accompa- nied by nervous erethism, occurring in any disease, it is prescribed. The dose is from gr. v. to ^ss. in the form of pill; but it is rarely given alone, in this shape, as an expectorant. MISTU'RA ASSAF(E'TID$, ASSAFETIDA MIXTURE. (Assafcetid. 51J; Aqua, Oss.) The gum of the assafetida is sufficient to cause the suspension of the resin, so that the.Lac Assafoetida— as it was formerly called — contains the main virtues of the gum-resin. In the thoracic affections for which assafetida is deemed proper, this is a good form of adminis- tration. For children, it may be sweetened with sugar ; and although it may be disagreeable to them at first, they soon become accustomed to, and even fond of, it. The dose to an adult is f. §ss to f. 31J; to a child, one or two tea-spoonfujs. GAL'BANUM. Galbanum,— whose general properties are described under Anti- spasmodics, — possesses the same excitant virtues as the other, so called, antispasmodic gum-resins, and is presumed to hold an inter- mediate place between ammoniacum and assafetida as an expecto- rant. It is very rarely, however, used as such ;— on this side of the Atlantic, never perhaps. The dose is from gr. x. to xxx. in the form of pill, or made into an emulsion. 13. AL'LIUM.—GARLIC. The bulb of Allium Sati'vum, Sex. Syst. Hexandria Monogynia ; Nat. Ord. Liliaceae (Lindley), is a well known culinary article, and although not much used in medicine is introduced into the Pharma- copoeias of Great Britain and this country. Garlic is indigenous in INULA. 233 the Southern countries of Europe, flowering in July, and is every where cultivated in the kitchen gardens. ■ The strong, peculiar, irritating smell, and acrid taste of garlic are owing to volatile oil, separable by distillation with water, — six drachms of which are obtained from twenty pounds of garlic. An acrid expressed oil can also be separated from it. The volatile oil has a very acrid taste, and strong smell. Like all substances whose medicinal virtues are dependent upon volatile oil, garlic is excitant; and consequently, when employed as an expectorant, it can only be in cases where there is no active in- flammation of the lining membrane of the bronchial tubes; and in states of the system and of the tubes, in which a gentle excitant is necessary, as in chronic bronchitis. In such cases, the expressed juice may be mixed with sugar ; or the following preparation may be advised : SYR'UPUS AL'LII, SYRUP OF GARLIC. (Allii recent, gvj; Acet. des- tillat. Oj ; Sacch. Ifeij ; f. Syrupus.) The vinegar is used in this preparation under the idea, that it is a better solvent of the active principle than water, which may be questioned. It is occasionally given to children affected with ordinary catarrh, in the dose of a tea-spoonful or two, but is not much prescribed by the physician. It is an officinal preparation in the Pharmacopceia of the United States, but not in that of any British College. 14. IN'ULA. —ELECAMPANE'. Elecampane is the root of In'ula Helen'ium, Sex. Syst. Syngene- sia Polygamia Superflua : Nat. Ord. Compositae Asteroideae, a large handsome plant, which is indigenous in various parts of Europe ; flowering in June and July. It has become naturalised in this country, and is cultivated in the gardens, and for medical use. The root is officinal in the secondary list of the Pharmacopceia of the United States. As met with in the shops, the drietl root is usually in longitudinal or transverse slices, of a yellowish-gray colour, an aromatic slightly camphoraceous odour, and a warm, aromatic and bitter taste. The medical virtues are imparted both to alcohol and water. The root has been analysed by different chemists, and found to contain, amongst other constituents, a peculiar aromatic principle — to which the names Hel'enin and Elecampane Camphor have been given ; resin, the taste of which is bitter, nauseous and acrid ; an amyla-i ceous substance termed In'ulin and Al'antin; and bitter extrac- tive. From this analysis it can be understood that Inula possesses the medical virtues of the aromatic tonics ; but it is rarely used except as an excitant expectorant in pulmonary catarrh, and bronchitic affections, in which there is no febrile or inflammatory excitement, It has had some reputation as an emmenagogue, but has outlived it. 20* 231 SPECIAL EXPECTORANTS. It may, like other aromatic tonics, act indirectly in asthenic cases of amenorrhcea. The decoction is the form commonly prescribed. (Inul. ^ss; Aqua Oj.—Dose, f. ^i tof. 31J.) 15. CREASO'TUM. —CRE'ASOTE. Creasote — whose properties are described under Excitants — has been used as an excitant expectorant in phthisis ; but the results have been discordant, as might have been anticipated in so in- tractable a disease. On the whole its employment has been pro- ductive of but little advantage. It is probable, however, that where there is much secretion from the bronchial mucous membrane it may be of service; yet in these cases, Tar-water—Aqua picis liquida (see under Astringents) which is probably mainly indebted for its efficacy to the creasote it contains — has been preferred by some. Wlien, in the distillation of coal tar, the last portion of the vola- tile oily product is collected apart and left to stand, a quantity of solid, crystalline matter separates, which is principally composed of Naph'thaline. This substance forms large, colourless, transparent, brilliant, crystalline plates, that exhale a faint and peculiar odour which has been compared to that of narcissus. It melts at 176°, and boils at 413°. It is insoluble in cold water, but soluble to a slight degree at a boiling temperature. Alcohol and ether dissolve it rea- dily. It has been given by M. Dupasquier as an excitant expecto- rant in chronic bronchitis, in the dose of from 8 to 30 grains in emul- sion or syrup, repeated at intervals of a quarter of an hour, until a copious expectoration supervenes. In psoriasis and lepra vul- garis, an ointment composed of two scruples of concrete naphthaline to 30 of lard, proved successful, according to M. Emery. Of late, under the name Naphtha, and Wood Naphtha, the Pyro- ace'tic spirit, Pyroace'tic ether grAc"etone has been recommended in pulmonary consumption by Dr. Hastings and others, but the evi- dence is far from establishing that it is possessed of more efficacy than creasote and the articles just mentioned. It is obtained by carefully distilling acetate of lead, and rectifying the crude spirit by repeated distillations from quick-lime. It is a colourless Limpid liquid, having a peculiar odour ; a density of .792, and boils at 132°. As found in the shops, its density, according to Dr. Bache, is generally not lower than .820. It mixes with water, ether and alcohol in all proportions. The dose in which it was used by Dr. Hastings — who proposed it as a cure for pulmonary consumption on very inadequate grounds, however— was from ten to forty drops three times a day. Like creasote, it may be found serviceable in chronic bronchitis, where an excitant expectorant is needed. ACACIA. 235 II. Demulcent Expectorants. 16. ACA'CIA. — GUM AR'ABIC. Gum Arabic is the concrete juice of Aca'cia vera, and other spe- cies of Acacia: Sex. Syst. Polygamia Monoecia ; Nat. Ord. Le- guminosae. The species of Acacia, which yield considerable quan- tities of gum, besides Aca'cia vera, a native of Arabia and of Africa from Senegal to Egypt, are—the Aca'cia Arab'ica, a native of Senegal, Egypt, Arabia and India; the A. Karoo, indigenous at the Cape of Good Hope ; the A. gummifera, native of Arabia and of Africa, near Mogadore; — the A. Seyal, native of Egypt and Sene- gambia; the A. tor'tilis, and A. Ehrenber'gii, natives of Arabia, and the A. Senegal', native of Arabia, and Fig. 32. Africa from Senegal to the Cape of Good Hope. The gum generally exudes from the Acaciae spontaneously, and concretes on the trunk and branches. At times, how- ever, incisions are made to facilitate its flow. It commonly exudes soon after the rainy season has softened the bark, and made it liable to split during the succeed- ing hot weather. It is exported to this country from the Levant, or some of the other parts of the Mediterranean; fromBar- bary and Senegal, and from the East Indies, Cape of Good Hope, &c. According to Dr. Pereira, duty was paid, in 1839, on the fol- lowing quantities imported into England. Acacia Arabica. Gum from the East Indies, Senegal Gum, Other sorts of Gum, Total, - 7,869 cwts. 24,698 7,759 40,326 The best gum arabic, often termed Turkey gum, is in rounded, or emorphous pieces; some of them transparent; others more or less opaque, with deep cracks extending through them. It is usually of a white or yellowish-white colour. The powder into which it is readily reduced is generally almost pure white. It is inodorous, and has a very feeble taste. Its specific gravity varies from 1.316 to 1.482. It is wholly soluble in water, forming a mucilage, which is an officinal preparation. It is insoluble in alcohol, which throws it down from its aqueous solution. These are the main qualities of the officinal gum arabic. It is apt, however, to be mixed with other varieties of gum, which are described by the different writers on pharmacology, but which de- mand no detailed account here;—for example: 1. The Bar'bary 236 SPECIAL EXPECTORANTS. or Moroc'co Gum, supposed to be the produce of Aca'cia gummife- ra, which is imperfectly soluble in water : 2. Gum Senegal', ob- tained from several species of acacia, which is by no means as easily pulverisable as the best gum arabic. 3. East In'dia Gum, some of which resembles the best gum arabic; but other portions are far more difficult to pulverise ; and 4, the Cape Gum, which is of a very inferior kind. Gum arabic has been subjected to analysis by Guerin, and found to consist of 79.40 per cent, of pure gummy principle, to which the name Ar'abin has been given, and which is wholly soluble; of 17.60 per cent, of water, and 3.00 of ashes. It contains no Bas'sorin or insoluble gum, which exists in such large quantities in Gum Bas'- sora, supposed to be Ihe concrete juice of a mesembryanth'emum. The essential action of gum arabic is that of a demulcent to the surfaces with which it comes in contact, — soothing the top of the larynx in catarrhal affections, and the soothing influence being ex- tended downwards along the trachea and bronchia by continuous sympathy. It is sometimes taken into the mouth in those affec- tions, and permitted to dissolve slowly, and is the basis of certain lozenges, which have attained celebrity for relieving cough, and facilitating expectoration. It is a valuable agent in many cough mixtures into which fixed oil enters—not simply as a demulcent expectorant, but to suspend the oil in water, and form it into an emulsion. The dose of powdered gum arabic has been stated at from 3SS- to 3J 5 hut it is obviously an article the dose of which can scarcely be fixed. It is taken ad libitum. MUCILA'GO ACACLE, MUCILAGE OF GUM ARABIC. (Acacia, in pulv. |iv. Aqua bullientis Oss.) It forms part of many mixtures for relieving cough ; but is chiefly used as a vehicle to render other substances miscible with water. 17. ALTH^E'A. —MARSHMAL'LOW. Marshmallow is the root of Altha'a officinalis, Sex. Syst. Monadelphia Polyandria; Nat. Ord. Malvaceae; an herbaceous perennial, which is indigenous in this country as well as in Europe, growing on the borders of marshes, and especially of salt marshes. The roots are collected in autumn; but those that are met with in the shops are chiefly obtained from Europe. They are generally deprived of epidermis, and are of a white colour, cylindrical shape, and of about the thickness of the little finger. Their odour is fee- ble ; taste sweet and mucilaginous. They are light, woolly exter- nally, and composed of delicate silky fibres. When chemically examined, theyarefound tocontain a little fecula or starch ; nearly 20 per cent, of mucilage ; some uncrystallisable sugar; and a crystallisable principle, identical with the aspar'agin of asparagus, —besides other less important constituents. AMYGDALA. 237 The virtues of marshmallow are similar to those of gum arabic, and it has been employed in the same cases, especially on the con- tinent of Europe. The Pate de Guimauve or Marshmallow Paste or Loz'enge is a favourite remedy in France in hoarseness, and catar- rhal affections in general. There is no officinal preparation of the althaea in the Pharmacopceia of the United States ; a Decoction is officinal in the Edinburgh and Dublin Pharmacopoeias, and a Syrup in all the British Pharma- copoeias. 18. AMYG'DALA. — ALMONDS. The Pharmacopceia of the United States, as well as those of Great Britain and elsewhere, admit both the bitter and the sweet almonds as officinal, —the former being the kernels of the fruit of Amyg'dalus commu'nis,—variety ama'ra ; and the latter of Amygdalus communis, —variety dulcis;—a tree in Sex. Syst. Icosandria Monogynia ; Nat. Ord. Rosaceae (Jussieu), — Tribe, Amygdaleae, which is indigenous in Barbary and Syria, and is cultivated in the southern parts of Europe, whence it has been introduced into this country, but with- out any advantage, except as an ornament. The general opinion is, that both varieties of almonds are furnished by a tree of the same species; some botanists, however, believe that they are produced by distinct species, and according to Dr. Christison, Nies von Esen- beck states, that he had been informed on good authority, that in the Palatinate bitter almonds are not unfrequently gathered from the sweet almond tree. The almond is so well known as not to require a description. Sweet Almonds are imported from Spain and the south of France. The Jordan Almonds, which are best, come from Malaga; other varieties, — according to Busby, — are the Valentia, the Barbary, and the Italian. The bitter almonds are brought chiefly from Mogadore. One variety only is known in commerce. Both sorts, when triturated with water, furnish a copious white emulsion. The composition of the sweet and bitter almond is interesting to the chemist; butnot much so to the therapeutist. The sweet almond contains about 54 per cent, of a bland fixed oil—the O'leum Amyg'- dal.3:,—24 per cent, of a variety of soluble vegetable albumen, termed emul'sin or syn'aptase, which is the principle that suspends the oil in almond emulsion ; sugar, gum, moisture and integuments. The bitter almond contains rather less fixed oil and more synaptase, and has, besides, a peculiar principle, called Amygdalin, which is interesting in its chemical, but not in any therapeutical relation. It contains, moreover, the elements of a bitter volatile oil, which does not exist in the bitter almond, but is speedily developed when water comes in contact with it. It has been found, that when bitter almonds are deprived of their amygdalin, they are incapable of yielding volatile oil; hence it has been inferred, that water acts upon this principle and generates the evil. Yet amygdalin and 238 SPECIAL EXPECTORANTS. water produce no oil, unless emulsin or synaptase be likewise pre- sent. Certain it is, that bitter almonds yield no volatile oil on pres- sure, which ought to be the case did it exist in them; as the volatile oil is soluble in the fixed oil; nor do they yield oil to alcohol or ether. This oil is highly poisonous, and contains hydrocyanic acid, for which — as elsewhere shown — certain preparations from the bitter almonds are occasionally used as substitutes. Both varieties of almonds are demulcents by virtue of the oil they contain, and it has been conceived, that the volatile oil, developed by the combination of water, amygdalin and emulsin, may com- municate to the emulsion of bitter almonds virtues similar to those of hydrocyanic acid, and not possessed by the emulsion of sweet almonds ; — and hence, that the former may be adapted for cases in which a demulcent expectorant is needed equally with hydrocyanic acid. Often, however, the bitter almond, in pharmaceutical, as in culinary preparations, is employed solely to communicate an agree- able flavour to the compound. MISTU'RA AMYG'DALjE, ALMOND MIXTURE. (Amygdal. dulc. gss; Acacia pulv. 3ss ; Sacchar. 3ij ; Aqua destillat. f. ^viij.) Almond mixture is an elegant demulcent expectorant, much prescribed for allaying cough in catarrhal affections, under the name of almond emulsion and almond milk. It is a good vehicle for the administration of other agents, as laudanum, paregoric, antimonial wine, &c. It may be taken almost ad libitum; but the ordinary dose is from f. ^j. to SYRUPUS AMYGDALA, SYRUP OF ALMONDS. (Amygdal. dulc. tbj; Amyg- dal. amar. ^iv; Aqua, Oiij ; Sacchar. Ifevj.) This is the syrup of orgeat, which has been introduced from the French Codex into the last edition of the Pharmacopceia of the United States. It may be used in the same cases as the almond emulsion, and is an agreeable drink in sickness. 19. O'LEUM AMYG'DAL^E. —OIL OF ALMONDS. Almond oil is the fixed oil of the kernels of Amyg'dalus comma'nis. (p. 237.) It is obtained by expression from either bitter or sweet almonds, but more commonly from the former, on account of their cheapness, as well as the greater value of their residuary cake. The average produce is from 48 to 50 lbs. from one cwt. of almonds. From what has been said elsewhere, it will be obvious, that in the case of bitter almonds, the contact of water must be avoided. As met with in the shops, oil of almonds is transparent and without colour, or of a slightly yellow tinge; nearly inodorous, and of a bland, oleaginous taste. It is soluble in ether, and in six parts of boiling, or twenty-five parts of cold alcohol. Its density varies from .917 to .920. The cake, left after the expression of the oil, when ground, forms Almond powder, which is used for keeping the skin of the hands soft. OLEUM OLIVJE. 239 Almond oil is sometimes prescribed in the form of the common oleaginous mixture, in cases of catarrh, as a demulcent expectorant. (Olei amygdal. f.^ny,Mucilag. acacia; Syrup, aa f. ^ss ; Aqua, f. £ivss. M. Dose, a table-spoonful, when the cough is troublesome.) To this mixture may be added sulphate, acetate, or muriate of morphia, or Tinctura opii camphorata, &c, according to the indications. An emulsion might also be made by the substitution of alkalies, or of the yolk of egg, for the mucilage ; but neither is so agreeable. Formerly, equal parts of syrup of violets or syrup of roses, and almond oil, was a favourite laxative mixture for infants, and it has been used likewise in the catarrhal affections of that age — simple syrup being substituted for either of the syrups mentioned. Formerly, too, almond oil was more frequently employed than at present in the formation of linctuses to allay cough. Of these, the following is a form ; li«— Confect. Rosa canin. ^j; Syrup. Papaveris ; 01. amygdal. aa f. ^ss. M. Dose, a tea-spoonful or two when the cough is trouble- some.) These linctuses are rarely employed, at the present day, in this country. 20. O'LEUM OLI'ViE —OLIVE OIL. Olive oil is the expressed oil of the fruit of O'lea Europa'a, European olive; Sex. Syst. Decandria Fig. 33. Monogynia; Nat. Ord. Oleaceae; a tree which is supposed to have been origi- nally from Asia, but has been cultivated, so far as history extends back, in the south of Europe. The finest olive oil is obtained from ripe olives, by crushing them immedi- ately in a mill, and subjecting the pulp or pericarp to gentle pressure. By aug- menting the pressure, a somewhat in- ferior— but still good — article is ob- tained. An inferior kind, again, is got by pouring boiling water on the residuum, to dissolve its mucilage, and subjecting it again to gentle pressure; and still stronger pressure forces out a turbid, impure oil, which is fit only for the soap-maker. An inferior oil is like- oiea Europe. wise obtained by allowing the olives to ferment for some days before they are subjected to pressure. The most esteemed oil is that made in Aix, and termed Provence Oil. Florence Oil or Salad Oil is a fine kind, imported from Leghorn in flasks. Gen'oa Oil is likewise a fine variety. The Gallip'oli Oil, Sic"ily Oil, and Spanish Oil, are inferior varieties; the last being esteemed the worst of all. 240 SPECIAL EXPECTORANTS. The quantity of olive oil consumed is very great. In the year 1839, duty was paid on 12,374 tons. It is an article so well known as not to need any description. When good, it is almost devoid of smell, and has a bland, slightly sweet taste. Its density at 77° Fahr. is about 0.911. It is soluble in one and a half times its weight of ether, and very slightly soluble in alcohol. By exposure to air, it readily becomes rancid, but more slowly than other fixed oils. It is said to be much subject to adulteration with poppyseed oil, rapeseed oil and other cheap oils; but as these oils congeal less readily than olive oil, the adulteration may be detected by reducing the temperature to the freezing point; or, the test suggested by Poutet, and adopted by the Edinburgh Pharmacopceia, may be used. When pure olive oil is mixed with a solution of mercury in nitric acid, prepared by heat, the whole becomes, in a few hours, a firm fatty mass, from the action of the hyponitrous acid in the solution. But if even so small a quantity as 5 per cent, of any other oil be present, the consolidation is much more firm and more tardy; and if the proportion amounts to 12 per cent., the foreign oil floats on the sur- face of a pulpy mass, for several days before showing any tendency to concrete. As a demulcent expectorant, olive oil is used in the same cases, and form of preparation, as almond oil. 21. CETA'CEUM.—SPERMACE'TI. Spermaceti is a peculiar concrete substance, approaching in cha- racter the concrete fixed oils or fats, which is obtained from Physe'- ter Macroceph'alus, or great-headed Cach'alot or spermaceti whale, order Cetacea, which inhabits the Pacific ocean, and the Indian and Chinese seas. It is found in various parts of the animal's body, being dissolved in small proportion in the blubber. The head, how- ever, contains that which we meet with in commerce. It is mixed with oil, in a large cavity in the upper jaw, anterior to, and quite distinct from, the cavity that holds the brain. There are two places in the head, which contain it, between which the nostrils pass ; and both cavities are divided into numerous cells, which are filled with a milky fluid, amounting in a large whale to about 50 cwt. The contents of these cavities are removed by buckets, and boiled, to separate the oleaginous from the solid matter. In this fluid, the spermaceti crystallises as it cools, and is separated in an impure state by draining off the oil, and subjecting what remains to strong pressure. The crude spermaceti is purified by melting it in water, and skimming off the impurities. It is then melted in a weak solu- tion of potassa, and finally melted a third time by a gentle heat, after which it is solidified in proper moulds, when it forms the spermaceti of the shops. It generally contains a small portion of oil, which may be removed by boiling in alcohol. The spermaceti, then called cetin, is absolutely pure. The spermaceti of the shops is a white concrete substance, of a SACCHARUM. 241 foliaceous texture, without taste, and almost without smell. It may be readily reduced to powder, by the addition of a few drops of rectified spirit. It is insoluble in water; slightly soluble in cold alcohol, but much so when the alcohol is at the boiling temperature. It is greatly soluble in ether, and readily so in the oils — fixed or volatile. Spermaceti possesses the demulcent properties of the bland fixed oils, but it is rarely given internally. When this is desired, it may be made into an emulsion with yolk of egg, or mucilage, the sperma- ceti being first pulverised by the addition of a few drops of alcohol. 22. SACCHARUM.—SUGAR. This, in the Pharmacopceia of the United States (1842), is the Fig. 34. Saccharum officinaruin. officinal name for the sugar of Sac'charum ofificina'rum or Sugar cane, refined. Sac'charum ojficina'rum; Sg.x. Syst. Tri- andria Digynia; Nat. Ord. Gramineae, is cultivated in the tropical regions of both the old and new world. Its native country can- not now be discovered, but it is supposed to have come originally from the East. It is the expressed juice of the ripe canes, clarified and allowed to crystallise or grain. The sugar, when put in casks and allowed to drain, forms Muscava'do, brown, or raw sugar ; and the uncrystallised portion is molas'ses. Six pounds of juice, in the East Indies, and eight pounds in the West Indies, according to Dr. Christison, yield one pound of raw sugar. Raw sugar contains various impurities, from which it can be puri- fied ;— by elutriation with a little water, solution in water heated by steam, clarification with blood and alumina, filtration through animal charcoal, concentration in vacuo at 150°, crystallisation, and displacement of the impure syrup in the crystalline mass by passing pure syrup through it. (Howard, cited by Christison.) The product is White Sugar, Refined Sugar, or Loaf Sugar — Sac'charum of the Pharmacopceia ot the United States — of which 79 per cent, may be obtained from good Muscavado sugar. The uncrystallisable syrup in this process is Treacle or Sugar-house Molasses. It is not necessary to describe further the processes for forming various kinds of sugar, or to dwell upon its properties. It may be well, however, to remark, that by the slow evaporation of a solution of sugar in water, a crystalline product is obtained, called Sugar Candy. Barley Sugar is obtained by evaporating syrup to a state of great concentration, taking care not to empyreumatise it, and then allowing it to cool. Taffy is made by evaporating a mixture of sugar and butter; and Candy by boiling syrup or molasses for a few minutes, with the addition of a little butter to prevent it from b'im- vol. i.—21 242 special expectorants. ing, and flavouring with lemon, peppermint, &c, should this be desired. Sugar is very soluble in water, and its saturated solution, called Syrup, is an officinal preparation. It is also soluble in alcohol, but not in ether. In the United States, according to M'Culloch, from 70,000 to 80,000 tons of sugar are consumed annually. Sugar is one of the best of the demulcent expectorants, and forms a part of most cough mixtures on that account. In the form of candies, lozenges, &c, it is much used in cases of tickling cough. A mixture of syrup and olive oil in equal portions is a common pre- scription in the catarrhal affections of infants ; and the various offici- nal syrups that are used as expectorants, as Syrupus, Syrupus allii, Syrupus amygdala, Syrupus scilla, S. scilla compositus, S. senega, and S. tolutani, owe a part of their efficacy to their saccharine con- stituent. SYRTPUS, SYRUP. (Sacchar. tbiiss; Aqua, Oj.) Simple syrup is rarely used alone as a demulcent expectorant, but it forms part of many mixtures that are prescribed for allaying cough. 23. GLYCYRRHI'ZA.—LIQ'UORICE ROOT. Liquorice Root is the root of Glycyrrhi'za glabra or Common Liq'uorice; Sex. Syst. Diadelphia Decandria; Nat. Ord. Legumi- nosae; a perennial herbaceous plant, which is indigenous in the south of Europe, and is cultivated at Mitcham, in Surrey, England, and at other places, for medicinal use. Much of the root which is im- ported into this country is said to come from the ports of Messina and Palermo in Sicily. (Wood & Bache.) Liquorice Root or Stick Liquorice of the shops, is in long cylin- drical pieces of varied thickness, from a few lines to more than an inch; of a grayish-brown colour externally, and yellow internally. It has little or no odour, but a remarkably sweet taste, with a slight degree of acrimony. Its main chemical constituents are Glyc'yrrhi- zin, Glyc'ion or Liquorice Sugar, which belongs to the uncrystallis- able sugars, that are not susceptible of vinous fermentation ; and a resinous oil, to which it owes the slight degree of acrimony which it possesses. The acridity seems to be seated in the epidermis, so that, for medical use, the epidermis should be removed. The active principle of liquorice root is soluble in water. Liquorice root is one of the most agreeable demulcent expecto- rants, and is generally given in the form of decoction, either alone or combined with other demulcents. It is not often, however, pre- scribed by the practitioner, and as a domestic remedy is more used in the form of the extract. It enters into the composition of Con- fectio Senna, Decoctum Sarsaparilla Compositum, Infusum Lini, Pilula Hydrargyri, and Syrupus Sarsaparilla Compositus of the Phar- macopceia of the United States. EXTRAC'TDI GLYCYKRM'ZiE, EXTRACT OF LIQUORICE. Liq'uorice Juice, LINUM. 243 Spanish Juice, Italian Juice, Black Sugar, is amongst the prepara- tions in the London arid Dublin Pharmacopoeias; but as it is altoge- ther imported into this country, it has been properly placed in the Materia Medica list of the Pharmacopceia of the United States. It is prepared in the same manner as the ordinary watery extracts, by boiling the root, and evaporating the strained decoction. Spanish juice is said to be prepared in Catalonia from Glycyrrhi'za glabra; the Italian from G. echina'ta. About 4,059 cwt. of foreign extract of liquorice, according to Dr. Pereira, paid duty in England in the year 1839. That which is used in this country is said to be brought from Leg- horn and Messina. It comes in cylindrical or flattened rolls, covered with bay leaves, and when good is very black, dry, brittle, and en- tirely soluble in water. It is rarely, however, wholly pure, as usually met with. Refi'ned liquorice is obtained by dissolving the im- ported extract in water, filtering the solution, and evaporating. The Pont'efract or Pomfret Loz'enges are made of refined liquorice. Extract of liquorice is taken into the mouth, and allowed to dis- solve slowly as a demulcent expectorant in cough. TROCHIS'CI GLYCYRRIIIZl ET OPII, TROCHES OF LIQUORICE AND OPIUM. (Opii, in pulv. ^ss ; Glycyrrhiz, in pulv., Sacchar. in pulv., Acacia, in pulv. aa ^x ; 01. Anisi, f. ^ij.) These lozenges combine the demulcent virtues of liquorice, sugar, and gum arabic, and the ano- dyne properties of opium. They are, consequently, well adapted to allay cough, where opium is admissible. Each lozenge contains about one-seventh of a grain of opium. A preparation similar to these troches is known in Philadelphia under the name of Wistar's Cough Lozenges. 24. LINUM. —FLAXSEED. Flaxseed, Linseed or Lintseed is the seed of Linum usitatis'simum, common flax; Sex. Syst. Pentandria Pentagynia; Fig. 35. Nat. Ord. Lineae— Linaceae, (Lindley), an annual plant, extensively cultivated in various parts of the globe, which flowers in June and July, and whose seeds ripen in August. Both the seeds and their ex- pressedoil are officinal. The seeds are oblong,oval, flattened on the sides, with acute edges, pointed at one end, smooth, glossy, brown externally and yel- lowish-white within, devoid of smell, and of an oily mucilaginous taste. The coat of the seeds is mucilaginous ; the nucleus oily. The entire seed yields about a sixth of dry mucilage, and a fifth of oil. Linseed meal is the oil cake, which remains after the expression of linseed oil, ground to pow- der. It abounds in mucilage, and is extensively d,i c ,• c ii." in xi • Linum usitatissimum in the formation of poultices, h or this pur- pose, it is better than the ground seeds, which contain oil, and are liable to become rancid. 244 SPECIAL EXPECTORANTS. Flaxseed is not given in substance. The .most common form of administration as a demulcent expectorant is the IXFU'SUMLIM, INFUSION OF FLAXSEED. (Lini, |ss; Glycyrrhiz. cont. 3ij ; Aqua bullient. Oj.) Flaxseed tea is a common domestic remedy in catarrhal affections. The formula given above is officinal in the Pharmacopceia of the United States. It is rendered more palatable by the addition of sliced lemon. The dose may be from f. 3ij; to f. giv, but it is generally taken ad libitum. 25. TRAGACAN'THA. — TRAG'ACANTH. Tragacanth or Gum Trag'acanth or Gum Dragon is referred to flstrag'alus verus by the Pharmacopceia of the United States (1842); but it is generally supposed to be the Fig. 36. concrete juice of various species of Astragalus; Sex. Syst. Diadelphia Decandria; Nat. Ord. Leguminosae. The greater part, however, of that which is met with in commerce would seem to belong to Astrag'alus verus, a native of Persia. Astrag'alus gum'- mifer, of Lebanon ; A. Cre'ticus, of Mount Ida in Crete, and A. strobilif- erus, of Koordistan, are also said to Astragalus verus. produce it. It exudes spontaneously from the stems and branches during the summer season, and concretes there. It is imported from Smyrna and other ports of the Levant. The entries of tragacanth for home consumption, in Great Britain, in 1831 and 1832, were, according to M'Culloch, at the rate of 45,836 lbs. a year. As seen in the shops, it is in small contorted pieces of the most irregular shapes ; of a yellowish-brown colour ; semi-transparent or translucent; hard ; tough ; devoid of odour and taste ; difficult of pulverisation, except at a temperature of 100° or 120° Fahr., (Chris- tison), or at a freezing temperature, (Wood & Bache.) Its specific gravity is 1.384. With cold water as well as hot it forms a muci- lage ; but a portion only appears to be dissolved; the remainder, after a time, being precipitated. Chemical analysis shows it, indeed, to be composed of common gum, identical with, or at all events re- sembling, the Ar'abin of gum arabic, which has been termed Traga- canth'in or Adragant'in, soluble gum or Ar'abin of trag'acanth ; and of Bas'sonn or insoluble gum of trag'acanth ; the former, according to one analysis, constituting 57 per cent.; the latter 43 per cent. Gum tragacanth is wholly insoluble in alcohol. From its property of swelling up in water, and forming a soft adhesive paste, it is much used in the shop of the apothecary for pasting labels, &c. Dr. Pereira describes two kinds of tragacanth, — Flaky or Smyrna Trag'acanth,—that usually found in English commerce, and which occurs in moderately large, broad, thin pieces, marked with SASSAFRAS. 245 arched or concentric elevations: and the Ver'miform or More'a Trag'acanth, common on the continent of Europe, and occurring in small, twisted, filiform, spiral pieces. Gum tragacanth possesses the same properties as gum arabic, but it is very rarely employed as a demulcent. It is more commonly used as a means of administering heavy powders by reason of the great viscidity it imparts to water: and in pharmacy in the forma- tion of troches or lozenges. Should it be desired to administer the powder, the dose may be from %ss. to ^ij. The Pulvis Traga- can'thje Compos'itus of the London and Edinburgh Pharmacopoeias, which consists of tragacanth, gum arabic, starch, and sugar, is chiefly used as a vehicle for the exhibition of heavy active powders to chil- dren, and is occasionally given as a demulcent. MUCILVGO TRAGACAN'TILE, MU'CEAGE OF TRAG'ACANTH. (Tragacanth. 31; Aqua bullient. Oj.) This mucilage is rarely given internally. It is chiefly used in pharmacy in the formation of troches or lozenges, as of the Trochisci ipecacuanha, T. magnesia, and T. mentha piperita of the Pharmacopceia of the United States. 26. SES'AMUM. —BENNE. Benne, which is in the secondary list of the Pharmacopoeia of the United States, is the leaves of Ses'amum Orienta'le or Benne plant; Sex. Syst. Didynamia Angiospermia; Nat. Ord. Bignoniae, Pedaliaceae, (Lindley,) an annual plant, which is a native of India, but has been cultivated in various parts of the world, and is sup- posed to have been introduced from Africa into the Southern states, as well as into the West Indies, by the negroes. The seeds afford, on expression, a fixed oil — O'LEUM SES'AMI or Benne oil—which is in the secondary list of the Pharmacopceia of the United States. It resembles olive oil in its properties, and is used for the same purposes. When one or two fresh benne leaves are stirred in about half a pint of cool water, a quantity of gummy matter is imparted to the water, which soon renders it viscid. When the leaves are dried, they may be put into hot water. The mucilage, thus formed, pos- sesses the same properties as the mucilage of gum arabic, and may be used as a demulcent expectorant. 27. SASSAFRAS MEDUL'LA.—SAS"SAFRAS pith. The pith of the stems of Laurus sas'safras,— whose general pro- perties are described under Excitants—is met with in the shops in slender cylindrical pieces, which are very light and spongy; and have a mucilaginous taste, with the flavour of sassafras. They con- tain a large quantity of gummy matter, which is imparted to water, so as to form a mucilaginous solution : this is used whenever muci- lages are required internally, and, therefore, as a demulcent expec- torant. The mucilage may be made for internal use, by adding a drachm of the pith to a pint of boiling water; but it is not often pre- 21* 246 SPECIAL EXPECTORANTS. scribed internally. It is most frequently used as a soothing applica- tion in ophthalmia. 28. ULMU?.—SLIP'PERY ELM BARK. The inner bark of Ulmus fulva, Slippery elm or Red elm; Sex. Syst. Pentandria Digynia; Nat. Ord. Amentaceae or Ulmaceae, abounds in mucilaginous matter, which it readily imparts to water. Slippery elm is indigenous in this country, flourishing in every part of the United States to the north of Carolina, but most so in the Western states. The inner bark is found in the shops, freed from the epidermis, in long, nearly flat pieces, which may be reduced to powder by grinding. Its smell is peculiar, but not agreeable ; and its taste, when chewed, is mucilaginous. Slippery elm bark is almost always given in the form of tea or in- fusion. A mucilage may, however, be made by stirring the powder in hot water. INFU'SUMULMI,INFUSION OF SLIP'PERY ELM BARE. (Ulmi, concis. et con- tus. ^j; Aqua bullient. Oj.) This may be taken as a demulcent ex- pectorant in catarrhal affections ; but it is not much used. 29. CETRA'RIA—ICELAND MOSS. Cetra'ria Islan'dica, Lichen Islan'dicus or Iceland moss; Sex. Syst. Cryptogamia; Nat. Ord. Lichenes,— Lich- Fig. 3?- enaceae, (Lindley,) is found in the northern latitudes of both continents, and is said to be abundant on the mountains and in the sandy plains of New England. It is im- ported into England from Hamburg and Gothenburg, and is said to be the produce of Norway and Iceland. In 1839, 15,933 pounds, according to Dr. Pereira, paid duty in England. As met with in the shops, it is of a brownish or grayish-white colour,has lit- tle or no odour, and a bitter, mucilaginous, somewhat astringent taste. The dry plant, steeped in water, absorbs more than its own weight of the fluid. When analysed by Berzelius, it yielded 44.6 percent, of starchy matter, Lichenin, — 3.0 of a peculiar bitter principle, termed Cetrarin, and whose medical properties will be considered elsewhere; 7.3 of gum and uncrystallisable sugar; 7 of extractive matter; 36.2 of starchy lignin, besides colouring matter, and various salts. Cetraria may be deprived of its bitter principle by a double mace- ration in water, or in water containing 7y7 part of an alkaline car- bonate. If it be then dried and reduced to powder, it forms a nutritive aliment, which is made into bread by the Icelanders and Laplanders, or boiled with milk. Cetraria has been much used in cases where demulcents in general are indicated, and, therefore, as a demulcent expectorant. It is em- CHONDRUS. 247 ployed, also, in pulmonary affections with the same view as arrow- root, sago, or tapioca, as a bland, nutritious article of diet, and it does not seem to possess any advantage over those articles. It has been highly extolled in pulmonary consumption ; but it is now uni- versally considered to possess no peculiar properties either in that or any other disease. The powder is occasionally — but very rarely — given in the dose of from 3ss. to 3j; and it is sometimes mixed with chocolate, and taken night and morning for breakfast and supper. The most com- mon form of administration is the DECOC'TUM CETRA'RLE, DECOCTION OF ICELAND MOSS. (Cetraria, gss; Aqua, Oiss. Boil to a pint, and strain forcibly). The bitter prin- ciple or cetrarin is contained in this decoction. It thus combines demulcent and tonic virtues. The bitterness may, however, be first extracted — as before remarked — by maceration in water, or in a weak alkaline ley. The quantity to be taken during the day, as a demulcent and nutrient, is about a pint in divided doses. It is sometimes mixed with milk. 30. CHONURUS.—IRISH MOSS. Car'rageen, Cor'igeen or Irish Moss, is Chondrus crispus, Lichen Car'rigeen, Fucus crispus, Spharococ'cus crispus, Ulva crispa, or Chondruspolymor'phus; Sex. Syst. Cryptogamia; Nat. Ord. Algae— Algaceae (Lindley). It is found in the Atlantic ocean, on the shores of England, Ireland, western France, Spain and Portugal, and as far as the Tropics, and is also said to be a native of the United States. For medicinal and dietetic purposes, it is collected on the coasts of Ireland (especially in Clare), where it is washed, bleached by ex- posure to the sun, and dried. In Ireland, it is used by the poor as an article of diet. When Irish moss is green it resembles Iceland moss; but as met with in the shops, it is dry, crisp, and of a yellowish or dirty white hue, resembling laminae of horn. It is nearly inodorous, and has a mucilaginous taste. When chewed, it feels like so much cartilage, but by the warmth and moisture of the mouth it soon loses its brittle- ness. Its main constituent is a vegetable jelly — which exists in it in the proportion of 79.1 per cent., and which has been considered to consist of Pectin, in large proportion — and starch, but which Dr. Pereira esteems a peculiar principle and calls Carrageenin. It con- tains likewise, 9.5 per cent, of mucus, and traces of salts. In order to obtain the jelly of the moss, it is cut small, carefully freed from impurities, and boiled with water or milk, if the latter should be desirable, and strained. Von Grafe obtained from nine ounces of milk, boiled with half a drachm of the moss, five ounces of jelly; and as much from a drachm and a half of the moss, and twelve ounces of water. To the jelly thus formed, any dietetic or therapeutical agent may be added. 248 special expectorants. Fis. 38. Irish moss has been recommended under the same circumstances as Iceland moss; and it would appear, that, like it, no more service can be expected from it than from substances that contain a similar principle. Accordingly, few prescribe it with any other view than as a demulcent and nutritious aliment, where such appears to be in- dicated. To remove any unpleasant flavour, which the moss may have ac- quired from impurities, it is advised, that before it is boiled, it should be macerated in water for a few minutes. Chondrus is in the secondary list of the Pharmacopoeia of the United States; Cetraria in the primary; but there is no sufficient reason perhaps to assign the one a more important place than the other. 31. FUCUS AMYLA'CEUS—CEYLON MOSS, MARINE MOSS. The attention of physicians was first directed to this vegetable by Dr. O'Shaughnessy, of Calcutta. Like chondrus, it belongs to the natural order Algae, and was first introduced some years ago from India into England. As met with in the shops, it is white, filiform and fibrous, and has the usual odour of sea weeds. Analysed by Dr. O'Shaughnessy, it was found to be composed of vegetable jelly, 54.50; true starch, 15; wax, a trace; ligneous fibre, 18; gum, 4; sulphate of soda and chloride of sodium, 6.50 ; sulphate and phos- phate of lime, 1 ; iron, a trace; loss 1. When boiled in water, a liquid results, which gelatinises on cooling. The jelly is prepared like that of chondrus, and it possesses simi- lar medical properties. It is largely employed by the practitioners of India. (See the Author's New Remedies, 4th edit. p. 314. Philad. 1843.) Fucus vesiculosus. it. Upper part of a frond. 4. Section of a receptacle. c. Tubercle. d. Filaments and sporangia, of which thu tubercles are composed. e. Filaments which issue from the pores on the surface of the frond.—(Pereira.) The Pharmacopoeia of the United States contains in its second- ary list: 32. Vi'ola, Vi'olet,— the herb of Vi'ola peda'ta. — Sex. Syst. Pentandria Monogynia ; Nat. Ord. Violaceae,— an indigenous vio- let, which flowers in May and June. All the violets contain a prin- ciple resembling emetia, which has been called J'i'oline or Vio'lia, BENZOINUM. 249 and the existence of which in small quantities — it has been sup- posed— may account for the expectorant properties ascribed to the plant. The author has never known it used. III. Nauseant and Emetic Expectorants. Of the mode in which nauseants and emetics probably act as ex- pectorants, a brief notice has been taken already (p. 218). It is evident, that all agents which are capable of inducing nausea, fol- lowed or not by emesis, may be employed as expectorants; and it is not improbable, that if they be given short of inducing nausea, some action of sedation maybe exerted by them, and that, therefore, they may be adapted as sedative expectorants for cases of pulmonary disease in which the organic actions are over excited. This at least may be the case with the Tartrate of Antimony and Potassa, Ipecacuanha, Lobelia, &c. ; but on the other hand, if certain agents, as Squill, be given in a small dose, they act as excitants, and hence it is important, that they should be pushed to an extent but little, if at all, short of inducing nausea. Of the nauseants, ipecacuanha is most frequently perhaps pre- scribed as an expectorant, singly, or — what is far more common — in combination with opium ; and not unfrequently it is added to de- mulcent mixtures to aid their expectorant agency. The following form, introduced into the last edition of the Pharmacopceia of the United States, (1842,) is a combination of this kind. Trochis'ci Ipecacuan'hje, Troches of Ipecacuan'ha. (Ipecac, in pulv. ^ss; Sacchar. in pulv. ^xiv; marant. pulv. ^iv ; mucilag. tra- gacanth. q. s. Each troche to weigh ten grains.) These lozenges are well adapted for inflammatory affections of the lining membrane of the bronchial tubes. IV.— Topical Expectorants.—Inhalations. a. Excitant Inhalations. 33. BENZO'INUM.—BEN'ZOIN. Of the virtues of this balsam as an excitant expectorant, mention has already been made (p. 229). At times, it is employed in the way of vapour ; but caution is demanded in inhaling it, as it excites coughing, unless largely diluted with atmospheric air. It ought to be inhaled along with the vapour of water, by breaking benzoin into pieces, putting them into a jar, and pouring boiling water over them. In this manner, the acid rises with the vapour and is taken into the lungs. Its action is excitant to the nerves of the lining membrane of the air passages, and through them to the respiratory nerves in general; and it has seemed to have afforded decided relief in asthma depending on some morbid condition approaching to paralysis of the pneumogastric nerves. (A. T. Thomson.) It is said to have proved 250 SPECIAL EXPECTORANTS. beneficial even in phthisis after the existence of tubercles had been clearly ascertained; but it can only have acted as a palliative, and probably in the manner already described, through its excitant im- pression on the respiratory nerves: expectoration being thus facili- tated, and dyspncea relieved. MM. Trousseau and Pidoux strongly recommend the mode of employing the balsams in chronic laryngitis, by throwing some of the benzoin or the balsam of Tolu on hot coals. They advise this plan in preference to inhalations of boiling water containing the balsam, inasmuch as the patient can remain without fatigue for whole days in a balsamic atmosphere. They affirm that chronic catarrh has been removed in this way, which had resisted the internal use of the balsams. None of the balsams are much used in this manner on this side the Atlantic, or in Great Britain. 34. ACE'TUM.—VIN'EGAR. Vinegar is the result of what is termed the ace'tous fermenta'tion, and is impure dilute acetic acid. All liquids, that are capable of the vinous fermentation, are capable of the acetous, and can, there- fore, afford vinegar: hence it is made from various substances; — in France and Spain from the lighter wines; in Great Britain from malt and malt liquors, and in the United States from cider. For the use of the white lead manufacturer, it is said to have been exten- sively prepared, of late years, from potatoes. (Wood & Bache.) The difference in the quality of commercial vinegars is very great, some being four times as strong as others. Certain vinegars are, indeed, so weak, as not to be fit for the preparation of the Ace'tum Destilla'tum, and others are so full of impurities, that they can scarcely be used for making certain officinal preparations. It was not without reason, therefore, that the framers of the Pharmacopceia of the United States (1842) gave the following rules for determining its strength and purity. " One fluidounce is saturated by about thirty-five grains of crystallised bicarbonate of potassa. It affords no precipitate with solution of chloride of barium, and is not coloured by sulpho-hydric acid." The solution of the chloride of barium de- tects sulphuric acid, if any be present; and the sulpho-hydric acid the presence of metallic matter. The French vinegars — as a general rule — are better for all pur- poses than the British. The best qualities imported into Great Bri- tain are from Bordeaux, and are known under the name of Cham- pagne Vinegar, although made from other wines. Two sorts of wine vinegar are met with in commerce, made from wines of a cor- responding colour: that from the red wines may be decolourised by passing it repeatedly through animal charcoal. In this country — as before remarked — vinegar is generally made from cider that has become sour. This is put into a barrel in a warm place, along with some good vinegar, or mother of vinegar, which acts as a ferment. The vinegar is ready in the course of a few weeks. CHLORINUM. 251 The constituents of vinegar are essentially acetic acid, and water, in addition to which it contains colouring matter, gum, starch, sugar, &c. &c., according to the particular substance from which it has been derived. As a topical expectorant, vinegar is sometimes used, being put into the ordinary inhaler hot, and in a dilute state. In this manner it acts as an excitant to the bronchial nerves, and is of service in the same cases as benzoic acid and other balsams, by facilitating the expectoration of mucus, and other secretions that may have col- lected in the air passages. It has been of advantage in asthma, and various spasmodic affections of the respiratory system. It has been advised by Dr. A. T. Thomson that distilled vinegar should be employed by preference, as common vinegar is apt to contain sul- phuric acid. 35. ACE'TUM DESTILLA'TUM. — DISTIL'LED VIN'EGAR. This is made by distilling, from eight pints of vinegar, seven, and preserving these for use. One fluid ounce of this should be capa- ble of being saturated by about thirty-five grains of crystallised bicarbonate of potassa. Distilled vinegar is colourless, or of a yellowish hue, and contains, besides acetic acid and water, a little alcohol, acetic ether, and a substance of a mucilaginous character, which, when the acid is saturated by an alkali, causes the solution to be of a reddish or brownish colour. When properly prepared, it has no empyreumatic or other disagreeable taint. A diluted acetic acid, which has the same strength as distilled vinegar, is made by taking the acetic acid— AC'IDUM ACE'TICUM of the Pharmacopoeia of the United States, (1842,)— which is prepared by the action of the sulphuric acid on acetate of soda, and diluting it with ten parts of distilled water. This is the AC'IDUM ACE'TICUM DILU'TUM or diluted acetic acid. Either this preparation or the dis- tilled vinegar may be employed in the way of inhalation. 36. TOLUTA'NUM. — TOLU. Balsam of Tolu—whose general properties have been already described (p. 226) — may be used as a balsamic fumigation in the same cases, and in the same manner as Benzoin. The air of the patient's chamber may be impregnated with the vapour, by placing a little of it upon live coals, and allowing the vapour to be dif- fused in the room ; or a drachm or two may be put in boiling water, and the vapour be drawn into the lungs by means of an ordinary inhaler. 37. CHLO'RINUM.—CHLORINE. Undiluted chlorine gas is irrespirable, occasioning spasmodic closure of the glottis, and immediate asphyxia. When largely di- luted, it is a powerful irritant to the mucous membrane of the respira- 252 SPECIAL EXPECTORANTS. tory organs, and may develope inflammation in it or in the tissue of the lungs, unless great caution is taken in administering it. When largely diluted, it may induce a salutary excitant agency, and has hence been employed as a topical expectorant of the excitant class. It has been, indeed, affirmed by Dr. A. T. Thomson, that " it is the best topical expectorant and the most salutary excitant to the mu- cous membrane of the lungs that has yet been inhaled." Chlorine has been administered as a remedy in phthisis ; and many testimonials have been brought forward in its favour. It has been observed in manufactories in which it is employed, that phthisi- cal patients have experienced decided benefit, but experiments made with it on an extensive scale in large public institutions have not confirmed these favourable reports; and some writers of dis- tinction have affirmed, that it has been prejudicial. In all cases it has to be employed carefully, and experimentally ; but no marked benefit can be expected from it in phthisis. It can only be adapted for cases of disease, in which the pathological condition of the bron- chial mucous membrane, or neighbouring parts, requires the exhibi- tion of an excitant. In this way, it may be occasionally serviceable in chronic bronchitis. It may be obtained by putting f. jj or f. gij of a saturated solu- tion of the gas in water—the Aqua Chlorini, (New Remedies, 4th edit. p. 153, Philad. 1843,)—into an inhaler containing about f. ^ij of hot water, and placing this in a basin of hot water, or over a lamp, in order to drive off the chlorine. The quantity, thus disengaged, may be inhaled every Fls- "• six hours. Recently, it has been proposed to diffuse it, by means of an appropriate apparatus, in the atmosphere of the sick chamber. For this purpose, any of the acids, as the chlorohydric, maybe drop- ped on a mixture of chlorinated lime, so that the chlorine may be disengaged slowly. An appa- ratus has been suggested, of late years, that answers this purpose well. It consists of a light open wire frame, about 18 inches high ; at the bottom of which is a spirit lamp A. At the proper height above it is an evaporating por- about six inches in and above this is a C, with its neck downwards. In the neck of the celain dish, diameter, B; glass globe downwards. globe is a cork D, bored, and through the opening is drawn, moderately tight, a short plug of IODINUM. 253 cotton wick, such as is used in a spirit lamp. In the glass globe at E, opposite the neck, is drilled a pin-hole, to allow air to pass in, according as the fluid within drops out through the neck. To use it, the porcelain dish is filled with hot water, the spirit lamp is light- ed, and as soon as the water in the dish has begun to boil, the glass globe containing the chloride — if this be the substance used — is placed as exhibited in the marginal figure. The rate at which the fluid in the globe shall percolate the cotton wick, and drop into the hot water beneath, is easily regulated. Should it not drop with sufficient rapidity, one or two of the threads of the cotton may be removed ; if too rapidly, the cork may be pressed in tightly, or one or more additional threads of wick be introduced. Eight ounces of a saturated solution of chlorinated lime may be poured into the glass globe ; and into the water of the porcelain dish two ounces of dilute sulphuric acid of the pharmacopoeias. As the solution of the chloride drops, the acid seizes on the lime, and chlo- rine is evolved in connexion with aqueous vapour. In this manner, a sufficient supply of aqueous vapour is given off to prevent any irritation of the lining membrane of the air passages, whilst the invalid experiences neither trouble nor fatigue. 38. IODINUM. — I'ODINE. The inhalation of iodine has been recommended as an excitant topical expectorant in the same diseases as that of chlorine. In phthisical affections it has been strongly advised. Sir Charles Scuda- more found the addition of a little tincture of conium beneficial in subduing the irritating qualities of the gas. His first formula was the following solution of ioduretted iodide of potassium : — Iodin. gr. viij ; Potass. Iodid. gr. iij ; Alcohol, f. ^ss; Aqua destillat. f. ^vss. M. Of this solution, from f. gj to f. 3yj,and from twenty to thirty- five minims of a saturated tincture of conium were used in each in- halation.) At the temperature of 90°, the volatile properties of iodine are given off very sensibly, but the conium requires more heat, and that of 120° is not too much for the iodine. Sir Charles now advises the following : — (Iodin. ; Potass. Iodid. aa ,^vj ; Aquce destillat. f. ^v & ^vj ; Alcohol, f. sjij. M.) He now prefers to add the conium at the time of mixing the iodine solution with the water, and recommends that it should be a saturated tincture of the genuine dried leaves. In the commencement of the treatment, he advises very small proportions of the iodine mixture ;—for example, from f. Jss to f. ^j, for an inhalation of eight or ten minutes' duration, and this to be repeated two or three times a day: of the tincture he directs f. 3SS — to be increased if the cough be very troublesome. He soon augments the quantity of the Iodine mixture from f. 3J to f. ^iv, but the feelings of the patient will be a great guide as to the proper strength of the inhaling mixture in any particular case. The author has often used the iodine inhalation in phthisis, but his experience has not been favourable to it; and the same view vol. 1.—22 254 SPECIAL EXPECTORANTS. has been entertained by others. It would seem to be better adapted for cases of chronic bronchitis. The inhalation may be practised in the method recommended for chlorine. At times, troublesome laryngeal irritation has been caused by it. Used, however, with the conium, or with aqueous vapour in the apparatus recommended by Dr. Corrigan, (p. 252,) this disa- greeable result may be prevented, and, in this way, it has^ been found to diminish most remarkably the purulent expectoration of phthisis. It improved the tone of the digestive organs ; alleviated the cough, and acted, therefore, as a valuable palliative. Dr. Cor- rigan has had his apparatus at work from eight to twelve hours in the twenty-four, and his method of managing it is as follows: —At night, when the patient is settling to sleep, the apparatus is sus- pended from the roof of the bed, and, when once arranged, it con- tinues its work for four or five hours, whilst the patient, asleep, is inhaling the medicated air. In the morning, for three or four hours before the patient rises, it may be again at work, and, if necessary, at mid-day, whilst he reclines on the bed, with the curtains drawn round three of the sides. The rate of evaporation, which has been generally found to give a sufficiently strong impregnation to the air, is when the tincture of iodine drops from the cotton wick in the globe at the rate of six or eight drops per minute. At this rate, about six drachms of the tincture will be evaporated in an hour. 39. VAPOUR OF BOILING TAR, BURNING WOOL, CRE'ASOTE, &c These vapours have been inhaled in cases of phthisis, and in chronic laryngitic and bronchitic affections. In the first disease, no great benefit can be expected from them. In the latter, they may act as excitants to the mucous membrane of the air-passages, and, in certain cases, be beneficial. Tar vapour was strongly recommended in phthisis by Sir Alex- ander Crichton; but although it has seemed to act occasionally as a palliative, it not unfrequently causes a temporary increase of cough and irritation. The tar employed should be that used in the cordage of ships, to every pound of which half an ounce of carbonate of potassa is added, in order to neutralise the pyrolig- neous acid, which is generally found mixed with the tar, and the presence of which may excite coughing. The tar, thus prepared, is placed over a lamp in a suitable vessel, and kept slowly boil- ing in the chamber night and day. The vessel ought, however, to be cleaned every twenty-four hours, otherwise the residuum may be burned and decomposed, which occasions irritation. It is a prevalent idea, that the terebinthinate impregnation of the air which exists in pine regions is beneficial to the consump- tive, and, accordingly, patients are frequently sent to spend some time in such localities. The Vapour of Resin has occasionally been used under similar TABACUM. 255 circumstances, as well as the fumes arising from burning wool that has not been dressed. All these vapours are apt to increase the cough at first, but both it and the expectoration would seem to have been ultimately diminished. They must obviously, however, be un- certain agents in all cases, and not easily regulated, and they cannot, of course, produce any material change in the tuberculous condition. Cre'asote, like tar vapour, has been occasionally inhaled in the same pulmonary affections: — five, ten or fifteen drops, according to the degree of tolerance of the lungs, being dropped into hot water, in an appropriate vessel, and the vapour being inhaled through the tube of an inverted funnel, or by means of any of the inhalers in use ; but the remarks on the value of tar vapour in phthisis, and other pulmonary affections, apply equally to creasote. b. Sedative Inhalations. 40. STRAMO'NIUM. Every part of Datu'ra Stramo'nium, — whose general properties are described under Narcotics, — has been smoked for the relief of asthma,— and whilst one part of the plant has, in this form, afforded relief in one case, another has been successful in a second. A case of this kind has been already referred to, (p. 222.) In this form of administration, a poisonous principle is probably developed ; for, according to Dr. Christison, Mr. Morries-Stirling obtained by destructive distillation a poisonous oil, composed of an inert true oil in union with an active principle, probably a modification of Da- turia. The author has often seen the inhalation of the vapour of strar monium highly beneficial. Its modus operandi is probably through the sedative influence exerted by the narcotic principle upon the ramifications of the pneumogastric nerves distributed to the bron- chial tubes, — the sedation being thence extended to the rest of the nervous system, so that the spasmodic affection is subdued. Almost all therapeutical writers affirm, that the smoking of stra- monium is attended with danger where there is a tendency to ence- phalic disease, and especially to apoplexy, and where a plethoric state of the system exists ; but the author has never witnessed bad effects from it. Of course, caution is needed in the use of this powerful narcotic as in that of tobacco, for similar acro-narcotic symptoms may be produced by both. 41. TAB'ACUM. —TOBACCO. When tobacco, — whose general properties have oeen described elsewhere, (p. 126,) — is smoked, not only does the nicotia pass into the lungs, but the empyreumatic oil of tobacco, which is an active poison, as formed in the pipe of the smoker, and appears to be nicotia attached to a true volatile oil. The effect of tobacco, when inhaled, is familiar to most persons, 256 ERRHINES. for there are probably few males who have not tested it. It is a powerful sedative, making its impression on the nerves of the bron- chial tubes with which it comes in contact, whence the impression irradiates to every part of the system. In this manner it is anti- spasmodic. It is in spasmodic asthma that its good effects have been most witnessed, but it does not agree with all, and requires caution, especially in those who have not been accustomed to its use. Smoking a cigar is said by Dr. Chapman, of Philadelphia, to have been used in a case of croup with great success. SECTION III. AGENTS THAT AFFECT PROMINENTLY THE FOLLICULAR OR GLANDULAR ORGANS. I. ER'RHINES. Synon. Ptarmica, Sternutatoria, Apophlegmatisantia per nares. Definition of errhines — Sternutatories — Modus operandi—Dangers of sneezing — Special errhines. This class of medicinal agents is much less used now than for- merly. There are, indeed, but few cases in which their employment can be suggested. At one time errhines were separated from ster- nutatories, — the former comprising agents, that excite an increased discharge from the Schneiderian membrane ; the latter those that provoke sneezing ; but the class of errhines is now made to include both under the definition — " Agents that occasion an increased dis- charge from the Schneiderian membrane, and sneezing." When an irritating substance is placed in contact with the Schnei- derian membrane, it excites a sensation, through the fifth pair of nerves, or nerves of general sensibility, distributed to the nose, and by a reflex action the appropriate muscles concerned in sneezing are thrown into contraction, in order that the source of irritation may be ejected by the anterior nares. At the same time, if the errhine remains, for any time, in contact with the membrane, a centre of fluxion is established ; the follicles augment their secretion ; and, if the substance be still more irritating, true inflammation is excited. This effect, of course, takes place more immediately in the part of the mucous membrane with which the errhine comes in contact; but the excitation is extended more or less to the mucous membranes, which may be regarded as continuous with that which lines the nasal passages —for example, those that line the sinuses and ductus ad nasum. In this way it can be understood, that the operation of an errhine may augment the secretion of tears, and occasion more or less suffusion of the eyes; and, conversely, that ERRHINES. 257 an inflamed state of the conjunctiva may give rise to increased dis- charge of mucus from the lining membrane of the nasal fossae and sinuses, and to sternutation. A sense of irritation in the nose, inciting to the operation of clearing the nasal fossae, is, indeed, a common accompaniment of ophthalmia. From what has been observed, it is clear, that if an errhine be too strong, instead of increasing the discharge from the Schnei- derian membrane, it may arrest even the healthy secretion. This is, indeed, one of the well known first effects of inflammation of any mucous membrane, and it is not until the inflammation has persisted for some time, that the secretions are materially aug- mented. To prevent the induction of inflammatory irritation, the more powerful errhines are always weakened by the addition of some inert powder. Therapeutical Applications of Errhines. A knowledge of the modus operandi of this class of medicinal agents at once suggests the cases, in which they might rationally be had recourse to. They occasion a centre of irritation in the part of the membrane with which they are made to come in contact; a derivation of nervous and vascular action from other parts is thus effected ; an increased discharge takes place from the exhalants and follicles of the nasal mucous membrane — although this has proba- bly but little curative agency — and if they excite sternutation, a strong revulsive impression is made. Possessed of these properties, errhines have been used in head affections in general; and especially in diseases of the eyes and ears ; but still, their remedial powers are very limited, and if much sneez- ing be produced, they may cause more mischief than benefit. It is on this account, that they are rarely administered except in popu- lar practice. Physiologically, sneezing is set up to clear the nostrils from any source of irritation. It is hence often excited in the way of an ex- ternal sensation — that is, by some substance impinging on the Schneiderian membrane. But it often occurs, also, as an internal sensation, — that is, produced by some organic change in the mu- cous membrane itself. Hence, it is a symptom of inflammation of the Schneiderian membrane, as in common cold, and in the catarrh that attends measles. Dr. A. T. Thomson refers to a case of benefit from sternutation, in which this agency appears to have been prescribed empirically. The result may be borne in mind with advantage, as it may attract attention to a cause of cephalalgia, that might otherwise be unsus- pected. A lady was afflicted with violent headache, accompanied by the sensation well known by the term stuffing in the head. Many remedies were proposed, and tried, but ineffectually. A physician was called in, who prescribed snuff as a sternutatory. It 22* 258 SPECIAL ERRHINES. produced violent sneezing, and the ejection, from one of the nos- trils, of a plug of hardened mucus, nearly an inch long; after which she experienced immediate relief, and, in 24 hours, was perfectly recovered. From the succussion produced during sneezing, and the compres- sion of the abdominal viscera, it has been advised in popular prac- tice, when torpor of the uterus exists after the extrusion of the foetus, with the view of exciting that viscus to contraction for the de- livery of the secundines; and, at times, it is successful; but an acquaintance with the physiology of sneezing will equally show, that it may occasionally be productive of mischief, by giving rise to in- creased flow of blood to the head by the arteries, and to impeded return by the veins, and thus produce apoplexy, epistaxis and other head affections. The succussion, too, accompanying it, is evidently improper in pregnancy, and a fortiori, where there is tendency to abortion ; or, where hernia or aneurismal diseases exist. Conradi esteems errhines to be contra-indicated when any inflammatory con- dition is present; but this caution is unnecessary, as it could scarcely happen, that they would be had recourse to, at least before remedies had been employed, which were considered proper for the removal of such condition. It is probably owing to the apparent violence done to the system, that the custom has so long existed, in certain countries more espe- cially, of offering a benediction to any one who sneezes. Amongst the Teutonic nations, some form of salutation is always bestowed on such occasions. Even a professor, whilst addressing his hearers, is compelled to bow to the force of custom when any of the class exe- cute this physiological act. It might be agitated here, whether the habitual use of errhines — as of snuff— be prejudicial; but this is a question, which belongs more to hygiene than to therapeutics, and has accordingly been in- vestigated in another place. (See the Author's Human Health, p. 334, Philad. 1844.) SPECIAL ERRHINES. 1. VERA'TRUM ALBUM. —WHITE HEL'LEBORE. The powdered rhizoma of White Hellebore — whose characters are described elsewhere — is possessed of very acrid properties when placed in contact with a mucous surface, and acts as a powerful errhine ; hence the common name of the root — Niesswurzel or " sneezing-root," in Germany, and of the powder—sneezing pow- der, in Great Britain. These properties are dependent upon its ac- tive principle, veratria. The action of powdered veratrum is so violent, that it requires to ASARUM EUROPiEUM. 259 be diminished by admixture with some mild powder, as starch, wheaten flour, or liquorice, — at least three or four parts of these powders being required to one of white hellebore powder. Three grains, united with nine grains of starch, snuffed up the nostrils for three evenings in succession, occasion a copious watery discharge from the nostrils, (A. T. Thomson.) In certain chronic encephalic affections, and in amaurosis, it has been used with this view, but it is not often prescribed. 2. VERA'TRIA. Veratria, — the active principle of veratrum album, — is a pow- erful errhine, the smallest appreciable quantity, applied to the Schneiderian membrane, exciting the most violent and repeated ster- nutation. A very minute quantity of the acetate of veratria, placed in the nostrils of a dog by M. Magendie, instantly caused violent sneezing, which continued for a long time. It has been remarked, that we possess the means of making a certain errhine, always of the same strength, by combining veratria with a portion of starch sufficient to cover its acrimony, yet it is proper to remark, that it is an article which is frequently adulterated; and it is in this way, that many account for the discordance amongst observers as to its virtues. It is, moreover, so violent at times in its operation, and if the Schneiderian membrane be abraded, so much inconvenience may result from its absorption, that if employed at all as an errhine, it ought to be so with the greatest caution. 3. HYDRAR'GYRI SULPHAS FLAVUS. —YELLOW SULPHATE OF MER'CURY. The yellow sulphate of mercury, described under Emetics, (p 130,) possesses strong errhine powers, and has the advantage over some others of always possessing the same degree of strength. It is so violent, however, in its operation, that it requires to be mixed with five or six parts of some farinaceous powder, as starch. A quantity of this compound powder, which contains one grain of the yellow sulphate, usually produces a discharge from the Schneide- rian membrane, which may continue for several days. It is said to have been found very useful in ophthalmic affections, and as it pos- sesses no narcotic properties, " there can be no doubt," says a recent writer, Dr. A. T. Thomson, " that it is superior to every other errhine in affections of the head." 4. AS'ARUM EUROPIUM. — ASARABAC-CA. Asarum of the British Pharmacopoeias is not identical with asarum of the Pharmacopceia of the United States, the latter being an excitant tonic, and, therefore, not falling under considera- tion here. The European as'arum or common asarabac'ca; Sex. Syst. Dodecandria Monogynia; Nat. Ord. Aristolochiaceae, is a small herbaceous plant, growing in moist hilly woods in England, 260 SPECIAL ERRHINES. as well as in many parts of the European continent. The leaves are officinal in the British Pharmacopoeias. They are almost inodorous, but have an acrid, aromatic and bitter taste. The root of the shops is about the size of a goose-quill, of a grayish colour, quadrangular, knotted and twisted. It has a smell like that of pepper, and a nau- seous bitter, hot, acrid taste ; much of its acrimony being lost, how- ever, by drying. The acrid properties of the asarum would seem to be mainly dependent upon liquid volatile oil, and a camphoraceous principle. It contains, moreover, bitter extractive. Asarabacca is an emetic, but is never used as such. It is only employed as an errhine, and is said to be the basis of cephalic snuff. When either the powdered leaves or the root are applied to the Schneiderian membrane, they excite sneezing, an increased secre- tion of mucus, and may even induce a discharge of blood. The quantity used as an errhine is one or two grains of the root, or three or four of the leaves, in some cases of obstinate cephalalgia, chro- nic ophthalmia, or tooth-ache. The Dublin Pharmacopceia has a Pulvis asari compositus, com- posed of asarum, 3jj ; lavender flowers, 3j ; which is used in the same cases in the quantity of gr. v to gr. viij. 5. TAB'ACUM. — TOBAC CO. Tobacco, in the form of snuff, is a well known errhine ; not, how- ever, habitually employed with that view, but as one form of induc- ing pleasurable excitement through its peculiar impression on the olfactory nerves. In the manufacture of snuff, the tobacco is cut into small pieces ; is first fermented by being placed in heaps, and sprinkled with water or a solution of salt — the latter preventing the tobacco from becoming mouldy. The heaps soon become hot, and evolve am- monia. The extent to which this process is permitted to go varies, according to the kind of snuff, from one month to two or three — the latter being the usual period. It is then ground in mills, or pow- dered with a kind of pestle and mortar. Some of the snuffs—as the Scotch, Irish, Welsh and Spanish—are high dried. Others — as the different varieties of Rappees — are moist. Of the effects of the abuse of snuff on the system, the author has treated in another work, (Human Health, p. 334. Philad. 1844.) In this place it has only to be spoken of as a therapeutical agent. To those who are unaccustomed to its use, it occasions an increased secretion of the nasal mucus and sternutation. Where slight and transient effects of this kind are needed, snuff may be employed, but it is a far less energetic errhine than others in the list. Besides the errhines mentioned, others have been occasionally employed. 6. Euphor'bium. — This is the concrete resinous juice of an un- determined species of Euphor'bia, which is obtained in Morocco, SIALOGOGUES. 261 and exported from Mogadore. It causes obstinate sneezing, dis- charge of bloody mucus, and great torture, if snuffed up the nostrils ; and, therefore, requires to be diluted with some mild, feculaceous powder. It is rarely, however, used, and is not in the lists of the Pharmacopceia of the United States. 7. The root of Iris Florenti'na or Florentine Orris, Sex. Syst. Triandria Monogynia; Nat. Ord. Iridaceae. 8. Rosmarinus or Rose'mary. 9. Lavan'dula or Lavender ; and 10. Orig'anum Ma- jora'na or Sweet Marjoram; Sex. Syst. Didynamia Gymnospermia: Nat. Ord. Labiatae; have been classed amongst the errhines, and may act as such by virtue of the essential oil which they contain ; but they are more employed, on account of their aromatic proper- ties, as adjuncts to errhines of a more powerful character. Dried lavender flowers are a constituent of the Pulvis Asari compositus of the Dublin Pharmacopceia. II. SIAL'OGOGUES. Sriroif. Ptyalogogues, ptyasmagogues, salivants, apophlegmatismi seu apophleg- matisantia per os. Definition of sialogogues—Their employment limited—Modus operandi of sialogogues— Mercury as a sialogogue—Special sialogogues. Sialogogues are agents, that increase the salivary discharge. The general modus operandi of local sialogogues or masticato- ries is analogous to that of errhines. By their excitant properties, they irritate the lining membrane of the mouth, and the irritation, thus induced, is extended along the ducts to the salivary glands ; so that not only is the quantity of fluid inhaled from the mucous mem- branes increased, but salivation results. In this way, depletion follows their employment, and more or less revulsive effect super- venes, which may act beneficially on parts at a distance labouring under disease. Occasionally, also, they may prove useful, as in cases of paralysis of the muscles of the tongue, by their directly ex- citant properties. It is obvious, however, that they cannot be of benefit except in local palsy of the organ. Where the origin of the disease is cerebral, little or no advantage can be expected from them. Therapeutical application of Sialogogues. The employment of sialogogues must necessarily be extremely limited. They are occasionally used as masticatories in toothache and in head affections, — precisely, indeed, in the cases that are considered to indicate the use of substances, which excite irritation in, and increased discharge from the lining membrane of the nasal cavities. By some writers on Therapeutics, mercury has been ranked 262 SPECIAL SIALOGOGUES. amongst the sialogogues, and salivation is certainly one of the effects resulting from its administration. It is now, however, generally admitted, that this result is never necessary, and that it is rather to be deplored, inasmuch as the increased discharge exhausts and irritates, without producing any benefit whatever. When this potent article of the materia medica is duly exhibited, it induces a new ac- tion, not only in the salivary glands, but in every part of the glan- dular and follicular, and, perhaps of the whole secretory system; and as this new action is incompatible with the one that may be already existing, the latter yields. In this point of view, therefore, mercury is a revellent, and is referred to elsewhere. Ptyalism may likewise be induced by various other agents — as by iodine, the preparations of gold, copper, antimony, arsenic, and it is said to have followed the employment of castor oil, digitalis, and opium. Medicines, which act in this manner, have been termed, specific or remote sialogogues. SPECIAL SIALOGOGUES. 1. PYR'ETHRUM. —PEL'LITORY. The An'themis Pyr'ethrum, Anacyc'lus Pyr'ethrum or Pellitory of Spain; Sex. Syst. Syngenesia Poljgamia superflua ; Nat. Ord. Compositae, is an inhabitant of Arabia, Syria, and of France, Italy, Germany, and other parts of Europe. The root is the officinal por- tion ; but none of it appears to have been imported into England from the Levant since the year 1836, during which year duty was paid on 420 lbs. (Pereira.) It has, indeed, fallen into disuse, and has been placed on the secondary list of the Pharmacopceia of the United States. The root, as met with in the shops, is in pieces about the length and thickness of the little finger ; of a brown colour externally ; mottled with black shining spots ; breaking with a resinous fracture, and having a radiated structure internally. It is inodorous, and, when chewed, occasions a peculiar sense of heat, pungency and tingling in the mouth, which continues for some time, and is accom- panied by a copious flow of saliva. Its properties appear to be dependent upon a brown acrid resin, an acrid brown fixed oil, and a yellow acrid oil, which have been termed collectively Pyr'ethrin: as, however, Hagen and Schon- wald have obtained from it a scentless volatile oil, possessing the peculiar taste of the root, it has been thought probable, that this is the active principle, and that it adheres forcibly to the resin and fixed oil. (Christison.) Pellitory root is employed almost exclusively as a sialogogue in certain neuralgic affections of the head and face, in palsy of the tongue, and of the muscles of deglutition ; and, occasionally, both ARMORACIA. 263 as a masticatory, and, in the form of infusion, in relaxation of the uvula and isthmus faucium. It has been much used as a mastica- tory in toothache, as well as in the form of tincture. (Pyrethr., Aqua, aa p. i: Alcohol, p. v.) 2. MEZE'REUM. —MEZE'REON. Mezereon bark, whose properties are described elsewhere, owes its excitant action to an acrid resin, by virtue of which it is a good masticatory, and has been used as such in cases of toothache ; — a small portion of the bark being kept constantly in the mouth, and the saliva being ejected as it is secreted, on account of the inju- rious effects likely to be induced on the digestive mucous membrane, should it be swallowed. In a case of dysphagia, induced by para- lysis of three years' standing, mezereon root was prescribed as a masticatory, and in less than a month the patient recovered the power of deglutition. 3. CAL'AMUS. —SWEET FLAG. The general properties of the rhizoma of Ac'orus Calamus are described under the head of Excitants. Its medicinal agency is dependent upon volatile oil. When chewed, it produces the ordi- nary excitant effects of the sialogogues in general, hence it is sub- stituted for tobacco by such as are desirous of discontinuing the use of the latter. It need scarcely be said, however, that the two agents resemble each other only in their operation as local excitants. The calamus is possessed of no narcotic properties. It may be used whenever a masticatory is needed. 4. ARMORA'CIA. — HORSERADISH. Horseradish is the fresh root of Cochlea'ria Armora'cia ; Sex. Syst. Tetradynamia Siliculosa ; Nat. Ord. Cruciferae or Brassica- ceae ; — a native of western Europe, growing wild on the sides of ditches, and other moist situations, and flowering in June. It is cultivated almost every where. Horseradish root, scraped, is a well-known condiment; has a pungent taste, and exhales a highly penetrating acrid vapour. These properties appear to reside in an exceedingly pungent, acrid, diffu- sible volatile oil, which is present in small proportion ; according to one experimenter (Duncan) cited by Dr. Christison, forming not more than four parts in a thousand; whilst another (Gutret) got scarcely a sixth part of that proportion. It is difficult, however, to conceive, that so small a quantity of the acrid principle can produce so much excitation. The odour of the oil, obtained by distillation without water, is extremely powerful, and like that of horseradish : a single drop is sufficient to impregnate the air of a whole room. Horseradish has been used as a masticatory in cases of paralysis of the tongue. It powerfully excites the nerves of the lining mem- 264 DIURETICS. brane of the mouth, and, through it, the salivary glands, which aug- ment their secretion. It is by virtue of its excitant agency, that it is serviceable, when made into a syrup, in certain cases of aphonia, dysphonia, or hoarseness, where the affection is dependent upon want of power in the nerves concerned in phonation, or upon a state of the intrinsic organs of voice, which excitants are capable of benefiting. 5. ZIN'GIBER. —GINGER. The rhizoma of Zin'giber ofiicina'le—which is described else- where—when chewed, occasions an increased flow of saliva. It has been used as a masticatory in paralysis of the tongue and of the muscles of deglutition. 6. TAB'ACUM. —TOBACCO. Tobacco is a well-known masticatory and sialogogue ; but it dif- fers from the other articles of the class, in possessing peculiar pro- perties by which it acts, when swallowed, on the nervous system, and — as has been seen elsewhere — powerfully depresses the pow- ers of the organism. When used, therefore, simply as a sialogogue, the saliva ought not to be swallowed. Indeed, there are few per- sons, who have been in the habit of chewing tobacco largely, that can swallow any portion of the juice with impunity. Tobacco is sometimes chewed to relieve toothache, and a portion of the relief obtained is, doubtless, owing to the action of the nar- cotic principle. It is not, however, an agent which is easy of ma- nagement in those who are unaccustomed to it; and they, who are in the habit of chewing it, receive little if any benefit from it. It is properly considered to be contra-indicated in paralysis of the tongue, and of the organs of deglutition. The simply excitant mastica- tories are to be preferred. HI. DIURETICS. Synon. Urelics. Definition of diuretics — Their modus operandi-—Mental diuretics — Therapeutical employment of diuretics — In dropsies — In various chronic diseases — Special diuretics. Diuretics are agents that increase the urinary discharge. Direct diuretics are such as act immediately and specially on the kidney, so as to increase its secretion, and to these the term is more particularly appropriated. As in other cases, however, it has been extended, so as to include any agency, that may indirectly produce diuresis. Thus, diluents may become diuretics, by increasing the mass of the circulating fluid, and, of consequence, the quantity of urine ; — in other words, by occasioning the elimination of that, MODUS OPERANDI. 265 which has been artificially introduced ; and, in the same manner, a cool temperature, by diminishing the amount of the cutaneous and pulmonary depurations, may augment that which is effected by the urinary organs. If, too, any inflammatory condition of the kidneys exists, blood-letting, although it diminishes the amount of circulating fluid, may restore the diminished renal secretion ; but it is unneces- sary to go into the consideration of the various agencies that may prove indirectly diuretic : they will suggest themselves readily to the pathological inquirer. The object, at present, is to investigate the modus operandi, and applicability, of substances, that belong strictly to the class of diuretics; — and which, if injected into the blood in appropriate doses, will seek out the urinary organs, and exert on them their operation ; — "in appropriate doses," because many of them, — as cantharides, and turpentine, — if given in too great quantity, may induce nephritis, and haematuria, without in any manner augmenting the urinary depuration. Under ordinary circumstances, it is necessary, that a certain quan- tity of urea, or its elements, should be separated from the blood ; otherwise, disease and death may ensue. Accordingly, whenever the urinary secretion is suppressed, in protracted or acute diseases, it is an unfavourable, and, in many cases, a fatal symptom, inasmuch as it exhibits a total revolution in the accomplishment of indispen- sable functions, and one not likely to admit of restoration. There are, however, anomalous cases on record, in which the urinary depuration has not taken place for years together ; and, in the " Philosophical Transactions," for 1713, Dr. Richardson gives the case of a youth — seventeen years of age — who had never passed any urine, and yet suffered no inconvenience. Where this has re- sulted from malformation,—as in the last case, — it may be con- ceived, that the function might be supplied through some other channel, — knowing, as we do, the surprising instances of a similar kind met with in certain cases of monstrosity; but it is not so easy for us to comprehend those cases, in which the depuration, — after having been established for a length of time, — has become entirely arrested, and with apparent impunity. Allusion has already been made to the compensation that appears to exist between tjhe two great depurations—urinary and cutaneous. This compensation is such, that if the one be diminished from any cause, the other is proportionably increased ; and it is probable, that when the urinary depuration is diminished, some of the principles may pass off by perspiration, as urea has been detected in the fluid of the cutaneous exhalation. Perhaps, too, in those diseases, in which we are in the habit, and with propriety, of regarding suppression of the urinary secretion as a fatal symptom, the mischief arises less from the reten- tion of matters that ought to be evacuated, than from the deranged state of the system — the complete bouleversement of functions — which the suppression announces. Of the different substances, ranked under the head of diuretics, vol. i.—23 266 DIURETICS. some pass into the mass of blood, and proceed to the kidneys, with- out experiencing any decomposition; others, on the contrary, un- dergo changes in the first passages, and it is the result only of such changes, that excites diuresis. To the first class belong — amongst other substances — potassa, dilute mineral acids, nitrate of potassa, the oils of turpentine, juniper, &c. The feaster on garlic and aspa- ragus is reminded, by the odour of the urine, of the kind of vege- table that has ministered to his repast; but these are more properly examples of the separation of the odorous principles in the first pas- sages. Reference has already been made to the opinion maintained, — that, when acetic acid is united to potassa, as in the acetate of po- tassa, a separation of the constituents takes place in the stomach, the potassa being set free, and the acetic acid digested,—and it was remarked on that occasion, that as the chlorohydric acid exists, in a state of health, in the gastric secretions, should any such sepa- ration take place, the potassa would belaid hold of by this acid,and chloride of potassium be formed, which would enter the circulation unchanged. The same may be said of the potassa, and its alkaline fellows, when united to other vegetable acids. Our knowledge, however, on this point of animal chemistry is not very precise, and many of our ideas are probably inaccurate. This seems to be the case in respect to the bitartrate of potassa, on which Dr. A. T. Thomson has the following remarks, when speaking of it as a diu- retic. " Its effects in this respect are explained by Dr. Paris on the probability of the decomposition of the salt in transitu ; and con- sequently the conveyance of the alkaline base to the kidneys. It is possible, that this explanation may be correct; but when we consi- der that the quantity of alkali contained in the dose of the bitartrate is equal only to five grains, when a scruple of the bitartrate is taken, and that seven grains of the alkali are taken when twenty minims of the liquor potassae are administered, yet that the effects of the bitar- trate are much more considerable in producing diuresis than the liquor potassae, there is some difficulty in assenting to the accuracy of this explanation." The comments previously made regarding the salts formed by a combination of a vegetable acid with an alkaline base, apply to this salt; and, if any decomposition be effected, it must probably be in part through the agency of the mineral acid, which is always contained in the gastric juice. In the mode and quantity, however, in which the bitartrate of potassa is usually taken as a diuretic,— that is, in solution, in the way of common drink — a portion probably escapes any kind of decomposition, and passes to the kidneys unchanged. In the state of solution, it is eminently adapted for ready absorption, and therefore is enabled to pass through the coats of the blood-vessels of the stomach and duodenum, by im- bibition,— in the way in which tenuous fluids in general readily enter the circulation. Of the diuretics, which are set free in the stomach, —- or, in other MODUS OPERANDI. 267 words, are separated there from the substances with which they are combined, we have marked examples in the vegetable substances, whose diuretic properties are dependent upon oil or oleo-resin; — as the different turpentines, copaiba, cubebs, juniper berries, &c. Even where essential oil is combined with resin it is not certain, that the resin is not separated from the oil by the digestive process, whilst the latter only is taken into the circulation, and proceeds to the kid- ney, to excite its appropriate impression. In the case, indeed, of every vegetable, a separation must take place in the stomach between the diuretic and the rest of its components ; and the same applies to the only animal diuretic in the lists — the cantharis or blistering fly, — the active principle of which — cantharidin — is separated during the digestive process, and probably alone enters the circula- tion, and proceeds to the urinary organs. Lastly, certain mental emotions may be regarded as diuretics: these are of the same character as the mental cathartics. Fear and anxiety of mind are well known agents. Dr. Thomson remarks, that various sounds and even odours operate in the same manner through the medium of the nerves, and refers to Shakspeare, who ascribes this effect to the sound of the bagpipe — " And others, when the bagpipe sings i'the note, Cannot contain their urine." Bat these are cases, which exhibit the influence of sensations and emotions on the power of retention rather than on that of secre- tion. The like result, too, is produced by the exciting emotions. Excessive joy has given rise to the same incontinence as exces- sive dread ; a fact well elucidated by Cervantes, in the effect which he describes to have been produced on Sancho's daughter, when the joyful tidings were communicated to her, that her father had been made governor of Barataria ! By occasioning a copious discharge of the more fluid portions of the blood, diuretics are, to a certain extent, evacuants, but they are rarely employed as such, unless for the purpose of occasioning greater activity of absorption, as in cases where an undue exhala- tion or accumulation of fluid has taken place into one or more of the serous cavities. In other words, diuretics are rarely employed as depletives, where antiphlogistics are indicated. Their effect is too trivial to make any decided impression. It is perhaps by their revulsive action, combined with the diuresis, that they are beneficial in certain diseases. The diuresis itself is a sufficient evidence of their operation as local excitants, even were we not aware, that nephritis, or haematuria, or both, frequently re- sult from their administration in too large a dose,— a fact, which it is important to bear in mind in affections of the kidney, accom- panied by inflammation, and diminished urinary secretion, in which, from an attention to the latter circumstance only, their employment might seem to be clearly indicated. In such affections, they could 268 DIURETICS. not fail to add to the mischief, and the best diuretics would ob- viously be — the lancet and the antiphlogistic medication, which, by removing the pathological cause of the diminished secretion, would give indirect occasion to its restoration. Therapeutical Application of Diuretics. Febrile and inflammatory affections. — From what has been said, then, of the properties of diuretics, their therapeutical employment will be readily intelligible. Much benefit cannot, of course, be ex- pected from them in febrile affections, or in internal inflammations of parts at a distance from the urinary organs; and it would ob- viously be improper to administer any but simple diluents, where the kidney is suffering under inflammatory irritation. It has been already remarked, that, as simple evacuants, not much reliance can be placed upon them : we have other depletives infinitely more effec- tive in such cases. Dropsies. — The chief diseases in which diuretics are prescribed are those of a dropsical character; especially of the abdomen or cellular membrane. By augmenting the secretion from the kidneys, the quantity of circulating fluid is necessarily diminished ; imbibi- tion is augmented ; the fluid of the dropsy soaks through the parietes of the blood-vessels, and, in this way, such collections maybe made to disappear. It is probable, too, that an essential part of the effect is dependent upon the revulsive operation of the diuretic. Acting as a local excitant to the kidney, it occasions an afflux of vital energy to the organ, and thus diminishes the too great exhalation from the vessels of the serous membrane. Reliance is, however, rarely placed upon the administration of diuretics alone in dropsy. The precise pathological condition, which gives rise to it, has to be attentively investigated, and an appropriate system of medication to be united with the diuretic. Thus, the dropsy is often manifestly of an active or sthenic character, so that blood-letting or cathartics, or both, are indicated, and, these being premised, more benefit may accrue from the diuresis than would otherwise have resulted. Fre- quently, in such cases, a combination of agents of another character with diuretics may be used with great advantage. Mercury is an excitant of the secretory system ; squill is a diuretic ; their conjoint action will, therefore, be as follows: — the mercury produces an action of revulsion, — a distraction of vital manifestation from the seat of the dropsical affection to the parts on which it exerts its local stimulation, — the exhalation from the serous membrane is consequently reduced even below the healthy point; a similar in- fluence is exerted by the local stimulation of the diuretic, whilst, in addition, under its operation the absorbed fluid is discharged. Hence, a combination of mercury with digitalis, squill, or some other diuretic, is one of the most useful and most common prescrip- tions in dropsical cases. SPECIAL DIURETICS. 269 It is obvious, that diuretics can never be productive of essential benefit, where organic mischief exists in any of the viscera. Im- peded circulation in the viscera gives occasion to the worst forms of dropsy, as the visceral mischief does not usually admit of remedy. Of this nature is the organic disease of the kidney, to which atten- tion was originally directed by Dr. Bright, in the first volume of his " Reports," and which is distinguished by the coagulable state of the urine— albuminuria. This is often accompanied by dropsy, al- though not always. In such cases, the author has been very cau- tious in the administration of excitant diuretics, under the appre- hension, that they might add to the irritation already present in the kidneys. It is proper, however, to observe, that they have not been regarded by some as contra-indicated in these very cases. Dr. Christison thinks, that a stimulus of one kind may be employed with impunity, and even with advantage, when an organ is labour- ing under irritation of a different kind; and he affirms, that diuretics do not augment the quantity of albumen in the urine, the amount of which has been generally regarded as an index of the degree of local irritation. He considers the best combination in such dropsi- cal cases, to be — digitalis, a sedative diuretic, with bitartrate of potassa, an excitant diuretic, — the efficacy of the diuretic in such cases being increased by the use of an emetic or brisk cathartic. R/ieumatic affections. — Diuretics have been frequently recom- mended in various chronic diseases, especially of a rheumatic na- ture. In lumbago and sciatica, the oils of the different terebin- thinates, as well as the terebinthinates themselves, have been much used, and, at times, with marked advantage ; but their modus operandi is probably altogether revellent,— not from the diuresis they occasion. On the whole, therefore, the class of diuretics, although often had recourse to by the practitioner, cannot be considered to comprise our most efficacious agents in the management of disease. They are applicable to but few morbid conditions, and many of these can be as well treated by other remedies. Accordingly, they are by no means as often employed at the present day as they were formerly. SPECIAL DIURETICS. These may be divided into two classes. 1. Excitant Diuretics, and 2. Sedative Diuretics; the former clearly acting as excitants to the kidneys, and not, therefore, well adapted when there is any in- flammatory condition of those organs; the latter acting more, per- haps, upon the organic actions generally, diminishing the power of the heart and arteries, and therefore well adapted for sthenic drop- sies. These substances seem to act but slightly on the kidneys as 23* 270 SPECIAL DIURETICS. true diuretics, and it has even been objected to ranking digitalis amongst the diuretics, — that its action seems to consist in remov- ing the cause of the dropsy, the fluid being then carried off in the usual manner, so that it is no more a diuretic than quinia, in drop- sies caused by intermittents. (Wohler cited by J. Miiller.) It is probable, however, that not only digitalis, but the other agents, classed as sedative diuretics, are capable of acting directly upon the kidneys so as to increase the secretion from them. I. Excitant Diuretics. 1. JUNIP'ERUS. — JU'NIPER. The excitant properties of juniper are described elsewhere. These are shown to be dependent upon its volatile oil—the O'LEOI JOIPERI. The diuretic virtue is dependent upon the same ; and according to some experiments, in the dose of four drops, which may be given in sugar, it is one of the most certain of diuretics. A recent writer, Dr. Christison, states, that he has found five minims of the oil, mixed with a fluidrachm of spirit of nitric ether, given three times a day in any common vehicle, produce diuresis in dropsy, when other means had failed. The berries, when eaten, affect the urinary organs, increasing the secretion from the kidneys ; and, in large doses, producing renal and vesical irritation. The urine acquires a violet odour under their use. They are occasionally given as a diuretic in dropsy, but are rarely trusted to alone. They may be rubbed up with sugar, and taken in the dose of a drachm or two, three or four times a day. This, however, is not the form in which they are usually prescribed. The author is constantly in the habit of directing them to be taken in infusion as common drink. This may be made by pouring on an ounce of the berries a pint of boiling water, letting it stand till cold, and taking the whole pint in the course of the twenty-four hours. Where the diuretic agency of bitartrate of potassa seems to be indicated, two drachms of it may be added to the juniper berries prior to infusing them. SPIRTTUS JUNIP'ERI COMPOSITUS, COMPOUND SPIRIT OF JUNIPER. (Juni- per, contus. ffcj; carui contus., fceniculi contus. aa. ^iss ; Alcohol. dilut. cong. ; Aqua, Oij.) This spirit, when sweetened, has been regarded as a substitute for Hollands, and for common gin, both of which contain oil of ju- niper ; and hence gin toddy, or hot gin and water, is occasionally prescribed to hydropics as a diuretic. The combination of carraway and fennel seeds adapts it more for an excitant and carminative ; but still, on account of the juniper berries, it is most commonly used as an adjunct to diuretic mixtures. It is rarely given alone. Its dose is f. 3ii to f. 3iv, and both it and the spirituous liquors named above may be of service in highly asthenic cases of dropsy. SCILLA. 271 2. SCOPA'RIUS. — BROOM. TJie fresh tops of Cyt'isus Scopa'rius, Spar'Hum Scopa'num or common broom; Sex. Syst. Diadelphia Decandria ; Nat. Ord. Le- guminosae, are in the secondary list of the Pharmacopceia of the United States, into which they have been admitted on account of their diuretic properties. Broom, — a shrub from three to six feet high, and flowering in June, — is indigenous in Europe, and cultivated in this country as an ornament to the gardens. The tops have a bitter, nauseous taste; and, when bruised in their fresh state, a strong peculiar odour. The seeds possess similar properties, and their virtues are yielded to both water and alcohol. Although broom has been placed in the secondary list of the Phar- macopoeia of the United States, and is but little prescribed by the physicians in this country, it is highly extolled, and placed in the first rank of the diuretics by some practitioners. Dr. Pereira, for ex- ample, affirms, that having very frequently employed it in dropsies, he can add his testimony to its powerful effects as a diuretic, and that he cannot call to mind a single case in which it has failed to act on the kidneys. In some cases, it produced a most marked and beneficial influence on the dropsical effusion, and, in his opinion, it is more certain than any other diuretic in dropsies. Owing to its bitter principle, it is at the same time tonic ; and, consequently, adapted for cases in which the union of a tonic and a diuretic is needed, as in the asthenic forms of dropsy. When given in too large a dose, it acts both as a cathartic and an emetic. The London Pharmacopceia has an Infusum Scoparii, (Scopar. ^j ; Aqua bullient. Oj ;) the dose of which, as a diuretic, is f. ^j. to f. 5ij ;—.-a Decoctum Scoparii Compositum, (Scoparii, Juniper., Taraxac, aa. §ss ; Aqua, Oiss. Boil down to a pint. Dose, f. ^j. to f. ^ij ;) which is a combination of diuretics ; and the Dublin Phar- macopoeia a watery extract prepared from a decoction of the tops — the Extractum Spartii Scoparii—the dose of which is from 3ss. to 5j; but it is rarely prescribed. 3. SCILLA. — SQUILL. Squill — which has been described under Emetics (p. 122) —has long had the reputation of an active diuretic, and as such has been frequently prescribed in dropsical cases, and, at the present day, is perhaps employed as often as any remedy belonging to the class. It is rarely, however, given alone, being combined either with other diuretics — as digitalis, bitartrate of potassa, or juniper berries — or with a revellent, as the mild chloride of mercury. It is an excitant diuretic, and therefore less adapted than digitalis for cases in which there is much vascular excitement, especially of the kidneys. Its dose, in substance, is one grain, repeated every four or five hours. At times, its diuretic influence is not exhibited until it has been pushed s'> as to induce nausea. 272 SPECIAL DIURETICS. The dose of the ACE'TUM SCILLE, (p. 122), as a diuretic, is f. 5SS to f. 3j; and of the TINCTU'RA SCILLE, (p. 122), from trix. to nixx. 4. CHIMAPHTLA.—PIPSIS'SEWA. The leaves of Chimaph'ila umbella'ta, Ch. corymbo'sa, Py'rola um- bella'ta, Pipsis'sewa, or um'bellated winter-green ; Sex. Syst. Decan- dria Monogynia ; Nat. Ord. Pyrolacea, are officinal in the Pharma- copoeia of the United States; and the whole herb in those of Edin- burgh and Dublin. It is a beautiful evergreen, and is indigenous in the northern parts of Europe, Asia, and America, flowering in June and July. The leaves have a bitter sweetish taste, with some degree of as- tringency. Boiling water and alcohol extract their virtues. When subjected to analysis, they yield bitter extractive, resin, tannic acid, gum, lignin and saline matters. It is not determined in what prin- ciple the main activity resides, but, it has been presumed, in the bitter extractive. The constituents would show, however, that the leaves must be tonic, by reason of the bitter principle ; and astrin- gent by reason of the tannic acid. They have, likewise, a decided effect in increasing the secretion of the kidneys; and like marvel- lous virtues have been assigned to them, as to diosma crenata and uva ursi, in diseases of the urinary organs in general! It is in dropsy, however, that the diuretic action of chimaphila has been most fre- quently serviceable, and it may be beneficially employed wherever a tonico-diuretic is indicated. The author has often used it in atonic dropsy, and with decided advantage. An extensive series of experiments was made at the Burger hos- pital at Pesth in regard to its remedial powers in dropsy. Within two years, nearly 200 cases are said to have been radically cured by it. Chimaphila is generally given in decoction, but a watery extract is sometimes prepared from it, which may be prescribed in the dose of 20 or 30 grains, three or four times a day. DECOC'TUM CHIMAPHM,DECOCTION OF PIPSIS'SEWA. (Chimaphil. cont. §j ; Aqua, Oiss. Boil to a pint.) The whole of this may be taken n 24 hours. Where it is desirable to act, at the same time, on the bowels, senna leaves may be added. 5. UAIN'CjE RADIX. — CAINCA ROOT. Radix Ca'in'ca, R. Chiococ'ca, R. Caina'na, R. Canina'na, R. Cahin'ca, R. Kahin'ca, R. Serpenta'ria Brazilien'sis, Cai'nca Root, is not in the British or American Pharmacopoeias. It is the root of Chiococ'ca anguifuga; Sex. Syst. Pentandria Monogynia; Nat. Ord. Rubiaceae; a shrub, which grows wild in Brazil, where the root is employed against the bites of serpents. It is of the thick- ness of the finger, round and knotty; the surface is irregularly wrinkled, the wood tough, and of a whitish colour; the smell, especially of SPIRITUS iETHERIS NITRICI. 273 the fresh root, is disagreeable, and the taste at first like that of coffee, but afterwards nauseous and pungent. The bark of the root is alone active, the woody portion being inert: its virtues are extracted by water and alcohol. Chemical analysis has shown one of its constituents to be a bitter principle, crystallisable in small, white, shining silky needles, which has an acid reaction, owing to the existence of a peculiar acid—the Cahincic acid — and in which the medical virtues appear to reside. It was found by MM. Pelletier and Caventou, to contain, likewise, a fatty, green, nauseous odorous substance, which gives the plant its smell; and a yellow, and, also, a viscid colouring matter. The main therapeutical effect of Ca'inca is exerted on the digestive and urinary organs. It occasions watery evacuations, and increased secretion of urine. It has been doubted, however, whether its bene- ficial effects in dropsical cases have not been dependent rather upon its cathartic than its diuretic agency. The testimony in regard to its action in dropsy has been discordant, but many have deposed very strongly in its favour. It is given in various forms of preparation — powder, infusion, de- coction, tincture, extract, syrup and wine. The wine is formed from one ounce of the powdered root to a pint of wine; the tincture from one part of the root to eight parts of alcohol. The dose of the powder is from 9j. to 3ss. in the 24 hours. It appears, however, that it gives rise to disagreeable symptoms more frequently than the other forms. It is affirmed, that there is a remarkable analogy between ca'inca and apocynum cannabinum. 6. BAL'LOTA LANA'TA. Bal'lota Lana'ta, Sex. Syst. Didynamia Gymnospermia; Nat. Ord. Labiatae, is a plant which grows exclusively and commonly in Si- beria ; where it has long had great reputation in dropsy. It has been, of late years, introduced into Russia, Germany and Italy, but has not been employed in this country. The whole plant is used, except the root; and ample testimony exists to show, that it largely increases the urinary secretion, and has produced unequivocally good effects in dropsical cases. The form of preparation usually prescribed is the decoction. (Ballot. Lanat. ^iss — ^ij; Aqua Oij ; boil to a pint. Dose, a cupful, night and morning.) 7. SPIRTTUS ./E'THERIS NITRICI. —SPIRIT OF NITRIC ETHER. The Spirit of Nitric Ether, Spiritus Nitri dulcis, Sweet Spirit of Nitre, Nitre Drops, or — as it is often called — Nitre, is a mixture of impure hyponitrous ether and alcohol. According to the process of the Edinburgh Pharmacopoeia, it is formed by first preparing nitric oi hyponitrous ether, and then diluting this with alcohol. The 274 SPECIAL DIURETICS. Pharmocopceia of the United States does not generate the ether by the direct mutual reaction of nitric acid and alcohol; but provides the materials for the formation of the nitric acid, as in the annexed process : — Take of Nitrate of potassa, in coarse powder, ffeij '■> Sul- phuric acid, foiss; Alcohol, nine pints and a half; Diluted alcohol, a pint; Carbonate of potassa, |j : Mix the nitrate of potassa and the alcohol in a large glass retort, and, having gradually poured in the acid, digest with a gentle heat for two hours ; then raise the heat and distil a gallon. To the distilled liquor add the diluted alcohol and carbonate of potassa, and again distil a gallon. The redistillation from carbonate of potassa is directed to get rid of some acid, which is always contained in the product of the first distillation. Spirit of nitric ether, thus obtained, has the specific gravity 0-834, is colourless, has a peculiar and fragrant ethereal odour ; and a pungent, slightly sweet and acidulous taste. It red- dens litmus paper, but does not effervesce with carbonate of soda ; by keeping, however, it becomes decidedly acid, and may decom- pose various substances, with which it is frequently combined in prescriptions. To obviate this, it may be kept on crystals of carbo- nate of potassa. It is very volatile, and therefore, requires to be kept in well stopped bottles. It dissolves in water and alcohol in all proportions. It is very extensively adulterated, sometimes with three or four times its weight of alcohol and water. Dr. Pereira states, that in July 1840, Mr. Hennell, of Apothecaries' Hall, Lon- don, informed him, that it was then selling in the trade at a price, which was but just above that of the duty on the spirit used in manufacturing the genuine article. Wholesale dealers, too, are said to keep two or even three qualities of the preparation. The density and flavour will lead to a tolerably accurate estimate of its goodness. Spirit of nitric ether decidedly increases the action of the kidneys ; yet it is rarely given alone in dropsical cases ; and not very often in association. It may be combined with squill, bitartrate of potassa, juniper berries, &c. It must be borne in mind, however, that it is an excitant diuretic, and ought, therefore, to be given with caution in dropsies connected with disease of the kidney. It is best adapted for those of the asthenic kind. Its dose as a diuretic is from f. 3SS to f. 3ij, in water, repeated two or three times a day. SALTS OF POTASSA. 8. POTAS'SiE BITAR'TRAS. —BITART'RATE OF POTAS'SA. Bitartrate of potassa, in small doses, is a diuretic, and as such is used in dropsical cases,— rarely alone, sometimes combined with other diuretics, as squill, digitalis, juniper berries, &c.; at others, united with cathartics, to which class of medicinal agents it likewise be- longs. (See page 186.) POTASS^ NITRAS. 275 As a diuretic, it may be given in molasses in the dose of a scruple to a drachm, repeated two or three times in the twenty-four hours. This is not, however, so good a form as the solution of the salt, made by pouring a quart of boiling water on half an ounce of the bitar- trate, sweetening with sugar, and flavouring or not with lemon- peel. This may be taken freely as common drink unless it should act too much upon the intestines. The ordinary imperial is made by dissolving a drachm or a drachm and a half of the bitartrate in a pint of boiling water, and adding lemon-peel and sugar. A cream of tartar whey is made by adding about two drachms of the bitartrate to a pint of milk, which may be diluted with water, and drunk as a diuretic in hydropic affections. It may also be rendered soluble by borax or boracic acid, and be given in this way. 9. POTAS'S^E NITRAS. —NITRATE OF POTAS'SA. Nitrate of Potassa, Nitre or Saltpe'tre, occurs in both the inor- ganic and the organised kingdom. In the former, it is met with in certain soils, efflorescing on the surface ; in the latter, it has been found in various plants. For the various modes in which it is ob- tained from its natural sources, as well as artificially, the reader is referred to chemical works. It is found naturally in various parts of the United States, especially in the southern and western portions, where it occurs, for the most part, in caverns or limestone rock, called saltpetre caves, and is associated with nitrate of lime. The earths, contained in these caves, are lixiviated, and yield, according to the impregnation, from one to ten pounds of crude nitre to the bushel. These caves are especially numerous in Kentucky, and are said to have furnished a large portion of the nitre used in the United States during the last war. (Wood & Bache.) The greater part of the nitrate of potassa used now in England and in this country, is ob- tained in various parts of the East Indies by a similar kind of lixi- viation. Crude saltpetre, as met with in commerce, requires to be purified for medicinal purposes. This is done by dissolving it in two parts of hot water, filtering the liquor and setting it aside, so that, on cooling, crystals may form. Nitrate of potassa is also prepared, in many parts of Europe, from soils artificially impregnated with animal matter, or from the mortar of old buildings, especially of the under-ground floor, or from artificial composts, consisting of animal substances, decaying vege- tables, ashes and chalk, marl or lime. The nitrate, thus produced in the first place, is the nitrate of lime, which is converted into ni- trate of potassa by the addition of carbonate of potassa. Nitrate of potassa, as met with in the shops, is tolerably pure. It is in fragments of crystals, of considerable size, which are striated, opaque, colourless, six-sided prisms, terminated by one, two or six converging planes. The crystals are unalterable in the air, and 276 SPECIAL DIURETICS. wholly soluble in water. They have a sharp, cooling taste. The salt is occasionally adulterated with sulphate of potassa, and muriate of potassa. The sulphate is detected by a solution of the chloride of barium, which occasions a white precipitate of sulphate of baryta ; the muriate, by the nitrate of silver, which produces a white preci- pitate of chloride of silver. Nitrate of potassa, besides its other properties, possesses those of a diuretic. It is taken up into the mass of blood, and is separated by the kidneys, so that it may be detected in the urine. It is not often, however, prescribed as a diuretic, in consequence of there being more potent articles of the class. It may be given in the dose of gr. x. to 3ss. dissolved in water, and its action may be facilitated by taking diluents freely. 10. POTAS'S^E ACE'TAS. — ACETATE OF POTAS'SA. Acetate of potassa, which was formerly termed Sal diuret'icus, had at one time great reputation for its powers in augmenting the urinary secretion; but it is not now much employed. In large doses — as elsewhere shown, (p. 190,)— it is cathartic ; and may produce a joint cathartic and diuretic action. It was highly thought of by Dr. Duncan, jr., in dropsy ; and Alibert considered it the best of diuretics in hydrothorax. It unquestionably is diuretic in small doses, and may, therefore, be serviceable in dropsies, but it is less efficacious, apparently, than bitartrate of potassa, which has now usurped its place. An acetate may be made by saturating vinegar with the potassa of the carbonate of potassa. Acetate of potassa — as before remarked — must undergo decom- position in the stomach, if chlorohydric acid be present, and it is affirmed, that if none should exist there, the potassa alone enters the circulation, and is separated by the kidney. If this explanation be true, the diuretic agency must be ascribed to the potassa, and not to the acetate. The dose, as a diuretic, is from gr. x. to gr. xx., given in any diluent or demulcent. 11. SALTS OF SODA. Many of the salts of soda are diuretic, but none of them emi- nently so. ^ The Borate— Sod^s Boras—- has been sometimes given in dropsy, in the dose of 3ss to 3j, frequently repeated ; the Carbo- nate— SoDiE Car'bonas — in the dose of gr. x. to 3ss; and the Bicarbonate — Sodje Bicar'bonas — in the dose of gr. x. to 3J ; but they are never trusted to alone, and it is doubtful whether they are worthy of being classed amongst the active diuretics. 12. CAN'THARIS.— SPANISH FLIES. The Spanish Fly or Blister Beetle — Class, Insecta ; Order, Co- CANTHARIS. 277 leoptera, is a native of the south of Europe, and also of Germany and Russia ; and it has been met with in Eng- ris- 4<>- land. In the summer of 1837, according to Dr. Pereira, it was abundant in Essex, and Suffolk. It is found on species of Oleaceae, as the ash, pri- vet, and lilac; and of Caprifoliaceae — as the el- cantharides. der and lonicera. It inhabits the earth in the larva state, and appears in the form of fly in May, when it infests the trees and shrubs in such numbers in some of the promenades of southern Europe, as to drive away the visiters. The flies are caught either in the morning or evening, at which time they are less active, by spreading cloths under the trees, which are strongly shaken or beaten with long poles. The collec- tors are obliged to have both their faces and hands protected. After they have fallen off they are killed by being exposed to the vapour of vinegar, hot water, spirit of wine, or oil of turpentine ; or by immersing the cloths containing them in hot vinegar and water, and then drying them. At one time, Spain supplied Cantharides largely, whence their name Spanish Flies ; but at the present day, they are imported partly from Messina, and partly from St. Petersburg. They are very abun- dant in the southern provinces of Russia. The Russian flies are the largest and most esteemed. In the year 1839, duty was paid in England on 16,376 pounds. (Pereira). Dried Spanish Flies — as met with in the shops — are from six to ten lines long, and about a grain and a half in weight. Their odour is peculiar and disagreeable; their taste acrid and burning. They should be kept perfectly dry by means of well stopped bottles, and as they are subject to destruction by insects — which devour the vesicating portion with the rest — it may be well to sprinkle them with pyroligneous acid, or with a few drops of strong acetic acid. This last has been found an excellent preservative. When dried, they can be reduced to powder, which has a grayish-brown appear- ance, with numberless shining green particles. It is in this state that they are most liable to adulteration. When in the entire state, their goodness is appreciated by their odour, and freedom from mites and other insects. The powder is sometimes adulterated with powdered euphorbium, especially in the formation of the plaster, and Dr. Pereira affirms, that he has been informed by persons well acquainted with the fact, that it is a common practice, amongst certain druggists, to mix one pound of euphorbium with fourteen pounds of powdered Spanish Flies. Cantharides have been often analysed, but the results obtained by vol. i.—24 278 SPECIAL DIURETICS. Robiquet have received the most attention. He found them to con- tain, 1. A peculiar principle — cantharidin — procured by concen- trating an alcoholic tincture obtained by displacement, and setting it aside, so that the cantharidin may crystallise : the blistering property of cantharides is evident in this. 2. A green fatty oil, soluble in alcohol. 3. A fatty matter insoluble in alcohol. 4. A yellow viscid substance, analogous to osmazome. 5. A black colouring matter. 6. A yellow colouring matter. 7. Free acetic and uric acids; and 8. Phosphate of lime, and phosphate of magnesia. The main active constituent appears to be the cantharidin, and it Would seem to exist only in the trunk and soft parts of the body, as the other parts have been found inert or nearly so ; yet there would seem to be some volatile odorous matter exhaled from the insects, as irritation is produced by sitting under trees on which they are found, or by breathing the vapour from a decoction of them. The virtues of cantharides are yielded to boiling water; but more readily to acetic acid, alcohol, pure and dilute, — ether, and the fixed and volatile oils. Of the effects of Cantharides, when applied to the cutaneous surface, mention will be made in another place. Taken internally, they are a most violent acrid poison, and have therefore to be pre- scribed with great caution as a medicinal agent. When given in too large a dose, their effects on the genito-urinary system are ex- hibited by the ordinary signs of nephritis and cystitis; and, by the extension of the irritation through contiguous sympathy, priapism, and sometimes satyriasis are induced in the male ; and irritation of the sexual organs, and occasionally abortion in the female. When given to this extent, the renal secretion maybe diminished or arrested. In a smaller dose, however, they excite the kidneys to increased action ; but although always classed amongst diuretics, they are un- certain in their operation, and are really more beneficial as revellents, through the nephritic irritation which they induce; accordingly, they are less prescribed in diseases, which, like dropsy, require an augmentation of the secretory action of the kidneys, than in neuralgic affections, which, like lumbago and sciatica, are best relieved by revellents. It can likewise be understood, that, by virtue of those same excitant properties, they may be beneficial in paralysis of the bladder, and in cases of atony of the genito-urinary organs in general. Should cystitis be induced by them, it must be met by blood-letting, and by the free use of demulcent drinks. The dose of the powdered flies is one or two grains made into a pill with conserve of roses, or extract of taraxacum, which may be repeated twice a day. The tincture, however, is more frequently employed. TINCTU'RA CANTHAR'IDIS, TINCTURE OF SPANM FLIES. (Cantharid. contus. ^j ; Alcohol, dilut. Oij. It may be prepared by simple mace- ration, or by displacement.) The dose is "Ix to f. 3J, repeated three or four times a day in some demulcent fluid, as barley water or flaxseed tea. TARAXACUM. 279 The external application of cantharides will fall under consideration elsewhere. 13. can'tharis vitta'ta. — pota'to flies. Can'tharis Vitta'ta, Lytta Vitta'ta or Pota'to Fly, is somewhat smaller than Cantharis Vesicatoria, — its length being about six lines. The head is of a light red colour, with dark spots on the top; the feelers are black; the elytra or wing-cases black, with a yellow, longitudinal stripe in the centre, and a yellow margin; the thorax is black, with three yellow lines; and the abdomen and legs, which are of the same colour, are covered with an ash-coloured down. (Wood & Bache.) The flies appear — as their name imports — on the potato plant, and are first observed about the end of July or the the beginning of August. They are found in the morning and evening; and are collected by shaking them from the plant into hot water; after which they are carefully dried in the sun. Cantharis vittata is a native of the middle and southern States. It resembles cantharis vesicatoria in all its properties. Other species of cantharis are found in the United States, viz. C. Ciner'ea, a native of the northern and middle States ; C. Margi- na'ta ; C. Atra'ta, common in the northern and middle States, &c. &c. ; but C. Vittata is the only one that is officinal. 14. TARAX'ACUM. — DAN'DELION. Leon'todon Tarax'acum, Tarax'acum Dens Leo'nisor Common Dan- delion ; Sex. Syst. Syngene- Fig. 41. States. When fresh, it is tapering, and abounds with a milky juice, which contains bitter extractive, caoutchouc, resin, gum, sugar, and various salts. It yields its virtues to hot water, and hence the decoction is officinal in the Edinburgh and Dublin Pharmacopoeias: the extract is in all of the British Pharmacopoeias as well as in that of the United States. 280 SPECIAL diuretics. Taraxacum is generally regarded as a diuretic and tonic ; nay, it has even been supposed to be in addition, " aperient, deobstruent [?] and alterative," but how it produces these effects, and in what cases, we have yet to learn. The author has often administered it, and the results of all his trials induce him to consider, that its reme- dial agency is extremely restricted. That it is possessed of tonic powers to some extent can no more be doubted of it than of other bitter vegetables; but even in this respect it is far inferior to most of the vegetable tonics. " After having been long abandoned in practice," observes a recent writer, Dr. Christison — " it was re- sumed not many years ago in this country, (Great Britain,) and be- came a fashionable remedy, especially in London, as a tonic ape- rient and alterative in dyspepsia, and as a deobstruent, and promoter of the biliary secretion in functional as well as organic diseases of the liver. It seems not without its use in dyspepsia and functional biliary derangements ; but my own observation of its effects would lead me to infer, that much has been ascribed to the extract of dan- delion in these and other affections, which musth&ve been owing to collateral remedies, or to regimen and diet." It is asserted to have been found beneficial in cases of dropsy de- pendent upon hepatic obstruction, but it is probable, that farther ex- perience will limit more and more the range of its employment, and that it may ultimately be discarded altogether. It may be given in the form of Decoctum Taraxaci, Decoction of Dandelion. (Taraxac. contus. ^ij ; Aqua Oij ; boil to a pint.) Of this, from one to two fluid ounces may be given three or four times a day. It may be associated with other diuretics, as squill, or bitar- trate of potassa. EXTRAC'TUM TARAX'ACI, EXTRACT OF DAN'DELION. This extract is made from a decoction of the fresh root. The dose is twenty or thirty grains two or three times a day. The author rarely prescribes it ex- cept as an excipient for certain tonic or other agents that require to be made into pills. Recently a Cream of Taraxacum has been proposed by Dr. Collier, which he prepares in the following manner. Cut the fresh roots of dandelion, — freed from any adherent earthy matter, and previously washed and scraped, — into transverse slices. Sprinkle any quan- tity of these, whilst moist, slightly with spirit of juniper, and ex- press them in a tincture press. The dose of the cream, thus ex- pressed, is a table-spoonful, or more, twice or thrice a day, which, according to Dr. Collier, will probably produce two or more bilious evacuations in the day. It may be diluted, and given in the form of draught, with any of the diuretic waters and infusions, or with a solution of cream of tartar. 15. O'LEUM TEREBINTHTN^E. — OIL OF TUR'PENTINE. The characters of this volatile oil arepointed out under Excitants. ERIGERON canadense. 281 In a moderate dose, it is unquestionably an excitant diuretic ; yet its properties in this respect are by no means marked, and much of its character may have been derived from the fact, that its use — as well as that of the terebinthinates in general — gives occasion to a violet odour of the urine. It has been administered, however, in dropsy, and in asthenic cases is said to have been occasionally serviceable. It certainly cannot be indicated in dropsy of the ac- tive kind, accompanied with vascular excitement. In larger doses — as elsewhere remarked — it is a powerful excitant of the abdo- minal nervous system especially, and hence has been given in cases of tubercular meningitis, or what has been conceived to be the stage of invasion of acute hydrocephalus ; but in such case its diuretic ope- ration was not looked to. In cases of lumbago, sciatica, &c, its operation is rather revellent than diuretic ; — the excitant or revel- lent action being exerted on the kidneys. It may be given in the dose of 8 or 10 drops three times a day, dropped on sugar, mixed with molasses, or made into an emulsion with mucilage or yolk of egg. 16. Copa'iba, and 17. Cubebs (see Excitants) act much in the same manner as oil of turpentine. They are never given in dropsy as diuretics ; but they are prescribed where it is necessary to exert a revellent or excitant action on the kidneys. Yet, they are often classed amongst diureties. Besides the agents already prescribed, the Pharmacopceia of the United States has admitted into the secondary list the following ex- citant diuretics. 18. Caro'ta, Car'rotseed—the fruit of Daucus Caro'ta ; Sex. Syst. Pentandria Digynia; Nat. Ord. Umbelliferae—a common plant, growing wild in the United States, and flowering in June and July. The properties of carrotseed are probably dependent upon volatile oil, and are readily communicated to boiling water. Carrotseed are not much used by the physician; but are fre- quently prescribed as a domestic remedy in affections of the urinary organs, and in dropsy. The dose of the bruised seed is from 3ss to 3J. They are more commonly given in infusion. (Carot. §j ; Aqua bullient. Oj. to be taken during the day.) 19. Delphin'ium, Larkspur, — the root of Delphinium Consol'ida ; Sex. Syst. Polyandria Trigynia; Nat. Ord. Ranunculaceae—a species introduced from Europe, and now naturalised; flowering in June and July. The flowers, seeds and root are all said to be diuretic ; but the last is the only part that is officinal. It is little if at all used. 20. Erig"eron Canaden'se Can'ada Fleabane; Sex. Syst. Syn- genesia Superflua; Nat. Ord. Compositae Corymbiferee — an indi- 24* 282 SPECIAL DIURETICS. genous plant, common in the northern and middle States ; flower- ing in July and August. The whole plant is officinal. Its main constituents are tan- nic, and gallic acids, bitter ex- tractive, and volatile oil. It is, therefore, astringent, tonic and, it is affirmed, diuretic ; and has been given in dropsy and also in chronic diarrhoea and dysentery ; either in pow- der, the dose of which is ^ss to 3J ; or in infusion. (Eri- ger. Canadens. ^i; Aqua bul- lient. Oj. Dose f. |iss to 21 & 22. Erig"eron He- terophyl'lum, Various-leaved Fleabane,andF,. Philadel'phi- cum, Philadelphia Fleabane; both of which are called Sca'- bious — are found in various parts of the United States, and are used as diuretics in dropsy. They are given in infusion or decoction. (Eriger. ^j; Aqua bullient. Oj. Dose f. ^ij to 31V, every three or four hours.) 23. Petroseli'num, Pars- ley — the root of A'pium Pe- troseli'num ; Sex. Syst. Pen- . tandria Digynia. Nat. Ord. Umbelliferae — a native of southern Europe, but culti- vated in gardens every where. It contains an essential oil, which is said to communicate to it diuretic virtues. It is also affirmed to be aperient. The strong in- fusion has been advised in dropsical affections, and in diseases of the urinary organs in which a diuretic is considered to be indicated ; but it is hardly ever used, and is not much worthy of the attention of the practitioner. II. Sedative Diuretics. 24. DIGITA'LIir. — FOXGLOVE. Digita'lis purpu'rea, or Purple Foxglove; Sex. Syst. Didynamia DIGITALIS. 283 Angiospermia; Nat. Ord. Scrophulariaceae, is an herbaceous bien- nial plant, growing wild in most of the temperate countries of Eu- rope, where it begins to flower in June, and ripens its seed in August and September. In the United States, it is cultivated both for orna- ment, and medicinal purposes. The leaves are alone officinal in the Pharmacopceia of the United States. The London Pharmaco- pceia admits also the seeds. Doubts have existed, in the minds of many observers, in regard to the equal activity of the cultivated and the wild specimens, and, in the doubt, the wild or native plants have been generally pre- ferred. The leaves are usually gathered, as first advised by Withering, in June or July, when the plant is coming into flower, or soon after- wards. It has been considered, however, unnecessary to restrict the gathering of them to this period, as their bitterness, which may perhaps be some measure of their activity, is very intense both in February and September, and their extract is highly energetic as a poison in the middle of April, before any appearance of the flow- ering stem. They should be dried very carefully, and be pre- served from light and air. The midrib and footstalk—being pos- sessed of little or no efficacy — may be removed before drying. In this state, they are of a dull green colour, faint odour, and a bitter nauseous taste. As met with in the shops of this country, digitalis is often in com- pressed masses, like the dried herbs in general prepared by the Shakers of Lebanon; and these cakes are not unfrequently found to be more or less mouldy; hence this mode of preparation has been properly objected to. (Wood and Bache.) Digitalis readily yields its virtues to water and alcohol. It has been repeatedly analysed, but no important pharmacological infor- mation has been obtained. At one time, its active principle was supposed to have been discovered, and was termed Digitalin; but the discovery was not confirmed, — the digitalin being esteemed a mixture of other matters. Recently, however, MM. Homolle and Quevenne have succeeded in separating it. When pure, it pre- sents itself in the form of a white, inodorous powder, of an exces- sively bitter taste, which is especially experienced in the fauces. When disseminated in very small particles in the air it causes violent sneezing. It is scarcely soluble in cold water; rather more so in boiling water; and is soluble in all proportions in dilute and con- centrated alcohol. Pure ether only dissolves traces of it; but the slightest addition of alcohol considerably increases its solvent power. An empyreumatic oil has been obtained from the product of de- structive distillation, which is composed, in part, of a highly narcotic crystalline principle. When given to a rabbit, it caused paralysis of the hind legs, convulsions, laborious and rapid breathing, and accelerated action of the heart. The effects of digitalis on the nervous system, and, through it, 284 SPECIAL DIURETICS. on many of the functions, will be described under the head of Narcotics. In this place, its action on the kidneys alone falls un- der consideration. This it exerts both in disease and health, and hence it is properly a direct diuretic. On inspecting the testimony of various observers in regard to the dropsical cases, in which the diuretic virtues of the digitalis have been had recourse to, much that appears to be irrational is percepti- ble. It is well known to be a powerful sedative, and as such is employed, whenever the force of the circulation has to be controlled, as in hypertrophy of the heart, and in great vascular excitement, no matter how produced ; hence it would seem to be especially adapted for the sthenic forms of dropsy ; yet we are told by Withering — and the remark has been handed down from one therapeutical wri- ter to another — that " it seldom succeeds in men of great na- tural strength, of tense fibre, of warm skin, of florid complex- ion, or in those with a tight and cordy pulse." " On the con- trary" — it is affirmed — "if the pulse be feeble or intermitting, the countenance pale, the lips livid, the skin cold, the swollen belly soft and fluctuating, or the anasarcous limbs readily pitting under the pressure of the finger, we may expect the diuretic effects to fol- low in a kindly manner." Yet, if we know any thing rational con- cerning the modus operandi of digitalis, it ought to be adapted for the first set of cases rather than for the last. Doubtless, it may be itself insufficient to reduce the sthenic condition of the system, and may require the use of an active antiphlogistic treatment, premised or combined with it; yet in the sthenic class of cases, its utility has been most manifested ; and such is the result of the author's expe- rience. It certainly has not been found by him, as by Dr. Christi- son, " most serviceable in dropsies associated with an enfeebled state of the constitution." The writer just cited affirms, moreover, that " dropsies depending on diseased heart, are more under its in- fluence than any other kind, and next those connected with diseased kidneys ;" but this cannot be regarded as established. No gene- ral assertion of the kind is, indeed, admissible, inasmuch as every thing will depend upon the degree of cardiac mischief, that gives occasion to the dropsy. Too often, in such cases, all remedies fail; and, in the very nature of the circumstances, they can only act as palliatives. As a diuretic, digitalis should be given in small doses — for ex- ample, one grain of the powder three times a day—until the effect is induced. In all cases, however, the patient should be watched, and if great depression of the powers of the circulation, giddiness, in- somnia, nausea and vomiting, or convulsions should supervene, its use ought to be suspended. It has been the opinion of some prac- titioners, that its effects are cumulative, and that they may explode — as it were— some time after it has been discontinued. This may be borne in mind. At the same time, it is proper to add, that al- though the author has prescribed it largely, in hospital and in pri- DIGITALIS. 285 vate practice, he has never witnessed this cumulation, which has been the source of so much alarm to others. It would seem, how- ever, from the results of recent experiments on digitalin by MM. Bouchardat and Sandras, that its toxical power has to be feared, notwithstanding the prescriber may have felt secure for several days. Digitalis is not often, perhaps, given as a diuretic alone. It is either combined with squill, bitartrate of potassa, or with the mild chloride of mercury — with the latter, for the reasons already ex- pressed, (p. 269). The Edinburgh College has a Pilula Digitalis et Scilla, which is a combination of two of the diuretics men- tioned. (Digital., Scilla §.a p. i: Confect. aromat. p. ii. Beaten into a proper mass with confection of red roses, and the mass divided into four-grain pills.) The Infusion and the Tincture are officinal in the Pharmaco- poeia of the United States; and the latter is perhaps most frequently employed. INFU'SUM DIGITA1IS, INFUSION OF FOXGLOVE. (Digitalis 3!; Aqua bullient. Oss; Tinct. cinnam. f. ^j.) The tincture of cinnamon is added to prevent the digitalis from affecting the stomach. The in- fusion is a good preparation ; by some, indeed, believed to be the most effective of any. Its dose is f. ^ss to f. ^j, repeated every six hours or oftener. The recent observations of Dr. Munk on a very large number of cases induce him to give the preference to the infusion as a diuretic over every other preparation of the drug. TINCTU'RA DIGITALIS, TINCTURE OF FOXGLOVE. (Digitalis §iv; Alcohol. dilut. Oij ; — made by maceration, or by displacement.) The usual dose of this tincture is ten drops, repeated three times a day, and cautiously increased where considered advisable. This quantity the author has generally found sufficient to induce rnot only the diuretic but the sedative effects of the drug. Others, however, fix the usual dose at ten minims repeated every six hours, and Dr. Pereira states, that he commonly begins with m„xx. The largest dose he has em- ployed is f. 3j- It has, he states, been given to the extent of one ounce ! The author has known some cases of protracted and severe disease in which very large doses have been administered with im- punity ; but these cases of resistance must be considered as excep- tions rather than as forming the rule. They may, also, be occa- sionally explained by inactivity in the preparation. None but well- prepared and well-preserved leaves should be used in the formation of the tincture ; and a great superiority has been noticed in that made from carefully preserved leaves imported from England. — (Wood & Bache). The Germans have a Tinctura Digitalis ./Etherea, made by macerating digitalis in sulphuric ether in place of dilute alcohol. Sir George Lefevre says, "that this is a very useful preparation, and a convenient mode of administering the remedy. The nauseating proper- ties of the digitalis, he thinks, are counteracted by the stimulant power 286 SPECIAL DIURETICS. of the menstruum," and in cases of serous effusion, where it is desira- ble to increase the action of the absorbents, and to determine to the kidneys, this preparation seems to combine these advantages with- out producing the nausea and exhaustion, which frequently accom- pany the use of the simple tincture. Digitalin, described above, when exhibited in a very serious case of anasarca complicated with pericarditis and haematuria, caused, ac- cording to M. Bouchardat, an enormous and immoderate diuresis, accompanied by greatly diminished frequency of pulse, which, in 48 hours, fell from 120 to 54 in the minute. The absorption of the dropsical fluid was effected very rapidly, and the treatment proved successful. In two cases of pleurisy, the diuretic action was evi- dent, and the absorption of the effusion seemed to be hastened. The dose and mode of administering this energetic agent require the greatest circumspection. M.M. Homolle and Quevenne, from comparative essays, have found, that four milligrammes (gr. .0616) of digitalin correspond in energy of action to about eight French grains (gr. 6.56) of digitalis. 25. COL'CHICI RADIX__COL'CHICUM ROOT; AND COL'CHICI SEMEN. — COL'CHICUM SEED. The general properties of Colchicum are described under the head of Sedatives. In its effects it is said by some to resemble digitalis in one thing, — that it renders the pulse less frequent. Others, how- ever, think, that it agrees more with the squill in certain respects, and they would, consequently, class it rather amongst the Excitant Diuretics. The root, and the seed have been given as diuretics in dropsy, both formerly and in more modern times. In such cases it is well to push the remedy until it affects the bowels as well as the kidneys. The dose of the dried root and of the seeds is the same, — from two to eight grains. ACE'TUM COL'CHICI, VINEGAR OF COL'CHICUM. (Colchic. rad. contus. |ij; Acet. destillat. Oij ; Alcohol, f. §j ; prepared either by maceration or displacement.) Vinegar of colchicum has been a favourite diuretic m dropsy. Its dose is from f. 3ss to f. 3j. The other preparations of colchicum are given under Sedatives. 26. VERA'TRIA. This active principle, whose properties are described under Seda- tives, is also possessed of diuretic powers ; partly, perhaps, as sug- gested by Dr. Turnbull, owing to the sedative agency, which it has been found to exert on the heart's action, even when applied exter- nally. The testimony of one observer in its favour is so strong as to savour of undue enthusiasm : — « Unadulterated veratria," says Lbers, " acts often on the urinary secretion with magical powers, ANTILITHICS. 287 and it may seem fabulous, when I state, that friction with a very weak ointment of veratria two or three times in the twenty-four hours on the inner part of the thigh, or the back, epigastric region or around the navel, has excited such a copious secretion of urine, that the patients, under its long continuance, began to feel weak and the anasarca, and even the dropsical accumulation in the abdo- men, in a short time almost disappeared;—circumstances, which indi- cate the caution that ought to be observed in apportioning the dose, when we are'satisfied of the goodness of the article." The experience of Ebers has been confirmed by that of others ; but some, as Messrs. Bardsley and Spath, have found it of no avail, and it is now scarcely employed. Veratria may be given in Tincture, (Veratr. gr. iv; Alcohol. |j. Dose, gtt. x. to xxv. in water); or rubbed on the skin in Oint- ment, (Veratr. gr. v.—xx. ; Adipis, 3j. A piece, the size of a hazelnut, to be rubbed on the skin for five or ten minutes, night and morning.) IV. ANTILITHTCS. Definition of antilithics, and of lithonthryptics — Calculous diathesis — Lithic and phosphatic diatheses— Different varieties of calculus — Therapeutical application of antilithics to those varieties—Lithonthryptics — Special antilithics. The class of antilithics comprises agents, that counteract the ten- dency to the formation of calculous concretions in the urinary organs. Under the same head may be investigated the modus operandi of lithonthryptics, or agents which are capable of dissolving such con- cretions ; but as our means for the latter purpose are extremely limited, and rarely available or successful, attention will be mainly directed to the class of antilithics. 1. Antilithics. Antilithics are amongst the most interesting of the classes of therapeutical agents ; for what disorder is there, that excites more mental uneasiness and apprehension than any form of calculous de- position. The pain attendant upon the presence of stone in the bladder ; the inutility of remedial agents, when once it has formed, excepting so far as concerns the prevention of its increase, and the serious operations demanded for its removal,— are sufficient grounds for the anxiety, which is felt by every one, when he has reason to believe that he is labouring under a calculous diathesis. That such a diathesis may be present, we have the most unques- tionable evidence, and when it exists the greatest difficulty occurs in removing the tendency to deposition. Often, it appears to be owing to an organisation derived from progenitors; when — like every other hereditary tendency— it is almost irremediable, although due attention to diet and regimen may accomplish much. 288 ANTILITHICS. That this diathesis is connected with a morbid condition of the secerning function of the kidney is clear. We find the organ form- ing that which it ought not, and the urine depositing that which it ought not ; but this vice of secretion is clearly connected with a morbid condition in other organs. The whole system of nutrition is often implicated ; the gastric functions are imperfectly performed ; the nutrition of the body is impaired, and in the phosphatic dia- thesis especially — when largely developed — every symptom is present, which is considered to indicate cachexia. The ordinary urinary calculi arise from the deposition of sub- stances, which are contained in that fluid in a state of health, but are rendered insoluble, owing to various circumstances; but some calculi— as the oxalates — do not exist in the urine in health, and must, consequently, be formed by chemico-vital influence in the kidney. It becomes, however, an interesting topic of inquiry — whether the mischief be, in these cases, seated altogether in the kidney, or whether it may not be, in part, owing to the blood being modified in consequence of general faulty nutrition, so that it con- tains matters which do not exist in it in the normal state. In reply to this, it has been urged, that such matters ought to be de- tected by the chemical analyst; but this objection is invalid, for the reasons elsewhere stated — tbat it is by no meaDS easy to detect even an inorganic substance, — of whose presence we may, not- withstanding, be certain, — when it becomes mixed with compounds of organisation: it may be so masked by the latter, that its presence cannot be indicated by the ordinary—or, indeed, by any — re- agents. On the other hand, there is strong reason for presuming, that the disease is not altogether seated in the kidney, when we reflect on the great similarity between the calculous and the gouty diathesis. It is a common remark, founded on just observation, that of the children of gouty parents some may be liable to gout, and others to calculus, — the males, who are exposed to indulgence in the ordinary exciting causes, being more subject to the former disease ; — the females to the latter. Both diseases are accom- panied by more or less gastric and intestinal derangement, and by modified nutrition in general; and another striking point of simi- larity is the presence of urate of soda in the concretions, which are met with in the joints of those who have suffered from repeated arthritic attacks. Lithic or uric acid was at one time supposed to exist in the urine only, and it is the constituent of one form of urinary calculi; yet, in gouty cases, we have it separated from the blood by other organs than the kidneys, and are, consequently, com- pelled to infer, that in calculous cases the disease may not merely consist in faulty secretion by those organs, but that the blood may contain elements, which can be combined in other secreting organs ; and they clearly are so, in the case of the gouty concretions in question. In the treatment of calculous cases, therefore, it becomes a matter ANTILITHICS. 289 of moment, that our attention should not be directed exclusively to the condition of the kidneys, but that it should be extended to the state of the whole system ; and experience exhibits the correct- ness of this doctrine. The results of the chemical researches of Liebig led him to infer, that when uric acid is subjected to the action of oxygen under certain conditions, it undergoes a metamorphosis, whence, amongst other matters, oxalic acid may result. " Calculi, contain- ing uric acid, or oxalic acid," he says, " are never found in phthisi- cal patients,"— a remark, however, which requires fresh observa- tions before it can be considered established ; and he adds : —"it is a common occurrence in France, among patients suffering from cal- culous complaints, that when they go to the country, where they take more exercise, the compounds of uric acid, which were de- posited in the bladder during their residence in town, are succeeded by oxalates, (mulberry calculus,) in consequence of the increased supply of oxygen. With a still greater supply of oxygen, they would have yielded, in healthy subjects, only the last product of the oxidation of uric acid, — namely, carbonic acid and urea." The two chief calculous diatheses are — the lithic or uric, and the phosphatic. The former is attended by a state of the urine, which reddens litmus paper ; by yellow, red, or lateritious, or pink depositions of lithate of ammonia; or by the appearance of red gravel, which consists of crystals of lithic acid. In the latter, the urine is pale ; at times alkaline ; and there is a deposition of white gravel, or crystals of phosphate of magnesia and ammonia ; or the white sediment contains the mixed phosphates of magnesia, ammonia and lime. At times, these two diatheses do not alternate in the same indi- vidual, but there is usually a great disposition for the lithic to change into the phosphatic. The urine becomes pale under slight causes of general, or gastric disorder ; mixed lithic and phosphatic deposits occur, or an iridescent pellicle of triple phosphate forms upon its surface. (Dr. Marshall Hall.) At length, the urine becomes alkaline, and white gravel is deposited. The phosphatic diathesis is now confirmed. These are the chief diatheses, but others may be enumerated. For example, the crystals of the triple phosphate are apt to be changed for a pulverulent deposit of that phosphate, mixed with phosphate of lime. This mixture constitutes the fusible calculus, and into it all the other forms of calculous diathesis have a ten- dency to pass. Again, a diathesis exists, in which the mulberry calculus or that which consists of oxalate of lime may be formed. From different data, examined by Dr. Prout, it appears that lithic acid predominates in more than one-third of the whole number of urinary calculi ; and very generally it forms the nucleus even of other varieties. It would seem, consequently, that the deposition of lithic acid is a primary step in the formation of urinary calculi, and vol» i.«—-25 290 ANTILITHICS. and that the phosphatic and oxalic formations are the result of a gradual transition from the lithic to the phosphatic or oxalatic dia- thesis. In the progress of this transition, the lithic acid deposition is, in the first instance, changed into one of lithate of ammonia, with a loss of the tinge derived from the colouring matters of the urine. After some time, this last gives place to a sediment, which is chiefly composed of carbonate and phosphate of lime ; and this is ultimately succeeded by a deposition of the phosphates of lime and magnesia, in combination with ammonia. From all his in- quiries on the interesting subject of urinary depositions, Dr. Prout conceives himself warranted in deducing the general law, " that in urinary calculi, a decided deposition of the mixed phosphates is never followed by other depositions." Any unusual formation of acid in the stomach, or elsewhere, may be the cause why lithic acid is deposited from the urine. If we add acid to healthy urine, it is thrown down in small reddish crystals. The litbate of ammonia, which exists in the urine, is decomposed; the acid, which we add, lays hold of the base, and lithic acid is de- posited. We can thus understand, that a deposition of lithic acid crystals may be an evidence of acid dyspepsia. In this last affec- tion, again, as well as in other states of the system, there may be an undue formation of lithic acid or of lithate of ammonia, — as in those labouring under the lithic acid diathesis, — and calculus of gravel may be deposited from such redundancy. Therapeutical Application of Antilithics. The remedies belonging to the class of antilithics, after what has been said, will be sufficiently apparent. Whenever, from the ap- pearances presented by the urinary deposits, and by the concomi- tant symptoms of lithiasis, it is manifest, that lithic acid or lithates are separated from the urine in undue quantity, remedies of the alka- line class should be employed to neutralise any predominant acid, and, along with these, tonic and revulsive means for improving the general health. Dr. Prout has shown, that when the lithic acid dia- thesis exists, and the urine is constantly acid, high coloured, and concentrated, repeated doses of alkalies not only render the urine alkalino, but keep it so as long as they are employed. With these views, the liquor potassa, or the carbonates of potassa and soda are administered with some vegetable tonic, and a thorough change of all the physical and moral circumstances surrounding the indivi- dual, — if this be practicable, — is recofnmended. Change of air, of society, and scenery, must, indeed, be regarded as amongst the most important agents, not only in the lithic acid— but in every kind of calculous—diathesis. The importance, too, of keeping up a free cutaneous exhalation is obvious. The perspiration is acid, and if this acid be not exhaled, its retention in the system may give rise to the acid predominance of which mention has been made. On ANTILITHICS. 291 these grounds it has been affirmed by Dr. Wilson Philip, that dys- pepsia tends to increase the deposition of lithic acid, and to lessen that of the phosphates, both by producing acidity of the primae viae, and by rendering the skin inactive ; and that indolence has the same tendency, both by inducing dyspepsia, and by lessening the activity of the skin, in proportion as it impairs the vigour of the consti- tution. Dr. A. T. Thomson asserts, that lithic acid, in a healthy condi- tion of the habit, is freely thrown off by the cutaneous exhalants, but he probably has not sufficient ground for the assertion ; nor is it necessary to suppose the exhaled acid to be the lithic — to ac- count for the increased deposition of the lithic acid from the urine, in the cases we have been considering. Any acid predominance may induce the same effect. It was affirmed by Mr. A. Ure, that hippuric acid is found in the urine after benzoic acid has been taken ; and that the quantity of lithic acid is thereby diminished. Hence, benzoic acid was recom- mended by him in cases of the predominance of lithic acid. The observations of chemists have not, however, confirmed this. On the contrary, they have shown, that although the benzoic acid appears to be converted into the hippuric, there is no diminution in the quan- tity of the lithic acid. Neither, therefore, in the lithic acid diathe- sis, nor in cases of the formation of gout stones or tophaceous depo- sits, — the chief constituent of which is lithate or urate of soda, — can the administration of benzoic acid be advantageous. A more important suggestion has been made by Dr. GoldingBird, founded on the remarkable solvent action of phosphate of soda on uric acid, to which Liebig has directed attention. This is to admi- nister the salt in solution, sufficiently diluted, — a scruple to half a drachm, for example, — in any vehicle, as broth or gruel. In two cases, its administration appeared to Dr. Bird to be followed by ma- nifestly good effects. The causes that give rise to the deposition of the phosphates are of different character. In one respect, indeed, they are antitbeses to each other. The phosphates in healthy urine are considered by Berzelius to be held in solution by free phosphoric and lactic acids ; and, if any thing interferes with the presence of these acids in due quantity, the phosphates are deposited. Prout offers another ex- planation, which is more simple and intelligible. The phosphates, he says, exist in the urine as supersalts, and in this state are soluble; but, if any thing neutralises the redundant acid, so as to reduce the supersalt to a neutral salt, it is then deposited — the neutral phos- phate being insoluble. If a few drops of ammonia be added to healthy urine, the phosphates are thrown down, and the cause of this deposition is differently explained by Berzelius and by Prout, according to their particular views ; — the former considering, that the ammonia neutralises the free phosphoric and lactic acids; and the latter, that it neutralises the excess of phosphoric acid. 292 ANTILITHICS. The general symptoms that accompany the deposition of the phos- phates are often very distressing: both the physique and the moral are greatly implicated. Derangement of the digestive Organs is a universal concomitant, succeeded by every symptom of impaired nu- trition. In some cases in which the bladder has lost a portion of its muscular power — as in disease of the prostate, in affection of the spine, and in the aged, — the urine is retained so long in the bladder, that it undergoes, it is affirmed, partial decomposition ; ammonia is generated, and a deposition of the ammoniaco-magnesian phosphates takes place. As far as regards the use of chemical remedies, the selection for the phosphatic diathesis is obvious. That which is proper for the lithic acid diathesis would be obviously injurious in this : accord- ingly, alkaline remedies have to be avoided, whilst acids,— espe- cially mineral acids, — can be administered with great advantage. They may not only pass into the blood, and act chemically on that fluid, but invigorate the digestive apparatus and prevent fresh deposition. In cases of the alternating calculi, the treatment has necessarily to be varied, according to the character of the deposition,— acid or alkaline remedies being given according as the deposits are at the time phosphatic or lithic acid ; but in the depositions of oxalate of lime, nothing but general management can offer any prospect of benefit. There is no chemical antilithic available in these cases. All that can be done in this, as well as in the other forms of the calculous diathesis — when inveterate — is to incul- cate the necessity of a thorough change of the physical and moral influences surrounding the individual, so as to break in upon the morbid catenation as effectively as possible. With this view, tra- velling, air, and exercise are recommended, with all their revul- sive accompaniments ; a well regulated diet and regimen; atten- tion to the condition of the bowels, and everything that can induce tone in the economy generally. By thus modifying the whole system of nutrition, the calculous diathesis may occasionally be got rid of, and no farther»signs of lithiasis may occur, even when the individual has been previously strongly disposed to, and even la- bouring under, calculous depositions. If the views of Liebig, however, be correct, (p. 289), it would seem, that in the case of lithic depositions, country air would be injurious to residents of towns by converting the depositions into those of the oxalates: — but this matter cannot be considered set- tled. In the case of an intelligent medical gentleman from the in- terior of Maryland, who consulted the author some time ago, phos- phatic depositions, which were copious, were invariably corrected by the free use of saccharine aliment. From what has been said, we can fully understand the agency of tonics and astringents, when employed as antilithics. But it has been imagined, that certain bitters, which combine an astringent LITHONTHRYPTICS. 293 principle, are peculiarly adapted for such cases; this principle being presumed to enter the circulation, and to act more particu- larly on the kidneys. At one time, indeed, it was believed — it need hardly be said most erroneously —that such vegetables pos- sess chemical or solvent properties. Of these tonics — presumed to operate especially as antilithics — the leaves of diosma crenata or buchu; the root of pareira brava, and the leaves of uva ursi have been mainly recommended ; but the author is not prepared to corroborate the once prevalent, but now generally exploded, idea, that they produce other results besides those of acting as astringent tonics on the stomach, and of improving the gastric functions. (See, on the nature and therapeutics of calculous depositions, the author's Practice of Medicine, 2d. edit. ii. 35, Philad. 1844.) 2. Lithonthryp'tks. Thus far of antilithics. — Not much can be and on lithonthryptics or solvents of calculi. The fact, that certain mineral waters, as the Vichy, render the urine alkaline, could scarcely fail to suggest their use in calculous affections. It would not seem, that the destruction of calculi by that water is effected merely, or perhaps chiefly, in the way of solution, but that it is accomplished in a very considerable de- gree, especially as regards those of the triple phosphates, by a kind of disintegration of their component particles. When calculi consist of the oxalate or phosphate of lime, mingled with lithic acid, lithate of ammonia, or the triple phosphate, Vichy water is said to attack and disintegrate them rapidly. These waters contain a large amount of free carbonic acid, and nearly a drachm and a half of bicarbonate of soda in every thousand drachms of the menstruum. Besides greatly increasing the quantity of the urine, they exert a decided influence on its chemical constitution ; rendering it rapidly neutral if pre- viously acid, and- afterwards alkaline : from being high-coloured it becomes pale, and having deposited copiously, it becomes limpid and transparent. The experiments of several observers are cer- tainly encouraging, and suggest the importance of employing the fictitious waters of Vichy where the natural water is not attainable. A formula for these is given hereafter. Under views analogous to those which have suggested the use of the alkaline mineral waters, the different alkalies and alkaline earths have been freely administered as lithonthryptics. It is not proba- ble, however, that either the mineral waters in question, or the alkalies, can generally be productive of benefit, except where the de- positions are of lithic acid or the lithates. Still the fact must be borne in mind, that under protracted administration of such waters, and likewise of alkalies, combined with the free use of diluents, calculi of other kinds have experienced disintegration. Where, too, these agents have failed to dissolve or break down the calculus, they would seem to have greatly mitigated the sufferings. Solvents might be brought into immediate contact with vesical 25* 294 SPECIAL ANTILITHICS. calculi by injection ; and, in this way, alkalies and acids, properly diluted, have been employed. Experiment seems to have shown, that the bladder cannot bear the presence of an alkaline solution sufficiently strong to dissolve a lithic acid calculus ; but it would appear, from the experiments of Sir Benjamin Brodie, — that loose concretions of the phosphates and of carbonate of lime may be acted upon by a weak solution of nitric acid, and thus be gradually removed from the bladder. The strength of the solution, employed by Sir Benjamin, was two minims and a half of the acid to a fluid ounce of distilled water. The injection was sent through a cannula of pure gold. It occasioned no pain : the patients experienced re- lief from all their symptoms; the quantity of adhesive mucus from the lining membrane of the bladder was diminished ; and the con- stant desire to empty the organ much abated. By testing the fluid that had been used with a concentrated solution of ammonia, phosphates were ab|pdantly precipitated, —proving that the calculi had been acted upon. It has likewise been proposed by MM. Prevost and Dumas to em- ploy galvanism for the decomposition of calculi in the bladder, by passing wires, connected with the poles of a galvanic apparatus, into that viscus; — but the proposition has received little attention. It is probable, indeed, that any decomposing power, which could be introduced within the bladder in this way, would be apt to act upon the organ itself, and, consequently, not be devoid of danger. Cystitis is an affection to be apprehended, indeed, from all such agents. The most important lithonthryptics belong to the domain of sur- gery, and do not, therefore, fall under consideration in this work. It seems clear, from the experience of practitioners on both sides of the Atlantic, that there are cases which admit of urinary calculi being broken down in the bladder, by the introduction of contunding in- struments mto that organ, without the bladder necessarily suffering ; and the operation of lithotrity, or lithothrypsy, or lithotresis, must be included amongst those improvements, for which the philanthro- pist has to thank the genius and daring of the modern surgeon. SPECIAL ANTILITHICS. 1. Acid Antilithics. The circumstances under which acids are advisable in calculous depositions have been pointed out already, (p. 291.) It was there shown, that they are eminently serviceable in the white or phospha- te depositions, whilst they cannot fail to augment the lithic depo- sitions. L r Of the Min'eral Acids, either the sulph'uric, the muriat'ic, or ALKALIES. 295 nitric may be prescribed ; but preference is usually given to the two first; under the notion, derived, perhaps, from two limited experi- ence, that the last disagrees with some stomachs. It has been given, however, in large doses without any such inconvenience resulting. The muriatic acid would seem to be the most congenial, inasmuch as it is one of the acids always secreted in the healthy state of the stomach, and, therefore, taken at times with impunity even by those who suffer from acidity. In neutral or alkaline indigestion, as it is termed, which is occasionally mistaken for acid indigestion, this acid is the great remedy. Muriatic acid may be given in the dose of from n\x. to rr\xl. in any demulcent drink; and during its administration—indeed, when- ever acids of any kind are given — the urine must be carefully in- spected, and if any signs of the lithic depositions appear, it must be discontinued. Both in the case of children and of adults, the careful use of mi- neral acids is to be preferred ; if for no other reason, on account of the uncertainty that exists in regard to the modus operandi of the Vegetable Acids. It is the common belief, indeed, that the latter are decomposed, and, accordingly, a difficulty may exist in knowing whether they may be beneficial or the contrary. Observation ought to settle this question, but it has not yet done so. Hence, the ordi- nary mineral water or soda water of the shops may be an equivocal remedy in phosphatic depositions, so far as regards its chemical agency ; yet it may be of essential service through the gentle sti- mulus which it gives to the digestive function. Of late, lactic acid has been suggested by M. Magendie, owing to the facility with which it dissolves phosphate of lime. From one to four fluidrachms of it may be dissolved in a quart of water, sweetened with two fluid ounces of syrup, and taken as lemonade. 2. Alkaline Antilithics. Alkalies, as already remarked, are indicated in cases of lithic de- positions ; in which they seem to prove beneficial not only through their action in the stomach, as antacids, but likewise by passing into the mass of blood and being separated by the kidneys. That they do act in the latter manner is shown by the fact, that after they have been administered for some time, the urine, from being acid, is ren- dered alkaline. In a state of health, indeed, the constant use of alkalies may occasion the deposition of white or phosphatic sediments. Mr. Brande has affirmed, that he has known " soda water, exhibited in a case of stone in the bladder, produce abundance of white sand, which the ignorance of the patient and his medical attendant led them to refer to the solvent power of the medicine upon the stone, which they thought was gradually giving way and being voided ; whereas great mischief was doing, by giving the urine more than its usual tendency to deposit the phosphates, and, consequently, to augment 296 SPECIAL ANTILITHICS. the size of the calculus." It would be singular, however, were the effect, in this case, to be referable to the action of the soda water, which, as generally sold in the shops, contains no alkali whatever, and is in reality acid by its impregnation with carbonic acid. Liquor potas'sje or Solution of potas'sa was at one time more employed as an antilithic and lithonthryptic than any of the alka- lies. An objection urged to the pure alkalies has been, that they are apt to induce irritation in the lining membrane of the sto- mach, and such might be the case if they were given in very large doses. It must be recollected, however, that more or less acid is generally present in that organ, by means of which a portion, and, in particular cases, the whole of the alkali administered maybe neu- tralised. Cases too, are recorded, in which the potassa has been administered for a long period, and in considerable quantity, with- out the supervention of any disagreeable results. One patient of Dr. Marcet took it regularly for ten years, and during that time passed many calculi, all of which had their angles rounded, and their edges blunted, " in a manner, which could hardly be explained, except from the long continued effect of the alkaline medicine." Still, the bicarbonates of the alkalies are devoid of the causticity of the pure alkalies, whilst they have the same antilithic properties. They ought, consequently, to be preferred. The dose of Liquor Potassae is "lx. to ^xxx., given two or three times a day in water. Veal broth and table beer have been recom- mended as vehicles, but although the latter disguises the urinous and unpleasant odour of the alkali, the acid of the beer may neutralise a portion of it; and the beer itself is but little calculated for the phosphatic diathesis. An empirical remedy for stone, known under the name of Dr. ChitticJc's nostrum, is said to be a solution of alkali in veal broth. Car'bonates of Potas'sa and Soda are milder preparations of the alkalies, and yet at least equally effective antilithics with the pure alkali. The bicarbonate of soda is the most agreeable, and is probably as efficacious as any of these preparations ; yet the use of potassa has appeared to prove beneficial in calculous affections, where soda failed to afford any relief, and it is important to bear in mind a fact mentioned by Prout, that the urate of potassa is a soluble salt, the urate of soda insoluble. As it is possible, however, that the main efficacy of antilithics may be exerted upon the first passages, and. on the blood, rather than on the kidneys, the circumstance, mentioned by Prout, may not be a valid objection to the use of soda. Sir Gil- bert Blane accounted for the greater advantage of soda in calculous complaints upon the assumption, that soda becomes applied to the purposes of the economy before it arrives at the kidneys; whereas potassa passes to those organs to be thrown off from the system. Ihe dose of the carbonates of potassa and soda as antilithics is from DIOSMA. 297 gr. x. to ^ss ; of the bicarbonates of the same alkalies, from gr. xx. to 3J. They may be given in water, or in the common soda water of the shops. Ammo'nia and Car'bonate of Ammo'nia are at times adminis- tered with the same view. Their effects would seem to be wholly exerted upon the primae viae ; and the same is probably the case with Magne'sia, Car'bonate of Magne'sia, and Limewater. The first and second of these are used largely as antilithics. Magnesia was first strongly recommended by Mr. Brande, who properly remarks, that under its use, in the lithic diathesis, the red deposit in the urine becomes much diminished, or disappears altogether, and the irrita- tion of the kidneys is proportionately relieved. It must be borne in mind, however, that magnesia sometimes accumulates in the bowels, when it is given for a long period. Either magnesia or its carbo- nate may be prescribed in the dose of from gr. x. to gr. xxx. in water or milk. The fluid magnesia, elsewhere described, (p. 159,) is a good preparation in these cases. It is a solution of magnesia in carbonated water. It is by virtue of the alkali they contain, that the Vichy waters, — already referred to — are so celebrated in France in calculous cases. These are in such high repute, that they are directed to be prepared artificially, and are sent to every part of Europe ; but it need scarcely be said, that no artificial or real water drunk away from the spring, and therefore without the accompanying advan- tages of travelling air and exercise, can be regarded as substitutes for the water taken at the source. The following form for the artificial Vichy water is given in the Codex Medicamentarius of Paris: Take of simple acidulous water, impregnated with twice its bulk of Carbonic acid, ^xxss; Carbonate of soda, gr. xxxij ; Sulphate of soda, gr. xvj ; Muriate of soda, gr. iv ; Carbonate of magnesia, gr. ss ; Muriate of iron, gr. \. — M. In this country, the Saratoga waters constitute an excellent remedy, and not the less so from the slight impregnation of iron, which they contain. 3. Tonic Antilithics. 1. DIOS'MA. —BUCHU. The Pharmacopceia of the United States, along with those of London and Dublin, refers Buchu leaves to Dios'ma crena'ta, whilst the Edinburgh Pharmacopceia assigns them to various species of Baros'ma. " This drug"— says Dr. Christison— " furnishes a good illustration of the inconvenience of attempting a correct botanic nomenclature of the articles of the Materia Medica. It has been known in Britain for about twenty years under its original Hottentot name of Buckhu or Buchu ; but the London College had scarcely admitted it into the Pharmacopceia under the botanical name of Diosma, before botanists discovered that the plant or plants from 298 SPECIAL ANTILITHICS. which it is obtained must be removed into a new genus, now termed Barosma." Dios'ma or Baros'ma, Sex. Syst. Pentandria Monogynia ; Nat. Ord. Rutaceae, is a native of Southern Africa, near the Cape of Good Hope. Several species are used by the Hottentots, on ac- count of their odorous and medicinal virtues. A powder, which they use for anointing their bodies, is composed of various odorous matters, and chiefly of Barosmas. They are small shrubs, which have a heavy and peculiar smell; hence the name Barosma — from 0Hvt, 'heavy,' 'powerful,' and etfil,, 'odour,' —by some considered 'di- vine' ; hence the name Diosma, from /„„ ' divine,' and effit„' odour.' Buchu leaves — as met with in the shops — are composed of those of several species of barosma, intermixed with stalks and fruit. They are smooth, somewhat shining, sharply or bluntly serrated or crenated, and are studded with little oil vesicles, containing the essential oil, which gives them a portion of their odour. The taste of the leaves is aromatic, somewhat pungent, and bearing some re- semblance, according to Buchner, to peppermint. Others, however, compare it to rue ; others to rosemary ; others to cumin ; and others, again, to the urine of the cat. (Pereira.) The main constituents, afforded by analysis, are a volatile oil, of a yellowish-brown colour, and lighter than water, which has the odour of the leaves, — and a bitter extractive matter, Diosmin. The leaves afford their virtues to both water and alcohol. The medical properties of diosma — like those of the other arti- cles under this head — have been greatly exaggerated. By virtue of the volatile oil, they are excitant, and perhaps slightly diuretic ; and, by their bitter extractive, tonic. They are, consequently, adapted for giving tone to the digestive organs, and through them to the general system ; but the evidence is utterly inadequate to show, that they have otherwise any effect in calculous diseases ; or that they possess any special action on the urinary organs Dr Wood has correctly remarked, that " they are chiefly given in com- plaints of the urinary organs, such as gravel, chronic catarrh of the bladder, morbid irritation of the bladder and urethra, disease of the prostate, and retention or incontinence of urine from a loss of tone in the parts concerned in its evacuation ;" —and he might have added, from his extensive acquaintance with the subject,— that we are not in possession of any remedy which could act beneficially in diseases of such opposite characters. The suggestion, that in lithiasis, attended with increased secretion of uric acid, diosma should be given m combination with alkalies, is good, inasmuch as in this manner we neutralise any preponderance of acid; whilst, at the same time, we give tone to the system, and thus remove the ten- dency to its fresh generation. The dose of the powder is from gr. xx. to ^ss. INFU'SDIDIOSMEINFU'SION OF BUCHU. (Diosma, %\; Aq. bullient. Oi ) Dose, f. 3j. to f. £ij. J'' PAREIRA. 299 The Dublin Pharmacopceia has a Tincture of Diosma, (Diosm. ^v ; Alcohol, dilut. Oij ; — made either by maceration or percola- tion,) the dose of which is from f. 3J. to f. §ss. 2. PAREI'RA. —PAREI'RA BRAVA. Pareira of the Pharmacopoeias is the root of Cissam'pelos Pareira, Pareira Brava or Velvet leaf; Sex. Syst. Dicecia Monadelphia ; Nat. Ord. Menispermaceae, a climbing plant, which is a native of South America and the West India islands. The root — as met with in the shops—is in roundish pieces, from half an inch to four inches in diameter ; from four inches to some feet in length, and often split longitudinally. The epidermis is thin, of a brown colour, furrowed longitudinally, and wrinkled trans- versely. The interior of the root is of a yellowish colour, very po- rous, and marked by irregular concentric circles. It is devoid of smell, and has a sweetish and afterwards nauseous bitter taste. The active principle of the root is considered to reside in a yel- low bitter matter, which is soluble in both alcohol and water. A new vegetable alkaloid principle has been separated by Wiggers, to which he gave the name Cissampeli'na ; but whose properties have not been described. Pareira yields its medical virtues to water, and hence an extract, and an infusion, are officinal in the London and Edinburgh Pharma- copoeias. The Pharmacopoeia of the United States has no officinal preparation of it. The same properties have been assigned to it as to the diosma ; with the addition, that it was at one time highly extolled as a lithonthryptic ; and it was even affirmed, that calculi — the size of an olive — had disappeared under its administration. The author has carefully watched its effects, but neither in its gene- ral action on the system, nor in its effects in calculous depositions, nor in chronic diseases of the urinary organs, has he seen any other properties than those possessed by the ordinary bitter tonics ; and, where other results have supervened, in the practice of others, it is probable that they were owing to the system of medication com- bined with it. He has not had the shadow of a reason for believ- ing it— as suggested by Dr^ Christison — "to possess specific vir- tues over various disorders of the urinary organs, more especially chronic inflammation of the bladder." " A careful inquiry into its physiological action," says the writer just cited, " is much wanted; for some have failed to observe the diuretic and aperient properties ascribed to it by others ; and they are disposed to think, as would be anticipated alike from its sensible qualities, and its place in the natural arrangement of vegetables, that it is nothing else than an excellent tonic bitter, akin to calumba. The authority of Sir B. Brodie, who has recommended it in chronic urinary diseases, and especially in chronic inflammation of the urinary bladder, has of late brought it into general employment. The information communi- cated to me on this point by various surgeons here who have made trial of it is not in its favour." 300 SPECIAL ANTILITHICS. Sir Benjamin recommends a decoction prepared by simmering four ounces of the root in three pints of water, until the fluid is re- duced to two pints. From six to twelve fluidounces of this decoc- tion may be taken in the twenty-four hours; but it is important to add, in judging correctly of its virtues, that Sir Benjamin is in the habit of adding to it the tincture of hyoscyamus; and where there is any deposition of the triple phosphates, indicated by milky urine, with an iridescent pellicle on the surface, he adds the muriatic or the nitric acid, — agents which, of themselves, are most valuable antilithics. The Infusum Pareirje of the London and Edinburgh Pharmaco- poeia is made by macerating six drachms of Pareira in a pint of boiling water. The dose of this is from f. ^j to f. ^iij. The Ex- tractum Pareira of the same pharmacopceia is prepared in the same manner as the extract of gentian. Its dose is, gr. x. to 3ss ; and it is often given along with the Infusion. 3. UVA URSI. Uva Ursi, in the London and United States Pharmacopoeias, is the officinal name for the leaves of Ar'butus Uva Ursi, Arctostaph' ylos Uva Ursi, Bearberry or Bear's Whortle'berry: Sex. Syst. De- candria Monogynia; Fig. 43. Arbutus Uva ur«i. Nat. Order, Erica- ceae ; a low evergreen shrub, which is a na- tive of the northern latitudes of Europe, Asia and America. On the American conti- nent, it extends from Hudson's Bay as far southward as New Jersey, whence it is obtained for the mar- ket of Philadelphia. (Wood&Bache.) The leaves are gathered in autumn, and the green ones are selected.— They are apt to be mixed with Vaccin'- ium Vitis Ida'a or Red Whortle'berry, a plant of the same na- tural family, the leaves of which are minutely toothed, and the under surface dotted ; whereas the edges of the genuine leaves are entire DIAPHORETICS. 301 and the under surface reticulated. Moreover, the spurious leaves are deficient in astringency, a remark which applies to the box-leaf, which is sometimes mixed with it; — the true uva ursi leaf having a bitterish and strongly astringent taste, but no odour except when in powder. It then resembles that of hay. Its virtues, which are mainly dependent upon tannic acid, are yielded to water and alco- hol. The tannic acid — as elsewhere observed — is the great as- tringent principle of vegetables. Uva Ursi is possessed of the powers of the ordinaryastringents, but, so far as the author has observed, of nothing more ; yet it has all the virtues ascribed to it that have been assigned to Diosma and Pa- reira. It has, indeed, been regarded " as a specific in diseases of the kidneys and bladder at large." " In recent times," says Dr. Christison, " it has been succeeded, as a panacea in urinary diseases, by the Pareira brava root — probably"—he gravely adds, " with- out sufficient reason." Nothing can be more feeble than the testi- mony, which has been brought forward in favour of its specific affi- nity for the urinary organs, and accordingly the confidence of sur- geons in regard to it is becoming less and less ; or at all events their sentiments are highly discordant. As an antilithic it appears to act solely by its tonico-astringent properties. The dose of the powdered uva ursi is from 9j to 3j> given three or four times a day ; but the form usually preferred is the DECOCTUM UV^ URSI, DECOCTION OF UVA URSI. (Uva ursi, §j; Aqua f. ^xx. Boil to a pint). The dose is from f. |j to f. |ij, three or four times a day. V. DIAPHORET'ICS. Stnon. Diapnoica. Definition of diaphoretics—Largely invoked in Therapeutics—Disease not often induced by suppressed perspiration—Modus operandi of diaphoretics—Are indirect agents— How their operation may be aided—Their therapeutical application—Special diapho- retics. Diaphoretics are defined to be — " agents that augment the func- tion of transpiration." As it was at one time imagined, that almost every disease, to which mankind are liable, is produced by obstructed perspiration, the class of diaphoretics was extensively employed in medical prac- tice, and numerous agents were admitted into the catalogues of the materia medica, which were supposed to be capable of augmenting the cutaneous exhalation. Even yet, this cause of disease is re- peatedly referred to, not only by the unprofessional, but by many of the profession. " Health," says a modern writer, Dr. Eberle, " is very intimately connected with the regular performance of the per- spiratory function. Whenever the transpiration by the skin is sud- vol. i.—26 302 DIAPHORETICS, denly checked, more or less derangement of the system is invariably the consequence. That portion of the circulating fluid, which na- ture designs to be cast off by the cutaneous emunctories, is no longer fit for the purposes of the animal economy ; is retained and becomes a source of morbific irritation to the heart and other organs." " Dis- ease," says another writer, Dr. A. T. Thomson, " is frequently the consequence of a sudden check to the perspiratory function : means, therefore, have been sought for to restore it ; and the substances, classed as diaphoretics, are supposed to have that power." It may admit, however, of well-founded doubt, whether disease be ever induced by suppression of the cutaneous exhalation. The two great fluids of depuration are the transpiration — cutaneous and pulmonary — and the urine. In summer, the former predominates over the latter, whilst in winter the opposite is the fact. Hence, there appears to be a sort of compensation effected between the two depura- tions, so that if one be diminished by a change of atmospheric tem- perature, the other is augmented. For this reason, we should not anticipate extensive morbid results from a general check given to perspiration, were we even ignorant of the impunity, with which we may pass from a heated apartment to the external air, and which follows the use of the cold bath, after the individual has been ex- posed to a very elevated temperature, as in the Russian vapour-bath. Observation has, indeed, sufficiently shown, that danger is less to be apprehended from such general checks, than from the partial and irregular application of cold and moisture. The danger of having the feet cold and wet, or of sitting with a part of the body exposed to a draught of cold air, is proverbial; yet, if we attempt to explain this by the check given to perspiration, we fail; for the loss of the ordinary depuration, in so small a portion of the body, is obviously insufficient to account for the phenomena; yet, disease is far more apt to be induced, in such case, than when the whole body is ex- posed to a sudden alternation of temperature from hot to cold, and when the check to the cutaneous depuration ought necessarily to be to a much greater extent. The author has elsewhere remarked, (Human Health, p. 45. Philad. 1844), thatthere is perhaps in every one, at any one particular time, some organ or tissue of the body more disposed to take on morbid action than another ; and that, be- tween every part of the capillary surface such an extensive sympathy reigns, that if one part be irregularly and morbidly impressed ; such impression vibrates to every part of the system, so that the tissue or organ most disposed to take on morbid action at the time, assumes it. Hence, if a dozen individuals be exposed to the irregular ap- plication of cold and moisture to the feet, they may not all have the same disease induced, because in all there was not, at the time, the same disposition in a particular organ or tissue to the assumption of disease. This irregular action of the capillaries of the part is the first link in the chain of phenomena, not the obstruction of perspiration. On ACTION OF. 303 this head, a modern writer, Dr. W. F. Edwards, of Paris, has ex- pressed himself in a sound and rational manner. The insensible perspiration he regards as a purely physical phenomenon of " evapo- ration," whilst the sensible " is a loss ordinarily produced by a vital action, in the form of a liquid which transudes." In prosecuting the consideration of this subject, he remarks ; — "all that we have hitherto shown on the subject of perspiration will considerably facili- tate our examination of a question, which naturally presents itself. Is perspiration susceptible of being suppressed ? It is easier to re- solve this question with regard to man and other warm-blooded ani- mals, than with respect to the cold-blooded vertebrata. Let us see what is the result of a very low temperature upon warm-blooded animals. We know by the effect of cold upon the sweat, that it diminishes transudation. Now let us suppose, that it may, by its intensity, sup- press it altogether, there will remain perspiration by evaporation, which will always take place, however humid the air may be. The high temperature of man, and other warm-blooded animals, warms the air in contact with the body, and changes its hygrometric state by removing it from its extreme of humidity, and consequently oc- casions evaporation. If, on the other hand, the temperature of the air be raised to an equality with that of the body, at the time that it is saturated with humidity in order to suppress evaporation, then perspiration by transudation is excited, and takes place to such an extent in man and other warm-blooded animals, that the sweat will stream from all parts of the body. We can then, in no case, sup- press the perspiration ; it will be performed either by evaporation or by transudation. We ought therefore to be careful, how we take literally what we find in medical books respecting suppressed per- spiration. There can be no such thing. That there may be sup- pression of sweat is evident to everyone; but it does not follow that, even in these cases, there is no transudation. " Since it is difficult to assure ourselves directly, whether transu- dation is ever entirely suppressed in man, and other warm-blooded animals, let us see what the cold-blooded vertebrata will offer on this point. The batrachians are the best adapted to this kind of re- search, on account of the nakedness of their skin, of the fineness of its texture, of the copious loss, which may be incurred through its medium, and, consequently, of the relation which their perspira- tion bears to that of man. On exposing frogs to the temperature of 0° Cent. (32° Fahr.) in humid air, in order to suppress perspiration by evaporation, they have lost by transudation, in different experi- ments, the thirtieth part of their weight. Transudation is more abundant in these animals than in man, though the latter be placed in circumstances much more favourable. WLen we consider how sensible these creatures are to cold, how much the activity of all their functions is diminished at a low temperature, and how much they may even then lose by transudation, it is not to be supposed, that cold suppresses this mode of perspiration in man, and the less 304 DIAPHORETICS, so from his having a temperature of his own, which varies very little with the changes of the atmosphere, a condition which has a pow- erful tendency to maintain transudation. It may be very much di- minished by the action of cold, but it appears that it cannot be alto- gether suppressed. It is a remarkable but well known fact, that when life is sinking, and to appearance nearly extinct, the body is covered with sweat — so strong is the tendency to continue this function." In any mode, consequently, of viewing the subject, it does not appear that we can ascribe any extensive series of morbid pheno- mena to simple suppression of perspiration. Such being the fact, the indication of restoring suppressed perspiration — if it be admit- ted at all — must exist much less frequently than has been imagined. Yet there are but few classes of remedies, that are more used, espe- cially by the older practitioners, than diaphoretics, and probably none which are more uncertain in their operation, and on which less reli- ance ought to be placed. Most of them, too, are agents, which sti- mulate the heart and arteries, and hence the indiscriminate employ- ment of heating diaphoretics has been productive of much mischief in febrile and inflammatory disorders. In a state of health, any thing, which gives occasion to the greater propulsion of blood into the cutaneous capillaries, will produce diaphoresis. In this way, exercise and external heat exert a diaphoretic agency ; but when the capillary action is in a state of exaltation from disease, the same agencies are not followed by a like result. This state of exaltation has to be reduced before diaphoresis can be effected. The same thing is also exhibited in another way. During the heats of sum- mer, the cutaneous capillaries are kept in a state of perpetual ere- thism, and although the sensible perspiration may be exhaled to a great extent, it would probably be more largely elicited were the erethism less ; accordingly, when we take iced wrater or any iced drink under such circumstances, the refrigerant influence is exerted on the capillaries of the stomach, and, owing to the extensive sym- pathy that exists between every part of the capillary surface, the cooling influence is at once communicated to the whole capillary system ; the erethism is thus reduced, and copious perspiration ensues. Every one must have observed how rapidly the sensible perspiration is thrown out in hot weather after the use of iced drinks. The effect is here diaphoresis, but the remedy operates as a refrige- rant — a class of agents far more efficacious than diaphoretics. It may be doubted, indeed, whether we have any internal remedies, which are capable of acting as direct diaphoretics ; — that is, by vir- tue of specific properties, which they possess over the glandular or diapnogenous apparatus of the skin. Dr. Paris thinks, that mercu- rials and sulphur act in this way, but the only evidence we have of this is, that they pass off by the skin, and as they emerge from the system in this manner, it would be fair, perhaps, to presume, that they may act on the cutaneous capillaries, but we have no evidence in favour of their producing augmented diaphoresis. ACTION OF. 305 The author, to whom allusion has just been made, has given the following table of what he considers the modus operandi of dia- phoretics. " Diaphoretics Occasion their effects — I. By stimulating the cutaneous capillaries. a. By external application. The stimulus of heat, frictions, fyc. b. By medicines which enter the circulation and stimulate the cutaneous vessels by contact. Mercurials — sulphur. c. By medicines which act on the surface sympathetically, through the medium of the stomach. Cold drinks, fyc. II. By increasing the general action of the vascular system. Violent exercise—Ammonia— Guaiacum—Alcohol, Warm bath. III. By relaxing the morbidly constricted mouths of the perspi- ratory vessels. Antimonials— Cold affusion— Venesection — Saline diaphoretics." It has been seen, that the modus operandi of cold drinks cannot be referred to any " stimulation" of the cutaneous capillaries, and the same may be said of the warm bath, which certainly does not operate by increasing the general action of the vascular system. Such may be, and is, the effect of the hot bath — aqueous, vapour, or air— but the warm bath acts precisely like the cold, by diminish- ing the action of vessels. A mistake is often made, and a hot stimu- lating bath is occasionally administered in violent inflammatory attacks, instead of the warm and soothing, — to the manifest detri- ment of the sufferer. The application of warmth, in the form of the warm water bath, is one of the most valuable therapeutical agents which we possess ; especially in the inflammatory and spasmodic disorders incident to childhood. At one time, the salutary agency was universally ascribed to the restoration of suppressed perspira- tion. It is now known to modify the condition of the capillary system, reducing it when over-excited, and producing a beneficial action of equalisation in the circulatory movements, so as to di- minish the exaltation of vital manifestations in the organ labouring under inflammation or spasm. In reality, there are no substances, administered as diaphoretics, on whose direct agency much dependence can be placed, unless they are such as are made to come in contact with the cutaneous surface. Diaphoresis follows the employment of many internal 26* 306 DIAPHORETICS, means, but the result is produced indirectly. Antimonials, for ex- ample, have been much relied upon for "relaxing the morbidly con- stricted mouths of the perspiratory vessels;" but this result is not produced by any specific action on those vessels, so much as by ex- citing a new impression on the system, which breaks in upon the cutaneous erethism. Perhaps we have no class of remedies more uncertain in their operation than anatomical diaphoretics, as ordi- narily administered. It might, indeed be said, that there are no agents so devoid of any beneficial action ; yet, if they are given so as to excite nausea, or a state approaching this, diaphoresis often results, but then it is immediately produced by the state of dimi- nished vital activity, occasioned by the remedy acting as a nause- ant— a set of agents possessed — as has been seen—of the most valuable properties for reducing morbid exaltation of the vital forces. The faith, however, that has existed in antimonials, as usually pre- scribed, for exerting a febrifuge action, has not been without its ad- vantages. Whilst trust is reposed in them, the feverish invalid is left in quietness, and the irritating system of cathartic after cathartic is, for the time, dispensed with ; but that the antimonial is, in many cases, inert, has been sufficiently shown from numerous experiments with Pulvis Antimonialis of the pharmacopoeias—a powder intro- duced as a factitious " James's Powder" — which have demonstrated, that the preparation is often almost wholly inoperative, even when given in very large doses. It is rarely employed on the continent of Europe ; but confidence is still, although unworthily, reposed in it by many practitioners of this country, and of Great Britain. " The utmost diversity of opinion," says Dr. A. T. Thomson, " exists re- specting the utility of this preparation ; many practitioners contend- ing that it is perfectly inert, others asserting, ' that it is one of the best antimonials we possess.' From the result of its administration in my own practice, 1 cannot place any confidence in its diaphoretic powers. If there be much muriatic acid present in the stomach, it may prove active ; but in general it displays no influence whatever on the system. It has been given in doses of sixty, eighty, and one hundred and thirty grains without any sensible effect. Its oc- casional activity may be ascribed to the oxide being accidentally in the state of a protoxide." The results of the author's observations have led him to conclu- sions identical with those of Dr. Thomson, yet he can well recollect how strongly it was urged, by an old and venerated preceptcr, to place full reliance upon the six or eight grain doses of this prepa- ration, in cases where a febrifuge was needed, and to be especially careful not to exceed this quantity, lest emesis should be induced. In every case, in which the skin is hot and dry, and the indica- tion appears to be, to establish diaphoresis, the cause of this condi- tion of the cutaneous exhalants must be inquired into, and, if pos- sible, removed. Hence it is, that the well-instructed practitioner employs indirect diaphoretics rather than such as are esteemed ACTION OF. 307 direct. Thus, diminished sensible exhalation takes place from the skin, during the existence of fever or of inflammation, but the phy- sician does not have recourse to any reputed diaphoretic, which acts by exciting the sanguiferous system. He adapts his antiphlogistic remedies, so as to reduce the already too much excited condition of the blood-vessels to the healthy standard, and he finds, when he has removed the internal inflammation, the heat and dryness of the skin subside, and diaphoresis satisfactorily established. Under si- milar circumstances, a full dose of opium is attended with a similar re- sult. Opium, in a large dose, exerts sedative properties. When, therefore, inflammation is present, sedation is produced by the drug; nervous and sanguiferous excitation are allayed, and the skin be- comes cool and moist. Hence it is, that morphia, in large doses, is often so powerfully diaphoretic. One of the most celebrated diaphoretics, or sudoriflcs — for the latter term is more frequently employed where the medicine is con- sidered capable of inducing sweating — is a combination of opium with ipecacuanha. Opium, in a small dose, is a stimulant; in a large one, a sedative. Ipecacuanha, in a full dose, is an emetic ; in a small one, a nauseant, and, by virtue of the latter property, a dia- phoretic. Ten grains of pulvis ipecacuanha et opii— Dover's powder — contain one of opium, and, under the combined action of the substances in this dose, augmented exhalation from the skin takes place as surely as after the administration of any internal diaphore- tic agent. It has been the fashion to explain its action by supposing, that, whilst the opium increases the force of the circulation, the ipe- cacuanha relaxes the exhalant vessels, and causes a copious diapho- resis. This, however, is an improbable hypothesis, and the true ex- planation perhaps, is, — that the combined influence of the two agents is exerted on the vascular and nervous systems, so as to re- duce inordinate activity ; in this way, the erethism of the capilla- ries, consequent on irritation existing elsewhere, is removed, and the cutaneous exhalation becomes manifest. It cannot be denied, that there may be remedies, which may hurry the circulation, and others that may relax the cutaneous exhalants, but it is not easy to conceive, that they can be readily brought to act simultaneously, and it is easier to account for the induction of diaphoresis, by such com- pound remedies as the pulvis ipecacuanha et opii, upon general prin- ciples, than by invoking specific influences, of the reality of which we must remain in strong doubt. It has been already remarked, that nauseants act as the most effective diaphoretics. Their operation is, of course, indirect; their main agency being exerted on the nervous and sanguiferous sys- tems, which they depress. The action of diaphoretics is aided by the free use of diluents; but much of their operation is to be referred rather to the tempera- ture of the fluid, than to their passing into the blood-vessels, and producing polyaemia. The experiments of Magendie have shown, 308 SPECIAL DIAPHORETICS. that if warm fluids be injected into the veins of an animal, a state of artificial polyaemia may be induced, during the existence of which, the pulmonary and cutaneous transpirations are greatly in- creased. Where, however, there is much erethism present, absorp- tion is but feebly effected. Were it otherwise, inflammatory diseases could hardly fail to be largely augmented by the free use of diluents. On the whole, then, even in febrile and inflammatory affections, the use of the ordinary internal diaphoretics is uncertain, and gene- rally of no avail; whilst several of them are decidedly injurious by their excitant properties; yet, in many such cases, advantage may be derived from the equalising influence of the warm bath; and, in minor inflammations, especially of the gastro-pulmonary mucous membrane — as catarrh — the good effect of warm diluents, aided by the warmth and quietude of bed, produce an effect of equalisa- tion, which is often most salutary. In no disease, perhaps, has the class of medicines, which we are considering, been more extensively employed than in rheumatism. Its pathology has always been con- nected with suppression of perspiration. Its very name, indeed, de- notes a rheum, a defluxion of catarrh, directed to the part labouring under it, and the cause of such defluxion has been almost always referred to some check given to the cutaneous transpiration. This applies more especially to chronic rheumatism, but the reasoning, and the practice founded upon it, have been extended to the acute forms of rheumatism or rheumatic fever, in which the copious exu- dation from the cutaneous exhalants, notwithstanding the hot skin, is one of the most striking symptoms. Dover's powder has long been a favourite remedy in this disease, and, when given in proper doses, it is often useful, for the reasons previously assigned. The combination is well adapted for diminishing vascular and nervous action ; but the indication, in these cases, is surely not to restore suppressed perspiration, but rather to diminish the singular state of erethism, which characterises this anomalous phlegmasia. In almost all cases, in which the employment of diaphoretics ap- pears to be indicated, the class of sedatives, or refrigerants, or both, will be found infinitely more advantageous, for reasons already assigned, and to be more particularly expatiated upon, when the modus operandi of those divisions of remedial agents comes to be considered. SPECIAL DIAPHORETICS. I. Sedative Diaphoretics. 1. ANTIMO'NIALS. The preparations of antimony, that are alone used as diapho- retics at the present day, are the tartrate of antimony and potassa; the pulvis antirnonialis, and the precipitated sulphuret of antimony. ANTIMONII ET POTASSJE TARTRAS. 309 a. antimo'nii et potas'sa tartras. — tartrate of an'timony and POTAS'SA. Tartar emetic has been regarded by many as the most certain of the antimonial diaphoretics, and it is assuredly more frequently given than any other. When pushed to the extent of inducing nausea — like other nauseant emetics, it is a true and valuable sedative, yet it is most frequently given in fever so as to produce a febrifuge effect without exciting nausea. In such case, as already remarked, it is an uncertain remedy, and nothing exhibits this more strongly than the discordant testimony in regard to it in continued fever : whilst many writers consider it to be of great service, others speak slight- ingly of it. " Of all the numberless febrile diseases," says a recent writer, Dr. Christison, " where antimonial diaphoretics are .preva- lently given, the only one where my own observation does not con- cur with that of most others as to their beneficial effects is con- tinued fever. After extensive experience as an hospital physician for twenty years, I must say, that I have seen no substantial rea- son for the warm commendations of this method of cure by some, either in the marked inflammatory type put on by the disease in the earlier periods, or in the late typhoid form which it has assumed, or in the synochous form in which it appeared in the middle of the term. What may have been, or may yet be, the case of other epidemics, it must be left to others to determine. In the late epi- demics of Edinburgh I have seen no good done by it except as a palliative, and not a very trusty one, in abating reaction in the early stages of synochus and typhus." The ordinary dose of tartar emetic as a diaphoretic is from one- sixteenth to one-sixth of a grain given in solution, or in powder. By many, in this country, a combination of nitrate-of potassa, calomel and tartar emetic is prescribed under the name of " Nitrous powders." The usual form of the prepaiation of these powders is the following. (Antim. et potass, tartr. gr. ^ ; Potassa nitrat. gss ; Hydrarg. chlorid. mit. gr. | ad gr. \. M. One of these to be given every two or three hours.) They are especially useful, where it is desirable to touch the mouth in fever ; yet it may be a question, whether there be any advantage from the reputed diaphoretics with which the mild chloride of mercury is combined. In the ad- vanced stages of typhus, accompanied with high encephalic excite- ment as manifested by loss of sleep, delirium, &c, good effects have resulted from the use of tartrate combined with opium ; yet these are precisely such cases as are benefited by the use of opium singly, and it has been found equally beneficial in encephalic dis- turbance supervening on other diseases, and associated with ady- namic phenomena. VINDI ANTIMO'NII, AXTMO ML WINE. The dose of this solution of the tartrate of antimony and potassa as a diaphoretic is from ten to thirty 310 SPECIAL DIAPHORETICS. drops, repeated three or four times in the course of the day. Each ounce of the wine contains two grains of the tartrate. b. pulvis antimonia'lis. — antimo'nial powder. Dr. James, of London, about the middle of the last century ac- quired great celebrity for a powder which was known under the name of James's Powder. This, on analysis, was found to consist of phosphate of lime, with about an equal quantity of oxide of an- timony. In accordance with this analysis, a preparation was intro- duced into the London Pharmacopoeia, which resembles in its in- gredients the real James's powder, but differs in their proportion. The London Pharmacopoeia has the following directions for its preparation. Take of Sesquisulphuret of antimony, in powder, a pound ; Horn shavings, two pounds : mix and throw them into a red-hot crucible, and stir constantly until vapour ceases to arise. Rub the residue to powder, and put it into a proper crucible. Then apply heat raised gradually to redness, and keep it so for two hours. Rub the residue into a very fine powder. By this process the animal matter of the horn is burnt away, and the subphosphate, with a little of the carbonate of lime, is left. The sulphur of the sesquisulphuret is expelled by the same agency in the form of sulphurous acid, whilst the antimony takes oxygen from the air, forming antimonious acid, and sesquioxide of antimony. The main constituents, therefore, are antimonious acid and subphosphate of lime. It is of a white colour, tasteless, and devoid of odour. Antimonial powder is extremely uncertain, as already remarked, (p. 305,) in its operation, and is generally wholly inert; for these and other reasons it has not been received into either of the two last editions of the Pharmacopoeia of the United States. Its ordinary dose is from three to ten grains and more, repeated three or four times in the course of the day. It may be given in pill, or sugar and water. Some practitioners have more confidence in the quack " James's powder;" but it, also, is exceedingly uncertain in its operation; and accordingly neither the one nor the other is much used in this country. C ANTIMO'NII SULPHURe'tUM PR^CIPITA'TUM. --PRECIPITATED SUL'- PHURET OF AN'TIMONY. The mode of forming this preparation, in the British Pharmaco- poeias and in that of the United States, consists in boiling sulphuret of antimony, and solution of potassa in distilled water for three hours, constantly stirring, and occasionally adding distilled water, so as to preserve the same measure. The liquor is then strained, and, while hot, diluted sulphuric acid is dropped in, so long as it produces a precipitate; the sulphate of potassa formed is then washed away IPECACUANHA. 311 with hot water, and the precipitated sulphuret of antimony is dried and rubbed into fine powder. Several old antimonial preparations were at one time largely em- ployed ; one of these was Kermes mineral. It is formed by boiling sesquisulphuret of antimony in an alkaline liquid, and allowing a reddish powder,—kermes mineral, — to be deposited on cooling. If to the filtered mother liquor, a dilute mineral acid be now added, the golden sulphuret of antimony — an orange-red precipitate — is thrown down; and if the acid be added before the kermes mine- ral has subsided, an orange-red precipitate is deposited, which is the oxysulphuret of antimony of the London Pharmacopceia, — the golden sulphuret of antimony of the Edinburgh, and the preci- pitated sulphuret of antimony of the United States Pharmaco- poeia. This substance is insoluble, devoid of smell, and of a slightly styptic taste. It is insoluble in water, but is wholly soluble in nitro- chlorohydric acid, with the evolution of hydrosulphuric acid. Precipitated sulphuret of antimony is not inert. It has, indeed, been given as an emetic, but, like the Pulvis antimonialis, is so un- certain in its operation, that it is rarely used. It was an ingredient in Plummer's Pill, and is therefore still retained in the Pilula Hy- drargyri Chloridi Composita of the British Pharmacopoeias. The dose as a diaphoretic is from two grains to ten, repeated once or oftener in the day. 2. IPECACUAN'HA. The remarks, made in regard to the tartrate of antimony and po- tassa as a diaphoretic, are equally applicable to the article now under consideration. When given alone, it is an extremely uncer- tain remedy; but when carried to the extent of inducing nausea, it is a valuable sedative, and, by allaying the excited organic actions, produces indirectly diaphoresis in febrile and inflammatory diseases. It is often, however, administered in such cases in so small a dose as to exert probably no action whatever, whilst at the same time, the disease is treated upon general principles, and successfully. The dose of powdered Ipecacuanha as a diaphoretic is from half a grain to a grain ; with such view, however, it is most commonly prescribed in conjunction with opium, as in the officinal prepara- tion : — PULVIS IPECAHIAN'ILE ET OPII, POWDER OF IPECACUAN'HA AND O'PIDI. (Ipecac.puW. ; Opii, pulv. aa 3J ; Potassa Sulphat. 3J.) This is known in the shops as Dover's powder, being an imitation of a well known formula, already referred to, which was used by Dover as a diaphoretic. The sulphate of potassa probably exerts little if any action on the economy. It serves a useful pharmaceutical purpose, by virtue of its hardness, — enabling the other ingredients to be minutely divided. Of the modus operandi of this compound pow- der, the author has already spoken (p. 305). It is very much used 312 SPECIAL DIAPHORETICS. by many practitioners, and is doubtless often given in cases for which it is by no means appropriate. It is best adapted for those in which the concentration of vital activity in some internal organ is not excessive ; and where the indication appears to be —to allay inordinate action and to procure rest. Hence, a full dose in adyna- mic and ataxic fever is often very beneficial; at the commence- ment, too, of minor inflammations, as catarrh, sore-throat, &c, when aided by diluents, it exerts an equalising agency, inducing general diaphoresis, and, in this manner, breaks in upon the hyperaemia. In cases of acute rheumatism, it is freely exhibited, and some trust to it entirely throughout that painful malady. It must be borne in mind, however, that acute rheumatism is generally a self-limited disease, — running its course with but little modification from the remedies ordinarily prescribed ; and when the Pulvis Ipecacuanhae et Opii seems to be beneficial, it is less, perhaps, from its diaphoretic, than soothing agency on the nervous system, which is so much impli- cated in that singular affection. It must be borne in mind, that when given in a large dose, the ipecacuanha may occasion vomiting ; and hence it will rarely be re- tained where nausea, or a tendency to it, exists. For the same reason, diluents which greatly promote its action, and which are themselves diaphoretic under certain circumstances, cannot be freely adminis- tered soon after a full dose of the powder has been taken. Where, for example, ten grains of the powder have been administered at bed-time to induce diaphoresis, as in an ordinary case of catarrh, it may be well to waif an hour, and then to give warm wine whey, or a more simple diluent, — as tea or gruel. The ordinary dose of the pulvis ipecacuanhae et opii is ten grains ; which may be repeated in the course of three or four hours. Tea or sugared water may be the vehicle. Ten grains contain one of opium and one of ipecacuanha; but the former is probably the most im- portant constituent. VMM IPECACUANHA, WINE OF IPECACUANHA, (p. 120.) The dose of this officinal preparation, as a diaphoretic, is from n\,x to f. jss ; and it not unfrequently forms part of diaphoretic mixtures, prescribed in febrile and inflammatory affections. When associated with the tincture or wine of opium, its action resembles that of the preparation last described. 3. O'PIUM. The effects of this valuable drug on the nervous system generally are explained under Narcotics. On the nerves of the skin, its agency is shown by a sense of itching or pricking over the surface of the body, and occasionally by a cutaneous eruption. WTien taken in very large sedative doses, all its preparations — but espe- cially those of morphia — according to the author's experience, in- duce diaphoresis ; and where opium has been taken for the purpose of AMMONIA carbonas. 313 destroying life, the perspiration induced by it has been, at times, ex- cessive. In a fatal case, the sheets of the bed were completely soaked to a considerable distance round the body. — (Christison). The effects of opium on the general system — as elsewhere shown — are altogether relative, and dependent upon the dose. In a small dose, it is excitant; in a large dose, sedative; and, accordingly, there are pathological conditions in which good effects might result from it in a large dose, whilst the same morbid condition might be aggravated by a smaller dose. For example, in febrile and inflam- matory cases, a small dose might add to the existing evil, and render the skin more hot and dry, whilst a larger dose might reduce the organic actions, and thus prove indirectly diaphoretic. The reader is, however, referred to another part of this work for a farther exposition of these views, the accuracy of which has been recently admitted by Dr. Spillan. Opium is rarely, however, administered alone as a diaphoretic. It is generally combined with ipecacuanha, or tartrate of antimony and potassa. See Pulvis Ipecacuanhae et Opii, (p. 311). II. Excitant Diaphoretics. 4. LIQUOR AMMO'NLE ACETATIS. — SOLU'TION OF ACETATE OF AMMO'NIA. Solution of acetate of ammonia, formerly called Spirit of Minde- re'rus, is best prepared by saturating diluted acetic acid with carbonate of ammonia. If quite neutral, it produces no effect either on tur- meric or on litmus paper : when pure, it is entirely colourless. Difference of sentiment has existed amongst observers in regard to this solution, as to whether it be excitant or sedative ; nor is the dif- ference confined to this point. Whilst some have the greatest con- fidence in it as a febrifuge, others consider it to be devoid of action on the economy. Four ounces were taken at once, and, soon after- wards, four ounces more, without any sensible effect. This is one of the articles, which the author sometimes prescribes in fever, but more from its serving a temporising purpose, than for any marked febrifuge power which he considers it to possess. It is often prescribed in other diseases of excitement, sometimes alone, but frequently along with antimonials, nitrate of potassa, &c. As in the case of other diaphoretics, its action may be promoted by the use of diluents, and by external warmth. The ordinary dose is from f. ^ss to ^iss, which may be repeated four or five times in the day. 5. AMMO'NLE CAR'BONAS. — CAR'BONATE OF AMMO'NIA. Carbonate of ammonia — as elsewhere stated — is an active ex- citant ; and, like other excitants, proves diaphoretic under certain circumstances. It is rarely, however, given as a diaphoretic alone, and not often in combination. Associated with opium, it is occa- sionally prescribed in protracted ataxic and adynamic fevers; and vol. i.—27 314 SPECIAL DIAPHORETICS. in acute rheumatism, it has been given by some in association with guaiac, but on no very rational principle: accordingly, at the pre- sent day, it is by no means frequently used. It is recommended, that its diaphoretic operation should be assisted by diluents and warm clothing, which are themselves diaphoretic agents. The dose as a diaphoretic is from gr. x to 9j ; and a good vehicle for its administration is almond emulsion. Sugared water answers, however, every purpose. Liquor ammonite or Solution of ammonia, is administered by some as a diaphoretic, under the same circumstances as carbonate of ammonia. The dose is "liv to "Ixx, in sugared water, or properly diluted. Citrate of ammonia, Ammonite citras, which is commonly pre- pared by saturating the ammonia of the carbonate of ammonia with fresh lemon-juice, is occasionally used as a diaphoretic both in the still and effervescent state. 6. EUPATO'RIUM. — THOR'OUGHWORT. Thoroughwort or Boneset, Sex. Syst. Syngenesia iEqualis; Nat. Ord. Com- Fis- 44« positae Corymbi- , wu.f uwsi. iuiu cio a oretic are esteemed by some to be Very powerful, and to sue- POTASSA CITRAS. 315 ceed when other excitant diaphoretics have failed. Hence it has been given freely in acute and chronic rheumatism. The tonic properties, which it possesses at the same time, render it especially adapted for cases in which a diaphoretic and tonic influence is de- manded. In very large doses it may prove emetic. As a diaphoretic, it is rarely given in substance. The ordinary dose of the powder is from §j to 3SS. The infusion is generally prescribed. INFU'SUM EUPATO'RII, INFUSION OF THOR'OUGHWORT. (Eupator. §j; Aq. bullient. Oj.) This should be taken warm, and freely, the patient remaining in bed. It has been recently very strongly recommended by Dr. Peebles, of Petersburg, Virginia, in influenza, — given so as to keep up a nauseant effect on the system. Eupatorium Teucrifolium, or Wild Horehound, — which grows in low wet places, is especially abundant in the Southern states, and flowers from August to November, — possesses similar virtues with E. Perfoliatum. The whole herb was formerly officinal in the secondary list of the Pharmacopceia of the United States. 7. SPIR'ITUS ^ETHERISNFTRICL — SPIRIT OF NITRIC ETHER. This preparation, whose general properties are given elsewhere (p. 273) — has been described as possessing the ordinary excitant properties of the ethers and alcohol. It may, consequently, prove diaphoretic, and be beneficial in fevers of the adynamic kind. It is not so easy to see how it can be refrigerant, although it is so re- garded by many. There is, indeed, no single article in the cata- logue of the Materia Medica, which is more frequently prescribed by the routinist in febrile cases in general. Fortunately, it is never given in large quantities, and, therefore,not much harm results; yet it is difficult to see how it can be appropriate where the vascular ac- tion is excessive as in our ordinary febrile and inflammatory affec- tions. By many it is associated with the liquor ammoniae acetatis ; by others with antimonials — the latter not being a very philosophi- cal combination, as one of the diaphoretics is excitant, the other sedative. With more propriety it has been advised in combination with a small quantity of compound spirit of ammonia, and pre- scribed in the low stage of fevers. Often, perhaps, — especially in the febrile affections of children,— it is prescribed in the dose of a few drops, without the practitioner having much, if any, confi- dence in its diaphoretic powers, but where it is necessary to do something. The dose of the spirit of nitric ether, as a diaphoretic, is f. 3ss to f. 31J, in water. 8. POTAS'S*E CITRAS. — CITRATE OF POTAS'SA. Citrate of potassa is never kept in the shops. It is readily made by saturating the potassa of carbonate of potassa with citric acid ; 316 SPECIAL DIAPHORETICS. but the salt is deliquescent, and crystallises with difficulty. A solu- tion of it is very frequently formed eKtemporaneously ; and the Pharmacopceia of the United States, for 1842, contains two formulae for the LIQUOR POTAS'Sl CITRA'TIS, or SOLUTION OF CITRATE OF POTAS'SA; the one made with fresh lemon-juice, and the other with citric acid. (Succ. limon. recent. Oss; Potassa carbonat. q. s. ; or, Acid, citric. ^ss; 01. limon. n£ij ; Aqua Oss; Potassa carbonat. q. s.) These formulae are properly, perhaps, introduced, seeing that the mixture is so often prescribed, in order that uniformity may be ob- served in its preparation. It is the well known neutral mixture, which, in one form or other, has been employed in febrile cases for ages. When properly prepared, it is merely a solution of neutral citrate of potassa flavoured with lemon-peel, and has no more dia- phoretic virtue than a similar solution of any of the neutral salts. Yet it is constantly administered in febrile cases, and as these gene- rally do well under the observance of a course, which avoids all un- necessary irritation, and removes, as far as possible, disturbing in- fluences when they occur, a portion of the good effects is very apt to be ascribed to any agent which is administered at the same time. The neutral mixture or saline mixture, as it has been likewise called, has been extensively used by the author ; but he has long abandoned its employment, except where it was necessary to carry out a tem- porising method of treatment; and in these very cases, it is much preferable to give the mixture in a state of effervescence, in order that the gently excitant influence of the carbonic acid may be ex- erted on the stomach. Still, for this purpose, the use of the mineral water or soda water of the shops is to be preferred. When kept cold — ice cold—it is an admirable refrigerant, and exceedingly grateful, much more so than the neutral mixture, no matter how well the latter may be prepared. The author has, however, elsewhere described his views in regard to the agency of Refrigerants in febrile and inflammatory affections. 9. CAM'PHORA. — CAMPHOR. Camphor—whose general properties are described under Ex- citants— by virtue of its excitant powers is diaphoretic ; yet it is rarely given alone. Combined with antimonials, as the tartrate of antimony and potassa, it is prescribed occasionally in fevers of the adynamic kind; yet the combination seems scarcely to be philoso- phical, inasmuch as one article is diaphoretic by virtue of its exci- tant, the other by virtue of its sedative, agency. It has been else- where shown, that in long protracted fevers of the adynamic and ataxic kind, it is often associated with opium. The ordinary dose of camphor as an excitant diaphoretic is ten grains, given in the form of pill or emulsion. Its officinal prepara- tions are scarcely ever prescribed as diaphoretics. GUAIACUM. 317 10. GUAFACUM. — GUAI'AC. Both the wood of the Guai'acum ofiicina'le — Guai'aci Lignum, and the concrete juice — Guai'aci Resi'na, Guai'ac — are officinal in the Pharmacopoeias of Great Britain and this country. They have, indeed, been employed in Europe, where they were introduced by the Spaniards soon after the discovery of the New World. Guaiacum officinale; Sex. Syst. Decandria Monogynia; Nat. Ord. Zygophyllaceae, (Lindley,) is a large tree, which is indige- nous in the West Indies, particularly in Saint Domingo and Jamaica. On the continent of Europe, the bark is much used, and it appears to contain more of the virtues of the tree than the wood, 1. GUAPACI LIGNUM, GUAI'ACUM WOOD, —is Lignum Vita, an extraor- dinarily hard and tough wood, which is used for making pestles, block-sheaves, &c. It is imported in logs or billets, consisting of a broad grayish-yellow alburnum, and a dark greenish-brown or green- ish-black duramen, the latter of which is the denser of the two. The specific gravity of the whole is 1.333, so that it sinks in water. Guaiac wood of the shops, Rasu'ra Guai'aci, consists of the turn- ings from the workshop of the turner, and is a mixture of both albur- num and duramen. It is almost devoid of smell, unless when rub- bed, rasped or heated, when it has an aromatic odour. It excites a bitter, acrid biting taste on the palate. When analysed by Tromms- dorff, it was found to contain 26 per cent, of resin — probably the guaiac, to be described presently,— with a bitter piquant extractive matter, which was most abundant in the alburnum; the resin abound- ing in the central wood or duramen. The central wood has gene- rally been preferred, and the alburnum has even been directed to be discarded by some, under the idea that its activity is altogether de pendent upon the resin it contains. This, however, as has been re marked by a recent pharmacologist, Dr. Christison, is a mistake and even if we were not to accord with him, that the more acrid alburnum ought, perhaps, to be preferred, we might still object to the rejection of the acrid principle. Guaiacum yields its virtues to both alcohol and water, but not equally well to both. The resinous matter is, of course, not wholly imparted to the latter. Alcohol has been found to dissolve 21 per cent. ; boiling water 10 per cent, according to one experimenter ; 17, according to another;—yet, the most favourite preparations of guaiacum wood have been at all times decoctions ; which would rather favour the idea, that the activity may be greatly resident in the acrid principle. Guaiacum wood is an excitant diaphoretic, less perhaps on ac- count of the acrid extractive which it contains than of the resin, which is nearly insoluble in water. It is rarely, however, administered as a diaphoretic. It has been given in chronic rheumatism in the form of decoction ; and has frequently been prescribed —as will be seen elsewhere — as a eutrophic, in diseases of the system of nutrition, as 27* 318 SPECIAL DIAPHORETICS. in scrofulous, syphilitic and syphiloid affections. WTiere the ac- tive excitant properties of guaiacum are wanted, the resin is almost always directed. A simple decoction of guaiacum may be made by boiling an ounce of the shavings or turnings, in a pint and a half of water down to a pint. To produce diaphoresis, th'is should be given warm, in the dose of four ounces repeated every five or'six hours if necessary. Guaiacum wood is an ingredient in the Decoctum Sarsaparilla compositum, and the Syrupus Sarsaparilla compositus of the Phar- macopceia of the United States. 2. GUAI'ACI RESI'NA, GUAI'AC, or, as it has been erroneously called, Gum guaiac, is an exudation from the tree, spontaneously or by means of incisions. It is obtained, also, by taking billets of the wood, boring a hole lengthwise through them, and putting one end in the fire ; the the other being so placed, that the melted resin, which runs through the hole as the wood burns, may be received into a calabash. This appears to be the process usually followed ; but it is likewise ob- tained in small quantities by boiling chips or sawings of the wood in salt water, when the resin swims on the top and may be skimmed off. The salt is added to raise the boiling point of the water. Guaiac, as found in the shops, is usually in irregular lumps, often containing chips of wood and other impurities. These are of a brown- ish-red or brownish-yellow colour at the surface, when fresh ; but they become greenish on exposure to the air. The fracture is brilliant and resinous. Its specific gravity is about 1.23. When rubbed, ithas a slight balsamic odour; with little taste, but leaves a sense of heat and pungency in the mouth. The whole of the resin is soluble in alcohol; the impurities being alone left. Water dissolves about 9 per cent. ; and the solution has a sweetish taste. The soluble matter is probably the extractive, which Brande found to exist in it in the proportion of 9 per cent. The resin, considered by some to be peculiar, and which has been called Guaiacimnd Guaiacic acid, forms, according to the same analyst, 91 per cent. Ether acts less energetically on guaiac than alcohol, and the fixed and volatile oils scarcely at all. This last circumstance enables an adulteration, which is sometimes practised on the continent of Europe, to be de- tected. The resin of the pine or colophony is coloured green, and mixed with it; and the adulteration is detected by the partial solu- bility of the suspected article in hot oil of turpentine, which dis- solves the colophony, but does not act on the guaiac. Itexhales, also, a terebinthinate odour when heated. Like the wood of guaiacum, the resin is possessed of excitant pro- perties, and, when aided by warm drinks — the patient being kept in bed — it proves diaphoretic. It is generally, however, associated with nitrate of potassa, ipecacuanha and opium, or antimonials; and is most frequently prescribed for this purpose in acute rheumatism after the more active period has passed away, and in chronic rheu- MEZEREUM. 319 matism. In such cases it is, at times, arbitrarily combined with sul- phur. It has likewise been given, on account of its excitant proper- ties, in chronic atonic gout. The dose of the powdered guaiac is from gr. x to Jss, given in the form of pill or bolus. The London and Edinburgh Pharma- copoeias have a Mistura Guaiaci or Guaiacum Mixture, which, ac- cording to the former, is composed of Guaiac, -zfn] ; Sugar, ?ss ; Mucilage of gum arabic, f. gss; Cinnamon water, f. §xix. The guaiac is rubbed with the sugar ; then with the mucilage; and to these, whilst rubbing, the cinnamon water is gradually added. The dose is f. ^ss to f. gij, two or three times a day. TINCTU'RA GUAI'ACI, TINCTURE OF GUAI'AC. (Guaiac. pulv. ftss ; Alco- hol. Oij.) This tincture is not unfrequently given in the rheumatic and gouty cases referred to above. When mixed with water, the guiacum is separated. Still it may be taken in this manner, but the best plan is to mix the tincture with mucilage before the water is added, and sweeten with sugar, as in the following form : — R. Tinct. guctiac. f. jvj ; Mucilag. acacia, f. ^ss ; Aqua cinnam., \e\\Aquapur., f. 3ivss. — M. Dose, a fourth part four times a day. The ordinary dose of the tincture of guaiac is f. 3J. to f. 3iij. TINCTURA GUAI'ACI AMMONIA'TA, AMMO'NIATED TINCTURE OF GUAI'AC. (Guaiac. pulv. ^iv ; Spirit, ammonia aromat. Oiss.) In conse- quence of the addition of the aromatic spirit of ammonia, this tinc- ture is, of course, more excitant than the preceding. It is applica- ble, however, to the same cases, and requires the same admixtures as the simple tincture. The dose is f. £j to f. gij. 11. MEZE'REUM. — MEZE'REON. The mezereon of the shops is the bark of Daphne meze'reum and Daphne gnid'ium; Sex. Syst. Octandria Monogynia ; Nat. Ord. Thymelaceae, (Lindley.) The British colleges refer it entirely to Daphne mezereum, Common mezereum, or Spurge Olive, a shrub which is common in shady woods throughout central and northern Europe, as well as in the northern parts of Asia, and is generally regarded to be indigenous in Great Britain. Dr. Christison, how- ever, considers it a " doubtful native," of that country. It is occa- sionally seen in the gardens of this country, being much admired for its beautiful fragrant pink flowers, and its splendid clustered scarlet berries. There is a variety, however, with white flowers, and with berries of a yellow or orange colour. It flowers from February to April inclusive, according to the greater or less temperature of the climate. In England and Scotland, the bark of the root is alone used; in this country, the bark of the stem is recognised, which is imported from Germany. It appears to be immaterial which is employed ; such, at least, would seem to be the opiniou of the framers of the 320 SPECIAL DIAPHORETICS. Dublin and United States Pharmacopoeias. Others, however, con- sider the root bark to be more active. It is commonly collected in the spring, from the root, where the root bark is employed, or from the bark of the stem and larger branches — as in Germany — when it is folded into small bundles, and dried for medical use. As we meet with it in the shops, it is in strips of greater or less length, folded in small bundles. It is tough, pliable and fibrous, of a brown colour externally, and white and cottony within. Its taste is sweet- ish at first, but this is soon followed by great acridity. It has no smell when dried, but when fresh, the odour is faint and unpleasant. Mezereon yields its virtues to water. These seem to be refera- ble to an acrid resin, which there is some reason to suppose is a compound of an acrid, vesicating, fixed oil and another substance, and which is made soluble in water by means of other constituents of the bark. All the" parts of the mezereon are highly acrid, so that — as else- where shown — when they are applied to the skin, they excite irri- tation and vesication. When taken internally, they are, therefore, powerfully excitant, and, in large doses, acrid poisons. Like guaiacum wood, it has enjoyed reputation as a eutrophic or alterative in the treatment of syphilitic and syphiloid diseases, and in chronic cutaneous affections, and morbid states of the system of nutrition in general. Its virtues in these relations are, however, treated of in another place. Like guaiacum wood, again, it has been given in rheumatism and gout as an excitant diaphoretic, but it is not much employed. A simple decoction of mezereon is offi- cinal in the Edinburgh and Dublin Pharmacopoeias. It is prepared of mezereon bark, in chips, 3ij ; liquorice root, bruised, ^ss ; water, Oij, boiled down to a pint and a half. The dose of this in chronic rheumatism is f. ^iv to f. ^viij, two or three times a day. Mezereon is an ingredient in the Decoctum Sarsaparilla composi- tum of the Pharmacopoeia of the United States. 12. SASSAFRAS RADFCIS CORTEX. —BARK OF SAS'SAFRAS ROOT. This drug— as elsewhere shown — is excitant by virtue of its es- sential oil; and, like other excitants, may — under certain circum- stances — prove diaphoretic. Dr. Wood remarks, that " its posses- sion of any peculiar tendency to the skin, independently of its more excitant property, is quite doubtful." This would apply perhaps to all excitant diaphoretics, which probably act—as the author has en- deavoured to show — in all cases indirectly. When taken in the form of hot infusion or tea, and aided by the warmth of bed and warm drinks, this drug certainly proves diapho- retic, and might, therefore, be given in incipient catarrhs, and in slight local inflammations, with advantage. It has, likewise been prescribed in chronic rheumatism ; and as will be elsewhere seen__ has formed part of diet-drinks administered in syphilitic and other vices of the system of nutrition. It is an ingredient in the Decoctum ASCLEPIAS TUBEROSA. 321 Sarsaparilla compositum of the Pharmacopoeia of the United States; although its volatile oil cannot fail to be driven off during the boiling. OIL OF SAS'SAFRAS, O'LEUM SAS'SAFRAS, is employed in the same cases as sassafras itself, and is an ingredient in the Syrupus Sar- saparilla compositus of the Pharmacopceia. Its dose is from n^ij to n\,x on sugar, or in some warm fluid. 13. MELIS'SA.— BALM. The leaves of Melis'sa officina'lis or Common Balm ; Sex. Syst. Didynamia Gymnospermia; Nat. Ord. Labiatae—are officinal in the secondary list of the Pharmacopoeia of the United States. The plant is a native of the south of France; but has been introduced into this country, where it is cultivated for use in the gardens. The flowers appear in July, prior to which the plant should be gathered. Balm has an aromatic bitter taste, and a strong peculiar odour, which is preserved by the dried plant, provided the desiccation be accomplished quickly ; but is lost in time. On analysis, it yields volatile oil, which resembles in smell the oil of lemons, — resin, bitter extractive matter, gum, tannic acid, and woody fibre. The volatile oil is not in great quantity. The leaves yield their virtues to hot water. Infusion of Balm or Balm Tea is stimulant by virtue of its es- sential oil; but as this is only in quantity sufficient to afford an agreeable flavour to the infusion, it cannot have much remedial agency. In domestic practice, when given hot, it has been es- teemed an excitant diaphoretic ; but the effects are probably refer- able to the hot water. The author has often seen it exhibited ; and is disposed to arrive at this conclusion. It may be given in catar- rhal and other affections in which a gentle excitant influence on the skin is considered to be indicated. 14. ASCLE'PIAS TUBERO'SA. —BUT'TERFLY WEED. The root of But'terfly Weed, or Pleu'risy Root, is in the secondary list of the Pharmacopoeia of the United States. It belongs, in the Sex. Syst., to Pentandria Digynia ; and is in the Nat. Ord. Ascle- piadeae. This species of Asclepias flourishes in every part of the United States, and flowers in June and July — the flowers being of a beautiful reddish orange colour. It is especially abundant in the Southern states. The root, as seen in the shops, is large and irregularly tuberous ; of a brown colour externally, and white and striated within. In its fresh state, it has a nauseous subacrid taste. Its virtues are im- parted to boiling water. Asclepias tuberosa belongs, doubtless, to the class of excitant dia- phoretics ; and, in large doses, is said to be cathartic. It has been prescribed in catarrh, and in inflammatory affections of the chest in 322 SPECIAL DIAPHORETICS. general, especially after blood-letting ; and, in consequence of its fan cied efficacy in pleu Fig. 45. risy, especially, has received one of its appellations. The dose of the powdered root is gr. xx to 3i, taken three or four times a day; but this is not the best form as a dia- phoretic. The de- coction or infusion is generally employ- ed for this purpose in the proportion of one ounce of the root to a quart of water, the dose being a teacupful every three or four hours, taken warm, and the patient being kept in bed, and warm dilu- ents allowed. 15. XANTHOXYLUM. — PRICKLY ASH. Xanthoxylum is the Asclepias tuberosa. barkof Xanthox'ylum Fraxin'eum ; Sex. Syst. Dioecia Pentandria ; Nat. Ord. Terebinthaceae, — Xanthoxy- leae, (Lindley,) a native of the United States, excepting of the south- ern portion, growing in woods and in moist shady places ; and flow- ering in April and May. The bark, as met with in the shops, is in quilled pieces with an ash-coloured epidermis ; that of the small branches having strong prickles. It is very light and brittle ; nearly without smell, and of a taste sweetish at first, and slightly aromatic, and afterwards bit- terish and acrid. Its virtues are communicated in part to boiling water. On analysis by Mr. Staples it was found to contain volatile oil, a greenish fixed oil, and resin, as its chief constituents. Xanthoxylum belongs obviously to the class of excitant diapho- retics, and is considered to resemble, in its action, mezereon and guaiac. It has been administered in similar cases, and is said by Dr. Bigelow, of Boston, to enjoy considerable reputation in chronic rheumatism. The dose of the powder is gr. x to 3ss, given three or four times ARUM. 323 a day. It is sometimes directed in the form of decoction — an ounce of the drug being boiled in three pints of water to two : a pint of this is taken in divided doses during the day. Boiling can scarcely fail, however, to dispel some of its active constituents, and therefore, cannot be a good form of preparation. " Xanthoxylum is in the secondary list of the Pharmacopceia of the United States. Besides the excitant diaphoretics already described, the Pharma- copceia of the United States has the following in its secondary list. 16. Ara'lia Spino'sa, Angelica Tree Bark. Ara'lia Spino'sa. Angelica Tree, Toothache Tree, or Prickly Ash; Sex. Syst. Pentan- dria Pentagynia ; Nat. Ord. Araliaceae, is an indigenous shrub, which grows chiefly in the Southern and Western states, and is cul- tivated in the gardens to the north as an ornamental plant. It flowers in August and September. The bark is generally given in decoction, (Aral, spinos, ^j; Aqua Oiss. Boil to a pint., Dose f. ^iss to Fi&- 46< f. ^ij, three or four times a day, in chronic rheu- matic cases. 17. Arum, Dragon Root, Indian Turnip, is the cormus of Arum Triphyllum, Dragon Root, Indian Turnip, or Wake Robin ; Sex. Syst. Monoecia Polyandria; Nat. Ord. Aroideae, — Araceae, (Lindley.) The plant is indigenous and common in the United States, and, like every species of arum, contains an acrid principle, when fresh, which can be driven off by heat, and is not imparted to water or alcohol, the ordinary pharmaceutical men- strua. By drying, the principle is lost, and the root becomes inert, con- taining a large quantity of starch, which can be separated from it and taken as an aliment. It is sometimes Used, when fresh; as a diapho- Arum triphylluirt. 324 SPECIAL DIAPHORETICS. retic and expectorant. The recently dried root is usually given, but it has not much efficacy. The dose is ten grains. 18. Car'thamus, Dyers' Saffron. The flowers of Car'thamus Fig. 47. Carthamus tinctorius. tincto'rius, Dyer's Saffron, Bastard Saffron or Safflower; Sex. Syst. Syngenesia iEqualis; Nat. Ord. Compositae Cinarocephalae—a plant, which is indigenous in Egypt and the Levant, but is cultivated in Europe and in this country, where it bears the name of American Saffron—are sometimes administered in warm infusion, (Car- tham. ^ss, Aqua, Oj,) as a diaphoretic, in domes- tic practice, to favour the eruption of the major exanthemata. They are rarely prescribed by the physician; and the same may be said of 19. Crocus, Saffron; the stigmas of Crocus sati'vus, Autum'nal Crocus; Sex. Syst. Trian- dria Monogynia ; Nat. Ord. Iridaceae ; — a native of Asia Minor, and Eastern Europe ; but cultivated in various parts of the world. Saffron is in the primary list of the Pharmacopoeia of the United States, but only because it enters as a colouring agent into various preparations; in some of which it is retained as a relic of antiquity, not because of any valuable remedial virtues. In domestic practice, it is still given in the same cases as carthamus, in the form of Saffron Tea. Its nominal dose is gr. x to gss ; but it is almost inert. It enters into the Pilula Aloes et Myrrha, the Tinctura Aloes et Myrrha; the Tinctura Cinchona Composita, and the Tinctura Rhei et Senna, of the Pharmacopceia of the United States. 20. Sambu'cus, Elder Flowers. The. flowers of Sambu'cus Cana- densis, or Common Elder ; Sex. Syst. Pentrandria Trigynia; Nat. Ord. Caprifoliaceae; a shrub, which is very common in the United States, flowering from May to July, are sometimes used as a dia- phoretic in the form of infusion. They contain a small quantity of volatile oil, which may be obtained by distillation with water, — con- stituting the Aqua Sambu'ci, or Elder Flower Water of the British Pharmacopoeias, which is used to flavour mixtures and emulsions. III. Topical Diaphoretics. 21. CALOR'IC. Along with the internal agents already described, caloric, in vari- ous forms of baths, is often employed as a topical diaphoretic. Of the effects of baths on the animal economy in health, mention has been made elsewhere. (See the author's Human Health, p. 358 ; Philad. 1844.) It remains to speak of them here as therapeutical agents of the diaphoretic class. WARM VAPOUR BATH. 325 a. warm air bath. Air, when heated to from 85° to 100° of Fahrenheit's scale, and placed in contact with the cutaneous surface, is a gentle excitant to the secretory apparatus of the skin, and occasions copious perspira- tion. WThen heated to a greater degree, it forms the hot air bath, which, in place of inducing diaphoresis, causes a degree of excite- ment that arrests the secretion. Warm air has been applied in va- rious ways ; either by raising the bed-clothes from the body by means of a wicker cradle, and then allowing the tube from a lamp to pass under the bed-clothes, or by burning alcohol in a cup or saucer under the same; in either case, the patient's head and neck being outside the bed-clothes. It might be applied also by means of one of the ordinary fumigating apparatuses, in which vapours are made to come in contact with the body ; or by heating the air of an apartment, by means of a cockle or some appropriate stove. Dry heated air is not, however, inhaled with entire impunity in all cases. It is greedy of moisture, and, where the lungs are diseased, may occasion much distress in respiration. At the temperature of 85° to 90°, applied to the surface in either of the two first modes, it is said by Dr. A. T. Thomson to be not stimulating, — to have a soothing effect on the nervous system, — and to be " more certainly productive of sweating than either the warm water bath or the va- pour bath." A bath of this kind has been found useful in chronic rheumatism, and in various neuralgic affections of deep-seated parts ; stiffness of the joints, &c. It is said, also, to have exerted a beneficial agency in cutaneous affections, especially of the squamous kind. Where the blood has receded from the surface, as in cases of congestive fever, or in spasmodic cholera, the bath is rendered more excitant by ele- vating the temperature. It then becomes a true excitant, and, ac- cordingly, is treated of under another head. (See Excitants.) b. WARM VAPOUR BATH. The warm vapour bath holds a medium place between the last and the warm water tbath. The vapoury medium is a better conductor of heat than air, and worse than water ; hence its temperature, to pro- duce analogous effects, must be higher than that of the warm water bath. The vapour bath differs, too, according to the mode in which it is applied. In the case of the Russian vapour bath, the whole body is exposed to the vapour, and it is of course inhaled into the lungs. In other cases, the vapour is made to come in contact with the whole of the body, except the head — none passing into the lungs. In another work, already referred to, (Human Health, p. 47.) the author has described the arrangement and effects of the Russian bath, which is used mainly as a hygienic agent. Owing to these differences between the vapour bath and the warm water bath, it has been laid down, that the temperature of the for- vol. i.—28 326 special diaphoretics. mer should always exceed that of the latter. If, however, the whole body be immersed in vapour, so that it is inhaled, it is recommended, that the temperature should be a little less than if the body alone were exposed to it; as the inhalation of vapour arrests the cooling process of evaporation from the lungs. The following is given on excellent authority, — that of Dr. Forbes, — as a comparative view of the heating powers of water, and of vapour, according as the latter is breathed or not. Tepid Bath, Warm Bath, Hot Bath. WATEK VAPOXTK. 85°— 92° 92°— 98° 98°—106° JNot breathed I Breathed. 9b1-—106u 106°—120° 120°—160° | 90°—100° 100°—110° U0°—130° In the work already cited, and in another part of the present, the author has stated the effects of the hot vapour bath to be — like those of the hot water bath—powerfully excitant, and therefore, not properly falling under consideration here. Those of the warm vapour bath are moderately excitant, but powerfully diaphoretic, producing a general equalising influence, followed by a feeling of languor, and by somnolency. Hence, it may be used with marked advantage in slight inflammatory affections, especially in those of the gastro-pulmonary mucous membrane. In such cases, it would obviously be better, that the bath should be so administered, that air loaded with vapour should be received into the air-passages. It may also be of service in dry chronic cutaneous eruptions, and in rheumatic affections ; although in these last, the hot vapour bath proves more serviceable. For therapeutical purposes, the patient maybe covered with an oil silk garment, which ties round the neck, and is made to fall at a dis- tance around him. A tube, connected with a kettle of boiling water, placed over a spirit lamp, may then be passed under the oil cloth at such a distance from the patient's body as to prevent his being scalded ; and in this way warm vapour may be made to come in contact with it. In certain of the public and private bathing estab- lishments an appropriate apparatus is provided for taking a steam bath at any temperature. Sometimes the vapour is medicated by impregnating it with aro- matic oils from plants boiled in the water, or from some volatile oil being added to it in the vessel ; but although these may somewhat augment the excitant action of the vapour, there is no great reason to believe that much remedial agency has been exerted by them. Of other vaporous agents that may be added, mention is made under those agents. c. warm water bath. The tepid bath, — the temperature of which may be ranged be- WARM BATH. 327 tween 75° and 90° of Fahrenheit, may rather be regarded as a re- frigerant than as a diaphoretic, and, therefore, its therapeutical effects fall more properly under Refrigerants, and are considered else- where. The ordinary temperature of the warm bath is between 90° or 92° and 96° or 98°. Even when as low as 90°, and lower, a pleasurable feeling of warmth is experienced on immersion, be- cause the temperature of the air is generally below this point, and, accordingly, the body is commonly parting with more caloric. Although when first applied, the effect may be to gently excite the secretory organs of the skin, the great influence is the equalisa- tion exerted by it, owing to the blood being solicited every where to the surface. Under this agency, inflammatory concentrations are broken in upon, and hence it becomes one of the most beneficial remedies in minor degrees of internal hyperaemia especially, and, likewise, in cases where the inflammatory mischief is to a greater amount. Its main action is, indeed, sedative, — that is, the gentle excitation first produced by it on the cutaneous system is so speedily followed by sedation, that the latter effect is markedly predominant. Accordingly, although, on immersion, the pulse may become more frequent, and the respiration somewhat accelerated, languor and evidences of diminished action soon succeed ; with impairment of muscular power; a tendency to faintness, and somnolency. Hence, it is used by the surgeon to relax constricted parts, as in cases of luxations, hernia, and of the passage of urinary or biliary concre- tions. In almost all acute phlegmasiae, after more powerful sedatives have been employed, the warm bath is found of decided service, on the principle just mentioned ; hence, in thoracic and abdominal inflammations, more especially when occurring in children, it is much used, and there is no remedy more soothing. In eruptive fevers, especially where the eruption does not appear kindly, its beneficial agency is often marked, and it is especially applicable to cases where the temperature of the surface is depressed, and the circulatory action feeble. In such cases, it ought to approach the hot bath in temperature, and many cases absolutely require the strong excitant influence of water heated above the temperature of the body. In chronic inflammations, the properly directed use of the warm bath is not less serviceable. In dyspepsia, too, it exerts a salutary effect, especially when conjoined with friction on the sur- face ; and in various spasmodic diseases,—as convulsions, particu- larly of children, — its soothing and equalising influence is ad- mitted by all. There is, however, so much inconvenience in its employment in the last case, when an infant is suddenly taken with convulsions, that, by some, as by Dr. Dewees, friction has been substituted. Like the warm vapour bath, it may be beneficial in various dry cutaneous diseases, and in rheumatic affections; and there are cases 328 SPECIAL DIAPHORETICS. of amenorrhoea and of dysmenorrhea, — in the latter especially, when accompanied by a membranous secretion, the result of an excited action of the secretory vessels of the lining membrane of the uterus, — in which it is of decided service. Dr. A. T. Thomson has invented an apparatus, which he regards as the simplest warm bath. It consists of a hammock a, of India rubber cloth, which is extended upon two long poles b b, passed through a Fig. 48. broad seam on each side of trie hammock, and kept asunder by the cross pieces, c, which are at- tached to the warm-Bath. poles by the thumb screws d d d. At one end of the hammock is an air pillow, which can be readily blown up ; and below it is a flexible tube f, made of the same material as the hammock, by which any water it may contain can be readily drawn off. When the poles are fixed, as in the mar- ginal figure, and the open end of the flexible tube twisted round one of the thumb screws, the bath is ready to receive the water. It may be supported upon two chairs,or upon folding tressels ee. The advantage of this bath, according to Dr. Thomson, is, that it re- quires a very small quantity of .water compared with that demanded for other baths, and that when the bathing is completed, the poles and the folding tressels can be placed aside in a small closet, or in the corner of a dressing room, and the hammock, when dried, be put into a drawer. Partial warm baths are much employed, where the desire is to affect particular portions of the cutaneous sur- Fig. 49. face, and through them, the whole system, or organs in the vicinity of those to which they are applied. Thus, the warm Hipbath is em- ployed particularly in inflammatory and other affections of the abdominal and pelvic viscera : the warm foot-bath, in colds, and with the view of restoring the menstrual secretion when ar- rested. The influence of the warmth is soon extended to other parts of the capillary system, and diaphoresis frequently results — especially HipBath. if it be favoured by the warmth of bed, and the use of warm diluent drinks. When the object is to exert a revellent influence in these cases, the temperature of FRICTION. 329 the water is elevated, and salt and mustard are at times mixed with it. The arm-bath and hand-bath are rarely used except as mere topical agents. In the use of the warm bath, there is rarely any shock experienced ; — in other words, no powerful impression is made by it on the nervous system : hence no apprehension need be entertained of its producing injurious con- sequences except in highly impressible per- sons. In such, or where there is a tendency to encephalic affections, the temperature must Foot-Bath. be carefully regulated so that it be not too ex- citant. Both the general and topical bath are likewise considered to be unadvisable in pregnancy, and whilst the catamenia are flow- ing ; but the effects, in such cases, have doubtless been exag- gerated. The time, during which the individual should remain in the bath, must be determined by the nature of the case. In acute diseases, a few minutes may be sufficient, but where it is desirable to relax either the skin, as in cutaneous diseases, or the powers of the sys- tem, the patient may continue in it for a considerable time. Where the affection is chronic, the bath may be taken two or three hours after a meal, so that digestion may not be interfered with. When the patient leaves the bath, friction with warm flannels may be used in chronic cases. In acute cases, he may be removed from it, and be placed in blankets. Warm fomentations and Poultices act as topical baths, by virtue of their warmth and moisture. They relax the parts with which they come in contact, and, as in the case of pediluvia, the sooth- ing influence they exert on the parts with which they touch is extended, elsewhere, so that a sedative influence may be exerted on the system generally, and especially on the vessels that may be affected with any internal hyperaemia. Injections of warm water thrown into the rectum or vagina, in cases of diseases of the uterus, peritoneum, or the upper portions of the intestines, act in the same manner as warm fomentations. d. FRICTION. Friction of the body, with dry flannels or with the flesh-brush, excites the action of the secretory organs of the cutaneous surface, and in moderation tends to the production of diaphoresis. It is rarely, however, employed with this view, except as an adjunct to the warm bath ; and even then is more used hygienically than thera- peutically. Friction is frequently employed topically to modify nutri- tion, but its consideration in that light will fall under the head of Eutrophics. 28* 330 NARCOTICS. SECTION IV. AGENTS THAT AFFECT PROMINENTLY THE NERVOUS SYSTEM. I. NARCOT'ICS. Synox. Obstupefacientia, Slupefacientia. Definition of Narcotics — May be used as excitants, and as sedatives — Their action elucidated by that of Opium—May act locally as well as generally—Mental nar- cotics — Therapeutical application of narcotics — In febrile diseases — In the phleg- masia, &c. — Special narcotics. Narcotics greatly resemble, in their action—when administered in appropriate doses— the class of sedatives. They differ from them, however, in several respects. Whilst the action of sedatives is not preceded by any degree of excitation, that of narcotics always is. In minute doses, again, narcotics may produce none of the effects that characterise them when given in large doses. Their agency maybe altogether excitant; and, with the view of obtaining the modification in the organic actions, which such agency is capable of exerting, they are occasionally exhibited in small quantity. When given to the extent of inducing their peculiar action, they may be defined — " agents, which first excite and then diminish nervous action, and, in appropriate doses, stupefy." The power of stupefying must, indeed, be esteemed one of their main character- istics. Although the above definition may apply generally to their opera- tion, when they are administered in a dose proper to produce a nar- cotic influence, it is obvious, from what has been said, that it is not wholly applicable, when they are given as mere excitants: in such case, they may not " diminish nervous action, and stupefy." They can then, however, be regarded as excitants only ; but, in' adequate doses, the latter part of the definition is strikingly appropriate ; and the effects mentioned must be regarded as the most essential conse- quents on their employment. Even when they are administered in a full dose, some degree of excitation is first perceptible; the func- tions of circulation, innervation, and secretion become more or less modified; the pulse beats more rapidly, and forcibly ; the skin is hotter and drier than natural; the nervous system exhibits greater impressibility ; and the mouth and fauces are dry, or their ordinary secretions are more tenacious than natural; but these evidences of excitement soon pass off— more rapidly in proportion to the size of the dose, — and a train of phenomena indicating sedation follows those of excitement; the respiration becomes slower; the skin moist- the pulse reduced to the natural standard, or even below it • the im- pressibility of the nervous system is obtunded ; the tongue becomes moist; and all the symptoms exhibit that a sedative and soothing NARCOTICS. 331 agency has been exerted. Perhaps, in every case, however large the dose of the narcotic may be, some degree of excitement might be perceived as a precursor of the sedation, were due attention paid; but the sedative effect of a very large quantity of any of the narcotics supervenes so rapidly on the stimulant, that the attention of the practitioner is scarcely directed to the latter operation — espe- cially as it is not the one for the production of which he has pre- scribed it. The marked difference between a stimulant and a sedative dose of the same agent can be understood from the cases, so often re- lated in the newspapers, of persons, who, for wagers, have swallow- ed, at once, a large draught of some alcoholic liquor. The sedative effects of this powerful excitant — excitant, that is, in a smaller dose — are so speedily exerted, that a stop may be put to all the functions, without there being any marked symptoms of previous hurry in the organic actions. When a narcotic is taken, the first effects occur in the nerves dis- tributed to the lining membrane of the stomach. These are ren- dered less impressible, and the obtunding influence is soon extended to the great nervous centres, which are affected like the nerves with which the narcotic first comes in contact. In this manner, the func- tion of innervation generally has its activity diminished ; and, there- fore— directly as well as indirectly—the gastric functions may be impaired. If the narcotic be taken before eating, and when a marked desire for food is present, the appetite may be diminished or extin- guished, under the new condition of innervation. If food have been received into the stomach, chyraification may, for like reasons, be retarded ; and the whole of the digestive operations — chymification, chylification and defecation — may exhibit an obvious degree of torpor. It can thus be comprehended, that the use of a narcotic may be followed by constipation, and that it may be well adapted for diarrhoea, where an indirect astringent agency appears to be indi- cated. The precise modus operandi of the narcotic may, in these cases, vary with the dose : where it is large, the whole function of innervation may be blunted ; and not only the secretions, but the peristole of the intestines be diminished ; whilst if the dose be smaller, the effect may be mainly exerted upon the nerves distributed to the gastric apparatus, without the rest of the nervous system ma- terially participating. In cases of diarrhoea, opium, like every the- rapeutical agent, has a relative action ; and the same may be said of its employment in other morbid conditions. If irritation or inflam- mation exist in any portion of the alimentary canal, such irritation or inflammation may be allayed by a sedative dose of a narcotic ; and, in this way, the pathological condition being removed, its symptom — the increased number and morbid character of the evacuations— may cease likewise. It has been a very common remark, that opium is not well adapted for cases of pneumonia, bronchitis, &c, because it " diminishes the 332 NARCOTICS. secretions," but this appears to be a faulty method of explaining its action. The suppression of secretions is not a pathological con- dition. It is only the symptom of such a condition, and when we state, that the indication is to restore the secretions, if the expression have any meaning at all, it can only convey the idea, that the pa- thological condition, which occasions their suppression, must be re- moved. Now, we know, that the first consequence of the inflam- mation of a mucous membrane is a diminution of its wonted secre- tion ; and that, after the inflammation has persisted for a time, an increase of the secretion takes place ; but it is no longer of a healthy character. It is a secretion, accomplished by vessels labouring under inflammatory excitement. Two opposite effects, then, on the* secretory function, are produced by different stages of inflammation. Yet, the indication, in both cases, must obviously be alike. It must be, to remove the pathological condition, of which these effects are symptomatic. A narcotic we know to be, in appropriate doses, a sedative ; — that is, it is capable of diminishing the force of the cir- culation, and the energy of innervation. It is, therefore, well adapted for acting as a contra-stimulant — for allaying inflammatory excite- ment. A knowledge of its properties would suggest to us the pro- priety of its employment in the diseased state of mucous membrane, instanced above ; and experience ought to show, — as it does daily show, — that in one of the conditions assumed, — that is, in the early period of mucous inflammation, — it will restore the secretions ; and, in the other, where the mucous secretions have become profuse, and morbid, it will diminish them, — by diminishing the inflammation that occasioned them. It is obviously, therefore, incorrect to lay down the broad law, that opium diminishes the secretions, and that its use is improper whenever the indication is to restore the secretions. Such an indication ought never to be imagined. It is unmeaning, and can only have been suggested in the ignorance of true pathology; and the author is happy to find, that a recent writer on therapeutics — Dr. Spillan — expresses his entire accordance with these senti- ments, as contained in the first edition of this work. In cases of pneumonia, where the expectoration has been free, a diminution of the sputa has seemed to supervene on the administration of nar- cotics ; but this has been owing to the agent not having been ad- ministered in a dose adapted to the pathological condition of the pulmonary organs. Where the opium is given in a small dose — as is too often the case — it will as surely add to the inflammation, as the same amount of any other excitant; and if we add to the inflammation, we may arrest the secretion altogether, by bringing back that condition of the tissue, which existed at the onset of the inflammation; but if, in this very case, a full sedative dose were administered, none of the evils might be found to follow. The sedative would allay the excited organic actions, and if the secre- tion were diminished — as it probably would be—it would be a fortunate diminution, because arising from lessened inflammatory MODUS OPERANDI. 333 excitement in the lining membrane of the bronchial tubes, or in the tissues in their vicinity. Another example may be taken, where the secretions and excre- tions are manifestly facilitated by narcotics. It has been already remarked, that opium is administered in cases wThere there is an undue number of alvine evacuations, with the view of exerting a constipating effect. But it is no less administered where constipa- tion is dependent upon certain pathological conditions. When en- teritis or inflammation of the peritoneal coat of the intestines ex- ists, constipation is a common symptom ; and, on the other hand, if the inflammation be seated in the mucous coat, diarrhoea is as common. Why this difference should exist is owing to the inflam- matory condition of the follicles, and of the mucous membrane generally, being accompanied, after the disease has continued for a short time, by augmented secretion. It might seem, however, that as the peritoneal coat so closely invests the muscular, the latter ought to be thrown into inordinate contraction, and an increase be occasioned in the number of the evacuations from this cause. Such contraction does exist, but the necessary irritation in the lining membrane is wanting to induce diarrhoea ; the contraction of the fibres has more of the character of spasm ; and a derivative effect is perhaps exerted, owing to the concentration of the excited organic actions in the peritoneal coat diminishing the amount of secretion from the mucous coat; in this manner, constipation comes to be one of the phenomena of peritoneal enteritis. In such a case, opium, judiciously administered, exerts its sedative agency ; diminishes the inflammatory action in the peritoneal coat, and re- solves the spasm in the muscular coat; so that the causes of the constipation being obviated, it ceases ; and we thus have a laxative, or cathartic effect, induced by remedies, which in other pathologi- cal conditions, are well adapted for producing opposite results. These are cases, which exhibit the value of the possession of sound pathological and therapeutical knowledge. We discover empiri- cally the property of our drug, and having accurately appreciated the agency it is capable of exerting, we can say d, priori what will be the pathological condition, in which the greatest benefit may be reaped from its employment. Accordingly, as the author has re- marked in an early part of this volume, analogy has led to the em- ployment of the invaluable agent — opium — in cases, in which some years ago it would never have been ventured upon. Some pathologists have considered it best adapted for phlegmasiae of the peritoneum — both of the membrane proper, and its extensions over the different viscera. Such was the view of the indefatigable in- vestigator of the diseased conditions of the animal economy — Armstrong. In these phlegmasiae, he conceived it to be perhaps the most efficient therapeutical'agent that we possess : and, although he esteemed it best to unite it with bloodletting, and to repeat both remedies according to the urgency of the case, he was dis- 334 NARCOTICS. posed to think, that if he himself were labouring under perito- neal enteritis, and were told, that he must rest his hopes upon the lancet singly, or upon opium singly, he should be disposed to select the latter. What Armstrong said of the use of opium in these cases has been extended to similar pathological conditions in other serous tissues and elsewhere, and many advantages have accrued from its employ- ment, in some form of preparation, in cases in which, at one time, its use was unknown, or considered inappropriate. In a work on Therapeutics by Dr. Chapman, of Philadelphia, we have the following remark. — " Concerning the operation of opium, medical sentiment continues to be divided, though the preponde- rance is decidedly in favour of its stimulant properties, and with such an impression it is employed." It is this belief, as well as the want of knowledge of the essential difference in the action of nar- cotics according to the dose, that has occasioned opium to be dis- carded in cases of undue vascular and nervous excitement for the removal of which it is so admirably adapted. Impressed with an unfavourable sentiment towards its use — a sentiment derived from authors, and teachers —the young practitioner is apt to administer it in phlegmasia! affections, either in doses so small, that no sedative effect is induced, or, in his caution, he strikes the medium ground between stimulation and sedation : in the former case, he witnesses, perhaps, an aggiavation of the excitement, and, in the latter, either no effect whatever, or one of aggravation; and he, therefore, too hastily concludes, that the use of opium is, in such cases, inappro- priate and injudicious. Under these feelings, he never employs it afterwards, and yet he conceives himself entitled to say, from expe- rience, that opium is, in no case, advisable, where inflammation is present. Such were the views strenuously inculcated when the author com- menced the study of medicine ; and many a practitioner of the pre- sent day, who may entertain them, will find, that his impressions have been derived from others. A little experience sufficed, in the author's case, to induce him to throw off the trammels of authority, and the judicious remarks of Armstrong confirmed him in his course. Both in public and in private practice, he has administered it largely; and, from the results, is prepared to say, that we have not in phleg- masiae in general a more valuable agent, if we except the lancet; and there are obscure cases of inflammatory action—in puerperal females especially — where it can be advantageously employed when the lancet cannot. It has, indeed, been argued, that where such affections have been relieved by opium, the very fact shows, that they were not inflammatory, and farther, that we may often mistake neuralgic diseases for inflammatory, as is sufficiently shown by the circumstance, that narcotics completely remove affections, which were previously supposed to be inflammatory. The result in no re- spect invalidates the diagnosis. Opium is a precious sedative, and MODUS OPERANDI. 335 it is, therefore, as well adapted for the one class of cases as for the other. A very slight reflection, on the mode in which opium relieves pain, will place this subject in a striking light. It will show how a narcotic may prevent the aggravation of diseased action. If we apply opium to a part of the dermoid surface, whose organic ac- tions are morbidly modified, the effect of the narcotic is exerted on the nervous ramifications themselves ; their impressibility is dimin- ished ; and the irritation, under which they have been labouring, may be no longer appreciated by the brain. In the same manner, if the narcotic be swallowed, its effects are exerted upon the nerves of the stomach, and, through them, on every part of the nervous system. The brain no longer appreciates the irritation, or does so in a diminished degree. The irradiations, which would otherwise have been reflected to every part of the economy consequently cease, and, by the simple arrest of morbid sympathies, the amount of disorder is diminished. In like manner, the induction of sleep by a full dose of opium will, at times, allay tumultuous action of the nervous and vascular systems, which could not have persisted without adding to the amount of mischief. In the disease of colica pictonum we have a state of the alimen- tary tube, in which the agency of opium may be usefully employed, with the view of removing constipation. This is often dependent upon irregular action of the nerves distributed to the muscular fibres of the intestines, — a state, which a combination of opium with some cathartic — as with the mild chloride of mercury — is well calculated to remove. The opium allays the inordinate action of the nerves,— resolves the spasm,—and permits the mild chloride to exert its ordinary cathartic action. For reasons like these, strength- ened by the results of experience, a combination of calomel with opium, or with sulphate, acetate, or muriate of morphia, is a com- mon prescription with many practitioners in enteric inflammation. In most of the London hospitals, it may be regarded as an officinal formula. It has been an interesting topic of inquiry, — how narcotics exert their constitutional effects;—that is, whether by the impression they make on the nerves of the part with which they come in contact — such impression being conveyed to the rest of the nervous system — or, whether they must not, in every case, enter the blood-vessels, affect the nerves distributed to the inner coat of the vessels, or pass with the current of the circulation to the great nervous centres. There are many facts, which may be adduced in favour of each of these views. As regards the first, one of the strongest arguments is, the rapidity with which the effects of certain narcotics are induced. Of these, perhaps the most marked is an agent, which the author has classed amongst the sedatives, but which has been placed, by many toxicologists, amongst the narcotics — hydrocyanic acid. The effects of this acid have been examined by numerous observers. 336 NARCOTICS. Magendie asserts, that if a single drop be put into the throat of a dog, the animal makes two or three deep, hurried respirations, and in- stantly drops down dead ; that it causes death almost as instantane- ously when dropped under the eyelid ; and that when it is injected into the jugular vein, the animal falls dead at the very instant, as if struck with a cannon-ball or with lightning. " In repeating these experiments," says Dr. Christison, " in order to determine, figura- tively, the shortest period, which elapses before the poison begins to operate, as well as the shortest time in which it proves fatal, I found that a single drop weighing scarcely a third of a grain, dropped into the mouth of a rabbit, killed it in 83 seconds, and began to act in 63 seconds, — that three drops, weighing four-fifths of a grain, in like manner killed a strong cat in thirty seconds, and began to act in ten, — that another was affected by the same dose in five, and died in forty seconds, — that four drops weighing a grain and a fifth did not affect a rabbit for twenty seconds, but killed it in ten seconds more, — and that twenty-five grains, corresponding with an ounce and a half of medicinal acid, began to act on a rabbit as soon as it was poured into its mouth, and killed it outright in ten seconds at farthest. Three drops, projected into the eye, acted on a cat in twenty seconds, and killed it in twenty more ; and the same quantity, dropped on a fresh wound in the loins, acted in forty-five, and proved fatal in a hundred and five seconds." Again, the empyreumatic essential oil of tobacco, as well as strychnia, has caused death in two minutes. Now, in the case of hydrocyanic acid especially, which proves fatal in a large dose, even before the animal can be removed from the lap of the experimenter, it seems difficult to offer any other ex- planation, than that its effects are exerted upon the nervous radicles with which it is made to come in contact, and that thence, with the rapidity of lightning, the lethiferous influence is propagated to the brain, which dies first, and, in due succession, all the functions, under its presidency, cease. Dr. Christison, indeed, when treating of opium, affirms, that " the old doctrine, that the blood-vessels have no concern with its action, and that it acts only by the conveyance along the nerves of a peculiar local torpor arising from its direct ap- plication to their sentient extremities, has been long abandoned by most physiologists as untenable. But some have adopted a modi- fication of this doctrine, by supposing, that opium may act both by being carried with the blood to the brain, and by the transmission of the local torpor along the nerves. They believe, in fact, that opium possesses a double mode of action, through sympathy, as well as through absorption." " It would be fruitless," he adds, " to inquire into the grounds that exist for adopting or rejecting this doctrine, because sufficient facts are still wanting to decide the controversy. So far as they go, however, they appear adverse to the supposition of a conveyance of impressions along the nerves, without the previous entrance of the poison within the blood-vessels." MODUS OPERANDI. 337 All the difficulties, in the way of the theory of the sympathetic action of opium, Dr. Christison thinks, are removed by the doc- trine of Messrs. Morgan and Addison. According to this, the ex- periments, which appear at first sight to prove, that opium ope- rates by being carried with the blood to the part on which it acts, are easily explained by considering, that the opium makes a peculiar impression on the inside of the vessels, which impression subsequently passes along the nerves to the brain. In the case of hydrocyanic acid, however, the imbibition must take place most rapidly, as the deadly results supervene so immediately on its appli- cation. Its penetrating power must largely exceed that of other narcotic agents, which require a long time before their effects are perceptible. Its action obviously can only be accounted for, by pre- suming, that its impression is made on the nerves, either of the part, or of the interior of the blood-vessels : there is not time for the poison to pass to the nervous centres with the circulatory current, and the experiment of Magendie — which showed that death supervened on the very instant when the acid was injected into the blood-vessels, whilst a few seconds elapsed before its fatal action was exerted when it was put in contact with an absorbing surface — would favour the notion of Messrs. Morgan and Addison, that the impression is made on the nerves distributed to the inner coat of the blood-vessels, although the difficulty remains, why these nervous filaments should be more impressible to poisons than the nervous radicles distributed to the external dermoid or other tissues. If, however, the view of these gentlemen be the true one, it must persist, whatever may be the difficulty in suggesting a satisfactory explanation of the phenomena. It is proper to bear in mind, in this investigation, that many agents of the class now under consideration do produce impressions on the nerves of the part to which they are applied, without the general system being materially implicated ; — a circumstance, which would favour the views of those, who consider it indispensable, that poisons should enter the blood-vessels, in order that they may act on the general system. Robiquet remarked, that when the vapour of con- centrated hydrocyanic acid was confined for some time in a glass tube, with a finger on each open end, the point of the finger became benumbed, and remained so for more than a day. Dr. Wilson Philip found, that when opium was applied to the mucous coat of the intes- tines of a living rabbit, the muscular contractions of the gut were immediately paralysed, without the general system being affected for some time. The same effect was observed by Messrs. Morgan and Addison to follow the application of ticunas to the intestine. An instantaneous and total suspension of the peristole took place when- ever the poison touched the gut. Dr. Monro, secundus, found, when an infusion of opium was inserted between the skin and muscles of the leg of a frog, that the leg soon became paralysed, whilst the ani- mal was able to leap about briskly on the other three. Many similar examples of purely local impression might be men- vol. i.—29 338 NARCOTICS. tioned, were it necessary. The singularity is, that the general system should, in these cases, remain intact. A striking instance of purely local action, and, at the same time, of that inexplicable preference, of which we have so many examples, in the influence exerted by various agents on the economy, is the effect of some of the class of narcotics in dilating the pupil. This is done by the extracts of bel- ladonna and stramonium, without the general nervous system being in the least implicated; whilst the most energetic of the narcotics — opium — exhibits no such preference of action on these nerves. There can be no doubt, then, that narcotics may affect the frame through the medium of the nerves, without its being necessary, that they should proceed with the blood to the great centres of the nervous system ; but there are strong facts to show, that, in certain cases, they are absorbed, and act through the medium of the circu- lation. Still, as has been suggested by Dr. A. T. Thomson, such absorption would seem to be by no means essential. The strongest arguments in favour of it — as properly stated by Dr. Thomson — are : First. The time that supervenes between taking a dose of opium and the manifestation of its influence on the system — a time suffi- cient, certainly, for the absorption of the narcotic ; but, in reply to this argument, he states, that the intimate combination of the meconate of morphia, with the other constituents of the drug, requires some time before it can be so far separated as to be able to act with energy on the sentient extremities of the nerves of the stomach : for " we find," he adds, " that the time, which supervenes, is in the direct ratio of the state of solution and separation from the other constituents of the opium, in which the meconate exists in the preparation em- ployed." But this explanation is unsatisfactory. When taken in a soft pill, opium produces its effects almost as soon as when any of its forms ©f preparation are administered. It has, indeed, been main- tained, that this is not the fact, but the very cases adduced are such as establish the affirmative of the position. In a case, related by M. Desruelles, the sopor was fairly formed in fifteen minutes, after two drachms of solid opium had been taken. Secondly. The increase of the symptoms, for ten or twelve hours after their inception, although the opium is as much in contact with the nerves in the first quarter of an hour, as at the end of the twelve hours. This argument, Dr. Thomson observes, is more difficult to answer than the first, and his opinion is, that it certainly indicates absorption. This is probable ; but, under any view, it is somewhat strange, that the augmentation should continue so long; and the supporters of the doctrine, which holds, that the effect must take place through the medium of the nerves, might suggest, with much speciousness, that such effect is as easily explicable, on the idea of the repetition of narcotic impressions made by fresh and fresh portions of the narcotic coming in contact with the nerves distributed to the inner coat of the blood-vessels, as by the view, that the narcotic must pass, with the blood, to the ner- vous centres themselves. Thirdly. The rapid effects, which follow MODUS OPERANDI. 339 the injection of opium, in solution, into the veins ; and not opium only, but any of the narcotics. Orfila found, that an ounce of the extract of the leaves of conium maculatum killed a dog in forty-five minutes. Ninety grains, inserted into a wound, killed another dog in an hour and a half; and twenty-eight grains, injected into a vein, killed another in two minutes. It is, therefore, legitimately inferred, that these substances act by entering the blood-vessels; but even granting this, it does not follow — as the author has endeavoured to show — that the substance must pass with the blood to the great nervous centres. It may act on the nerves of the inner coat of the veins. Indeed, the short time that elapses, prior to the supervention of the narcotic effects, when the poison is injected into the blood- vessels, is somewhat unfavourable to the doctrine of the necessity of direct contact with the great centres of the nervous system. But there are facts which show incontrovertibly, that opium may enter into the fluid of the circulation. During the confinement of the lady of a friend of the author, it was considered necessary to administer morphia to her; when the infant became so completely narcotised, that serious apprehensions were entertained for its safety. It ultimately recovered. A similar case is given by Barbier. The infant was manifestly affected through the milk of the mother, who had taken a large dose of the wine of opium. In these instances, the narcotic must have passed into the circulation of the mother, and been separated by the mammae. We are compelled, therefore, to admit, that opium may commingle with the blood in the vessels, and even if it be not admitted, that it proceeds to the great nervous cen- tres,— there to exert its appropriate influence,— it maybe con- ceived, that by coming in contact with the nerves distributed to the coats of their blood-vessels, it may produce a more powerful effect upon the nervous system, than if its action were wholly exerted on the inner coat of the vessel, into which it first passes. With these facts, it is impossible to arrive at any single exclusive deduction. It would seem, that narcotics may exert their effects upon the nerves of a part of the dermoid surface, and on those dis- tributed to the inner coats of the blood-vessels; and that they may pass into the current of the circulation, and proceed, with it, to exert what precise agency is not so clear. Dr. A. T. Thomson has affirmed, that the nerves, more particu- larly affected by narcotics and sedatives, are the respiratory ;—but it is not easy to see how he attains this conclusion. He quotes, in confirmation of the opinion, a series of experiments, conducted by Sir Benjamin Brodie, who introduced, in one instance, a drop of volatile oil of bitter almonds into a wound in a rabbit: after five minutes, respiration had ceased; but the heart " was still beating through the ribs;" and, by renewing and keeping up respiration, by artificial means, for sixteen minutes, spontaneous breathing was re-established ; all the functions of the brain revived, and life was in fact restored. Dr. Thomson adds —" It is not easy to explain, 340 NARCOTICS. why one set of nerves should be more particularly influenced than another by narcotics." This case does not, however, appear to be in point. There is a marked difference between the voluntary, the excito-motory, and the organic nervous systems. The voluntary muscles are under the presidency of the first: — the involuntary, under that of the second, and probably of the third : the respiratory organs are supplied by encephalic nerves, as well as by the true spinal or excito-motory, and by ganglionic nerves: but the heart is singularly situate as regards its nerves. Although capable of being affected through them, its action may continue after the great ner- vous centres have been destroyed — provided it receives its ordi- nary stimulus, by the maintenance of artificial respiration. When, however, the cerebro-spinal axis is destroyed, the mechanical phe- nomena of respiration necessarily cease. In like manner, if the functions of the brain be suspended by the action of a powerful narcotic, the respiratory phenomena, which are dependent upon the influence of the brain, are suspended also ; and if the action of the narcotic be fleeting, we may conceive, that, by keeping up the mechanical phenomena of respiration, and thus maintaining the heart in action, as the influence of the narcotic passes away, the encephalon may resume its wonted functions, and respira- tion be completely re-established. An interesting case of the kind has been recorded by Dr. Casper Morris, of Philadelphia. The experi- ments of Sir Benjamin Brodie ought, therefore, to be borne in mind; and although, in the case of narcotics, whose action is prolonged, no useful hint may be derived from them of a therapeutical nature, yet, as has been said before, where a narcotic has been taken, whose action is transitory, the recollection of them, and a due acquaintance with the physiological inferences deducible from them, may, lead to the preservation of a life, which, otherwise, might have been lost. % Narcotics, then, may be used as excitants, or as sedatives. Gene- rally, they are employed to diminish impressibility, and to allay ex- citement ; and a knowledge of their medicinal properties enables us to administer them even when high inflammatory action may be present. The case of severe headache supervening on great loss of blood from the uterus was before selected with the view of pointing out the difference that may exist between hyperaemiae of various kinds. It was then remarked, that a few hours after blood has been lost to an inordinate extent by this, as well as by other he- morrhages, the nervous impressibility may be irregularly developed, and, under the erethism of the nerves distributed to particular blood- vessels, these vessels assume augmented action, and evidences pre- sent themselves in the circulatory movement, which appear to indi- cate the existence of vascular force and repletion ; and that, in all such pathological conditions, the indication cannot be,-—to draw more blood from a system already exhausted, as far as is compatible with the persistence of life. On the contrary, it must clearly consist in USED AS EXCITANTS AND SEDATIVES. 341 allaying that irritability of the nervous system, which has been so inordinately developed ; and the best mode to accomplish this is to administer a full sedative dose of opium, under the action of which the nervous and vascular turmoil rapidly subsides into a state of quietude. It is astonishing to what an extent narcotics may be borne with impunity, where a habit of resistance has been acquired by long protracted indulgence. Dr. Russel, in his ' History of Aleppo,' states, that a Turk of the name of Mustapha Shatar -— an opium eater in Smyrna — took daily three drachms or 180 grains of opium ; and in the c Confessions of an English Opium Eater,' the author of that work is affirmed to have consumed, at one time, eight thousand drops of laudanum, daily. If we consider, that 25 drops of lauda- num are equal to one grain of opium, this would make 320 grains, or upwards of five drachms, in the day. In a case of cancer of the uterus, treated by Drs. Monges and La Roohe of Philadelphia, the quantity of laudanum was gradually increased to three pints in the 24 hours, besides a considerable quantity of solid opium. Besides the physical agents, classed under the head of narcotics, there are certain moral influences, which may be placed in the same division. These have been termed mental narcotics ; and it has been properly remarked by Dr. A. T. Thomson, that " persons, who are endowed with great nervous sensibility, are for the most part powerfully affected by mental pleasures and pains ; and, there- fore, when the higher orders of society and men of intellectual ac- quirements are affected by mental diseases, it is sometimes neces- sary to employ mental narcotics, when material substances fail in procuring repose." Perhaps, however, in all cases, such mental operations are wholly of a revellent kind ; and sleep ensues by the mind being diverted from trains of thought, or impressions, which prevented it. Impressions, made upon the nerves of audition, have a soothing effect, more than those on any of the other senses. It is thus, that music exerts so powerful an effect on the frame, ^-partly, perhaps, by the mere excitation of the auditory nerves, and partly, also, by the abstraction, which it induces, when selected so as to suit the precise feeling. Its effect upon the hearer has been beau-. tifully depicted by Dryden, in his Alexander's Feast; and, that the picture is not overdrawn, must be admitted by all, who have heard thepiece well read, with the " action suited to theword,"and,indeed, on simple perusal, by every one, whose mind is attuned to the live- lier sympathies. If the musical air be lively, and varied, the attention may be kept on the alert, so that sleep may be dispelled ; but if its charac- ter be " most musical, most melancholy," and, withal, more or less monotonous, sleep is almost sure to ensue. Armstrong—-himself one of the profession — has well described the effects of music when he says: 29* 342 NARCOTICS. " Music exalts each joy, allays each grief, Expels diseases, softens every pain." But, it is not necessary, that the intellectual pleasure of music should be always experienced, when the object is to restore sleep to the suf- ferer, or to one who is in health. Any succession of unvaried sounds can induce it; as the bubbling of a brook ; the purling of a rill; the hum of a distant, busy multitude ; a discourse — however interesting — delivered in a drawling monotonous manner ; the clacking of a mill, &c. In like manner, the ballad of the nurse, with the rocking of the cradle, soothes the restless infant: with the same view, the nurse scratches its back, and the older individual is often recommended to count, over and over again, as far as fifty ; — and the expedient often succeeds. The mind is abstracted from the thoughts and reflections that occupy it, and tbe monotony of the occupation combines to accom- plish the desired result. The passes and other manipulations of the animal magnetiser induce a like effect, along with a series of singular and anomalous phenomena, the consideration of which would be in- appropriate here. It can readily be conceived, that in many cases of insanity appro- priate music may exert a valuable therapeutical agency, but it re- quires the greatest caution on the part of the practitioner to adapt it to particular cases. Lively music may abstract the melancholic from his corroding dejection ; and the more soothing has been known to produce the happiest effects on the furious maniac. To adapt it properly, it is important to know something of the history of the patient, lest associations of a painful character should be called up, which might vibrate to every part of the frame, and give rise to an increase of the aberration. « Therapeutical Application of Narcotics. The inquiry, already entered into, respecting the properties of narcotics as medicinal agents, has rendered it unnecessary to say much concerning their therapeutical application. Allaying pain, producing sleep, and diminishing action, in large doses, it is only in such doses that their use can be proper, where there is aug- mented vital activity. On the other hand, as they are excitant in small doses, they must be exhibited in such doses, where the object of the physician is to add to the amount of excitation. Intermittents. — In intermittent fevers, they are occasionally ad- ministered to stop an anticipated paroxysm: this effect is probably induced by the new action they occasion on the nervous system, which breaks in upon the morbid catenation that exists in these periodical affections. Continued and remittent fevers. — In continued, and remittent fevers, when narcotics are considered to be indicated by extreme watchfulness and restlessness at an early period of those diseases, THERAPEUTICAL APPLICATION. 343 they should obviously be given in such quantities, that their seda- tive influence may be fully exerted ; otherwise, the exaltation of the vital manifestations may be augmented by them. The author well recollects, at the period when he followed the clinical lectures of the late Dr. Home, at the Royal Infirmary of Edinburgh, but little hesitation existed as regarded the administration of opium, after the ninth day of a continued fever; not because the intelligent Professor conceived, that there was philosophy in the observance of days, but because it had appeared to him that prior to this period — that is, during the first week of the disease — the beneficial effects of the opiate were not as marked as they were afterwards. The ordinary dose, directed by Dr. Home, was thirty-five drops of the tinctura opii. Pursuing the plan, inculcated by him, the author was in the habit — early in practice — of waiting until about the com- mencement of the second week, and then of prescribing this quan- tity, but, as he became better acquainted, from experience, with the properties of the drug, and with the pathological conditions pre- sent in fever, he did not hesitate — in public and in private prac- tice — to give it in larger doses, and even at an early period of the disease ; and he is not prepared to say, that he has, in a solitary instance, observed unpleasant results from its administration. He generally begins with 40 or 50 drops, in the case of the adult, or with 15 or 20 drops of the black drop, or with one of the prepara- tions of morphia, and is careless as to the precise period of the complaint, provided symptoms exist, which appear to him to indi- cate its use. Inflammation, spasmodic diseases, fyc. — Of the employment of narcotics in the different phlegmasiae, the author has already treated at so much length, that it is not necessary to add any thing farther here. In the spasmi of Cullen, and in some of the vesaniae, they are, at times, the only agents that afford the slightest relief, and it is aston- ishing what quantities may be taken without the supervention of narcosis. In all such cases, they act as indirect agents belonging to the class of " antispasmodics." In delirium tremens, opiates are trusted to solely by some, but they are rarely, if ever, indispensable, — the disease generally yielding to an expectant mode of management. It would be endless, however, to attempt to point out every pathologi- cal state, in which the use of narcotics may be indicated. The practitioner must judge for himself, and if he understands the nature of the morbid phenomena, and is well acquainted with the medicinal properties of his narcotic, he cannot fail to know where its employ- ment would be salutary or noxious. The object of this work is to attempt to lay down great general principles of therapeutics, and to avoid detail. Of the evils of too great detail, we have, indeed, the most marked examples in some of the existing works on Thera- peutics and Materia Medica, from the perusal of which it is im- possible for the student to rise with other feelings than those of con- fusion. 314 SPECIAL NARCOTICS. SPECIAL NARCOTICS. 1. O'PIUM. Opium is the concrete juice of the unripe capsules of Papa'ver somnif erum. The process for procuring it is much the same in all countries. It consists in making incisions into the capsules, and collecting the juice that exudes. Its name — from osros,, "juice," sufficiently indicates its nature. The poppy is cultivated in various countries, but especially in Asia Minor, Hindusthan, and Egypt; and opium is collected, although not to much extent, in Europe. In fact, the price at which Turkey opium can be imported renders it an un- profitable speculation. The principal varieties of opium, met with in commerce, are the Turkey, the Egyptian, the East Indian, the Persian, and the Eu- ropean. 1. Turkey or Levant Opium is raised in Anatolia, and is exported from Smyrna to the extent of about 400,000 lbs ; hence it has been called, also, Smyrna opium. It is produced at several places, from ten to thirty days' distance in the interior; but that grown at Caisar, about 600 miles from Smyrna, is said to be most esteemed. It comes to the United States either directly from the Levant, or indirectly through some of the ports of the Mediterranean. This variety of opium is said to be beyond comparison the most abundant in our market, and it is that from which the ordinary descriptions of opium are drawn. It occurs in irregularly rounded or flattened masses, varying in size, but rarely exceeding two pounds in weight, usually surrounded with reddish capsules and leaves of some species of rumex. When first imported, it is soft, and of a reddish-brown colour; but becomes hard and blackish by keeping. Dr. Wood states, that the colour of the finer parcels of Smyrna opium is light brown ; of the inferior darker. When cut into, it has a waxy lustre; and, when torn, minute shining tears are observable, seeming to show, that the masses are made up of agglutinated tears. Although this variety would appear to be the purest met with, it is frequently largely adulterated. Dr. Pereira states, that from one sample, weighing ten ounces, he obtained ten drachms of stone and gravel. The average quantity of morphia, that can be obtained from it, has been estimated by Dr. Pereira at about 8 per cent. Dr. Wood affirms that good Smyrna opium ought to yield 10 or 11 per cent. A variety is imported from Turkey, which has been termed Con- stantinople O'pium. Of this there would seem to be two sorts,— the one in very large irregular cakes, which is of very good quality, and the other in small flattened regular cakes, from two to two and a half inches in diameter, and covered with the poppy leaf. It has a more feeble odour than the other, and blackens in the air. The cakes are never covered with the rumex like the Smyrna opium. Constantinople opium is much inferior to Smyrna opium, but supe- OPIUM. 345 rior to the Egyptian. Guibourt states, that it does not yield more than half the quantity of morphia obtainable from Smyrna opium ; yet there is great discrepancy in the statements on this head, suffi- cient to lead to the belief, that different kinds of opium are taken to Constantinople and exported from thence, so as to be called Con- stantinople opium. 2. Egyp'tian Opium is only of recent introduction into commerce, and is understood to be one of the products of the agricultural specu- lations of the present Pacha of Egypt. (Christison.) It is imported in round flat cakes, weighing from four to eight ounces, and wrapped up in some leaf. It is hard and dry; of a pale-brown colour, and waxy lustre. According to Guibourt, it affords only five-sevenths of the morphia obtainable from Smyrna opium. By another experi- menter, Merck, from 6 to 7 per cent, was obtained from it, and it yielded much meconic acid. Another specimen, examined by Mr. J. Evans, of Philadelphia, afforded only 3.55 per cent. It is evi- dently, therefore, inferior to the varieties of opium already consi- dered ; yet some of it would appear to be excellent: a specimen taken from a large quantity, that was purchased for Constantinople opium, yielded Dr. Christison rather more chlorohydrate of morphia than average opium from Smyrna. It would appear, according to Dr. Christison, to have been pretty largely imported into Great Britain for a few years past, and to have been freely purchased at a price from ten to twenty-five per cent, under that of fine Smyrna opium ; although, for the most part, more inferior than in proportion to the difference of price. 3. Indian or East Indian Opium. Three varieties of East Indian opium are known in commerce,— the Malwa, the Bena'res, and the Patna. The last two would, however, appear to be undistinguish- able ; and accordingly they are considered, by most pharmacologists, under the name of Bengal opium. Little of the East Indian opium reaches the United States. Bengal opium is met with in balls, each weighing about three pounds and a half, packed in chests, each containing about forty balls, which are hard, and consist of a case about half an inch thick, and half a pound in weight, formed of tobacco leaves and aggluti- nated poppy petals, and filled with a black pitch-like mass, soft enough, even when some years old, to be taken out with a spatula. According to Dr. Pereira, it is the most inferior of the East Indian opiums, — not containing more than half the quantity of morphia procurable from good average Turkey opium. The Benares opium is the kind prepared by the Chinese for smoking, and its con- sumption would appear to be enormous. Prior to the difficulties with China, the sales there alone, according to Dr. Christison, had rapidly risen to the amount of three millions of pounds avoirdupois, worth about as many pounds sterling. A variety of Bengal opium, 346 SPECIAL NARCOTICS. called Garden Patna Opium, results from an improvement in the mode of preparing it. Dr. Christison states, that he has examined specimens, which were little inferior to average Turkey opium in the quantity of morphia they contained. This variety is not, how- ever, known in commerce. Malwa opium, has usually been regarded as an inferior kind of East India opium, but it is said to have risen greatly in value, and to be now highly esteemed. Dr. Pereira describes two varieties of it; the one in round flattened cakes or balls, weighing ten ounces ; packed in a coarse kind of chest, composed of broken poppy petals; of a dark brown colour; homogeneous texture when cut into, and of an odour similar to that of Smyrna opium : — the other in flattened cakes without any outer covering; dull, opaque, of a blackish-brown colour externally, and somewhat darker and soft within; having an odour something like that of Smyrna opium, but less powerful, and combined with a slight smoky smell. According to Guibourt, it fur- nishes not more than one-third of the morphia obtainable from Smyrna opium. Under East India opium, Dr. Pereira describes two other varie- ties — the Cutch opium and the Kandeish opium,, but they are of but little interest as they are not found in commerce. 3. Per'sian Opium, also called Treb'izon Opium, in consequence of its being imported into Europe from Trebizon on the Black Sea, is in the form of cylindrical sticks, become somewhat angular by pressure; of about six inches in length, and half an inch — more or less — in diameter; enveloped in a smooth shining paper, and tied with cotton. It is soft and flexible, and does not become hard even when kept for years. It is of a paler brown colour than any other kind ; and of a distinctly granular texture. Its taste is intensely bitter; and it is of very inferior quality. Dr. Christison states that, in 1834, he saw in the London Docks many large chests of it, which were quite unsaleable. It has been seen in this country, but not often. 4. Europe'an O'pium. This name is given to opium which has been made in Great Britain, France, Germany, and Greece. It can never become an article of commerce, in consequence of the low price at which foreign opium can be imported. Some that was raised by Dr. Young of Edinburgh closely resembled in its cha- racters the Egyptian or the Malwa opium, excepting that it was in roundish masses. It was hard, dry, pulverisable, of a light brown colour, shining and perfectly homogeneous, and brought a better price in the market than fine Turkey opium. From some prepared by Messrs. Cowley and Staines 7.57 per cent, of morphia were obtain- ed. Another specimen of British opium yielded, however, only 4.4 per cent. The opium made in France is described by Pelletier as of a deep OPIUM. 347 reddish brown colour, and brittle when dry; yielding in some spe- cimens a considerable per centage of morphia, — according to Pel- letier 10.38 per cent. German opium, prepared from the purple poppy, Papaver somniferum — var. nigrum, yielded likewise a large percentage: — according to Biltz as much as 20 per cent. It is doubtful, however, whether these estimates can be used compara- tively, as we have no evidence that the morphia in all the cases was equally pure. The physical properties of opium are generally taken from the Smyrna opium. There are certain qualities, which belong, how- ever, more or less to all. The odour is strong, peculiar and cha- racteristic in all the varieties, but in some more so than in others. The taste is very bitter, and somewhat pungent, exciting irritation in the lips and tongue when chewed for any length of time. The best opium does not undergo any change by keeping, excepting that it becomes harder; and this change it is important to bear in mind, inasmuch as there must be great diversity in the strength according to the degree of dryness ; hence, some of the Colleges have di- rected, that the preparations of opium shall be made from the pow- der. Some of the coarser kinds of Turkey opium, and the common Bengal variety in balls, are apt to become mouldy after a time ; and the latter, as well as Persia opium, never seems to harden thoroughly under exposure to the air, which has been supposed to be owing to the admixture of oil. (Christison.) When thoroughly dried, it can be reduced to powder, but as it attracts moisture from the air, and becomes lumpy, the powder should be kept in well stopped bottles. The quantity of opium used in various parts of the world is as- tonishing. Allusion has already been made to that consumed by the Chinese prior to the late interdiction of its use. In England, the quantity, on which duty was paid in the year 1841, was, accord- ing to Dr. Pereira, 37,960 pounds ; and in the year preceding, it was 45,589 pounds; the greater part of which was imported from Tur- key. From the treasury returns of the United States for the year 1829, it appears that the value of opium imported from the Turkish dominions was 92,924 dollars; from Mediterranean France 12,187 dollars, and from every other part of the world 2,040 dollars. None was imported from India. (Wood & Bache). Water dissolves about two-thirds of Turkey opium, including a great proportion of its active ingredients; alcohol nearly four-fifths of its weight, and all its active constituents. Sulphuric ether dis- solves little more than one of the active principles, which is not so- luble in water — the narcotin ; and the dilute acids, both mineral and vegetable, entirely exhaust it of its virtues. It contains a great variety of principles, and has received much attention from ana- lytical chemists, from whose labours it results, that it has at least the following constituents: — morphia, narcotin, codeia, narcein, me- conin, thebain or paramorphia[?], pseudomorphia, meconic acid, 348 SPECIAL NARCOTICS. brown acid extractive, sulphuric acid, resin, fat oil, gummy matter, caoutchouc, albumen, odorous principle and lignin. The most im- portant of these are morphia, codeia, and narcotin, of which the first is an officinal preparation, and will be described hereafter. They are all of modern discovery. Of the six crystalline principles, morphia, codeia, and paramorphia, narcotin, narcein, and meconin, the three first are alkaline, and the others neutral. Codeia or Co'deine, the preparation of which is given by the au- thor elsewhere, (New Remedies, 4th edit. p. 170, Philad. 1843,) is a white crystalline solid, soluble in water, alcohol and ether; uniting readily with acids ; and, with the chlorohydric especially, forming a salt which crystallises with great facility ; 1000 parts of water, at 60° Fahrenheit, dissolve 12.6 parts of codeia: the same quantity at 100°, 37 parts, and at 212°, 58 parts. The experience of different observers on the effects of codeia on the economy has been discordant. Magendie states, that it causes sleep, and, in large doses, stupor. He considers one grain of codeia equivalent to half a grain of morphia. Two grains often excited nausea and even vomiting. A syrup, each ounce containing two grains of codeia, has been given in hooping-cough, and in other dis- eases in which opium has been found useful; and it has been found serviceable by Dr. Miranda, of the Havana, in cases of what he terms " powerful nervous irritations of the mucous membrane of the stomach." The chlorohydrate has been used in Philadelphia, but it has not been found to have any virtues, not equally pos- sessed by the salts of morphia, whilst it has the objection that the price has been enormous— as much as four dollars the drachm. Nar'cotin or nar'cotine is commonly procured either from the aqueous extract of opium by means of ether, which only dissolves the narcotin, and, consequently, requires but to be evaporated to obtain it; or from crude opium, which has been exhausted by cold water. It may hence be obtained from the residue after the prepa- ration of the aqueous extract of opium of the shops. It crystallises in very white needles; is devoid of taste and smell; neutral; in- soluble in water, but soluble in ether, boiling rectified spirit, and dilute acids. By its not affecting vegetable colours, it is readily distinguishable from both morphia and codeia. The views in regard to the medical properties of narcotin have been contradictory. Magendie was of opinion, that morphia is the sedative or anodyne principle of opium, — narcotin the exciting. Orfila, on the other hand, entertained various notions in regard to it,— at one time believing it to be inert; at another, to have the same action as morphia ; and at another, to concur, when combined with morphia, in the properties of opium, but to a slight degree only — since opium, deprived of narcotin, is not less deleterious — and to possess another modus operandi than opium, without, however, his being able to OPIUM. 349 regard it as the exciting principle. Others have given it in large doses without any narcotic effect having been induced by it; and hence it has been imagined, that the narcotin of the earlier experi- menters was an impure article. Owing to all the uncertainties ap- pertaining to it, narcotin is but little employed in medicine. It would seem, however, that the exciting properties of opium do not belong to it exclusively, for—as elsewhere remarked — there are many persons who are as disagreeably affected by morphia alone as they are by opium, which contains both morphia and narcotin. Recently, narcotin has been employed as an antiperiodic in the treatment of remittent and intermittent fevers. (See Tonics.) The other constituents o"f opium are not of much, if any, thera- peutical interest. Narcein, meconin, pseudomorphia, and meconic acid appear to be inert, and, according to Magendie, thebain or paramorphia, when injected into the jugular vein, or placed in the pleura of an animal, causes tetanus and death in a few minutes. The therapeutical effects of opiates in different doses have been briefly referred to under the general observations on the class of Narcotics. That they are excitant in a small dose is admitted by all; and that they are sedative in a large dose is equally admitted by most observers. A grain of opium, which is an ordinary dose, first of all excites the organic actions, but this excitement is followed, in the generality of cases, and in a short time, by sedation. The animal functions are likewise exalted along with the organic, so that sensi- bility and muscular motion are exerted with more vigour; but this excitation is sooner or later followed by a disinclination to movement, and a decided tendency to sleep. Usually, during the period of excited action, the mouth is dry and clammy, and the individual therefore thirsty; the appetite is impaired, — the secretions and peri- stole of the intestinal canal seeming to be diminished, so that con- stipation ensues. Hence, in the healthy state of the frame, as well as in certain conditions of diarrhoea and dysentery, small doses of opium are often used as indirect astringents. When larger doses are administered, — say from two to three grains, or more, — the excitement of the animal and organic functions may still be percepti- ble in the first instance ; but commonly the excitation persists for a very short time, and is succeeded by a marked sedative influence and a state of dreaminess followed by stupor, and ultimately by an irre- sistible desire to sleep. When sleep is not caused by it, and a full dose has been taken, the patient is often amused — and at times annoyed — with the multitude of fantastic groups, which he can frequently call up at pleasure. In many cases, when the effects of the opiate pass away, more or less disturbance of the functions of the stomach and bowels remains, with languor and listlessness. When given to a still greater extent, opium and its preparations are narcotic poisons ; they are the types, indeed, of the class. In such large doses, no signs of excitement are perceptible, the first evidences of the poisonous action being giddiness and stupor, which vol. i.—30 350 SPECIAL NARCOTICS. rapidly increase so that there is a suspension of all mental and moral manifestations, — the individual appearing to be in a deep coma, breathing slowly ; the eyes closed, and the pupils contracted. Unless relief is obtained, the countenance assumes a ghastly character, the pulse becomes more and more feeble, the muscles are exceedingly relaxed, and death closes the scene. Should he on the other hand, recover from this state of coma, it generally passes into deep sleep, which usually terminates in from twenty-four to thirty-six hours, and is followed by nausea, vomiting, giddiness, and loathing of food. (Christison). Opium does not affect all persons alike. There is perhaps no article of the materia medica, which disagrees with so many indi- viduals, or, in other words, which so often produces effects on the system not desired by the physician; and frequently there is a capri- ciousness in this respect, which is as strange as it is inexplicable ; — opium itself, or some of its preparations producing disagreeable im- pressions, whilst congenerous preparations have all the pleasant and soothing operation that is desired. These disagreeable phenomena are — instead of sleep or a placid condition, — fever, quick pulse, headache, restlessness, watching at times, delirium, nausea and vomiting. They are considered to be— and, doubtless, usually are — the result of idiosyncrasy; but Dr, Christison asserts, that he has known them induced in those with whom opium in general agrees, if they happened to take it in too large a dose, or soon after a full meal with more than an ordinary allowance of wine. Perhaps the preparation, that is the least likely to produce these results, is the muriate or one of the other salts of morphia: the black drop is, also, an excellent preparation ; and the author has often found the Tinctura Opii camphorata, and the Pulvis Ipecacuanha compositus succeed, when opium in substance, or the Tinctura Opii, could not be tolerated. In regard to susceptibility of individuals to the action of opiates, there is much diversity. Some resist large quantities, and it has been shown, (p. 341,) that by habit the endurance or tolerance be- comes astonishing. Others, on the contrary, are affected by the smallest quantities. This has to be discovered by observation of particular cases; and a single dose is sufficient to communicate the important information. It is essential, however, to bear in mind, that infants are extremely impressible to its action, and that a drop of laudanum cannot always be administered with safety to an infant a few weeks old. The action, too, is modified according to the sur- face to which it is applied. The full effect is induced when taken into the stomach. When thrown into the rectum, the general rule is to give it in three times the quantity that would be administered in the same case by the mouth. This rule has, however, been strongly objected to as one of universal application, and there may be cases in which the practitioner might be surprised to see unusual effects induced by it, but such a case has never fallen under the OPIUM. 351 author's observation. "It is conceived" — says Dr. Christison — " in some continental countries, especially in France, that it acts three or four times more energetically through the rectum than by the stomach. This must be an error ; for in Britain it is not uncommon to give sixty minims of laudanum or four grains of opium by the rectum, — doses which, according to the French view, ought to occa- sion always alarming symptoms, and sometimes even death." A safe plan would be, to inject the same quantity — if a full dose — as would be prescribed by the mouth, and repeat the dose every half hour, unless its effects were apparent. It is in disease, however, that we witness the most anomalous re- sistance to the action of opium. It can rarely happen, that the pa- tient is rendered more impressible to it; and in a large class of dis- eases the resistance to it is so great, that, occasionally, enormous doses are needed. For example, in spasmodic affections, such as tetanus, hydrophobia, neuralgia, — and indeed in other neuroses — as mania, delirium tremens, &c, the quantities required to produce the narcotic effects of opium are often enormous ; and even when the erethitic condition of the nervous system has been overcome, no phenomena may exist indicating that a narcotic has been taken. When applied to the denuded skin or endermically, opiates do not act as energetically on the system, as when administered by the mouth or rectum ; but not unfrequently, where opium disagrees with the individual, the endermic application can be tolerated, and all the beneficial results of the narcotic be obtained. The effects of opium, when received into the air tubes in the form of smoke, we have no opportunity for observing, except in the way of experiment. By the Orientals, it is employed in enormous quan- tities. The Chinese use an aqueous extract for this purpose, which they term Chandoo, and the effects would appear to be the same as when swallowed ; yet, as Dr. Christison has remarked, opium is known to be decomposed by such a heat, as is necessary in the pro- cess of smoking a pipe, and none of its active principles are volatili- sable. He adds, that several of his pupils have tried the process with a Chinese pipe, and Chinese extract, but experienced no other effects than severe headache and sickness. The remarks made as to the therapeutical application of narcotics apply rigidly to opium; and the great point to be borne in mind is, — the difference in its action according to the dose in which it is given; excitant—as we have seen in a small dose; sedative in a large. In fever—as elsewhere remarked, (p. 343)—it is beneficial under numerous conditions, especially where there is insomnia, oreat restlessness, low delirium or tremor. Where much cerebral disturbance exists, it has been advised to give it in combination with the tartrate of antimony and potassa. Still, the main effective ao-ent is the opium. Its valuable sedative influence renders it well adapted for many inflammatory diseases; although, at one time, 352 SPECIAL NARCOTICS. when its modus operandi was less understood, it was carefully avoided in those diseases, under the idea, that it might induce un- due excitement. Not only does it diminish the over-excited or- ganic actions, but it lessens pain, and causes sleep. After blood-letting has been employed, a full dose of opium is often one of the most precious sedatives that can be prescribed. In the inflammations of the lining membrane of the intestinal canal, opium is a most valuable remedy. In simple diarrhoea, it is often employed alone or associated with chalk and aromatics ; in ordinary cholera morbus, a full dose frequently relieves almost instantaneously: and in dysentery, its combination with calomel is often advantageous. In too great secretion from the mucous membrane of the bowels, it allays, by its sedative agency, the inflammatory or other irritation, and thus diminishes the secretion, and, at the same time, the in- creased peristaltic action. In encephalitis alone, doubt might exist as to the propriety of its administration, and some have pronounced it to be positively injurious in that form in which the cerebral sub- stance is inflamed, and indeed in inflammation of the parenchyma- tous tissue of organs in general; but although more caution may be required in encephalitis in its administration, there is little, if any, reason for the belief, that it is injurious in parenchymatous inflam- mation, provided it be prescribed with a due knowledge of its pro- perties; indeed, it has been before shown, (p. 331,) that in pneu- monia, its administration is often attended with signal advantage, when given in appropriate doses. In acute rheumatism it has been prescribed largely, and with much benefit, both alone, and when associated with ipecacuanha; and a full dose often arrests an ordinary catarrh or inflammatory sore throat at its very inception. In the various neuroses, it has been copiously administered. In mania, for example, the excessive excitement has been overpowered by full doses of opiates ; and in delirium tremens, it has been by many considered almost a sheet anchor. It is, however, in spasmo- dic diseases, that it is most trusted to. In every variety of these, it is used beneficially, and in the more violent, as tetanus, hydrophobia, &c, — although too often insufficient—more trust is reposed in it than in any other remedy. But it is almost impracticable to point out the numerous cases in which this invaluable anodyne and hyp- notic is capable of rendering service. A due knowledge of its pro- perties cannot fail to suggest those in which its operation will be beneficial. When employed topically, it is chiefly with the view of relieving pain, although its anodyne and other virtues are not readily exerted through the cuticle. In cases, however, in which there is cutaneous ulceration or abrasion of any kind, the anodyne effect is signally ap- parent. It is prescribed in certain cases of ophthalmia, in painful ul- cerations of all kinds, and in painful chronic cutaneous diseases ; and a recent writer, Dr. Christison, affirms that both in erythema and in all OPIUM. 353 kind of erysipelas — even idiopathic erysipelas of the face — the best of all applications, not merely for allaying pain, but likewise for ar- resting the local inflammatory action, is a lotion made by preparing an infusion of 32 grains of opium, and a solution of as much acetate of lead, each in four ounces of water, then mixing the solutions, and filtering the mixture to separate the insoluble meconate of lead. Opi- ate frictions have likewise been used in chronic rheumatism, in sprains, and in deep-seated painful affections in general, no matter of what character. It is moreover employed in similar cases in form of plas- ter ; is applied to the bottom of a carious tooth ; and added to the most varied topical applications, — always, however, with the view of allaying pain or irritation. The dose of opium varies, according to the effect which it is de- sired to induce. As an excitant narcotic, it may be given to the amount of a quarter or half a grain. To induce its ordinary anodyne and hypnotic effects, the dose is a grain or a grain and a half; and a full dose, capable of exciting all the sedative operation of the nar- cotic, is from two to four grains. The last quantities should only be given, however, where pain is inordinate ; spasm severe ; or where a powerful sedative influence is needed after blood-letting. It is usually prescribed in the form of pill. At times it is used as a sup- pository, — four or five grains being formed into a cylinder with soap, and introduced into the rectum, in painful affections of the uterus or rectum. PILULE OPII, PILLS OP OPIUM. (Opii pulv. 5j; Sapon. gr. xij; to be divided into 60 pills.) Each of these contains a grain of opium ; the soap serving no other purpose than to communicate the proper consistence. In the last edition of the Pharmacopaeia of the United States, an anagolous formula has been introduced under the name PILULE SAPO'- NIS COMPOS'lTiE, or COMPOUND PILLS OF SOAP. In this, half an ounce of opium in powder is beaten with two ounces of soap so as to form a pilular mass. The object of this formula is to have an opportunity of prescribing opium in cases where it is deemed advisable that the patient should not know he is taking it. CONFEC'TIO O'PII, CONFECTION OF OPIUM. (Opii, pulv. 31VSS ; Pulv, aromat. ^vj; Mel. despumat. 3xiv.) This is a relic of the old Philonium, and has been much used but is not so at present. The aromatic powder, associated with the opium, renders it an ex- citant narcotic, and adapted for cases of flatulent colic, and for atony of the digestive organs. It is most frequently, perhaps, prescribed in cases of diarrhoea unaccompanied by vascular excitement. When added to cinchona or to sulphate of quinia, it is said to increase greatly their efficacy in obstinate intermittents. About 36 grains of the confection contain one grain of opium. TINCTU'RA O'PII, TINCTURE OF O'PIUH. (Opii, pulv. giiss; Alcohol. 30* 354 SPECIAL NARCOTICS. dilut. Oij.) Laudanum—for so the tincture of opium is commonly termed—is more frequently used than any other preparation of opium, and this mainly owing to the facility with which it can be given. About one grain of opium may be contained in about thirteen minims of the tincture, although it is not easy to fix upon the exact proportion. Twenty-five ordinary drops are generally regarded as equivalent to a grain of opium. The dose varies from twenty-five drops to a hundred. The tinc- ture should always be clear. When not so, it is owing to the depo- sition of opium, which may add materially to the strength, if it be shaken. TINCTU'RA O'PII ACETA'TA, AC 'ETATED TINCTURE OF OPIUM. (Opii, |ij; Aceti, f. ^xij ; Alcohol. Oss.) This preparation is prescribed in the same cases as the Acetum opii or black drop. Its dose is ten minims, or about twenty drops, which are considered to be equivalent to a grain of opium. TINCTU'RA O'PII CAMPHORA'TA, CAMPHORATED TINCTURE OF OPIUM. (Opii, pulv.; Acid. Benzoic, aa ^i; 01. anisi, f. ^i; Mel. despumat. ^ij; Camphor, gij; Alcohol, dilut. Oij.) This is the well known Pare- goric Elixir, much used in popular practice. It is an agreeable pre- paration, owing to the aromatic and saccharine additions, which like- wise cause it to agree, at times, with persons when the tincture of opium cannot be tolerated. By reason of the comparatively small quantity of opium contained in it, it is not well adapted for cases in which powerful opiates are indicated; but it is greatly used where gentle opiates are required — as to allay cough, and to procure sleep in children. Rather less than half a grain is contained in half a fluidounce of the tincture. The ordinary dose for an adult is a fluid- drachm, or an ordinary tea-spoonful. VINUM O'PII, WINE OF O'PIUM. (Opii, pulv. gij; Cinnam. contus.; Cary- ophyll. contus. aa 3J.; Vini, Oj.) This is the Laudanum of Syden- ham, in contradistinction to the Laudanum or Liquid Laudanum just described. Wine dissolves the active properties of opium, and the aromatics may adapt it for cases in which the Tinctura opii disa- grees. It is not much used, however, internally. It has been dropped on the conjunctiva in turgid states of the vessels of that membrane, and with decisive advantage, especially where there has been great sensibility. The dose of the wine for internal adminis- tration is the same as that of the Tinctura opii. _ ACE'TUM O'PII, VIN'EGAR OF O'PIUM, BLACK DROP. (Opii, in pulv. crass. gviij ; Myrist. in pulv. crass. 3iss; Croci,, §ss; Sacchar. 5xij ; Acet. destillat. q. s. The opium, nutmeg and saffron are digested in a pint and a half of distilled water for forty-eight hours, and strained. The residue is digested in an equal quantity of distilled vinegar for twenty-four hours. The whole is then passed and repassed by dis- MORPHIA. 355 placement, until it comes away quite clear; and distilled vinegar, enough to make the whole three pints, is passed through likewise. The sugar is then added, and the whole evaporated to three pints and four fluid ounces.) This is essentially a solution of the principles of opium in vinegar, rendered slightly excitant by the nutmeg, and merely coloured by saffron. It is the officinal black drop, and is intended as a substitute for the celebrated empirical medicine, — called by the same name, and sometimes the Lancaster or Quaker's Black Drop. It is adapted for many cases in which opium produces its disagreeable effects, and is a very favourite article with many practitioners. It is stronger than the tincture of opium, the ordinary dose being from vj to xxx drops. _ EMPLAS'TRUM O'PII, O'PIUM PLASTER. (Opii, in pulv. |ij; Picis abietis, 3iij ; Emplast. plumbi, tfej ; Aqua bullientis, f. ^iv. The lead plas- ter and Burgundy pitch are melted together; the opium, previously mixed with the water, is added, and the whole boiled over a gentle fire to the proper consistence.) This plaster is employed to relieve neuralgic and other pains, by being applied immediately over their seat. Opium forms part of the Pulvis ipecacuanha et opii of the Pharma- copoeia of the United States. MORPHIA. In the London Pharmacopceia, morphia is directed to be precipi- tated by the addition of solution of ammonia to chlorohydrate or mu- riate of morphia, which lays hold of the chlorohydric acid, and sepa- rates the morphia. In the Pharmacopceia of the United States, morphia is separated from opium by successive macerations in dis- tilled water until the salt of morphia is extracted. The fluid of the macerations is then mixed and filtered ; and alcohol and solution of ammonia are added, by which the meconate or other salt of morphia is decomposed ; — the alcohol dissolving the colouring matter as soon as it is separated by the ammonia ; and the morphia itself being, con- sequently, precipitated in a purer state. The crystals of morphia are colourless, and wholly inodorous. They are scarcely soluble in cold water, and very slightly so in boil- ing water, but are readily dissolved by boiling alcohol. They have an alkaline reaction, and their primary form is the right rhombic prism. Morphia dissolves readily in dilute acids, neutralises them, and forms salts, which are for the most part soluble, permanent and crystallisable, and are used in medicine. On account of its very sparing solubility in water, it is but seldom prescribed, although it has been affirmed by one observer, M. Bally, that it is equally efficacious with any of its salts. As this, however, is probably owing to the presence of acid in the stomach, and the amount of acid varies, the salts of morphia generally, if not always, 356 SPECIAL NARCOTICS. at the present day, receive the preference. The dose is one sixteenth to one-fourth of a grain. 1. MOR'PHLE ACE'TAS. —ACETATE OF MORTHIA. The acetate of morphia is made by mixing morphia in powder, freed from narcotin by boiling in sulphuric ether, with distilled water, and then carefully adding acetic acid, until the morphia is saturated and dissolved. The solution is then evaporated, and the acetate dried with u gentle heat, and rubbed into powder. Acetate of morphia, obtained in this way, is amorphous ; and not wholly soluble in water, in consequence of its containing a portion of free morphia, which, however, is rendered soluble by the addition of a few drops of acetic acid. It is less soluble in alcohol than in water. The salts of morphia may be administered advantageously, not only in cases where opium is indicated, but where it disagrees. With many persons, and in many cases, they possess decided advantages over opium, but the author has pretty generally found, that where opium disagreed, morphia and its preparations did so likewise. By one method of exhibition — the endermic — the salts of mor- phia can be used where opium and its preparations cannot. This method is adopted, when opium or the salts of morphia cannot be borne internally ; and where a blister has been directed in neuralgic and other cases, it is not uncommon to direct the denuded surface to be sprinkled or dressed with a salt of morphia. A quarter of a grain or more is placed upon the cutis vera, and this is repeated should the case require it. In the severer neuralgic and neurotic cases, the quantity applied in this way is sometimes very large. In a case of hydrophobia reported by a recent observer, Dr. Burne, ten grains at a time were sprinkled on a blistered surface with excellent tranquilis- ing effects. Occasionally, when applied to a blistered surface, for several days in succession, a papular eruption is observed, which has quickly become vesicular, proceeding from the edges of the blister, and gradually spreading over the entire surface. It has been proposed to inoculate with the salts of morphia, which, when thus used — the point of a lancet being dipped in an aqueous solution of the salt — give occasion to the formation of a papula surrounded by an areola and accompanied by itching, which is at its height in about an hour. In one case, — in which thirteen punctures were made on the anterior part of the forearm, — the patient experienced heaviness of the head, frequent yawning, clamminess of mouth, and an invinci- ble desire to sleep ; yet the quantity of the salt of morphia used could not have been more than a quarter of a grain. It has been suggested, that inoculation with morphia may supersede the use of blisters and ammoniacal plasters. The acetate has also been given in injection in cases of chronic diarrhoea, and has been made into an ointment to be rubbed over pained parts, or applied immediately to them, where MORPHIA SULPHAS. 357 this is practicable. In the dose of a fourth of a grain every half hour it was found by one practitioner, M. Gerard, to be preferable to every other remedy. He continued it until the serious symptoms — the spasms, diarrhoea and vomiting—had ceased, or reaction ensued. The ordinary dose of acetate of morphia is from an eighth to a quarter of a grain, repeated so as to induce the anodyne or hypnotic effect. As in the case of opium, under excessive pain, or long con- tinued use, the system may be so habituated to its action as to bear very large doses. A case has been published in which a female, under a painful affection, took scruple, and — according to her own report — half-drachm doses of the acetate. 2. MOR'PHLE MU'RIAS. —MURIATE OF MOR'PHIA. Muriate of morphia of the Pharmacopceia of the United States is made by mixing morphia, in powder, with distilled water, and carefully adding muriatic acid till the morphia is saturated and dis- solved. The solution is then evaporated until crystals form upon cooling. These crystals are of a snow-white, feathery appearance, and wholly soluble in water. They are devoid of smell, and of a bitter taste. This salt of morphia is but little used in this country, but is more prescribed than either of the others in Great Britain. There are some, indeed, here, who prefer it to the sulphate, which is most frequently given with us ; but it is probable that more accurate ob- servation will show, that they are capable of being substituted, in all cases, for each other. The dose of the muriate is the same as that of the acetate. 3. MOR'PHLE SULPHAS. —SULPHATE OF MOR'PHIA. Sulphate of morphia is formed in the same manner as the muriate — diluted sulphuric acid being substituted for muriatic acid. It is in snow-white feathery crystals, which are wholly soluble in water. The dose is the same as that of the acetate. LIQUOR MOR'PHLE SULPHA'TIS, Solu'tion of Sulphate of Mor'phia. (Morphia sulphat. gr. viii; Aqua destillat. Oss.) This solution un- dergoes change by keeping, and admits of minute quantities of the sulphate being administered. A fluidrachm, or about a tea-spoon- ful, contains one eighth of a grain. A combination of nitric acid with opium, forming a nitrate of morphia, is the basis of a mixture attributed to Dr. Baillie of Lon- don, and of one which has been much used in this country in dy- sentery and chronic diarrhoea, under the name of Hope's Mixture, so called from its proposer. It is made as follows :---ftcid. nitros. seu nitric, f. 3J. Aqua camphor, f. Jviij; Tinct. opii, gt. xl. Dose a fourth part every three or four hours. Many years ago, a Liquor MoR'pniiE Citra'tis was directed to 358 SPECIAL NARCOTICS. be prepared in the following manner. Beat four ouuces of the best crude opium in a mortar with two ounces of crystallised citric acid ; mix well with a pint of boiling water, and filter after 24 hours' maceration. This was proposed by Dr. Porter, of England, and is spoken well of by Dr. Paris. Megendie recommends a citrate to be formed more immediately, according to the following formula. Morphia pur. gr. xvi; Acid, citric, crystallis. gr. viii; Aqua destillat. |j; Tinct. cocci q. s. ut fiat solutio. The dose is 20 to 24 drops in the 24 hours. A Tartrate of Morphia was suggested by the author's friend) Mr. C. T. Haden, as a substitute for the liquor opii sedativus of Mr. Battley, — a nostrum. Mr. Haden prepared it by macerating the dregs remaining after making tincture of opium in a solution of tartaric acid. Forty drops acted in every respect like twenty of the liquor opii sedativus. It neither excited or induced costive- ness. A Bimec'onate of Morjphia has been introduced by Mr. Squire, of London, and has been highly spoken of as an anodyne and hypno- tic ; but the formula for its preparation has not been given to the profession. The same may be said of a preparation termed McMunn's Elixir of Opium. 2. PAPA'VER.— POP'PYHEADS. Papa'ver somniferum, Somniferous or WJvite Poppy ; Sex. Syst. Polyandria Monogynia ; Nat. Ord. Papaveraceae, is indigenous in Asia and Egypt, and grows wild in some parts of England,"having probably escaped from gardens. (Pereira.) It is cultivated in orien- tal countries for the sake of opium, and in Europe for its heads or capsules, as well as for the oil contained in the seeds, which is used in the arts. The heads are obtained generally from the white variety, being the largest, and they are directed by the Edinburgh college to be gathered before they are wholly ripe, because at that time they abound in the milky juice of which opium is made ; whilst, if allowed to ripen before they are plucked, as directed by the London and Dublin colleges, the juice is in a great measure exhausted. The heads — as met with in the shops — vary in size from that of a hen's egg to that of the fist, are of a dirty white or purplish- brown colour, of a papyraceous texture, devoid of smell, and have a slightly bitter taste. When subjected to analysis, they contain principles similar to those of opium, which they readily impart to water. The preparations of poppyheads are exceedingly variable in strength, partly owing to their being gathered at different stages of their growth, and partly, also, owing to differences in the variety of the plant used ; and they are, consequently, but rarely prescribed internally. They have been thought, by some, to agree where ' HYOSCYAMUS. 359 opium did not, but this is questionable ; and they are not adapted for any purposes which opium does not better subserve. The decoction is much used in Great Britain as an anodyne fomentation, although it has been properly questioned, whether it produce any effect, which would not equally follow the use of a mucilaginous decoction. 3. HYOSCY'AMUS. — HENBANE. Hyoscy'amus niger, or Common Henbane; Sex. Syst. Pentandria Monogynia ; Nat. Ord. Solanaceae ; is indigenous in many parts of Europe, and is cultivated for me- dicinal purposes. It has, also, been introduced into this country, in the northern and eastern parts of which it is found in the vicinity of the older settle- ments. It flowers in July. The leaves — Hyos- cy'ami Fo'lia, and the seeds Hyoscy'ami Se- men — are offici- nal in the Phar- macopoeia of the United States. It is generally re- commended that the plant should be gathered when in flower; but it has been found sufficiently active even in the spring before the appearance of the flowering stem. The wild plant, as in the case of other narcotics, has been esteemed preferable to the cultivated, but Dr. Christison affirms, that, from experiments made at the Royal Infirmary of Edinburgh, the infe- riority of cultivated plants, if it exist at all, seems not to be appre- ciable in practice. The plant is said to be only fit for medicinal use in the second year. The fresh herb has a disagreeable virous smell, and a mucilaginous slightly acrid taste. The leaves should be dried at a temperature not exceeding 120° Fahr., by which pro- cess 100 lbs. of the fresh herb are said to lose 86 per cent. When Hyoscyamus niger. 360 SPECIAL NARCOTICS. dried, they ought to preserve, in some measure, their odour. The seeds have the smell of the plant, and a bitter taste. Both the seeds and extract have been analysed, and found to con- tain a vegetable alkali, almost identical with atropia, to which the name Hyoscyam'ia or Hyoscyamina has been given. An empyreu- matic oil of henbane, whose properties resemble those of the empy- reumatic oil of foxglove, was obtained by destructive distillation, which proved to be a powerful narcotic poison. " In large doses, hyoscyamus is an acro-narcotic poison, occasion- ing at times — but not so often as belladonna, and stramonium, — nausea and vomiting, purging, disturbance of vision, dilatation of the pupil, coma, and often delirium, followed by death. In medi- cinal doses, it exerts a soothmg influence over the nervous system, without that manifest precursory excitement which is produced by many of the articles of the class. In larger doses still, it acts as an hypnotic ; at least such is the general belief. It must be admitted, however, that it frequently fails ; and it is affirmed to induce deli- rium rather more frequently when pushed to a great extent. It cer- tainly is not at all comparable to opium as an anodyne and hypno- tic ; yet there are cases in which opium and its preparations disa- gree, and in which henbane may be prescribed as a substitute. For example, opium, even in small doses, occasions, in particular per sons, violent cephalalgia, nausea and vomiting, and is apt to induce constipation; none of which phenomena follow the use of hyoscya- mus. It is not, however, extensively employed; for whilst one re- spectable writer, Dr. Wood, remarks, that it is "at present used almost exclusively to relieve pain, procure sleep, or quiet irregular nervous action," another, Dr. Christison, states, that " probably the chief consumption of it now-a-days is in combination with those purgatives which cause griping, and more especially with the com- pound colocynth pill-mass." It is unnecessary to enumerate the cases in which hyoscyamus is given internally. It would be but repeating what is said under the various narcotics. Wherever an anodyne, hypnotic, or antispas- modic is needed, it is prescribed ; and, as already shown, there may be cases in which it may be used when opium cannot be ; al- though whenever the latter can be borne, it is infinitely preferable. Like belladonna, it may be used to dilate the pupil, but it is not so energetic ; and like it, it has been employed in the way of injec- tion, and as a fomentation in painful tumefactions and ulcerations. The dose of the powdered leaves—which, however, are rarely prescribed — is from gr. v. to gr. x. EXTRAC'TUM HYOSCY'AMI, EXTRACT OF HENBANE, is the inspissated juice of the leaves. 112 lbs. of the fresh plant yield from 4 to 5 lbs., according to one experimenter, Mr. Brande; according to another, Mr. Squire, ibv. |ix. That used in this country is chiefly obtain- ed from Great Britain, and is very variable in its quality. It is the BELLADONNA. 361 preparation of henbane, which is most commonly prescribed, — be- ing given internally in the dose of gr. v to gr. x, or more. It is a common adjunct to the compound extract of colocynth, and to aloes, whose irritating qualities it obviates; so that in pregnancy, pills of aloes and hyoscyamus may be taken with safety. Like other nar- cotic extracts, it may be added to topical applications to tender parts — as to hemorrhoids; and it is occasionally formed into a plaster, which is used in neuralgic pains, glandular and scirrhous swellings, &c. An ALCOHOLIC EXTRACT OF HYOSCY'AMUS — EXTRAC'TUM HYOSCY'AMI ALCO- nOL'ICUM, has been introduced into the last edition of the Pharmaco- poeia of the United States (1842). It is made from the leaves, in coarse powder. The dose is about the same as that of the simple extract, than which it has been regarded as more certain. TINCTU'RA HYOSCY'AMI, TINCTURE OF HENBANE. (Hyoscyam. fol. £iv; Al- cohol, dilut. Oij; prepared either by simple maceration or by dis- placement.) The dose as an hypnotic is f. 3J to f. :rij. Should it act on the bowels, it has been suggested, that a very small quantity of the tincture of opium should be added to it, which may be done in cases where opium does not disagree. 4. BELLADON'NA. Belladonna is the officinal name, in the United States Pharmaco- poeia, for the leaves of A'tropa Belladon'na, Common Dwale, Deadly Nightshade; Sex. Syst. Pentandria Monogynia; Nat. Ord. So- lanaceae, a plant, which is a native of Europe, growing in hedges and waste ground on a calcareous soil; flowering in June and July, and ripening its fruit in September. The leaves are usually collected before the flowers bloom or soon afterwards. The root, also, is offi- cinal in the Dublin Pharmacopoeia. The dried leaves are of a dull greenish colour, with a feeble narcotic smell, and a subacrid and slightly nauseous taste. They impart their virtues to both water and alcohol. On analysis, belladonna yields a vegetable alkaloid — Alrop'ia — on which the narcotic properties appear to be dependent, and which may be obtained by a process similar to that for procuring aconitia from aconite. This principle has not been admitted into the Phar- macopoeias. It is a most virulent poison — a tenth of a grain caus- ing, in the human subject, dryness of the mouth, constriction of the throat, difficulty of deglutition, headache, dilatation of the pupil, and stupor. Belladonna is a powerful narcotic poison in large doses. To a less extent it possesses the ordinary properties of the narcotics, along with some that are peculiar to itself. When carried to such an ex- tent as to affect the system, it induces dryness of the mouth and throat, vertigo, dilatation of the pupils, dimness of sight; when to a greater vol. i.—31 362 SPECIAL narcotics. extent, delirium, and—it is affirmed—an eruption closely resem- bling that of scarlatina. To this, reference will be made presently. The first set of symptoms were induced on the author by tasting some newly prepared extract of belladonna prepared by himself. The dilatation of the pupil continued for a fortnight, becoming gradually less and less, but impairing vision whilst it persisted. These effects show, that the main effect of belladonna is exerted upon the or- gans of innervation : those of secretion become modified subse- quently. Belladonna is administered in many diseases for the purpose of al- laying pain, or diminishing the impressibility of the nervous centres or of the nervous cords. In this respect, it is, as a general rule, far inferior to opium, yet there are some diseases in which it occasion- ally succeeds after opium has failed ; for exaynple, in the various forms of neuralgia, in which it is often necessary to push the reme- dy, until some of the effects above mentioned are induced. Ad- ministered in this manner, — like the other narcotics, it has been pre- scribed in rheumatism. In diseases characterised by great nervous impressibility, as hooping-cough, it has occasionally afforded relief: but it can only be regarded as a palliative in that singular self-limited disease. A mo- dern writer, Dr. A. T. Thomson, affords, however, the following strong testimony in its favour :—"I have ordered the extract in doses of one-eighth of a grain to a child of eight years of age, and gradually increased the dose to a quarter of a grain. Its power over the cough is extraordinary. It produces a state of the skin closely resembling scarlatina, accompanied with fever, suffused eye, dimness of sight, and frequently, although not always, headache. Whilst these symp- toms continue, the cough remains absent, but it returns as soon as they disappear. By keeping the habit for a sufficient time under the influence of the remedy, the period of the disease has always been greatly shortened." Belladonna has also been prescribed in epilepsy, mania, hysteria, chorea, and in the neuroses in general; but no marked effect has re- sulted, except what would probably have equally resulted from the employment of opium or some of its preparations. Dr. Graves has ingeniously suggested the use of belladonna in cases of fever accompanied with contraction of the pupil, under the view, that the state of the brain, which accompanies dilatation of the pupil, is different from that which accompanies contraction; and hence, as belladonna occasions dilatation of the pupil, its adminis- tration may do much towards counteracting the condition of the en- cephalon that occasions the opposite condition of the pupil. Were this view, however, correct, it would seem equally probable, that as aconite produces contraction of the pupil, it ought to be a remedy for encephalic conditions that are accompanied by dilatation of the pupil ; and farther, that aconite ought to be capable of counteracting the dilatation of the pupil occasioned by belladonna. These woulu be strange results if they really occurred. belladonna. 363 The property possessed by belladonna of dilating the pupil adapts it for the treatment of certain diseases of the organ of vision. It is largely used by the surgeons of Europe, both for the purpose of ex- ploration and treatment. In cases of cataract, for example, it enables the surgeon to appreciate its extent; and,in obscure diseases, to in- spect the depth of the eyeball. In the operation for cataract, it allows of the lens passing out more readily. In iritis, it prevents adhesions between the posterior part of the iris and the anterior part of the cap- sule of the crystalline, or ruptures them when fresh. It is occasion- ally, also, used in inflammatory and other affections of the eye, to diminsh the sensibility of the organ to light. For producing dilatation of the iris, a little of the extract may be rubbed with the wet finger round the eyelids, or a solution be dropped into the eye. In a few hours, the pupil generally becomes largely dilated, so much so, that, the iris appears, at times, as if it were totally gone. This condition generally continues for a few days. Owing to its effect upon the iris, its use has been suggested in la- bour accompanied with unusual rigidity of the os uteri. With this view, either the soft extract, or an ointment composed of Extract of Belladonna 3j—3ij ; Spermaceti Ointment or Lard |i, may be rub- bed upon the os uteri. It is not, however, much employed. In spas- modic and neuralgic affections of the urethra, bladder, rectum, and vagina, belladonna has likewise been used, either applied to a bougie, or passedrinto the rectum, in the form of injection or suppository. In all crises, it is important that there should be no abrasion—-as the belladonna might produce an undesirable narcotic impression upon the system. In certain painful affections of the chest, and in painful scirrhous and glandular enlargements, a belladonna plaster is not unfrequently applied. Its narcotic influence may be partially exerted in this way ; but it is probably but little adapted for the removal of those affections, as was at one time believed. There is one other application of the belladonna, which remains to be particularly noticed—as a preventive of scarlatina. It has already been remarked, that when given fo a certain extent, it is apt to induce a cutaneous efflorescence similar to that of scarlatina. This, of course, suggested to the homoeopathist to make trials of the remedy as a prophylactic against that often formidable disease. In another work, (Practice of Medicine, 2d edit. ii. 537, Philadelphia, 1844,) the author has stated, that he has never witnessed the erup- tion, nor does its production seem to be considered necessary where the belladonna has been given as a prophylactic. The testimony, for and against its preventive powers in scarlatina, has been consi- derable. It is easy to see, however, that inasmuch as all are not at- tacked, who are exposed to a disease which is unquestionably con- tagious, any article, exhibited with the view of prevention, may rea- dily gain credit for the possession of such powers without meriting it. Still more easy is it, in the case of a disease like scarlatina, which many consider spreads by epidemic rather than by contagious 364 SPECIAL NARCOTICS. influences. The belladonna certainly has often failed, and a striking case of the kind is given by a recent respectable writer—Dr. Sigmond — of a family of eleven persons, who took it, yet every one of them was attacked. Hahnemann's direction for exhibiting it in such cases is to dissolve three grains of the extract in a fluidounce of cin- namon water, and to administer three drops of this solution, twice a day, to a child a year old, adding one drop for every year, until twelve drops are taken for a dose ; this course to be adopted at the commencement of the epidemic, and to be persevered in whilst it rages. The dose of the powdered leaves of Belladonna is one grain, which may be gradually increased until its peculiar effects—dry- ness of the mouth, dilatation of the pupil, or some of the cephalic phenomena supervene. The powder is rarely, however, given in- ternally. The fresh leaves are sometimes applied warm as a fomen- tation to pained parts; and, occasionally, an infusion is used for a similar purpose, or the powder is made to form part of a cataplasm. EXTRAC'TUM BELLADONNA, EXTRACT OF BELLADON'NA. This extract is made from the expressed juice of Belladonna. It is the preparation most frequently used. The dose may be a quarter, or half a grain, repeated three times a day, and gradually increased until the con- stitutional effects of the remedy appear. It has, however, been given in much larger quantities. Its topical uses have already been referred to ; but it may be added, that a decoction of the extract or of the leaves has been recommended, like other narcotics* as an in- halation in spasmodic asthma. An ALCOHOLIC EXTRACT OF BELLADON'NA—EXTRAC'TUM BELLADON'NA ALCO- HOL'ICUM — has been introduced into the last edition of the Pharma- copoeia of the United States (1842.) It is prepared by the action of diluted alcohol, by displacement, on Belladonna in coarse powder. The fresh leaves are not always attainable, and this formula fur- nishes a method for obtaining the extract in their absence. TINCTU'RA BELLADON'NA, TINCTURE OF BELLADON'NA.(Belladonn. §iv; Alco- hol, dilut. Oij ; prepared by maceration or displacement.) The dose of the tincture is from ir^xx to rr^xl, watching the effects. It is offi- cinal in the Pharmacopoeia of the United States, not in those of Great Britain. EMPLAS'TRUM BELLADON'NA, PLASTER OF BELLADON'NA. (Emplastr. Re- sin, ^iij ; Extract. Belladonna, ^iss.) This plaster is used as an anodyne and revellent in neuralgic pains, and, indeed, in most pain- ful affections that are deep seated. Dr. Wood states, that he has seen the constitutional effects of belladonna result from its applica- tion. Care ought to be taken not to apply it to an abraded surface. 5. STRAMO'NIUM. Datulra Stramo'nium, Thorn Apple, or Jamestown Weed; Sex. STRAMONIUM. 365 Syst. Pentandria Monogynia; Nat. Ord. Solanaceae, is met with in various parts of Europe, Asia, and America ; but its na- tive country appears to be unknown. In the United States, it is very common in the vicinity of every inhabited spot, in waste ground, and on dunghills. It flow- ers from May to Au- gust, according to the temperature. The leaves, Stramo'nii Fo'lia ; the root, Stramo'nii Radix ; and the seeds, Stra- mo'nii Semen, are officinal in the Phar- macopoeia of the Uni- ted States. The first are gathered when the flowers are full blown, at which time they possess an unpleasant virous odour, sufficient to produce a disagreeable impression on the olfactories, when the place is approached in which the plant grows. Their taste is bitter and nauseous. The disagreeable odour is lost by drying, but the taste remains. The seeds are small, compressed, kidney shaped, and of a brown, almost black, colour, without smell, but having the bitter, nauseous taste of the leaves, and a somewhat acrid taste. All parts of the plant yield their virtues to water, alcohol, and the fixed oils, which are consequently used in various preparations. The plant has been analysed by different chemists, and found to contain an active vegetable alkali, to which the name Datu'ria or Daturina has been given, and which is separated in the same man- ner as hyoscyamia. It dilates the pupil, and is highly poisonous to animals, but is not used in medicine. By destructive distillation, a poisonous oil is obtained, which does not differ in its physical and chemical properties from the empyreumatic oil of foxglove. Stramonium is a powerful narcotic, producing effects like those of belladonna, when taken in large doses, — as dryness of the throat, and delirium, followed by coma, with dilated pupils, and at times 31* Fig. 52. Datura Stramonium. 366 SPECIAL NARCOTICS. convulsions. In medicinal doses, it appears to resemble hyoscyamus ; to be anodyne, and, to a certain extent, hypnotic ; rather tending to relax the bowels than to constipate, and agreeing where opium can- not be borne. Still, for internal use, it is less employed than the other narcotics already considered, although it may be used in the very same cases. In spasmodic asthma — as elsewhere shown — it is made to come in contact with the pneumogastric nerves by inhalation, with marked advantage, — the benefit resulting, in such cases, from its narcotic influence. Like the other narcotics it is also used externally, the leaves being applied warm to painful tumours, irritable ulcers, &c. For the purpose of dilating the pupil, as well as of diminishing the sensibility of the retina to the influence of light, belladonna is more used in Europe: in this country, the extract of stramonium is often employed. The dose of the powdered leaves is two or three grains ; that of the seeds, a grain, repeated until the constitutional influence is manifested, or until some effect is exhibited on the morbid phe- nomena. EXTRAC'TUM STRAMO'NII FOLIO'RUM, EXTRACT OF STRAMO'NIUM LEAVES. This is the inspissated juice evaporated. EXTRAC'TUM STRAMO'NII SEM'EVIS, EXTRACT OF STRAMO'NIUM SEED. This is obtained from stramonium seed by the process of displacement, through the action of dilute alcohol. It is the alcoholic extract of the seed, and is preferable to the first. The dose of the first is a grain ; of the last half a grain, gradually increased. When applied to the eye to induce dilatation of the pupil, in the same cases as the extract of belladonna, it may be softened and gently rubbed over the eye- lid, or a solutiou may be dropped into the eye. ^ TINCTU'RA STRAMO'NII, TINCTURE OF STRAMO'NIUM. (Stramon. sem. contus. 3iv ; Alcohol, dilut. Oij. Prepared either by maceration or by dis- placement.) The dose is n\x to n\xx, two or three times a day, un- til some effect is induced. It may be given wherever stramonium is indicated. UNGUEN'TUM STRAMO'NII, OINTMENT OF STRAMO'NIUM. (Stramon. foL re- cent, concis. fbj ; Adipis, tbiij ; Cera flava, fbss. The leaves are boiled in the lard until they are friable, then strained, and to the pro- duct, the wax, previously melted, is added.) This ointment is used as an anodyne application to painful ulcers, hemorrhoids, &c, and is a great favourite with some surgeons, being prescribed in cases where others would use nothing more than simple cerate. Atrop'ia, At'ropine (see page 361 of this volume,) has been re- cently recommended by Mr. W. W. Cooper, Surgeon to the North London Ophthalmic Institution, as a substitute for belladonna for dilating the pupil in cases of cataract, &c. He dissolves two grains in a drachm of alcohol to seven drachms of distilled water. A full CONIUM. 367 drop of this solution, placed in the eye, produces, in the generality of cases, a speedy and complete dilatation of the pupil. In some in- stances, however, a stronger solution may be required. Mr. Cooper never observed any ill effects from its use, although he has tried it in the proportion of four grains to the ounce. He directs a drop to be used night and morning where he wishes to keep up the dilata- tion of the pupil. 6. CONI'UM.—HEMLOCK. Both the leaves, Coni'i Fo'lia, and the seed or fruit, Coni'i Semen, of the Conium macu- lat'um, are officinal in riS- 53- the Pharmacopoeia of the United . States. The plant, called also common or spotted hemlock; Sex. Syst. Pentandria Digynia; Nat. Ord. Umbelli- ferae, is indigenous in Europe, and has been naturalised in the Uni- ted States, and also in Chili, growing usu- ally in waste grounds, and by the roadsides, especially in inhabited places. It flowers in June and July, and the fruit ripens in August and Septem- ber. The whole plant has an exceedingly disagreeable virous smell, compared by some to that of mice ; by others to that of cantharides, or of the urine of the cat, by which it may be distinguished from other umbelliferous plants. Its proper characteristics are, however, botanical. The plant is consi- dered to be more active in warm countries, and in hot and dry sea- sons. The leaves are generally gathered when the plant is in full flower, or even later, when the fruit is forming. Dr. Christison,- however, affirms as the result of his experiments, that there seems to be no great difference in its poisonous properties at any season, as even in November and March of its first year its activity is very great. The same gentleman remarks, that, contrary to the opinion of Conium maculatum. 368 SPECIAL NARCOTICS. Geiger, the seeds have always appeared to him to be considerably more active when green than when ripe and dry : they are much more active than the leaves, and he considers this an objection to the adoption of the seeds by the London College as an article of the Materia Medica, and the remark would of course apply equally to the Pharmacopoeia of the United States— unless they were used for some special purpose different from those to which the leaves are ap- plied. A great advantage, however, of the seeds would seem to be, that they retain, for a much longer time than the leaves, their active principle unchanged. Hemlock leaves, when dried at a temperature not higher than 120° Fahr., and with exclusion of solar light, have a fine green colour, and the characteristic smell of the plant. They should be preserved in tin canisters well closed. It would seem, however,* that but little reliance can be placed upon the dried leaves, as, according to Dr. Pareira, however carefully prepared, they sometimes yield none of the active principle, conia, even although they may have a fine green colour, and the hemlock smell. The taste is nauseous, but much less so than that of the fresh plant. The seeds have very little odour, and a slight, somewhat bitter, and nauseous taste. Conium has been repeatedly subjected to chemical analysis, but without any great advantage to pharmacology. One of the most curious results was obtained by Schrader, who found the analysis of the hemlock and cabbage to be strikingly analogous! When sub- jected to distillation, a volatile oil, of an acrid taste and of the pecu- liar odour of the plant, passes over, which is not, however, poison- ous ; hence, the smell of the leaves would be an unsatisfactory test of their activity. When triturated with a solution of potassa, an intense and peculiar odour is exhaled, arising from the disengagement of the active principle Conia, Con'ein, Con'icin or Ci'cutin, which is supposed to be present in combination with an acid, and requires the agency of an alkali to disengage it. It is possessed of wonderful activity as a poison. It cannot be procured from the dried leaves; but may be from the dried fruit. Conium is one of the narcotics so strongly extolled by Storck in cancerous affections, not simply with the view of its narcotic action, but as a modifier of the system of nutrition, or a eutrophic. At the present day, however, the latter action has been more properly re- ferred to the therapeutical agents prescribed with it, for the belief of its < deobstruent' operation has now altogether passed away in the opinion of the best observers. In regard to its precise operation on the encephalo-spinal system, and the phenomena induced by it, discordance of sentiment exists, — so much so, that a very recent writer, Dr. Christison, expresses the opinion, " that the entire subject of the medicinal actions and uses of hemlock requires to be investigated anew ; and it well deserves investigation, considering its singular energy and peculiar effects as a poison." CONIUM. 369 Cases are on record, in which the leading symptom produced by it was coma: others have ascribed convulsions to it. On the other hand, the experiments of Dr. Christison led him to infer, that it does not excite convulsive spasms, or bring on insensibility ; but that it exhausts the nervous energy of the spinal chord and voluntary mus- cles, occasioning merely convulsive tremors and slight twitches, and eventually general paralysis of the muscles, and consequent stoppage of the breathing. He found, however, that it leaves the heart's ac- tion unimpaired, and does not prevent the blood from coagulating — as was at one time imagined — any more than other causes of death by asphyxia. On the other hand, however, Mr. Judd infers from more recent experiments with medicinal doses on cats and other animals, that the well-made extract causes great languor and drowsi- ness, and often profound sleep for two or three hours, lessens mus- cular excitability, and reduces the circulation as well as the animal heat. He is, consequently, induced to believe, that it really deserves the reputation it has enjoyed with many of being an efficient ano- dyne and hypnotic ; he adds, that on some trials with it in affections of the chest, he found it to allay cough and promote sleep, and he considers it especially applicable to the treatment of hypertrophy of the heart, phrenitis, and other affections attended with an excited or excitable state of the circulation. Recently, Dr. Pliny Earle has instituted some experiments upon himself to determine the physiological effects of the extract. In fifty grain doses it caused vertigo, dimness of vision, a feeling of mingled weariness, and weakness in the knees ; defective firmness in the gait; the same kind of feeling in the lower part of the biceps of the arm as in the knees ; with a constant disposition to bend and extend the forearm. The pupils were apparently dilated ; but it did not appear to induce any hypnotic effect. Dr. Earle states, that for several years he has been accustomed to the free use of the extract of conium in the treatment of insanity, without ever having produced sleep by it, even in doses gradually raised to 60, 80 and 90 grains, three times a day. The author has given the remedy a fair trial in various painful affections, but he has been extremely dissatisfied with it; and is dis- posed to think, as the result of his observations, that it is often alto- gether inert. It is used internally in the same cases as the narcotics already described ; and a fomentation of fresh hemlock leaves, or a poultice of the extract or of a decoction of the leaves, or a hemlock ointment or plaster is not unfrequently prescribed to allay the pain of malignant ulcerations, or of neuralgic suffering. Like some of the other remedies of the class, it has been supposed to possess antaphrodisiac virtues, and has, consequently, been pre- scribed in cases in which there was over-excitement of the venereal appetite. It has also been supposed to possess diuretic properties. In the experiments of Dr. Earle, however, there was no perceptible aug- 370 SPECIAL NARCOTICS. mentation or diminution of the urine. On two occasions, once after taking one of the largest doses of the American, and once after one of the largest doses of the British extract, he felt an acute, lancinating, and transient pain in the region of the neck of the bladder, which he believed to have been caused by it. The ordinary dose of powdered conium is three or four grains, twice or thrice a day, — the dose being gradually increased, until some degree of cephalic uneasiness is experienced. The powder, however, speedily loses its virtues, and different specimens appear to have different potency ; so that care may be necessary, if a different specimen of the same preparation be given, that an over-dose be not prescribed. EXTRAC TUM CON II, EXTRACT OF HEMLOCK. This extract is prepared from the inspissated juice,—too much pressure being avoided — as the extract, obtained in this manner, is, according to M. Brande, less active. It is the preparation most frequently employed, yet it is extremely unequal and always uncertain. Indeed, most of the ex- tract of conium of the shops is wholly inert. (Pereira.) It is con- sidered to be of good quality only when it disengages the odour of conia, which is strong and penetrating, something like that of hem- lock, — but more analogous to that of a combination of the odour of tobacco and mice. (Pereira.) It does not, however, contain much conia at any time. From 3iv of the extract, obtained by Dr. Pereira from one of the most respectable druggists in London, he was unable to procure any sensible quantity of it. It would appear, that in the process of evaporation the conia is decomposed ; and that in the very best extracts it disappears after they have been kept for some time. When we take all this into account, with the differences in the plant itself, according as it is wild— which is the most active — or cultivated, or as it is culled at different periods, it is obvious that no great dependence can be placed upon the greater part of the com- mercial extract. One cwt. of the leaves yields from three to five pounds of extract. The ordinary dose is two or three grains gradually increased until some constitutional effect is induced. It is usually given in the form of pill. In place of the Extract, Dr. Neligan, of Dublin, recommends the Succus conii, which he obtains as follows: — Take of fresh hemlock leaves any quantity ; express the juice in a tincture press ; set it aside for forty-eight hours ; pour off the clear supernatant liquor from the fecula and chlorophyll, which it has deposited ; and, lastly, add to it a fifth part by measure of rectified spirit. This preparation he has found to keep well for two years. The dose he gives is thirty minims three times a day in a little water. This may be increased to forty or sixty minims, and be decreased or wholly withdrawn ac- cording to the phenomena induced. The most unpleasant effect, when given in full doses, was a disagreeable sense of dryness in AC0NITUM. 371 the throat, accompanied with a feeling of constriction, and some dif- ficulty of swallowing. When this was the case, the medicine was omitted for a short time. The United States Pharmacopceia (1842) has an ALCOHOLIC EXTRACT OF HEMLOCK —EXTRAC'TUM CONl'l ALCOHOL'ICUM — which is made from the dried leaves, like the alcoholic extract of belladonna. It is ap- plicable to the same cases as the ordinary extract, for which it is a substitute, although it is probably even less satisfactory. TINCTU'RA CONl'l, TINCTURE OF nEMLOCK. (Conii fol. Jiv; Alcohol. dilut. Oij ; prepared by maceration or by displacement.) The Edin- burgh College prepares a tincture from the expressed juice, which, for the reasons before given, must be much more active than the tincture of the dried leaves. The dose is from f. 3SS. to f. 3J. A tincture of the dried fruit or seed has been proposed, which would necessarily be more active. 7. ACONITUM.—ACONITE. In the Pharmacopoeia of the United States, (1842,) Aconitum is defined to mean " the leaves of Aconitum napellus and of A. pani- cula'tum, (De Candolle.)" Wolf's bane or Monk's hood. The Dublin College adopts A. panicula turn as officinal, and directs the leaves to be used: the London College directs, in addition, the root to be employed; and the Edinburgh, the leaves of Aconitum napel- lus. They belong to Sexual System, Polyandria Trigynia; Nat. Ord. Ranunculaceae ; are indigenous in Europe, where they are often cultivated in the gardens, and are seen occasionally in those of this country. The leaves are usually collected when the flowers begin to appear, or shortly before. Neither the leaves nor the root of aconite have any smell, but when chewed, they slowdy occasion a strange sense of tingling and numbness in the tongue and interior of the mouth. The root is gathered in the spring, just before the leaves appear. The expressed juice, as well as the alcoholic extract of the leaves, possesses all the properties of the plant. The watery extract is regarded as a preca- rious and very irregular preparation. Aconite yields, on analysis, a peculiar alkali termed Aconit'ia or Aconitina, and a volatile acrid principle, which is readily decom- posed. It is an active poison of the acro-narcotic class, producing, in small doses, the tingling and numbness already mentioned, and in larger doses, symptoms of gastric irritation, accompanied or followed by signs of narcosis — as stupor, convulsions, coma, and death. From recent observations by Dr. Richard Eades, the following were the most marked phenomena exhibited by animals to which belladonna had been given : — weakness ; staggering ; gradually in- creasing insensibility of the surface ; slowly increasing weakness of the voluntary muscles ending perhaps in paralysis; great languor of 372 SPECIAL NARCOTICS. the pulse ; more or less blindness, and convulsive twitchings before death. Small and repeated doses of the alcoholic tincture of the root, taken internally, are said to cause a sensation of heat and tingling in the extremities, and occasionally slight diuresis. Unlike belladonna and stramonium, when applied to the eye, it induces contraction of the pupil; and the powers of the circulation appear to be depressed by it. Storck of Vienna first introduced this remedy, as well as others of the class, to the notice of physicians, and it was employed in nume- rous diseases ; the chief of which were rheumatism, gout, scirrhus and cancer; but it is now rarely administered. Owing to its sedative influence on the circulation, it has been given in hypertrophy of the heart. Experiments have been made by Dr. Fleming to determine more accurately its action. From a consideration of its effects on the cir- culation, he deduces the following inferences -r- First. That it is a powerful antiphlogistic. Secondly. That it is calculated to be of great value in all cases where there is inordinate activity of circula- tion. Thirdly. That it is contra-indicated when there is obvious mechanical impediment to the passage of the blood, particularly through the heart or lungs: and — Fourthly. That it is contra-indi- cated wherever there is irritability of the circulation with great dimi- nution of power, such as occurs after severe venous hemorrhage. These inferences apply, however, to sedatives in general. It would appear to be a remedy of great power, and ought to be administered with exceeding caution. In neuralgia, it has been extravagantly praised by some,— a single application of the tincture, it is said, producing amelioration, and a fewr applications an entire cure. It must be admitted, however, that it often fails — as often, indeed, as any other narcotic. In rheumatic affections, it has also been of great service. Those of the chronic kind have been most benefited; but cases of acute rheumatism have likewise been greatly relieved. It has, also, been largely employed externally. The dose of powdered aconite is one or two grains, which maybe gradually increased until its effects are apparent. When good, it causes the tingling and numb sensation before described. Of the preparations of aconite Dr. Eades thinks the tincture of the root, and the alcoholic extract are most to be depended upon. His observation induces him to regard the alcoholic tincture of the root to be stronger than that of the leaves. TINCTU'RA AC0NTT1, TINCTURE OF ACONITE. (Aconit. giv; Alcohol, dilut. Oij : prepared either by maceration, or by displacement.) The dose of the preparation is five drops, given three or four times a day ; but its effects should be carefully watched. Dr. Male, of Birmingham, England, took tincture of aconite for four days, beginning with five ACONITIA. 373 drop doses either twice or thrice a day, and increasing the dose to six, eight and ten drops, so that on the evening of the fourth day he had taken a dose often drops. On the morning of the fifth day, the injurious effects of the remedy on the nervous system appeared, and he died on the morning of the seventh day. It is applied as an em- brocation in neuralgia and rheumatism, by means of a small piece of sponge attached to the end of a stick. Dr. Pereira states, that the use of an aconite plaster, made by spreading the soft alcoholic ex- tract on adhesive plaster, in neuralgia, has been suggested to him. EXTRAC'TUM ACONITI ALCOHOL'ICUM, ALCOHOLIC EXTRACT OF ACONITE. This is made by distilling off the alcohol from the tincture of aconite, until the extract has the proper consistence. The ordinary dose is one- sixth of a grain, made into a pill with crumb of bread. It has been given to a greater extent in articular rheumatism, — half a grain every two hours, gradually augmenting the dose. An ammoniated extract of aconite has also been advised to be applied externally by Dr. Turnbull. It is made by evaporating very carefully, and at a low temperature, a tincture of the dried root of the plant to the consistence of an extract; adding to every drachm of this eight or ten drops of liquor ammoniae, and allowing the mix- ture to stand a short time in a very gentle heat, to drive off the excess of ammonia. It is used in the form of ointment, composed of one drachm of the ammoniated extract to three drachms of lard. When this ointment is rubbed upon the skin, it occasions a pungent sensation like that produced by aconitia ointment. In less severe cases, Dr. Turnbull advises the application of a simple saturated tincture of the dried roots, with or without the addition of a little ammonia. An ointment of the simple alcoholic extract is sometimes used, composed of one part of the extract to two parts of lard. It may be spread on adhesive plaster. Aconit'ia, acon'itine. The active principle of Aconitum has been brought forward with overstrained eulogies of late years. They have been sufficient, however, to introduce a formula for its prepara- tion into the last edition of the London Pharmacopoeia. This consists in exhausting aconite root by means of alcohol; distilling off the spirit until the extract remains ; dissolving this in water, and filtering; evaporating the solution to the thickness of syrup; adding dilute sulphuric acid mixed with distilled water to dissolve the aconitia; next dropping in solution of ammonia, and dissolving the aconitia, thrown down, in dilute sulphuric acid, mixed, as before, with water; adding animal charcoal, and shaking; lastly, filtering and dropping in solution of ammonia to precipitate the aconitia, which is finally washed and dried. This substance is of a white colour; inodorous, and of a bitter vol. i.—32 374 SPECIAL NARCOTICS. taste, leaving behind it an acrid but not burning sensation in the throat. It is uncrystallisable, requires one hundred and fifty parts of water at the ordinary temperature to dissolve it; but only fifty parts of boiling water. Aconitia is a most virulent poison—• said to be the most so known, not even excepting hydrocyanic acid, — one-fiftieth of a grain, pre- pared by Mr. Morson, endangering the life of an individual. Ac- cording to Dr. Pereira, it produces contraction of the pupil, when applied in a minute portion mixed with lard to the eye. According to Geiger and Hesse, dilatation of the pupil is the consequence. When a small quantity, either made into an ointment, or dissolved in alcohol, is rubbed for a minute or two on the skin, a sensation of heat and prickling is experienced, to which succeeds one of numb- ness and constriction in the part, which lasts from two or three to twelve or more hours, according to the quantity rubbed in. So small a portion as the hundredth part of a grain has produced a sensation, which has continued a whole day. Turnbull found, that unless these peculiar impressions were caused by the aconitia, no benefit whatever was to be expected from it; and he observes, that if there be the slightest abrasion of the skin, an application of such activity should not be resorted to, and that it should be carefully kept from coming in contact with any of the mucous membranes. The diseases in which it has been chiefly used are of the neuralgic kind ; and gouty and rheumatic cases. It is applied either in solution in alcohol, in the proportion of a grain or more to the drachm; or of ointment made by rubbing two grains of aconitia with six drops of alcohol, and mixing this well with one drachm of lard. A small portion of this may be rubbed on the affected part, until either the pain is relieved, or the peculiar sensation described above is induced. The appli- cation may be repeated three or four times a day if requisite. Aconitia has nearly gone out of use. The extravagance of the price, in England — 3s. 6d. or upwards of three quarters of a dollar per grain — would, indeed, have limited its use had it been more advantageous than it has proved to be. It would appear, indeed, that all its powers are possessed by the tincture of aconite, or by the alcoholic extract. A spurious aconitia — according to Pereira — is found in the shops, which is imported from France, and bears the stamp and label of a celebrated French chemical firm. Its colour is grayish yellow, and it is said to be inert, or nearly so. 8» LACTUCA'RIUM. Lactucarium is the inspissated juice of Lactu'ca sati'va, Lettuce; Sex. Syst. Syngenesia Polygamia /Equalis. Nat. Ord. Compositae — a plant whose native country is unknown ; but which is supposed to be Indigenous in the East Indies, and is cultivated in every part of the civilised world. Before the flower-stem shoots up, the plant LACTUCARIUM. 375 abounds with a bland milky juice; and afterwards with one that is intensely bitter and milky. When incisions are made in the flower- ing stem, the juice exudes, and, when collected and dried, it con- stitutes the Lactuca'rium, Thrid'ace or Lettuce opium. The ancients were well acquainted with the soporific virtues of the common garden lettuce; but Dr. J. R. Coxe, of Philadelphia, appears to have first proposed the employment of the inspissated juice in medicine. There are three kinds of lactucarium. The first, and the best and the most costly, is obtained from incisions made in the stalks as men- tioned above, whence the juice exudes, which is dried in the air. This preparation has a bitter taste ; soon becomes of a brown colour and solid ; and has a gummy fracture, but absorbs moisture from the air, becoming soft and clammy. The second is obtained by expression of the selected stalks, and subsequent evaporation, either in the air or by artificial warmth. This is said to be the variety most commonly met with on the European continent. The third is prepared in the same manner as any common extract from every part of the plant. This is the Thridace of some. The first is the only one worthy the attention of the therapeutist. Lactu- carium has been several times subjected to analysis ; but with no ad- vantage to pharmacology. Neither morphia nor narcotia has been found in it. The results of the author's experience in regard to the medical pro- perties of lactucarium have been negative. They certainly do not enable him to say, that it is possessed of the sedative and hypnotic powers that have been assigned to it. By many, it is conceived to be adapted for cases in which opium disagrees, and especially for al- laying the cough ofphthisis, and other pulmonary affections. Being devoid of an exciting property, it has been given unhesitatingly when the patient was at the same time labouring under increased vascular action. The usual dose is from gr. iij to gr. v ; but it has been given to the extent of several drachms a day, without any very marked effect. There can be no doubt, indeed, that its virtues have been greatly exaggerated. As in the case of every anodyne and hypnotic, the dose should be increased until the desired effect is induced. It has been applied externally in conjunctivitis, in the quantity of four grains to the ounce of water; and, like other narcotics, has been formed into a plaster. Lactu'ca Viro'sa, or strong scented Lettuce of Europe, as well as L. Scariola, possesses properties analogous to those of L. sativa ; It is affirmed, indeed, that the former yields a much larger quantity of lactucarium, and of superior quality. Lactuca elonga'ta or Wild Lettuce, which is common in this country, was originally intro- duced into the secondary list of the Pharmacopoeia of the United States, as a substitute for the lactuca virosa of Europe. The ex- tract prepared from it is said to be anodyne and hypnotic, in the dose of gr. v to gr. xv. 376 SPECIAL NARCOTICS, 9. HU'MULUS.—HOPS. Hops are the strobiles of Hu'mulus Lu'pulus, Hop plant; Sex. Syst. Dioecia Fig- 54. Pentandria; Nat. Ord. Urticaceae, which is in- digenous in the United States, and in Europe, and flowers from June to August. It is extensive- ly cultivated in this country, and chiefly in New Eng- land. The cones or stro- biles consti- tute the hops of commerce, which are gathered in England in September, and dried in kilns. They have a peculiar smell, and an aromatic intensely bitter taste, — the aroma being lost in process of time ; but the bitterness continuing. The bitter taste, and the aroma, reside chiefly in the lupulinic glands or grains, the LUPULI'NA or LUTULIN of the Pharmacopceia of the United States, whichforms about a sixth part of the weight of dried hops, and may be separated by thrashing, and to which Dr. Ives considers that the hops are indebted for all their medicinal virtue. These grains are of a cellular texture, and golden yellow colour Unless carefully dried, they soon lose their taste and smell, and the aroma is always im- paired by keeping. Lupulin, on chemical analysis, yields about 2 per cent, of vola- tile oil of hops: upwards of ten per cent, of bitter principle of hops, Lu'pulite, and 50 to 55 per cent, of resin. The scales afford but very little lupulin. Both they and the lupulin yield their virtues to water ; but still better to alcohol — pure or diluted. The emanations from hops are generally considered to possess Humulus Lupulus. CANNABIS INDICA. 377 hypnotic properties ; hence a hop pillow is sometimes used to invite sleep. It was directed in the case of George the Third, of England, when he was affected with insanity; and came, on that account, much into use. Dr. Pereira states, that he has several times seen a pillow of hops promote sleep ; but the author has not been able to arrive at this inference. He has often directed it, and sleep occa- sionally supervened ; but he has not been able to decide that it was not induced, either in consequence of the effect of the imagination, or independently of the hops. The different preparations of hops and of lupulin are certainly most unsatisfactory narcotics, and by no means to be depended upon. Their bitter principle renders them valuable tonics; and hence their use in ale and beer, as well to communicate a pleasant aromatic flavor as to check the acetous fer- mentation. Beer is accordingly prescribed as a tonic and nutritive drink in many cases. INFU'SUM HU'MULI, INFUSION OF HOPS. (Humul. §ss; Aqua bullient. Oj.) The dose of this hop tea, which is rarely used, however, is f. |j to f. |ij. TINCTU'RA HU'MULI, TINCTURE OF HOPS. (Humul. %v ; Alcohol, dilut. Oij.) This preparation has been proposed as a substitute for lauda- num when the latter disagrees ; and the condition of disease, to which it has been considered best adapted, is the wakefulness at- tended with tremors and general nervous derangement, to which habitual drunkards are liable, and which frequently precedes an attack of delirium tremens. The dose is from f. 3SS to f. jiij- LUPULI'NA. --LU'PULIN. Lupulin may be given in the same cases as hops, in the dose of gr. vj to gr. xij, made into pills by being rub- Fig. 55. bed in a warm mortar until they acquire the proper consistence. TINCTU'RA LUPULI'NA, TINCTURE OF LUPULIN. (Lupulin. §iv; Alcohol. Oij.) The dose of this preparation is f. 3J or f. 3ij, in sugared water, or any mucilaginous flUld. nried lupulinic Hops are also used externally in the way of fomen- sr,ain w-th 'ls tation, in painful affections of an internal or external fled.) (Pereira.) character. A dry hop poultice is often applied in internal affections of the abdomen, — the hops being sewed up in a flannel bag, heated and placed over the inflamed part. An ointment has also been used in cancerous sores, composed of powdered hops and lard. Lupulin may be added to poultices, or formed into ointmenc, and be applied in the same cases. 10. CAN'NABIS IN'DICA. —INDIAN HEMP. The term " Indian Hemp" has long been appropriated in the 32* 378 SPECIAL NARCOTICS. Fig. 56. United States to the Apocynum cannabinum ; and the name having been assigned to the hemp raised in India, occasion has been given in Europe and in this country to confusion as regards the two articles. Although the epithet " Indica" has been applied to the Cannabis of India, it does not appear to possess any specific difference from common hemp — Can'nobis sati'va, — and accordingly, by most botanists, they are es- teemed to be identical. Its narcotic powers have been long known to the people of Southern Africa, South Ame- rica, Turkey, Egypt, Asia Minor, India, and the adjacent countries of the Malays, Bur- mese and Siamese, by whom it is used in va- rious forms to induce intoxication. It is also employed extensively in popular practice in different diseases. In certain seasons a resi- nous juice exudes and concretes on the leaves, slender stems and flowers. This constitutes the churrus of Nipal and Hindusthan, and in it reside the powers of all the preparations of hemp. This resin, cannabin, is very soluble in alcohol and ether, and partially so in alkaline solutions, but inso- luble in acid solutions. When pure it is of a blackish gray colour; is hard at 90° of Fahrenheit, but softens at higher temperatures, and Juses readily. It is soluble in the fixed and in the several volatile oils. Its odour is fragrant and narcotic.; taste slightly warm, bitter- ish, and acrid. The dried hemp plant, which has flowered, and from which the resin has not been removed, is called Gunjah. It yields to alcohol twenty per cent, of resinous extract, composed of the resin—churrus — and green colouring matter. Gunjah is used for smoking. The largest leaves and capsules without the stalks, con- stitute Sedhee, Subjee or Bang, which is used to form with water an intoxicating drink. When the plant is distilled with a large quantity of water, traces of volatile oil pass over, and the distilled fluid has the powerful narcotic odour of the plant. Cannabis sativa. Although the Indian, the European, and the American plants appear to be botanically the same, they are possessed of very different powers. The former alone appears to have any activity. Mr. Dono- van has recently experimented fully with hemp raised by himself, and has become satisfied, that " domestic hemp is proved to be desti- tute of the principle, which renders the Indian plant so desirable an excitant to the voluptuous people of the East." Dr. O'Shaughnessy, who first made extensive trials with the remedy, noticed that the general effects observed on man were alle- viation of the pain in most cases, remarkable augmentation of appetite, CANNABIS INDICA. 379 aphrodisia and great mental cheerfulness. The more violent effects were a peculiar form of delirium, and a cataleptic state. Under the influence of fourteen grains of the resinous extract taken at bed- time during an attack of neuralgia, Mr. Donovan awoke early in the morning with a rush of strange sensations through his head, accom- panied by a crackling and singing noise, and a vibratory motion through his whole body. These gradually subsided, and whilst "dozing off" he thought an explosion took place in his head, followed by the same rushing noise and vibration as before, and afterwards by a strange metallic sound. Various other noises succeeded. His sense of touch and feeling had gradually become more and more obtuse, until at length he lost all feeling, unless he pinched himself severely. "The effects" says Mr. Donovan, "were now at their height, and the consequences were surprising. I absolutely lost the conscious- ness of having a body, and my corporeal existence appeared to be comprised within the head, and a small portion of my chest near the throat: in these spots I felt as much alive as ever, but all other parts were without feeling, and to my perceptions annihilated. My intellect was not in the least disturbed ; memory was as good as ever. I reasoned well enough; was conscious of external objects as in perfect health ; but I had some notion that if I gave way to sleep, I should never awake in this world ; yet, strange to say, I felt perfectly resigned to this sudden termination of existence." Similar anomalous phenomena where observed on his own person by an eminent physician of Philadelphia from a much smaller dose of the extract. Possessed of such powers Cannabis suggested itself as a remedy in various diseases. In cases of hydrophobia, its soothing influence has been manifested; but the testimony is strongest in regard to its efficacy in tetanus, Dr. O'Shaughnessy gives the results of 14 cases of the traumatic form, of which nine appear to have recovered ; and from which he concludes, " that in the hemp the profession has gaiued an anti-convulsive remedy of the greatest value." The re- sults, however, of different observers are by no means in accordance. Whilst some believe it capable of replacing opium, where opium dis- agrees ; others have found it fail where opium had failed. Recently, Dr. Lawrie, of Glasgow, has reported its effects on twenty-six cases, from which he draws the following conclusions. " First. It seems to belong to that class of narcotics, which rapidly induce excitement and intoxication, followed by sleep, neither sound nor refreshing. Secondly. In a full dose it acts powerfully on the heart, causing pal- pitations, and rapid, weak, intermittent pulse ; and on the nervous system producing delirium, coma, convulsions, and dilated pupils. Thirdly. Its effects are generally transitory. In one case, however, the intoxication and dilatation of the pupils lasted nearly 48 hours. Fourthly. It is a very uncertain agent, in some cases producing the most violent and seemingly dangerous symptoms ; in others being nearly inert. Fifthly. It very frequently causes vomiting, which, 380 SPECIAL NARCOTICS. whether it occur spontaneously or from emetics, very speedily relieves its unpleasant and perhaps dangerous effects. Sixthly. Applied around the eye it does not dilate the pupil. Seventhly. It exerted little influence on the few patients to whom it was given, in the form of enema. Eighthly. I do not think it is a valuable addition to our narcotic medicines. In very few instances did it act as an agreeable soporific and anodyne; in none did it succeed when opium had failed; and in one case only was it preferred to opium. I do not think it is to be trusted to. Ninthly. So far from acting generally as an anodyne, its effect was so disagreeable, that the majority of those who took it once, only did so a second time on compulsion, and this is the more remarkable, as the patients on whom I experi- mented belong to a class to whom stimulants of all kinds are familiar, and who would greedily swallow opium and spirits to an unlimited amount. Tenthly. It seemed useful in two cases of subacute rheu- matism ; and lastly. It caused an immediate craving for food, and in a few permanently increased the appetite." Professor Miller, of Edinburgh, believes Cannabis to be compara- tively valueless as an anodyne, as well as an hypnotic, in ordinary circumstances. Its virtue seems to him to consist in a power of con- trolling inordinate muscular spasm, which it exhibited in a case of traumatic tetanus, reported by him. Many cases have been recently published, in which its anti-convulsive power was confirmed. On the other hand, Dr. Clendinning has no hesitation in affirming that, in his hands, its exhibition has usually, and with remarkably few substantial exceptions, been followed by manifest effects as a so- porific or hypnotic in conciliating sleep ; as an anodyne in lulling irritation ; as an antispasmodic, in checking cough and cramp ; and as a nervine stimulant in removing languor and anxiety, and raising the pulse and spirits: and that these effects have been observed in both acute and chronic affections, in young and old, male and female. The form in which Cannabis is usually given is the alcoholic extract, which is by no means of uniform strength or action. The author has known all the effects induced by half a grain; whilst in the spasmodic neurosis, ten or twenty grains of the extract of the shops are often needed. It may be made into a soft pill, and be thus swallowed, or be chewed by the patient, and repeated according to the effect. A Tincture may be made of 24 grains of the Extract to a fluid ounce of dilute alcohol. Of this, a fluidrachm may be given in tetanus, every half hour, until the paroxysms cease, or cata- leptic phenomena are induced. In cholera, Dr. O'Shaughnessy found ten drops given every half hour check the vomiting and purging, and bring back warmth to the surface. 11. SP.R'ITUS iE'THERIS SULPHU'RICI COMPOS'ITUS.—COMPOUND SPIRIT OF SUPH'URIC ETHER. (JEther. sulphuric, Oss ; Alcohol. Oj : 01. other, f. ^iij.) This SPIRITUS jETHERIS sulphurici compositus. 381 preparation, which is an imitation of one described by Hoffmann, and hence termed Hoffmann's An'odyne Liquor, or Hoffmann's Min- eral An'odyne Liquor, is regarded by many — as its name imports — to be possessed, in moderate doses, of narcotic powers. In very large doses, like alcohol, it is unquestionably narcotic. Many per- sons have a high opinion of its anodyne properties, which they are disposed to refer to the oil of wine that enters into its composition. Others believe, that it possesses no other virtues than the ordinary sulphuric ether. Certain it is, that little dependence is placed upon it in cases where potent anodynes are indicated ; and notwithstand- ing the authority that has been brought forward in its favour, the au- thor is compelled to say — from the results of careful experiments instituted with it on the sound and the sick — that he has not noticed in it any anodyne or hypnotic virtue, except that which has been induced by the evanescent excitant action of the ethers in general. It is added, however, to other decided narcotics — as to lauda- Fig- 57- num — its action preventing the nausea, which occasionally super- venes on the use of the latter. The dose of the spirit is f. 3SS to f. 3ij, in sugar and water. Besides the preceding narco- tics, the following are officinal in the secondary list of the Pharma- copoeia of the United States. 12. Ascle'pias Syr'iaca, Com- mon Silkweed, Milkweed; Sex. Syst. Pentandria Digynia ; Nat. Ord. Asclepiadaceae, is a very com- mon plant in this country ; flower- ing in July and August. The root is officinal, and is said to possess anodyne properties. The dose of the powder is 3J, in divided doses given through the day. It has, likewise, been administered in strong infusion. The author has had no experience with it. 13. Ly'copus, Bugleweed, Ly'- copus Virgin'icus; Sex. Syst. Diandria Monogynia ; Nat. Ord. Labiatae, is an indigenous herb, met with in the greater part of the United States; flowering in August. Lycopus Virginicus. The whole herb is offici- 382 SPECIAL TETANICS. nal. Its odour is peculiar, and taste slightly bitter and nause- ous. It readily yields its virtues to water. Bugleweed is said to be a mild narcotic ; allaying irritation and cough; and diminishing the activity of the circulation. It is given in infusion, (Lycop. § j; Aqua bullient. Oj. Dose, f. |ss to f. §iij,) but—like a multitude of other agents — its virtues are scarcely sufficient perhaps to warrant its retention in the lists of the materia medica. II. TET'ANICS. Definition — Modus operandi — Therapeutical application — Special Tetanics. Between the agents described under the head of Narcotics, and those that fall under consideration here, there is a well-marked dif- ference ; for whilst the former are anodyne and hypnotic in appro- priate doses, the latter— leaving the encephalon untouched — may affect most prominently the nerves of voluntary motion ; giving rise to tetanic convulsions, especially in parts which are affected with paralysis ; and only in excessive doses induce the ordinary signs of acro-narcotic poisoning. It is in consequence of this effect upon the nerves that are distributed to the muscles, or to the portions of the nervous centres with which they are connected, that this class of agents has been termed, by some recent writers, Tetanics ; and, to avoid confusion, the author has adopted it rather than attempt to suggest another appellation, and perhaps one that would not be more expressive. Dr. Pereira has called them also convulsives, and has defined them to be — " agents which augment the irritability of the muscular fibre, and in large doses occasion convulsions;" but their action seems manifestly to be exerted upon the nerves, and through them on the muscular irritability. The fact, indeed, that they in- duce involuntary muscular contractions of the voluntary muscles, from slight twitchings to the rigidity of tetanus, according to the quantity given, is sufficient to demonstrate, that the phenomena, re- sulting from their administration, are purely nervous. They are chiefly given in paralysis, and especially in the local forms; — none of them being well adapted for cases in which the cause of the paralysis is encephalic. SPECIAL TETANICS. 1. NUX VOM'ICA. Nux vomica is the seed of Strychnos Nux Vom'ica; Sex. Syst. NUX VOMICA. 383 Pentandria Monogynia; Nat. Ord. Apocynaceae, (Lindley,) a middling-sized tree, which is indigenous in Coromandel, and other parts of India, and in Ceylon. The wood — Lignum Colubri'num, or snakexoood — is very bitter, and has been employed in the treatment of intermittents; and the bark was for a long time known under the name of false Angustu'ra or false Cus- pa'ria bark, and was at one time referred to Bru'cea ferrugin'ea or antidysenter'ica. The berry is round, smooth, of the size of a pretty large apple, and covered with a smooth, some- what hard shell, of a rich orange colour, and Btrychnos Nux vomica. filled, when ripe, with a white, soft gelatinous pulp, containing the seeds. These — as met with in the shops — are circular, and flat, nearly an inch in diameter; concave on one side; slightly convex on the other; and thickly covered with short, brown, satiny hairs. From their resemblance to buttons, the seeds have sometimes been termed Bach'elor's Buttons. They are devoid of smell, but of an acrid, and very bitter taste. The quantity of nux vomica, on which duty was paid in England, in 1840, was, according to Dr. Pereira, 550 lbs. They are with difficulty divided finely. The simplest method is to rasp, or to soften them well with steam, and then slice, dry and grind them. The powder is of a grayish-yellow colour, of a faint sweet odour, and an intense, durable bitter taste. Alcohol is the best solvent; but dilute alcohol and water take up the bitter active constituents. They have frequently been subjected to analysis, but the results, obtained by Pelletier and Caventou, are considered the most satisfactory. Those gentlemen found them to contain, — strychnic or igasuric acid ; strychnia and brucia, in com- bination with strychnic acid; wax, in small quantity; concrete oil; yellow colouring matter; gum; a little starch: bassorin, and woody fibre. Carbonate of lime, and chloride of potassium, were found in the ashes. Nux vomica possesses the power of exciting the spinal marrow without implicating, otherwise than indirectly, the functions of the brain. The chief diseases in which it is administered, as well as its varied effects in accordance with the dose, may be considered under the head of its active principle, strychnia, with which — in a the- rapeutical point of view — it may be esteemed identical. It may be given in powder, in the dose of five grains, repeated three or four times a day, and gradually increased until the special effects of strychnia on the muscles are perceptible. The greatest objection to this form is its uncertainty, and hence the ALCOHOL'IC EXTRACT has been generally substituted. This is prepared by taking any quantity of nux vomica rasped; exhausting it by repeated maceration in alcohol 384 special tetanics. of .817, and evaporating it slowly to the consistence of an extract. When this extract is given in an over-dose, it occasions tetanic convulsions and death ; and, in medicinal doses, in cases of paralysis, tetanic convulsions and a feeling of creeping are experienced, which indicate the action of the remedy. Occasionally, it would seem to accumulate in the system, and afterwards to explode ; death, at times, supervening with distressing cerebro-spinal phenomena; hence it is not always proper in ence- phalic paralysis. It is, however, in paralysis, general and local, that it is most frequently administered ; indeed, in all the cases in which its active principle — strychnia — is given. The dose of the extract — made into a pill — is one grain, the dose being gradually augmented, until the peculiar effects are in- duced. It may be taken at bed-time, as night affords the best oppor- tunity for noticing the tetanic phenomena. Generally, from four to six grains are sufficient; but, at times, it is necessary to carry the dose to twenty or thirty grains. Should the administration of the remedy have been interrupted, the patient ought to recommence with the small doses, and increase them gradually as before. It is sometimes given in tincture — three grains of the extract being dissolved in an ounce of alcohol at .837. It is given by drops in cases in which the alcoholic extract itself is suggested: M. Petre- quin also employs a tincture of nux vomica, prepared of four ounces of the powder and a quart of brandy, which is used altogether exter- nally as an embrocation to palsied parts. A liniment is not unfre- quently prescribed in similar cases, composed of an ounce of the Tincture of Nux Vomica, and two drachms of Liquor Ammonia. a. strych'nia. This alkaloid was discovered in 1818 by MM. Pelletier and Ca- ventou. It has been found in Strychnos Nux vom'ica, S. Igna'tia, S. Colubrina, and S. Tieut'e; is often associated with brucia, and always with an acid. In the Pharmacopceia of the United States (1842) it is directed to be prepared by a process of which the follow- ing is the rationale. Nux vomica, rasped, is digested and boiled in two gallons of water, acidulated with muriatic acid; this decomposes the strychnate of strychnia as it exists in nux vomica, and a muriate of strychnia is formed. The residuum is boiled again and again in acidulated water, and the decoctions, after being strained, are mixed and evaporated to the consistence of syrup. Lime, previously mixed with water, is now added, and the mixture is boiled for a little while, frequently stirring. This decomposes the muriate of strychnia, and the powder which is precipitated, is pressed, dried and powdered. This powder is now treated repeatedly with boiling alcohol, until deprived of its bitterness ; the liquors are mixed, and the alcohol is distilled off. The residue is mixed with water, heat applied, and sufficient diluted sulphuric acid added to neutralise and dissolve the strychnia ; purified animal charcoal is now added to deprive it of its STRYCHNIA. 3S5 colouring matter; it is then boiled for a few minutes, filtered and crystallised. The sulphate of strychnia, thus formed, is dissolved in water, and sufficient solution of ammonia added to separate and-pre- cipitate the strychnia, which is dried on bibulous paper. Thus obtained, strychnia is a white powder, of an intensely bitter taste, almost insoluble in water; slightly soluble in cold alcohol antl readily soluble in the same menstruum when boiling. Although almost insoluble in water, it has a powerful bitter taste. A solution made in the cold, and therefore containing only 5-^th part of its weight, may be diluted one hundred times, and still retain a very decidedly bitter taste. It has an alkaline re-action, and forms, with acids, salts that are mostly crystallisable, and insupportably bitter, and are more soluble than pure strychnia. The action of strychnia is precisely like that of nux vomica, for which it is now pretty generally substituted. In adequate doses, it is one of our most energetic poisons, producing death through its lethiferous action on the spinal marrow. A case of this kind, de- tailed by Dr. Blumhardt, of Stuttgart, is given by the author at length in another work. (New Remedies, 4th edition, p. 549, Philad. 1843.) Morphia appears to be the best antidote to its effects. It is in paralysis that strychnia has been most prescribed ; and from the results of numerous observations, it would seem, that it is most efficacious in paraplegia ; less so in hemiplegia, although it has been given, at times with advantage, in the latter affection. Its ad- ministration in hemiplegia requires, however, special circumspection, particularly when the paralysis has succeeded to apoplexy; as there has been reason to believe, that the excitant influence of strychnia has had some effect in inducing a recurrence of the apoplexy. It is in local paralysis, that it is most serviceable — as in aphonia, amau- rosis, paralysis of the bladder, and rectum, of the facial nerve, &c. In high degrees of paraplegia, the internal use of the remedy is some- times preferred ; but the endermic administration is more general. In paralysis of the limbs, a spot is selected in the vicinity of the spinal marrow. Strychnia has, likewise been given in neuralgia, trau- matic tetanus, hysteria, hypochondriasis, dyspepsia, chorea, epilepsy, and catalepsy ; but the author has never seen any advantage from it in these affections. It has been administered, likewise, in dysentery and diarrhoea, and has been used endermically as well as internally in cholera, in which it was frequently prescribed to allay vomiting ; — from a quarter to half a grain being added to three ounces of water, and this solution given in the dose of a spoonful every hour. A modern writer, Dr. Ryan, asserts, that he has repeatedly known a few of the fol- lowing pills check a profuse diarrhoea with rice-coloured evacuations, even when the extremities were blue, in malignant cholera. (Strych- nia, gr. i; Confect. Ros. 3ss ; Pulv. Glycyrrhiz. 9ss. — M. et divide in pil. xii. Dose, one, night and morning, gradually increased to four or five daily.) From its occasional efficacy in analogous condi- 386 SPECIAL TETANICS. tions of the digestive mucous membrane, it has been suggested, that it might prove useful in bronchitis. Strychnia is best given in the form of pill, or tincture. The dose is from Tyh to $th of a grain, which may be gradually increased until a grain is taken, or until its peculiar effects upon the muscles are apparent. Should these be too severe, they may be moderated by a dose of opium or morphia. A Tincture may be made of Strychnia, gr. iij ; Alcohol, f. |i; the dose of which is from six to twenty-four drops, twice or thrice a day. In the endermic application of the remedy, a blister of the requi- site size is applied, and a quarter of a grain is sprinkled twice a day on the denuded surface ; the quantity being slowly increased to half a grain or more, should this be necessary. When used endermi- cally, the preparations of strychnia produce much more powerful local effects than those of morphia ; they are apt to keep the abraded portions of the skin in an inflamed state, promote suppuration more than morphia, and occasion violent itching and burning, with a feel- ing as if needles were run into the skin. When strychnia, administered in larger doses, does not act bene- ficially in any case, it will be advisable to discontinue the remedy for a few days — after which smaller doses may again exert their in- fluence — rather than to carry the dose still higher. At times, dur- ing its endermic use, the blistered surface becomes covered with a layer of coagulable lymph, in consequence of which the strychnia does not make its appropriate impression. This layer must be re- moved, as far as practicable, at each application ; and as the vesi- cated surface becomes daily less and less sensible, the dose must be proportionately increased. Besides strychnia, several of its salts are occasionally used in medicine; for example, the Acetate, the Iodate, and the Nitrate. They are given in the same cases as strychnia itself. b. bru'cia. From Nux Vomica Bark an alkaloid'is obtained analogous to strychnia. It is also associated with strychnia in the seeds of nux vomica, and in St. Ignatius's bean, and is combined with igasuric acid. In the bark of nux vomica, however, it is combined with gallic acid. In the preparation of it an alcoholic extract of false an- gustura bark is first made, which is dissolved in a large quantity of cold water, and filtered to separate the fatty matter. The colouring matter is precipitated by acetate of lead, the excess of which is thrown down by sulphuretted hydrogen gas, and the brucia by an alkaline base, for which purpose magnesia may be employed. The precipitate from the magnesia is then washed, dried, and treated with alcohol, which lays hold on the brucia. This is obtained by evaporation. Pure brucia is of a white colour, and in crystals, which have the form of oblique four-sided prisms. Its taste is very bitter, and it TOXICODENDRON. 387 is soluble in 500 parts of boiling water, and in 850 parts of cold. It dissolves readily in alcohol. With the acids it forms neutral salts. Brucia acts on the economy like nux vomica bark, but much more energetically. It is analogous to strychnia in its operation, but much weaker, — in the ratio of 1 .to 10 according to Pelletier, of 1 to 12 according to Magendie, and of 1 to 24 according to Andral. It is scarcely ever used, however. It may be given in pill or in tincture. 2. AR'NICA. — LEOPARD'S BANE. Arnica — the root and herb of Ar'nica monta'na ; Sex. Syst. Syngenesia Polygamia superflua ; Nat. Ord. Compositae, is in the secondary list of the Pharmacopoeia of the United States. It is common in the Alps, and is met with also in the mountainous parts of the north of Europe. It is said by Mr. Nuttall to be found also in the northern regions of this continent to the west of the Mississippi. The whole plant, and especially the root, possesses a peculiar aromatic unpleasant odour, and an acrid nauseous taste. The root yielded, on analysis by Pfaff, volatile oil, acrid resin, gum, extractive, and woody fibre ; and Dr. A. T. Thomson is of opinion, that the igasurate of strychnia exists in the plant. Arnica, in large doses, belongs to the class of acro-narcotic poi- sons. In smaller doses, it has been employed, especially in Ger- many, in paralysis, as an excitant to the nervous system. In this country, however, it is not much used, and there does not appear to be any clear appreciation of the affections for which it is adapted. Such seems to be the case with the French practitioners. "It maybe concluded," — say MM. Merat and De Lens,— " that we have as yet insufficient data to pronounce positively on the affec- tions in which the arnica can be unequivocally efficacious; we must consequently always bear in mind its heating and active qualities when we prescribe it." The volatile oil of the flowers has been much prescribed in Ger- many, in old cases of paralysis, the result of the apoplectic condi- tion. Schneider mixes four drops of arnica oil with half an ounce of Hoffmann's anodyne liquor or spirit of nitric ether; and of this he gives from four to twelve drops several times a day. The Germans, according to Sir George Lefevre, class arnica among sacred remedies ; and its virtues are extolled throughout two pages of the " Pharmacopoeia Ruthensis." Sir George himself was much disappointed in its effects. It is much more uncertain than strychnia in its operation ; and he has known it exhibited in large doses without producing any sensible results. 3. TOXICODENDRON. —POISON OAK. The leaves of Rhus Toxicodendron; Sex. Syst. Pentandria Tri- gynia; Nat. Ord. Terebinthaceae, are in the secondary list of the 388 ANTISPASMODICS. Pharmacopoeia of the Uniied States. Rhus Toxicoden'dron and Rhus radicans or Poison vine, are mere varieties of the same plant. The Poison Oak is a shrub from one to three feet in height. It is very common in the United States from Georgia to Canada, flowering in June and July. The juice, which issues from it when wounded, applied to the skin, excites erythematous inflammation and vesi- cation, sometimes putting on the characters of ordinary local ery- sipejas ; at others, of herpes. Nor does it seem to be necessary that the juice of the plant should come in contact with these plants to produce this effect. An acrid volatile principle appears to escape from them, which causes the mischief. This generally appears soon after exposure, and generally declines in about a week. The leaves, when taken internally in large doses, are acro-narcotic. In medicine, their use has been almost restricted to old paralytic cases dependent upon torpor of the nerves, — the same cases as require the use of strychnia, —but they are not much prescribed. The dose, usually given, has been from gr. ss. to gr. j.; but much larger quantities may be prescribed without inducing its disagreea- ble excitant effects on the nerves. It is said to induce twitchings of the affected muscles like strychnia. III. ANTISPASMODICS. Definition of antispasmodics—Spasm considered—No direct antispasmodic—Modus operandi of the indirect mental antispasmodics—Therapeutical application of anti- spasmodics, in tetanus, chorea, epilepsy, asthma, hooping cough, colic, hysteria, &». —Special antispasmodics. Great discrepancy has existed among therapeutical writers as to the precise situation in which antispasmodics ought to be placed. Murray classes them, with narcotics-, amongst the " diffusible stimu- lants ;" whilst Thomson places them with these same agents, — as substances that diminish action secondarily. A short inquiry may tend to place them in their proper position. They are usually de- fined ;— "substances that allay irregular muscular contraction," and Dr. Paris affirms, that there are certain medicinal bodies, which would appear to exert a specific control over spasmodic action, from whatever cause it may have originated: such, he says, are as- safetida, galbanum, musk, castor, ammonia, valerian, &c. He pro- perly adds, however, that " in a more general view of the subject, we must admit, that this class branches, by indefinable gradation, into narcotics and tonics; for since spasm may be connected with the most opposite states of the body, it is very evident, that many of the individuals included in the class of antispasmodics can only be relative agents : spasm, for instance, may arise from excessive irritability, as from teething, wounds, worms, &c, in which case a narcotic would prove beneficial; or it may depend upon a state of ANTISPASMODICS. 389 general debility, the proper remedy for which would be the admi- nistration of an aromatic stimulant, or the assiduous exhibition of some permanent tonic." — It maybe affirmed, however, that we are not acquainted with a single article of the materia medica, which acts specifically on the muscular fibre when in a state of spasmodic contraction. That such may exist cannot be denied, but at this time we know of none. They may all be regarded as indi- rect agents ; relieving and removing spasmodic action, in conse- quence of their agency being exerted on other parts of the nervous system than those concerned in the irregular muscular contraction, and thus deriving from the nervous influence concerned in the pro- duction of the latter. In order to thoroughly comprehend this position, it is proper to in- quire into the nature of spasm. The Greeks gave the name to every kind of convulsion ; and, by modern nosologists, convulsions are ranked amongst the * spasmi.' The term is now usually applied, however, to involuntary contractions, especially of the voluntary muscles ; and these, again, have been divided into tonic spasms, when they consist in permanent rigidity of the muscles concerned, of which we have an example in common cramp ; — and clonic spasms, which consist in alternate contractions and relaxations — of which we have an example in the convulsions of children. It is now admitted by almost all physiologists, that the muscular fibre, like every primary tissue of the body, is possessed of excitability or irritability, — that is, of a power of being acted upon by appropriate stimuli, and of moving responsive to such stimuli. This vis insita, however, absolutely requires that it shall be acted upon by stimuli before motion is perceptible. The muscular filaments of the voluntary muscles are supplied with nerves from some part of the cerebro- spinal axis, and along these nerves the appropriate stimulus \% sent which rouses them to contraction. In the case of voluntary motion — as of the biceps to raise any weight attached to the hand, or to the extremity of the forearm — an act of volition is exe- cuted, under the influence of which the portion of the cerebro-spinal axis, whence the nerves proceed to the upper extremity, is excited to send the proper nervous influx along those nerves, in quantities strictly in accordance with the ejxtent of action, which the muscle should execute. The muscle immediately contracts responsive to the stimulation. Now, if any cause of irritation exist in the cere- bro-spinal axis, or indeed In any part of a nerve distributed to a muscle, such irritation may induce the same effect as the act of volition, and the muscle may, in this manner, be permanently or intermittently contracted. In all cases, therefore, spasm appears to be a nervous phenomenon, and remedies adapted for its removal must exert their agency on some part of the nervous system — not on the muscular fibres, over the condition of which they would not appear to have the slightest control. They who admit direct antispasmodics find that difficulties environ 33* 390 ANTISPASMODICS. them, the very nature of which entangles the subject in inextricable confusion. A late writer on therapeutics, Dr. A. T. Thomson, after entering into a long and singularly infelicitous disquisition on the precise modus operandi of antispasmodics — suggests, as a point re- quiring consideration,— whether they are stimulants or sedatives? and he decides that they are sedatives ; " for," he remarks, " if the irregular or inordinate action which they overcome be the conse- quence of irritation, either mental or corporeal, it follows that, in re- solving spasm, the susceptibility of impression in the extreme motor nerves must be diminished ; and this can only be the result of a se- dative power. It may, however, be affirmed, that this must either be immediate oi consecutive of a previous stimulant operation ; thence we can explain, why some of those medicines, which can only be regarded as direct antispasmodics, stimulate the general system, and, consequently quicken the pulse ; since, like narcotics, this action may be primarily of a stimulant character, and be quickly followed by collapse. According to this mode of reason- ing, the same results may follow from antispasmodics operating ex- clusively on the motor nerves, as from narcotics operating on those of sensation." Without animadverting on many of the hypothetical positions con- tained in this extract as to the modus operandi of antispasmodics, and the parts on which they specially act, it may be observed, that every difficulty vanishes when we regard the direct — for such only can be esteemed true antispasmodics—as acting only by virtue of the new impression which they make on the gustatory or gastric nerves, or both, and thus deriving from the inordinate action going on in some other portion of the nervous system. What, indeed, are the reputed direct antispasmodics ? — musk, — castor, — Dippel's oil,— oil of amber, — valerian, — assafetida, — galbanum, — skunk-cab- bage,— ethers, &c; — all substances belonging to the class of ex- citants, and many of them calculated, in addition, to make a powerful impression on the nerves of gustation, and olfaction: and what, again, are the indirect antispasmodics? Dr. Thomson divides them into material, including tonics and narcotics ; and, mental, com- prising fear and abstraction. It is strange, however, that he should not have classed blood-letting amongst the material agents, especial- ly as he had previously remarked, with much propriety, that, whether the effects of antispasmodics be perceptible very soon after their ad- ministration must necessarily depend on the cause of the spasm, " whether it arise from exhaustion and collapse: such, for example, as occurs from blood-letting when the quantity of the vital fluid ab- stracted is more than the condition of the system can support, in which case nothing is more common than for syncope to be attended with convulsions ; or whether it depend on the opposite state, ful- ness of the vessels of the brain, sufficient to produce epilepsy, or on some degree of inflammation, as in phrenitis, which is sometimes also attended with convulsions." " It should ever be remembered," he MODUS OPERANDI. 391 adds, " that although antispasmodics are indicated, and proper in the first state, just described, yet, that this class of medicines is posi- tively injurious, when the spasmodic action is the consequence of in- flammation of the brain, or spinal marrow, or their coverings; under such circumstances, blood-letting and measures calculated to subdue the primary disease are the means to be adopted." One of the great difficulties, indeed, in discriminating the character of different diseases of the convulsive kind, is involved in the consideration, whether they be dependent upon an inflammatory or congestive con- dition of vessels, or connected with exhaustion, or excessive irri- tability of the nervous system. In another section, however, the au- thor has dwelt on every thing applicable to this portion of the subject, when considering the effects of the abstraction of blood in such dis- eases. To that section he must refer the reader. (See Sedatives.) In ordinary cases of spasmodic action, not dependent upon any ex- cited action of vessels, any thing that produces a new nervous impres- sion proves antispasmodic. Narcotics do so by blunting the impres- sibility of the whole nervous system. Nauseous agents produce their effects upon the olfactory or gustatory nerves ; and, if they be ex- citants at the same time, upon the nerves of the stomach. Simple ex- citants and tonics act on the same nerves, and through them on the general system. Nothing, indeed, could better elucidate the modus operandi of these agents, than those which Dr. Thomson has termed mental narcotics — Fear and Abstraction. He refers to a striking instance of the sanative effect of fear in hooping-cough kept up by habit. The patient, a young boy, was threatened with the applica- tion of a large blister, and although it was not applied, but merely placed within his view, the dread of it completely relieved the cough. Boerhaave is asserted to have cured epilepsy by taking a red hot poker, at the moment of the expected attack, and threatening to push it down the throat if the patient should have a fit. Still more recently, the same remedy has been advised to be directed towards the nether extremity of the body. Iu a treatise on plague, dysentery, and oph- thalmia, Dr. Louis Frank recommends, that a dysenteric patient should be tied hand and foot and be held by two men, when — " chirurgus cum,ferro candenti,figuram coni habenti, coram agroto compareret, et id versus anum dirigiret, quasi id ano intrudere vellet ! " All these are cases of the simple revulsive effect of fear, and in this way any mental emotion may prove antispasmodic. Any form indeed, of abstraction, or rather of distraction, is necessarily revel- lent, and antispasmodic. When Cato, the Censor, reduced luxa- tions, as he pretended, by certain mystic words, (p. 58,) he diverted the attention of the sufferer, prevented inordinate contraction of the muscles around the dislocated joint, and a slight manipulation only was necessary to reduce it. At the present day, the surgeon is in the habit of employing this agency; and although he may have no faith in set forms of speech, or in cabalistic expressions, he knows, that if he can concentrate the attention of the patient, he may lessen 392 ANTISPASMODICS, the contraction of the implicated muscles, by diverting, in some measure, the nervous influx from them ; and if he then suddenly exerts his skill at reduction, the bone occasionally slips readily into its place. The same kind of revellent influence is invoked in cases of cramp. In the " Table Talk," of Coleridge, there is an allusion to one of the popular charms for cramp, of which there are so many. "When I was a little boy at the Blue-coat School, there was a charm for one's foot when asleep ; and I believe it had been in the school since its foundation in the time of Edward the Sixth. The march of intellect has probably now exploded it. It ran thus : — Foot! foot! foot! is fast asleep ! Thumb ! thumb ! thumb ! in spittle we steep ; Crosses three we make to ease us, Two for the thieves, and one for Christ Jesus. And the same charm served for a cramp in the leg, with the fol- lowing substitution: — The devil is tying a knot in my leg ! Mark, Luke and John, unloose it, I beg! Crosses three," &c. (Table Talk. ii. 33. — American Edit.) Partly by an analogous agency, the animal magnetiser operates his cures, and change of air, society, and scenery exert their good effects in nervous maladies. Some years ago, the author visited a gentleman who had suffered for some hours under such excruciating pain in the bowels as to induce him to believe that he was labour- ing under enteritis. As soon as the author had examined into his case, and laughed at his fears, — under the new mental condition induced, — the colicky spasms rapidly yielded, and in half an hour he was well. Certain highly nervous and imaginative persons can feel pains wherever they please, and many an individual, by the pe- rusal of cases of disease, has fancied himself affected with the same sufferings which he has seen depicted. If, therefore, attention can direct the nervous afflux to a part, it is obviously of great moment so to impress the nervous system of the individual, that no concen- tration of the kind may take place towards the suffering organ ; and this may be accomplished by engaging the mind on some subject of entertainment or reflection, or by impressing the totality of the ner- vous system, or by affecting nerves at a distance from those impli- cated. The author has before observed, that he does not regard the direct or true antispasmodics, as they have been termed, to be worthy of the name, and that he believes them to produce their effect by the impression they make on the nerves of two of the senses, and by their stimulant properties, which, — in the case of the articles re- IN TETANUS. 393 ferred to, as true antispasmodics,— are dependent upon animal resin, empyreumatic oil, volatile oil, or gum-resin. It has been affirmed, however, that this view is negatived by the fact, that assafetida — and the remark applies to other articles on the list — relieves hyste- ria, even when injected into the rectum, and when, of course, there can be no impression made on either the gustatory or olfactory nerves. This is true; but the whole effect appears in such case to be produced by the excitant properties of the gum-resin ; and that this is the case is demonstrated by the fact, that if we throw up an excitant — which may never have been regarded as an antispasmo- dic — we produce the like result. By either agent, a new impres- sion is made on the nerves of the rectum, which at times rouses the individual to consciousness. In such cases, the author is in the habit of administering an enema of oil of turpentine, — not, however, because he regards it as possessing any virtues over the excitant oils in general, or as entitled in any respect to the appellation of a di- rect or true antispasmodic. Therapeutical Application of Antispasmodics. To exhibit what little confidence is reposed in true antispasmo- dics, by practitioners in general — even by those who consider that such a class really exists — it is well to glance generally but briefly at the different antispasmodics — direct and indirect — that are em- ployed in affections of the nervous system, and are regarded by all as eminently adapted for them ;— an inquiry which will signally ex- hibit how much more the latter class is relied on, when much dis- ease is present, than the former. There is, indeed, but one morbid condition, in which direct antispasmodics are largely employed at the present day, and the rationale of their action in it is sufficiently ma- nifest. Tetanus affords us an example of a tonic spasm, which would seem to be signally adapted to test their efficacy. The disease is seated in the great nervous centres, and unfortunately is too often totally irremediable. Rarely, however, do we find musk, or assa- fetida, or castor, or any of the direct antispasmodics employed, be- cause experience has exhibited their insufficiency. Trust is placed almost wholly in indirect agents, and especially in narcotics, of which opium is usually chosen ; and it is astonishing what quanti- ties can be borne without the induction of any signs of narcosis. Cases are on record in which fifteen or twenty grains have been given every three hours for several days in succession, and yet but little effect has been produced on the disease, or the patient. Under the excessive erethism of the nervous centres, which constitutes the pathology of tetanus, narcotics do not produce their ordinary results, and the same remark applies to cases of great exaltation in the ac- tion of the nervous centres, which characterises many of the dis- eases belonging to the class Neuroses. 394 ANTISPASMODICS, A case of tetanus algidus or tetanus from cold, already referred to, that fell under the author's care — may serve to illustrate the mode in which antispasmodics exert their agency. A young man, whilst heated, threw himself into a river to bathe. He immediately ex- perienced some indisposition, and, in a few hours afterwards, was attacked with tetanus, in the form of opisthotonos. He was put upon the use of narcotics, but without the disease yielding. He was now taken out of bed, placed in a brook that ran by the house, and pail- ful after pailful of cold water was thrown over him, whenever the spasms became violent. Soon after the adoption of this treatment the spasms yielded, and, by a continuance of it, they ultimately passed away. The boy wholly recovered. This remedy probably exerted its agency in the manner described as applicable to antispas- modics in general. It made a new impression on the nervous system by the shock that accompanied the affusion, and thus broke in upon the chain of morbid phenomena seated in the cerebro-spinal system. Chorea is another disease in which the true antispasmodics might seem to be indicated, yet they are but rarely employed. The disease appears to depend usually upon great mobility of the nervous system, — chiefly of the part connected with the nerves distributed to the voluntary muscles, — united with diminished impressibility of the nerves of some other parts, as of the stomach and intestines : hence tonics and purgatives are chiefly relied on, and they become indirect antispasmodics. Epilepsy is dependent upon so many causes, that its treatment has to be varied according to circumstances. In the majority of cases, however—as in every disease characterised by periodicity — a powerful impression made upon the nervous system will prevent a paroxysm ; but the impression must be made immediately before it is expected. Except for the purpose of preventing a paroxysm, true antispasmodics cannot in any respect be relied on; but if a large dose of assafetida, castor, or musk were administered immediately before the hour at which a fit of epilepsy or of ague were expected, it might prevent it. It is in such cases that mental antispasmodics have been mainly employed. Any agent, indeed, that excites a new and powerful impression — any revellent— may be followed by the same results. Most commonly, epilepsy is attended by evidences of great impressibility and debility of the nervous system; and tonics — especially metallic tonics—are chiefly relied on. It is probably altogether by exciting a new condition in the part to which it is ap- plied, and by modifying circulation and innervation, that a ligature, put around one of the extremities, will at times arrest a paroxysm of the disease. Asthma, again, as elsewhere remarked, must be looked upon as a nervous disease — spasmodic in its character generally, that is, de- pendent upon erethism of the branches of the pneumogastric nerves distributed to the bronchial tubes, — but sometimes owing apparently to something like paralysis of the same nervous branches. Hence, IN HYSTERIA. 395 different agents are effectual, according to the precise pathological condition. Commonly, however, narcotics are signally beneficial. Opium is given in large doses ; — stramonium is smoked ; — lobelia inflata is freely administered ; galvanism is employed ; and all these are occasionally eminently successful; but we rarely hear of the ad- ministration of direct antispasmodics, although from the suddenness of the attacks of the disease they might seem to be indicated, and might occasionally be useful. They are so completely eclipsed by the indirect agents of the class, that they are very rarely employed. Hooping-cough, although a peculiar disease, is somewhat analogous in its pathology to the last. When Nasse bruised and pinched one of the pneumogastric nerves in a living animal, so as to break down the structure of the nerve, he found, that convulsive cough was excited, like that of hooping-cough. But, although this disease is so markedly convulsive as to have received the name ubex convul- siva," and various others indicative of its character, none but indirect antispasmodics have received the confidence of the practitioner. Narcotics generally have been employed, and of these belladonna more frequently perhaps than any other; but, scarcely ever, assafetida, musk, castor, or any of the direct agents belonging to the class. In common colic, both direct and indirect antispasmodics may be at times advantageously used ; and the same may be said of some forms of gastrodynia. When these are dependent upon causes, which gentle excitants are capable of obviating, a stimulating gum resin — like assafetida — may be employed with prospects of benefit. Hence it is serviceable in flatulencies, for the removal of which it is often had recourse to, in popular practice. It is only in hysteria, however, that direct antispasmodics are, at this day, much used. The affection is cerebro-spinal, and the symp- toms that indicate it are numerous and varied. There is scarcely a nerve or a ramification, however small, which does not occasionally seem to participate in the morbid condition. Generally, the nervous erethism is chiefly concentred in the cerebro-spinal axis, whence irradiations proceed to every part of the economy ; and the object, which the practitioner has in view, is to divert the nervous action to some other portion of the frame. Hence, he administers substances that are as nauseous as possible, combined or not with excitants as he may think proper. With this view he prescribes assafetida, vale- rian, dracontium, and all the reputed direct antispasmodics, during the paroxysm ; and in the interval adapts his remedial agent to the indications which may suggest themselves. These few observations on the use of antispasmodics in diseases in which they would appear to be signally appropriate will exhibit the little reliance that can be placed upon such as are esteemed direct agents — the antispasmodica vera ; and the author does not think he ^•an better terminate the few remarks he has considered it expedient to make upon this class, than by quoting the conclusion at which a therapeutical writer often referred to, Dr. A. T. Thomson, has ar- 396 SPECIAL ANTISPASMODICS. rived, after having occupied several pages of his work with the ex- planation of the modus operandi of direct antispasmodics. " From what has been said, it is evident that the range of this class of medi- cines (antispasmodics) is extremely limited ; and, in fact, that every thing which the substances placed in it can effect, even as direct anti- spasmodics, may be accomplished by other orders of medicines — purgatives, diaphoretics, narcotics, and tonics. At best, anti-spas- modics can be regarded only as auxiliaries; and the spasm and convulsions are less to be considered than the causes which induce them: remove the cause, and the effect will cease." The author has been gratified to find, that the above views on the agency of antispasmodics, as contained in the first edition of his " Ge- neral Therapeutics," have been adopted, with due acknowledgments, by a recent writer on the subject, Dr. Spillan, and the whole article is translated in La Lancette Francaise, 8 Fevrier, 1839. SPECIAL ANTISPASMODICS. I. Excitant Antispasmodics. i. ASSAFCE'TIDA. — ASSAFET'IDA. Assafetida is the concrete juice of Fer'ula Assafce'tida; Sex. Syst- Pentandria Digynia; Nat. Ord. Umbelliferae; which is indigenous in Persia, the mountains of Chorasan and Laar. It is considered probable, however, that assafetida is obtained from at least two species of plants. Seeds of the Chorasan plant, which were sent to London in 1839, would seem to have belonged to three species. It is ob- tained by making incisions into the upper part of the root; the foot- stalks of the leaves and the fibres at the top of the root having been previously removed. The juice is scraped off as it exudes. The process may be repeated as often as twelve times in the course of six weeks, before the root is altogether exhausted. The assafetida, gathered from several plants at one time, is united into masses of about one or two pounds in weight, and when farther hardened by keeping, is sent to the ports of Persia for exportation, or is consumed in the country as a condiment. With the Orientals, indeed, it is highly esteemed — being termed Le manger des Dieux, whilst, on the other hand, with us, it bears the undignified but expressive appellation of Devil's dung, — German, Teufelsdreck. Assafetida is usually sent from the Persian Gulf to Bombay, whence it is exported to Europe. In 1839, the quantity on which duty was paid was twenty-four cwts. That which we receive in this country is either brought directly from India, or indirectly by the way of Great Britain. As met with in the shops, it is in irregular pieces of different sizes, varying generally from half a pound to two pounds ASSAFCETIDA. 397 and upwards in weight. The pieces have an irregular, amygdaloid appearance externally, as well as internally, seeming to be com- posed of irregular shaped tears, agglutinated by a softer substance. In the inferior kinds, the tears are few in number, and the aggluti- nating materials more copious. The best pieces are of a yellowish white colour externally; the inferior sorts of a brownish red hue. All the varieties have the peculiar alliaceous odour, by which it is so well known ; and a strong, bitterish, somewhat acrid taste. By exposure to the air, it loses its most striking qualities, and is best preserved in bladders, or in some close space. Except in very cold weather, it cannot be reduced to powder, and then it is apt to co- here. When softened by heat, it may be forced through a cloth, and in this way be freed from its impurities. Dr. Pereira describes three varieties. 1. Assafetida in the tear, which he suggests to be the concrete juice of Fer'ula Per'sica; 2. Lump Assafe'tida, the kind usually met with in the shops, the produce of Ferula Assafostida; and 3. Stony Assafetida, which he has never met with in commerce, and which seems to contain 51.9 per cent, of gypsum. Assafetida has been often subjected to analysis, and its main con- stituents have proved to be, 1. Volatile oil of assafetida, which, like the essential oils in general, is excitant, and possesses the odorous quali- ties of the gum-resin ; 2. Resin of assafetida ; and 3. Gum. Water, cold or warm, dissolves the gum, and the mucilage, thus formed, suspends the resin and volatile oil. Its virtues are yielded to alco- hol, and when this is diluted with water, the hydrated resin is sepa- rated, and the fluid rendered milky. Assafetida is the best example of what have been termed direct antispasmodics. It contains — as has been seen — a volatile oil of an extremely disagreeable character, but which is powerfully excitant, and makes a nauseous impression upon the gustatory nerves; and likewise resin, which is also excitant. It is by virtue of these properties — as remarked of antispasmodics in general — that it is highly useful in diseases in which it is import- ant to make a new nervous impression; hence its value in hysteria especially, and in certain cases of hypochondriasis. It is, likewise, used in chorea and in hooping-cough ; but although much testimony has been adduced in its favour in the latter disease, the author has never seen it of marked advantage. Hooping-cough is a self-limited affection, and no remedies can be productive of much benefit except as palliatives ; nor has assafetida, in the author's experience, effected this much. In old cases of catarrh, it has been of service, as else- where remarked, (p. 232,) as an expectorant. In like manner, its excitant properties render it well adapted for flatulent colic. Perhaps in the whole class of phenomena, termed nervous, there is no article of the materia medica which is more employed, and none which is more satisfactory by reason of the powerful impression it vol. i.—34 398 SPECIAL ANTISPASMODICS. makes on the special nerves of gustation, as well as on those of the stomach, and through them on the general system. The average dose of assafetida is ten grains, which, as an anti- spasmodic, ought to be given in the liquid form, in order that all the effects of the remedy may be exerted. Its operation in this form is likewise more speedy. When given in enema — as it not unfre- quently is, in torpid conditions of the bowels, as well as in the paroxysm of hysteria and other convulsive affections — from half a drachm to two draehms may be rubbed up with warm water. MISTim ASSAFffi'TIM, ASSAFETIDA MIXTURE, (p. 233.) The dose of this mixture, as an antispasmodic, is f. ^ss to f. ^iss. It is often given in hysteria and other nervous affections. PIL'ULJ) ASSAFffi'TJM, ASSAFETIDA PILLS. (Assnfcet. §iss; Saponis, |ss. Make into 240 pills.) Each pill contains three grains of assa- fetida. PIL'K ALOES ET ASSAFffl'TID^E, PILLS OF ALOES AND ASSAFETIDA, (p. 173-) Adapted for nervous cases, which are accompanied with con- stipation. TINCTU'RA ASSAFMDJ, TINCTURE OF ASSAFETIDA. (Assafcetid. giv ; Alcohol. Oij.) This tincture possesses all the virtues of the assa- fetida, and may be given in the dose of f. 3ss to f. 3ij. When water is added to it, it becomes milky, owing to the separation of hydrated resin ; but the mixture is efficacious. EMPLAS'TRUM ASSAF(E'TULE, ASSAFETIDA PLASTER. (Assafcetid., Em- plastr. plumbi, aa tfej ; Galban., Cera flava, aa loss ; Alcohol, dilut. Oiij. The assafetida and galbanum are dissolved in the alcohol; the liquor is strained, and evaporated to the consistence of honey; the lead plaster and wax, previously melted, are then added, and evaporated so as to form a plaster.) This plaster is applied over the stomach or abdomen in cases of flatulence, especially when accom- panied by hysteria ; and to the chest or between the shoulders, as an antispasmodic in hooping-cough. It is exceedingly questionable, however, whether any of the virtues of the assafetida or galbanum be exerted in this manner; as simple rubefacient plasters appear to be of the same efficacy. Assafetida is one of the ingredients of the Pilula galbani compo- sita of the Pharmacopceia of the United States. 2. CASTO'REUM—CASTOR. This is a peculiar concrete substance from Castor fiber, the Beaver; order Rodentia ; an inhabitant of northern Russia, and of the northern parts of North America. Castor is obtained from two follicles situ- ate between the anus and external genitals of both sexes, which are filled with a thick fluid secretion, that slowly concretes after they are removed from the animal. They are generally dried either by smoke, VALERIANA. 399 or in the sun ; and are frequently united by a part of the preputial membrane. Almost all the castor of Europe is derived from North America, the Russian being so very rare as to be scarcely ever seen in Great Britain. Very little Russian castor reaches this country ; that which is brought to Philadelphia being derived chiefly from Missouri. (Wood & Bache.) In the year 1839, according to Dr. Pereira, duty was paid in England on 800 lbs. — the greater part being sold for exportation. The American castor of the shops is contained in sacs about two inches long ; flattened and wrinkled ; having the appearance of a pair of dried testicles united by their spermatic chord. It is of a dark liver-brown colour externally; of a lighter hue internally; of a resinous fracture ; a strong, peculiar, disagreeable smell; and an aromatic bitter, nauseous taste. Alcohol is its best solvent. Russian castor is so scarce, that it brings a very high price. Dr. Pereira states, that he has paid for a museum sample £2 per ounce ; whilst the American castor brought only twenty shillings a pound. One variety, the chalky Russian castor, effervesces when diluted chlo- rohydric acid is dropped upon it. The analysis of castor has afforded, as main constituents — a vola- tile oil of castor; a peculiar substance, called Castorine or casto- reum camphor, scarcely any of which can be obtained from Ameri- can castor, — and resin, which has a slight odour of castor. Castor is much less excitant, and less powerful as a nervine than assafetida. It is prescribed in the same diseases, however. The dose is from gr. x to gr. xx ; but it is better given in tincture. TINCTU'RA CASTO'REI, TINCTURE OF CASTOR. (Castor, cont. gij; Alcohol. Oij.) The dose is from f. 3ss to f. 31J. 3. VALERIA'NA. —VALE'RIAN. Officinal Valerian is the root of Valeria'na officinalis, officinal or great wild Vale'rian ; Sex. Syst. Triandria Monogynia; Nat. Ord. Valerianaceae, which inhabits wet places, and sometimes dry banks in most parts of Europe, of which it is a native. The root is dug up in the autumn, when the leaves have decayed. It is sometimes, also, collected in the spring before the stem rises. The rhizoma consists of a tuberous rootstalk forming a head, and of numerous long, slender, cylindrical fibres issuing from it. It has likewise portions of the stem attached. The colour of the root is externally yellowish or brown ; internally, white : the odour is strong and characteristic, and although disagreeable to man, is quite the contrary to cats, which delight in rolling upon it. Its taste is warm, bitter, and nauseous. All its virtues are readily com- municated to water, alcohol, and ammoniated alcohol, which are the menstrua employed in the officinal preparations. When sub- jected to analysis by Troramsdorff, it was found to contain volatile 400 SPECIAL ANTISPASMODICS. oil, which is its active constituent; valerianic acid, resin, and resi- nous extractive. The valerianic acid, it has been thought probable, is formed by the oxidation of the volatile oil. Valerian, in large doses, is excitant to the nervous system, inducing headache, mental excitement, hallucinations, &c. Its action, how- ever, in medicinal doses, is more like that of assafetida, and the other antispasmodics already considered ; and it is prescribed in identical cases, especially in hysteria, and hysteroid affections. The dose of the powder is from 3SS to 31SS, three or four times a day. It is obvious, that as the virtues of the root reside in vola- tile oil, neither decoction nor extract, which would drive it off, is a proper preparation. The infusion is, however, a correct and good form. INFU'SUM VALERIA'NA, INFUSION OF VALERIAN. (Voter. §ss; Aqua bul- lient. Oj.) The dose of this is f. ^iss. or f. ^ij, repeated according to the urgency of the phenomena. TINCTU'RA VALERIAS, TINCTURE OF VALE'RIAN. (Valerian, cont. §iv ; Al- cohol, dilut. Oij. Prepared either by maceration or displacement.) The tincture possesses all the virtues of the valerian, but is rarely given alone, on account of the too excitant effects of the alcohol. A drachm may be added to each dose of the infusion. TINCTU'RA VALERIAN! AMMONIATA, AMMONIATED TINCTURE OF VALE'RIAN. (Valerian, cont. jiv; Sp. Ammonia aromat. Oij; made either by maceration or displacement.) The addition of the spirit of ammo- nia, and the aromatics which are associated with it in the Spiritus ammonia aromaticus, renders the valerian a more active excitant an- tispasmodic than the simple tincture. It is an excellent remedy in hysteria, and may be given in the dose of f. 3J or f. 31J, diluted with water, and sweetened. The Valerianate of Zinc (See Mineral Tonics,) has been ex- tolled by some of the Italian physicians in nervous diseases. 4. GAL'BANUM. Galbanum is stated, in the United States Pharmacopceia, to be the juice of an unknown plant. It would seem, that no sufficient evidence exists in regard to its origin ; nor is the precise country where it is produced ascertained. It is taken to Europe partly from the Levant, and partly from India, and is met with in two forms — in tears and in lumps. The latter is the form in which it is usually seen, the lumps being composed of whitish, reddish, or yellowish tears, agglutinated by a darker coloured substance, usually mixed with pieces of stalk, seeds or other extraneous matter. At a freez- ing temperature, it is capable of being reduced to powder; and at the temperature of boiling water, 212,° is sufficiently soft to admit BRACONTIUM. 401 of being strained. It has a peculiar balsamic smell, and a hot, acrid, bitter taste. On analysis, like assafetida, it yields volatile oil, resin, and gum. Like the other gum-resins it forms a milky mixture with water. Its properties are yielded to proof spirit, which dissolves all except the impurities. Galbanum has antispasmodic virtues, but to a less degree than assafetida ; alone, it is very little employed, however, internally. The dose is from ten to twenty grains given in pill: or it may be formed into an emulsion with the addition of gum arabic, sugar, and water. PIL'ULjE GAL'BAM COMPOSITE, COMPOUND GALBANUM PILLS. (Galban., Myrrh., aa ^iss ; Assafatid. |ss ; Syrup., q. s. to form 480 pills.) These pills contain half a grain each of galbanum, myrrh, and assa- fetida. They have been long known under the name of ' Gum pill,' and have been much prescribed in Great Britain in hysterical habits. Sometimes, the Extractum colocynthidis compositum, or aloes is added, when the object is to make them act on the bowels at the same time. The dose is from gr. x to gr. xx. EMPLAS'TRUM GAL'BANICOMPOSITUM, COMPOUND GALBANUM PLASTER. (Gal- ban. 5V11J '■> Emplastr. plumbi, ffeiij; Terebinthin. 3x ; Picis abietis, ^iij.) Used in the same cases as the Emplastrum assafcetidse; but more commonly as a simple excitant plaster, in obstinate tume- factions of an indolent character. 5. DRACON'TIUM.—SKUNK CABBAGE. Dracontium is the root of Draeon'Hum fee'tidum, Ic'todes fa'tidus, Symplocar'pusfce'tidus; Sex. Syst. Tetrandria Monogynia; Nat. Ord. Aroidese, which is indigenous in the United States, growing abundantly in meadows and swamps throughout the whole northern and middle sections of the Union ; flowering in March and April, and somewhat earlier to the south. Every part of the plant has a disagreeable skunky smell, which resides in a very volatile prin- ciple that is dissipated by heat, and is of*course diminished by drying. The root is in the secondary list of the Pharmacopceia of the United States. It is collected in autumn or early spring, and is carefully dried. The dried root, as usually met with, consists of the body, and the separated radicles. The odour is much less than in the fresh root, but continues for some time. It is not, however, fit for use longer than a single season. When chewed it is distinctly acrid. The principle, on which its virtues are dependent, is volatile, and is dissipated by heat; consequently, decoction is an inadmissible form. In large doses, dracontium is stated to be narcotic; but in medicinal doses, it possesses the virtues of the articles already men- tioned. It may be given in the dose of ten or twenty grains of the powdered root; or in infusion. A syrup — prepared from the 34* 402 SPECIAL ANTISPASMODICS. fresh root—is said to be a domestic remedy. Dracontium is not, however, much used, and the dried root, as met with in the shops, is of very uncertain strength. 6. AMMO'NLE PR^EPARA'TA. — PREPARATIONS OF AMMONIA. All the preparations of ammonia are excitant, and antispasmodic ; but the only one that is much prescribed, and the best, is the SPIR'ITUS AMMO'NLE AROMAT'MS, AROMATIC SPIRIT OF AMMO'NIA. (Ammon. muriat. Sv ; Potassa curb. §viij ; Cinnam. contus., Caryophyll. contus. aa ^ij ; Cort. limon. ^iv; Alcohol., Aqua, §§, Ov. Seven pints are distilled.) This is one of the forms of the old Sal volat'ile, much used in popular practice, and in hysteric and nervous affec- tions in general. The result of the process is really ammoniated alcohol, impregnated with excitant volatile oils. The dose is from rt\,xx to f. 3j5 given in sweetened water. Spiritus ammonise aromaticus enters into the composition of the Tinctura Guaiaci Ammoniata, and the Tinctura Valeriana Ammo- niata of the Pbarmacopoeia of the United States. 7. J2THE/REA.— PREPARATIONS OF ETHER. All the preparations of ether are excitant and antispasmodic. They are very transient and diffusible in their action, and well adapted for cases in which the Spiritus Ammonias aromaticus is indicated. In spas- modic asthma, and other forms of dyspnoea of a nervous nature, they often afford great relief, when dropped on sugar, and inhaled into the air passages. In all cases of severe internal spasm, the pre- parations of ether are almost always had recourse to, either alone or associated with narcotics. 1. jEther Sulphu'ricus, Sulph'uric Ether, (described under Ex- citants.) The dose of this is f. 3ss to f. ^\], dropped on sugar, to which a little water is added ; or it may be incorporated with any aqueous mixture, by rubbing it in a mortar with two grains of sper- maceti to each fluidrachm of the ether. 2. Spir'itus jE'theris Sulphu'rici Compos'itus, Compound Spirit of Sulph'uric Ether, (see Narcotics, p. 380.) Hoffmann's anodyne liquor is more frequently used as an antispasmodic in hysteric and hysteroid cases than any other of the ethereal preparations. The dose is f. 3SS to 31J, in the same vehicle as the aether sulphuricus. 3. Spir'itus .E'theris Ni'trici, Spirit of Nitric Ether, (see Diu- retics, p. 273.) Sweet spirit of nitre has the virtues of the prepa- rations already mentioned ; but it is not so often given as an anti- spasmodic. The dose is f. 3j to f. 3ij, in a little water. 8. LAVAN'DULA. —LAVENDER. Lavender — as elsewhere shown —is an aromatic excitant, (see M0SCHUS. 403 Excitants ;) and when its volatile oil is imparted to water, or to dilute alcohol, the preparation is by no means agreeable to the taste of most persons. It, consequently, along with its excitant action on the nerves of the stomach, powerfully impresses those of gustation. The preparation most frequently prescribed, as an antispasmodic and nervine, is the SPIR'ITUS LAVAN'DULE COMPOSITUS, COMPOUND SPIRIT OF LAVENDER. (See Excitants.) This is a favourite agent in hysterical and hypochon- driacal cases, and is much used as a popular remedy in all cases of nervous faintness, and anomalous symptoms of a similar character. The dose is f. 3ss to f. 3j, dropped on sugar, or taken in a small quantity of sugared water. 9. MOSCHUS. — MUSK. Musk is a peculiar concrete juice, obtained from Moschus mos- chif'erus, the musk animal, a wild ruminating quadruped, rather larger than the domestic goat, and approaching the deer in its cha- racters, which inhabits Thibet and other parts of central Asia, but more especially the Himalaya and Altai mountains. At the poste- rior part of its abdomen, a small sac is situate, immediately under the skin, which opens a little in front of the preputial orifice for the penis, and is filled with a thick fluid, particularly abundant in the rutting season. This fluid, when dried, is musk. It is removed from the animal, with the bag that contains it, and is dried for ex- portation. Two kinds of musk are met with in commerce, — the China, Tonquin, or Thibet; and, the Siberian, Russian, or Kabardine, which is an inferior kind. The musk-bag or musk-pod is generally plane on one surface ; convex on the other, — the plane surface being usually bare ; the convex covered with brownish-yellow, or grayish or whitish bristle- like stiff hairs, arranged concentrically around the orifice of the sac ; but, at times, the plane surface is covered with hairs, and the other is not. The remains of the penis are always discoverable. (Pereira.) The pods are about 2\ inches long, and If broad ; and they weigh, on an average, six drachms and a scruple ; and contain about two drachms and forty grains of musk. The musk itself, or grain musk, is granular — as the name im- ports— of an unctuous feel, of a dark reddish-brown colour, and mixed with hairs. It has a bitter aromatic taste ; and a characteris- tic smell, which is agreeable to most persons, but the contrary to some. It is an odour, which is not restricted to the musk animal, but is exhaled by others, and by some plants. The only invariable distinction, which Dr. Pereira has observed between the Chinese and the Siberian musk, is in the scent, which is much less powerful in the latter, and more nauseous and disa- greeable, being somewhat empyreumatic. 404 SPECIAL ANTISPASMODICS. The quantity of musk imported into England is considerable. On an average of three years, ending with 1832, the imports of musk from all places eastward of the Cape of Good Hope, with the exception of China, amounted, according to McCulloch, to 4965 ounces a year. Musk has been frequently subjected to analysis, but the odor- ous principle has not hitherto been isolated. Artificial pods of musk are not uncommonly met with, of which Dr. Pereira says he has seen several imported from Canton. This is called Wampo musk, and the mode, in which these pods are distinguished from the genuine, is by the absence of any aperture in the middle of the hairy coat, the hair not being arranged in a circular manner, and by the absence of the remains of the penis. The odour of the musk in these spurious sacks is ammoniacal. Musk is, likewise, subjected to various admixtures, and especially with dried blood. Musk is unquestionably excitant, and, by reason of its excitant property, as well as by powerfully impressing the nerves of smell, it is antispasmodic. Jorg found it to be hypnotic in small doses ; and in large doses it caused headache, tremors and even convulsions. Other observers, however, as MM. Trousseau & Pidoux, experi- enced neither excitant nor hypnotic effects from it, but it appeared to them to stimulate the genital organs. It is in the neuroses and in spasmodic affections, that it has been most prescribed, — for exam- ple, in hysteria, epilepsy, convulsions of children, chorea and hic- cough ; and it has been given in tetanus. Its excitant properties have led to its use in low fevers, accompanied with much nervous debility; in retrocedent gout, &c. It is not, however, worthy of the reputation, which it had at one time, whilst it is a very expensive article, and by no means always pure. Hence, it is not much em- ployed at the present day. The medium dose is ten grains, to be repeated every two or three hours in the form of bolus ; or it may be suspended in water by means of mucilage of gum arabic and sugar. It has been given in the form of enema in the convulsions of children. 10. SUC'CINUM. —AMBER. The O'LEUM SUC'CINI RECTIFICA'TUM or RECTIFIED OIL OF AMBER, as elsewhere shown, is excitant, and by reason of its powerful impres- sion on the nerves of gustation and olfaction, is likewise antispas- modic. It has been given in the various neuroses, in which anti- spasmodics in general are indicated, in the dose of from gtt. v to gtt. xv, dropped on sugar, or made into an emulsion with mucilage of gum arabic and sugar. It has been advised also locally in hoop- ing-cough, and convulsions of children, mixed with an equal portion of laudanum, and diluted with three or four parts of olive oil and brandy. This was a favourite prescription with the late Dr. Parrish, of Philadelphia. EMMENAGOGUES. 405 11. CREASO'TUM. —CRE'ASOTE. The powerful sensible properties of this substance, described else- where, (see Astringents,) would naturally suggest its employment as an excitant antispasmodic ; yet it has not been much used as such, although, in well regulated doses, it may be as efficacious as any of the class. In certain cases of neuralgia, advantage appears to have been derived from it, although, in general, it was of little or no service. Good effects have followed its use in hysteria — of course when there was no inflammatory complication, as well as in spas- modic erethism of the nervous system, and in palpitation. It has, also, been used with benefit in hysteric croup, in the way of inhalation by Dr. Herndon, of Virginia, —thirty drops being added to a quart of hot water. The dose may be a drop or two of creasote given occasionally in gum water ; or the following mixture may be prescribed. (Creasot. nyv; Aq. camphor, f. |vj. M. Dose, one quarter.) 12. Certain Volatile Oils — besides those already mentioned, as Oleum Terebinthinje, Dippel's Animal Oil, Oleum Cajuputi, &c, which, along with their excitant qualities, make a powerful impression on the nerves of gustation and olfaction, are generally classed amongst the antispasmodics. Their general properties are described elsewhere. The same may be said of Camphora. (q. v.) SECTION VII. AGENTS THAT AFFECT PROMINENTLY THE ORGANS OF REPRO- DUCTION. I. EMMEN'AGOGUES. Synono Menagoga. Definition of emmenagogues — Modus operandi — No direct emmenagogues — Special emmenagogues. Emmenagogues may be defined—"Agents, that promote the menstrual discharge." That there are any such specific agents is by no means established. In the present state of our knowledge, in- deed, we may affirm, that none exist. Experience alone has taught us this; for there is obviously no more reason, why there should not be substances capable of exerting a remedial agency on the organs concerned in the function of menstruation, than that there should not be others, which exert a cathartic or emetic operation-by their pre- ference for the stomach and intestines. The views of Dr. Paris on this division of medicinal substances closely correspond with those of the author. — " As amenorrhcea, or 406 EMMENAGOGUES. retention of the menses," he says, " is generally the effect of a mor- bid state of the body, it follows, that remedies capable of acting as emmenagogues can only be relative agents, unless indeed we are disposed to accede to the opinion so generally maintained in the writings of the older physicians, but now generally discarded, that certain substances exert a specific action upon the uterus. It may certainly be asserted without fear of contradiction, that there are many substances, which, when received into the stomach, have their stimulant operation more particularly determined to one part than to another, — alkalies, for example, to the kidneys ; cantharides to the bladder; mercury to the salivary glands, &c. Reasoning therefore by analogy, it was not unphilosophical to conclude, that similar medicines might exist with respect to the uterus ; but experience has negatived the supposition, there being no proof of any of the sub- stances styled emmenagogues producing their effects by any specific influence upon the uterine system. If the term emmenagogue be assumed conventionally, according to this view of the subject, it may be retained without any fear of error, otherwise it would be wiser to remove the name from our classification." One of the most recent writers on Materia Medica and Thera- peutics, Dr. A. T. Thomson, has given us the following table of direct emmenagogues, or, in other words, of such as are " supposed to operate by their stimulant influence on the uterus itself," and he has subdivided them, it will be observed, into immediate and me- diate. " In the second of these subdivisions," he remarks, " some substances will be found, the direct influence of which on the uterus is doubtful; they maintain their place rather in conformity with the prevailing opinions, than from a conviction that their action on the ute- rine system is such as to authorise the position which they hold." " Direct Emmenagogues: 1. Immediate. a. Electricity. — Electricitas. 2. Mediate. * Organic Products. b. Oleo-Resins. — Contained in Roots — Poly gala Senega. Ruta graveolens. Herb. —Juniperus Sabina. c. Bitter Principle. — Contained in Roots. — Rubia Tinctorum. ** Inorganic Substances. d. Mercurials. — Praeparationes" [Prjeparata] « Hydrargyri." — EMMENAGOGUES. 407 Yet none of these agents can be properly regarded as producing their effect by any specific operation on the uterus. The only one, which we know to operate upon that organ — inasmuch as we can subject the region directly to its action — is electricity ; and it does so only by virtue of that excitant agency, which it exerts upon every other tissue — not by a special action, which can entitle it to the appellation of a true or direct emmenagogue. Dr. Thomson's doubts of the propriety of his own classification, and of the admis- sion of direct emmenagogues, is signally shown in the following re- marks, after he has described the fancied emmenagogue virtues of the different articles comprised in the list just cited. " Upon the whole, from what has been said, it is obvious, that electricity is the only direct emmenagogue, and that the idea of the others acting upon the uterus itself is rather inferred than certain. It is neverthe- less true, that, in whatever manner they act, emmenagogues stimu- late the uterus ; and therefore caution is requisite to be observed in their administration. We must be certain, in the first place, that the suppression is not connected with pregnancy : in such a state, it would be highly injurious to prescribe direct emmenagogues ; as not only abortion may be induced, but inflammation may be set up, and lay the foundation of an organic disease of the uterus. There is often, indeed, much difficulty in deciding upon the propriety of employing direct emmenagogues, even when the suppression is not connected with pregnancy: the uterus may be in such a state of active disease as to render their influence upon it extremely hazard- ous." Much harm has arisen from a belief in the existence of direct em- menagogues, without discriminating the causes that may have given rise to the suppression of the menstrual secretion. In all cases, such causes must be appreciated, and the treatment be directed to their re- moval, as well as to that of the morbid condition of the general system, or of the uterus, produced by them. Accordingly, emmenagogues must always be of an indirect kind, and the term, as Dr. Paris has suggested, should be retained as conventional, to express such an in- direct operation. Most commonly amenorrhcea is connected with a state of atony of the general system, which demands the use of exci- tants ; and hence, amongst the reputed emmenagogues, we have a long catalogue of substances belonging to the divisions of excitants proper, and of tonics. The oxides and salts of iron have been especial favourites with the practitioner ; and, accordingly, we find enume- rated, under the present divisions of remedial agents, the carbonate, the sulphate, the black oxide, the alkaline solution, the ammoniuret, the tartrate, &c, of that metal. But, although atony may be the general cause of amenorrhcea, the disease is sometimes induced by an opposite condition of the system, in which excitants would be manifestly improper, and remedies of another kind be clearly indi- cated. This is not the place to inquire, whether menstruation be a process of secretion, or of simple transudation of blood through the 408 EMMENAGOGUES. parietes of the vessels of the uterus. The author has elsewhere ex- pressed the opinion, (Human Physiology, 5th edit., vol. ii., p. 343. Philada. 1844,) that the fluid differs somewhat from mere blood ; but whether we regard it in this light, or as a periodical hemorrhage, it is clear, that the lining membrane oi the uterus, with the rest of the internal genital apparatus, must be a centre of fluxion, nervous and vascular, during the period of the flow; and if any powerful mental impression be made, when the discharge is about to take place ; or a source of morbid irritation be present in any viscus ; or if there be undue energy in the system generally, and in the uterus in particular, — or an opposite state ; the due concentration of nervous and vascular energy towards the uterine system may be interfered with, and amenorrhcea supervene, and continue until such distracting cause is removed. From what has been observed regarding the conditions of the general system, which may occasion amenorrhcea, it will be easy to understand, that the plan of medication must, in all cases, vary, ac- cording to the state of the general health. But remedies may be ad- ministered as emmenagogues, which act little on the general system, and affect the uterus by contiguous sympathy chiefly. Thus, if that viscus be in a state of asthenia, a diuretic or local stimulant to the kidneys may prove emmenagogue ; and, in the same manner, a ca- thartic, especially one that acts on the lower portion of the intestinal canal, may excite the uterus to the point appropriate for the fulfil- ment of its healthy functions. On these grounds, aloes, as else- where seen, has acquired its reputation as an emmenagogue, and there is, perhaps, no article of the materia medica which has been so extensively administered with this view. It appears to have no direct operation on the uterus : its agency is confined to its cathar- tic powers, — the local stimulation, thus induced, extending by con- tiguous sympathy to the uterus, and, in this indirect manner, occa- sionally producing a restoration of the suppressed secretion. Formerly, the condition of the uterus was looked upon as exert- ing a predominant influence on the rest of the economy, and as the cause of various morbid phenomena, which could not well, in the existing state of knowledge, be referred to any other agency. The protean symptoms of hysteria, as the name imports, were all consi- dered to be engendered in the uterus. The name, still retained, and the terms prsefocatio matricis, vapores uterini, strangulatio uterina, and the German names mutterkrankheit, mutterbeschwerden, and mut- ierbeschwerung, — from mutter, " the uterus," —sufficiently indicate the supposed seat of the mischief. It is now admitted to be caused by cerebro-spinal irritation, connected in particular cases with ute- rine disturbance, — such disturbance, however, appearing to act in- directly only, by producing, or developing general nervous irrita- bility ; and this view is confirmed by the fact, that well marked hysteria is occasionally met with in men. The condition of the uterine functions has always to be looked SPECIAL EMMENAGOGUES. 409 to, — especially in chronic diseases, — but experience has shown, that any aberration of those functions is more frequently the conse- quence than the cause of such diseases. The author cannot, indeed, conclude the consideration of emmenagogues better than by quoting the following apposite remarks of a writer already cited, Dr. Thom- son, at the termination of his investigation into the properties usually assigned to this class of remedies. " The importance of the cata- menia in preserving the health of the female habit is undeniable ; and therefore every thing that can tend to maintain its regular re- turn, and to promote its due quantity, is of great importance in a practical point of view. In every chronic complaint of a female it is requisite to ascertain the state of the catamenia; but, before ad- vising any medicine for the purpose of influencing the uterus in any manner, the cause of the suppression or the irregularity, of what- ever description it may be, must be minutely investigated. Without obtaining such a knowledge of the state of the organ, and ascer- taining how far the suspension or irregularity is due to the condi- tion of the organ itself, or to the general system, our practice must ever be uncertain : in floundering about, and trying various reme- dies, without rule or discrimination, we may, it is true, stumble by accident on something effectual ; but much evil may be produced." The local means, that are most frequently employed with the view of soliciting the blood towards the uterus, or the lower part of the body — are pediluvia and semicupia; fomentations to the generative organs ; warm injections into the vagina or rectum ; leeches to the pudendum and inner sides of the thighs ; cupping over the latter re- gion; and bleeding from the feet; but these, to be useful, ought to be employed about the expected period of recurrence of the cata- menia, and especially when general or local polyaemia exists. Fric- tions have, likewise, been made over the lower extremities, and electricity—as will be seen — has been used to arouse the uterus, where there has been reason to suspect torpor of that viscus. Whatever agents are. employed, must be prescribed with due cau- tion, and with proper attention to the pathological condition that gives occasion to the amenorrhcea. SPECIAL EMMENAGOGUES. I. Cathartic Emmenagogues. 1. A'LOK.—AL'OES. Under another head, (p. 171), it was shown, that the cathartic effect of aloes is exerted chiefly on the lower part of the intestinal canal; and it has been just remarked, (p. 408,) that by contiguous sympathy, it may excite the uterus, so as to favour the recurrence of the menstrual secretion, when it has been arrested by any cause vol. i.—35 410 SPECIAL EMMENAGOGUES. which a local excitant is capable of removing; " its action on the rectum, and extension of this action to the uterus, producing a state of the organ closely allied to that which is the result of the appli- cation of a direct stimulus." (A. T. Thomson.) It has been affirmed, however, that aloes has a decided tendency to the uterine system, and Dr. Wood adds, that he can see no reason why the medicine should not act specifically upon the uterus, and that its influence in promoting menstruation is by no means confined to cases in which its action upon the neighbouring intestine is most conspicuous. It is true there is no reason ; but, at the same time, there appears to be no adequate evidence, that any such special action on the uterus is exerted by aloes; and it certainly has not seemed to the author to be more efficacious than other excitant agents thrown into the rectum in restoring the catamenia. Cullen was, indeed, of opinion, that it rarely succeeds; and most unquestionably it often fails; — more frequently than could well happen, if any special action were exerted by it upon the uterine vessels. When not given in the form of enema, which, in the London Pharmacopceia, is directed to be made of Aloes, ^iy, Carbonate of potassa, gr. xv; Decoction of barley, Oss, — a short time before the expected return of the catamenia, — one of the following formulae may be prescribed, for two or three days prior to the expected men- strual period. PILULiE AL'OES ET MYRRILE, PILLS OF AL'OES AND MYRRH, (p. 173.) These pills, commonly called Rufus's Pills, are given in the dose of ten to twenty grains. PULVIS AL'OES ET CANEL'LJI, POWDER CF ALOES AND CANEL'LA, (p. 173.) This powder so long known under the name Hiera Picra, or "the holy bitter" — vulgarly pronounced Hikry Pikry—is a popular remedy in amenorrhcea, either taken alone or mixed with wine or brandy. Its dose is from ten to twenty grains. TINCTU RA AL'OES ET MYRRILE, TINCTURE OF AL'OES AND MYRRH, (p. 173.) The properties of this tincture are like those of the Pilula Aloes et Myrrha. The dose is f. Jss to f. ^ij. VMM AL'OES, WINE OF AL'OES, (p. 173.) The dose of this in amenorrhcea is f. 3i to f. 3»j. Besides aloes, other cathartics, as colocynth, gamboge, rhubarb, and croton oil, are occasionally administered as emmenagogues, but by no means so frequently as it. 2. HELLEB'ORUS. — BLACK HEL'LEBORE. This is the root of Helleb'orus Niger, Black Hellebore, or ChrisU mas Rose; Sex. Syst. Polyandria Polygynia; Nat. Ord. Ranuncu- laceae; an herbaceous plant, which is a native of various parts of HELLEBORUS. 411 Greece, as well as of the Levant, and inhabits sub-Alpine woodland regions in the middle and southern parts of Europe. It flowers between December and February, and hence its name, — Christmas Rose. It is cultivated in the gardens, chiefly in consequence of the period of the year at which it flowers. The hellebore of antiquity appears to have been Helleb'orus ofificina'lis. It is usually imported into England from Hamburg, but sometimes from Marseilles. (Pereira.) Black hellebore root consists of a black root stock, and numerous fibres or radicles, which are of a brownish black colour externally, whitish or yellowish within, and of about the thickness of a straw. The smell is feeble, and like that of senega root; and the taste slight at first, and afterwards bitterish, nauseous and acrid; but, as met with in the shops, it does not exhibit much acridity. The active properties would seem to be dependent upon an acrid oil. They are extracted by both water and alcohol. Black hellebore, in over doses, is an acro-narcotic poison. In medicinal doses, it is emetic and cathartic ; but, although much used by the ancients in head affections, and especially in insanity, it is now never given as a simple cathartic or emeto-cathartic. Many, however, of the present day, have great confidence in its emmena- gogue virtues, which some have ascribed to its possessing a specific action on the uterus; but the majority, with more propriety, refer its action on that organ to its effect upon the intestinal canal. Dr. Mead believed it to be superior to any other emmenagogue. The dose of the powdered root, as an emmenagogue, is from gr. v to gr. x, or more, according to the effects. _ TINCTU'RA HELLEB'ORI, TINCTURE OF BLACK HEL'LEBORE. (Hellebor. contus. giv ; Alcohol, dilut. Oij ; prepared either by maceration or dis- placement.) The dose of this preparation is from f. 2jss to f. %i. EXTRAC'TUM HELLEB'ORI, EXTRACT OF BLACK HEL'LEBORE. (Made, by the process of displacement, from black hellebore in coarse powder.) This preparation, which is not officinal in any of the British Phar- macopoeias, purges drastically in the dose of twelve or fifteen grains. It is rarely or never employed as an emmenagogue. Backer's Pills, formed of this extract and myrrh, each 5i; pow- dered leaves of carduus benedictus 3iij, — were introduced into the French codex under the name Pilula ex Helleboro et Myrrhd, and had a high reputation as an emmenagogue ; but they are not much, if at all, used. II. Excitant Emmenagogues. As the condition of amenorrhcea is so often dependent upon an asthenic condition of the system, a multitude of excitants have been employed, including almost all those, that are usually regarded as antispasmodics; the following have, however, been held in highest repute by different therapeutists. 412 SPECIAL EMMENAGOGUES. 3. ASSAFCE'TIDA. — ASSAFETIDA. It has been long maintained, that assafetida has a specific action on the uterus, and the results of various observers appeared to show, that it was capable of bringing on the menstrual discharge sooner than usual, (Jorg); but if it be admitted, that such is the result of the use of assafetida in health — for the experiments were made on healthy individuals — it is by no means admitted, that the same result would follow in disease; and accordingly assafetida is now rarely or never employed in amenorrhcea, and the same may be said of 4. CASTO'REUM. — CASTOR ; and 5. GAL'BANUM, which were used as emmenagogues by the ancients; and are still occasionally employed, but not in this country, in affections, that are complicated with obstruction of the catamenia. 6. HEDEO'MA.— PEN'NYROYAL. This herb — as stated under Excitants — is indebted for its pro- perties to the essential oil which it contains. It is a popular em- menagogue, but is rarely prescribed by the physician. It is usually given copiously in the form of hot Pennyroyal tea ; the feet being, at the same time, placed in warm water ; or in a mustard pedilu- vium. European Pennyroyal — Mentha Pule'gium — is considered to pos- sess the same properties, and is used as a domestic remedy by Eu- ropean females. 7. JUNIP'ERUS VIRGIN IA rN A. —RED CEDAR. This evergreen, Sex. Sxst. Dicecia Monadelphia; Nat. Ord. Coniferae, grows in every part of the Union. The leaves are in the secondary list of the Pharmacopceia of the United States. They have a strong characteristic odour ; and an aromatic bitterish taste. The esential properties reside in volatile oil; and, besides, tannin exists in them. The medical virtues of juniperus virginiana are analogous to those of savine, but less in degree. It is, indeed, frequently known throughout the country by the name of Savine. (Prof. Bigelow.) It may be given as an emmenagogue, in infusion, (Junip. Virgi- nian. 31J ; Aqua, Oss, Dose, f. ^iss to f. ^iij ;) but it is not often prescribed. 8. SABI'NA. —SAVINE. Savine is the tops of Junip'erus sabi'na or common savine, which is a native of the south of Europe, and of Asiatic Russia, but thrives under cultivation in Great Britain. It is said also to grow wild in the neighbourhood of the northwestern lakes. The tops have a strong characteristic smell, especially when bruised ; and a disagree- SABINA. 413 able, bitter, acrid taste ; and these properties are retained, to a cer- tain extent, when the tops are dried. The medical properties of savine, are chiefly dependent upon an essential oil, which is officinal; and they are yielded to water, alcohol, and fixed oils. The leaves have been subjected to an- alysis by Mr. C. H. Needles, and have yielded the following con- stituents— gum, tannin, resin, chlorophylle, fixed oil, volatile oil, salts of potassa, lime, and bitter extractive. Savine, in large doses, is an acrid poison, inducing vomiting, purg- ing, and every sign of violent inflammation of the lining memhrane of the stomach and intestines. In one case, in which the oil had been given with the view of inducing abortion, it caused violent ne- phritis. It is by reason of its powerful action on the system of the mother, that it is sometimes effective in separating the connexion between her and the foetus, and thus occasioning the expulsion of the latter. Fatal cases are, indeed, recorded, where it had been given as an emmenagogue. Dr. Francis Home, of Edinburgh, highly extolled it in amenorrhcea dependent upon torpor of the uterus; but it has not been much used of late, in consequence of the uncertainty, and at times the severity, of its operation. Dr. Pereira has affirmed — as the result of his own observation — that it is the most certain and most powerful emmenagogue of the materia medica; that he has employed it in numerous cases, and has never seen any ill effects from its administration. The dose of the powder is from gr. v to gr. xv, repeated three or four times a day. It may, likewise, be given in infusion, (Sabin. gj ; Aqua bullient. Oss. Dose, one or two table-spoonfuls.) O'LEUM SABI'NJ], OIL OF SAVINE. This oil is obtained from savine by distillation. It has the odour of the plant; and an exceedingly acrid bitter taste. It is used in the same cases as the savine itself, and is the preparation generally employed when the object is to induce abortion. This it accomplishes by the violence it does to the system of the mother, inducing gastro-enteritis, and nephritis, and occasion- ally death. As an emmenagogue, the dose is from two to six drops, made into a mixture with sugar or mucilage. Dr. Pereira regards the oil as by far the most convenient and certain preparation of sa- vine, and it is the one which he always employs. 9. RUTA.— RUE. Rue is the root of Ruta Grav'eolens, Common or Garden Rue; Sex. Syst. Decandria Monogynia, Nat. Ord. Rutacea? ; a perennial plant, which is indigenous in the south of Europe and the Levant; and is often cultivated in the gardens of this country. It flowers from June to September. The leaves are officinal in the secondary list of the Pharmacopceia of the United States. The herb has a strong disagreeable odour, which is dependent upon a volatile oil, obtainable by distillation, — the O'leum Ruta 35* 414 SPECIAL EMMENAGOGUES. of the Dublin and Edinburgh Pharmacopceias. It contains, also, bitter extractive. The taste of the leaves Fig. 59. is bitter and acrid ; and when fresh, they irri- tate the skin, and, at times, even excite vesi- cation. They yield their virtues to hot water. From what has been said, it is obvious, that rue is a powerful excitant; hence, and as it makes also a powerful impression on the nerves of gustation and olfaction, it proves antispasmodic, and is frequently used as a domestic remedy in hysteric and other ner- vous affections. It is not often prescribed, however, by the physician, as an antispas- modic. Amongst the laity, it has great reputa- tion as as an emmenagogue; and some practi- tioners have believed it to be not only as use- ful in catamenial obstructions as other more esteemed emmenagogues, but have thought its action to be so peculiarly directed to the uterus as to be capable of inducing menorrha- gia, abortion and inflammation. (Christison.) It is rarely, however, used by the profession as an emmenagogue. The dose of the powder is from fifteen to thirty grains, two or three times a day; but it Ruta graveoiens. must be given with caution, as there is some rea- son to believe it to be an acro-narcotic poison. It is more commonly given in infusion — Rue Tea (Ruta, ^j ; Aqua bullient. Oj. Dose, f. 5iss to f. ^ij.) Oil of rue is sometimes prescribed in the dose of two to six drops in sugared water. 10. RU'BIA.—MADDER. Madder is the root of Ru'bia Tincto'rum, Dyer's Madder; Sex. Syst. Tetrandria Monogynia ; Nat. Ord. Rubiaceae; a native of the south of Europe and the Levant, which is cultivated in various parts of the continent of Europe ; and is exported largely from the Levant, Holland, and the south of Europe. It contains a variety of colouring matters—the most important of which is the madder-red or Alizarin. (Pereira.) The root — which is officinal in the secondary list of the Pharmacopceia of the United States—is long, cylindrical, of about the thickness of a writing-quill, and a deep, reddish-brown colour externally. The woody meditullium is yellow when fresh, but becomes reddish by drying. The odour of the root is weak and peculiar ; the taste bitter and astringent. Madder has been considered by some to be possessed of emmena- gogue virtues; and Professor F. Home, of Edinburgh, believed it to be the strongest and safest emmenagogue known. It may be ELECTRICITAS. 415 of service, when tonic emmenagogues are indicated, but it has not the confidence of physicians, and is, therefore, scarcely ever used. Its remarkable property of colouring the bones of animals fed on it red is well known. The dose of madder may be half a drachm, repeated three or four times a day. 11. TANACETUM.— TANSY. Tansy — whose general properties are described under Anthel- mintics (p. 215) — has been much used in domestic practice in ute- rine affections. It has borne the reputation of an emmenagogue; and, by virtue of its bitter principle, and essential oil, it may act as such in cases where the excitant emmenagogues are indicated. In popular practice, it is supposed even to arrest uterine hemorrhage; and, in the Southern states, the author has known a bag of tansy placed over the abdomen restrain the flow. It is scarcely ever prescribed by the regular practitioner. 12. ELECTRICITAS. — ELECTRICITY. The excitant influence of electricity (see Excitants) can be made to bear immediately upon the uterus, when, from the attending phe- nomena, there is reason to believe that amenorrhcea is dependent upon torpor of that organ. The practitioner has it in his power to graduate the amount of ex- citation. Thus, where a gentle stimulation is needed, it may be sufficient to insulate the individual, and to draw electricity from the pelvic region in the form of the electric pencil ; where a greater de- gree is needed, by sparks ; and where a still greater, to make the uterus a part of the electric circuit, and to discharge a Leyden jar through it — graduating properly the extent of the discharge accord- ing to the demands of the case. Or, Galvan'ic Electric"ity may be substituted, or the shocks produced by interrupted currents, as by the elec'tro-magnet'ic ap- paratus. Such are the prominent articles that have been used as emmena- gogues. Besides them, however, others have been proposed by dif- ferent observers. A recent writer, Dr. Churchill, expresses the opinion, that Iodine, Ergot and Strychnia, are the least doubtful in regard to their power of acting on the uterus. The iodine may be given in the form of Tinctura Iodini composita, (q. v.), the dose of which may be gtt. x to gtt. xxx, three times a day. Ergot may be prescribed in powder, gr. v —x, two or three times a day, and strychnia, in the form of tincture, (p. 384,) from six to twenty-four drops, twice or thrice a day. It is very doubtful, however, whether any of these agents be entitled to any reputation ; indeed, they have been classed, along with others, by a recent respectable writer, Dr. Ferguson, as nostrums. "There are numberless nostrums" — he 416 PARTURIFACIENTS. remarks — " of greater or less value, which, from their very num- ber, prove how capricious a disease is amenorrhcea, and how curable. Dale excites the mammae by repeated application of one or two leeches; the organ enlarges greatly, and the uterus sympathises on being thus aroused. Very many authors give five to eight grains of ergot. Carron du Villard recommends cyanuret of gold in minute doses; Bradley gives strychnine; Brera, iodine; Amussat applies an exhausted glass to the uterus, and Rostan, leeches." The tincture of guaiacum, so highly extolled by Dr. Dewees as a specific in amenorrhcea and dysmenorrhcea, might be classed in the same category. II. PARTURIFACIENTS. Syjtoit. Parlurifacitntia, Parturientia, Abortiva, Amblotica, Phthoria, Apophtho- ria, Ectrotica, Ecbolica, Abortives, Parturients, Ecbolics. Definition of parturients — Most of them indirect agents— Often destroy the mother — Aristolochics — Special parturients. What has been said of emmenagogues might, perhaps, be extend- ed to the'division of parturifacients or abortives, which have been de- fined by Dr. Eberle — " substances that promote the parturient en- ergy." Certain it is, that fifty years ago, no man of science, in this country, would have asserted that we are possessed of any agent that acts by virtue of specific powers over the uterine fibres. Since that period, however, such an agent — ergot — has been brought to the notice of the profession, and has received so many. testimonials in its favour as to cause its admission into every work on Materia Medica. In no country has this substance been more employed than in the United States, and in no country has it so many supporters. Yet there are many, who, from their expe- rience, are not satisfied that it exerts the power over the gravid uterus that has been ascribed to it. It must be admitted, that no cases could present themselves, in which it is more difficult to trace accurately the relation between cause and effect. Every one, who has practised extensively in obstetrics, must have observed, that the parturient efforts occasionally flag, and indeed are wholly suspended, yet they recur, and the labour proceeds rapidly to a favourable ter- mination. Now, if in any such case, a remedy, presumed to be parturient, were administered during the period of the cessation of pain, the recurrence of the pain in this sudden manner, could hardly fail to be ascribed to the antecedent — the administration of the presumed parturient. Let the obstetrical practitioner, who has never had recourse to any such agent, call to mind, how few the cases are, in which delivery has had to be assisted, in consequence of the total cessation of the pains, and how common it is to meet with a partial ERGOTA. 417 or temporary cessation ; and he will see, that the absolute necessity for the use of a parturifacient is not a common occurrence. But, if hesitation be indulged in regard to the possession by the ergot of any specific powers over the uterus, there can be none as respects the other substances, that have been employed as parturients. All these are indirect agents, and act only upon the ovum through the mother, endangering her life, as well as that of her infant. The remark of the poet of antiquity, that " she who destroys her off- spring in utero, often perishes — (sape suos utero qua necat, ipsa perit,") — is admitted to be correct by all writers on medical juris- prudence, and by every one who has at all investigated the subject. The drugs and agencies employed with the view of inducing abor- tion are of the most powerful kind, — emetics, purgatives, acro-nar- cotic poisons, mercury, &c. Bleeding, too, has often been practised with this intent, but it has rarely or never been successful. aristoloch'ics. The German writers admit a class Aristoloch'ica, or agents which pro- mote the lochial secretion, (Conradi); but it need scarcely be said, that there are no such direct agents, and that the pathological cause of the suppression or diminution of the discharge must always be appreciated and combated. Warm fomentations over the uterine region, warm injections into the vagina and rectum, leeches to the labia pudendi or to the inside of the thighs, are amongst the topical remedies which are employed to solicit blood towards the uterine region ; but these agents cannot be proper in all cases, and their employment must be regulated by general principles. SPECIAL PARTURIFACIENTS. 1. ER'GOTA. —ERGOT. Ergot, SecaT cornu'tum, or Spurred rye, from French, ergot, 'a spur,' is generally considered to be the result of a disease in rye, occurring most frequently when a hot summer succeeds a wet spring. For the various opinions that have been entertained in regard to ergot, the reader is referred to another work, (New Remedies, 4th edit. p. 248, Philad. 1843.) It may be sufficient to state, that the diseased state of the grain is occasioned by the growth of a fungus not previously detected, and to which has been given the name Ergotae'tia abortans or E. abortifa'ciens. Ergot consists of grains from a third of an inch to an inch and 418 PARTURIFACIENTS. ahalflong,andfromalineto threelines in diameter,usually curved like the spur of a cock, whence the name, F»g- 60. —having commonly two longitudinal furrows, and being often irregularly cracked and fissured. Externally, it is of a dingy purple hue, but inter- nally of a pale grayish red, or gray- ish white. Its odour is peculiar, fishy and nauseous; taste obscurely acrid and disagreeable. Unless kept excluded from the air, it swells and softens, acquiring a deep black co- lour, and heavy smell, and becoming infested by a little acarus, which is about one fourth the size of the mite of cheese, and destroys the interior of the ergot, leaving the grain as a mere shell. In four months, according to Dr. Pereira, seven and a half ounces of faecal matter of the acarus were formed from seven pounds of ergot. The powder becomes quickly damp, and full of animalcules. The ergot should therefore be fresh ; certainly it ought not to be kept for more than two years. It is affirmed, that a small piece of camphor kept in the stoppered bottle, which contains the ergot, soon annihilates the whole race of insects, and prevents any fresh formation. When ergot is examined with the microscope, its internal structure is found to consist of minute roundish cells, many of which contain particles of oil; and the bloom seen, at times, on its surface, appears to be composed of the sporidia of the fungus to which it is b elie ve d, by many, to owe its origin. Various analyses have been made of ergot by Vauquelin, Maas, Bonvoisin, Pettenkofer, Winkler, Robert, Wiggers, and Wright. The analysis of the last gentleman is considered to be the most accurate. He found it to consist, in 100 parts; — of thick white oil, 31.00 ; osmazome, 5.50 ; mucilage, 9.00 ; gluten, 7.00 ; fungin, 11.40; colouring matter, 3.50; fecula, 26.00; salts, 3.10; loss, 3.50. Dr. Wright considers it to differ from sound rye, chiefly in the presence of oil, osmazome, and fungin. Ether and the volatile oils remove its active part. It would ap- pear, however, that its activity resides in the fixed oil, — Oil of Secale cornutum. ERGOTA. 419 Ergot — which may be readily obtained from the powder by agi- tation with sulphuric ether, and expulsion of the ether by spon- taneous evaporation. As it is important to judge between a good and a bad specimen of ergot, Dr. Wright states, that if it be clear and smooth on its surface, not powdery ; of a deep purple colour; neither entirely black nor light brown; have a full strong odour; break clearly, exhibiting a pink blush internally; be unpunctured by insects ; burn with a clear jetting flame, and be of a less specific gravity than water, its activity may be trusted. The effects produced by ergot, when eaten as food, are referred to elsewhere ; as well as the sedative influence, which it is capable of exerting in various diseases. The extraordinary property ascribed to it of assisting the parturient efforts alone falls under consideration here. This has been long credited in Germany; as the old German names Mutterkorn "womb grain," and Gebarpulver, "parturient powder," and the Pulvis Parturientis of the Marburg Pharmacopceia sufficiently testify. Between thirty and forty years ago, it was recommended in this country by Dr. Stearns, of Saratoga county, New York, and since that time, an immense mass of evidence has been adduced in its favour. Still, there are many who deny it all power over the uterus, both in the unimpregnated and the impregnated state, and who affirm, that it acts only indirectly on that viscus through the general disturb- ance it occasions. Such is the opinion of a modern experimenter, Dr. Jorg, who affirms, as the result of his experiments and observations, that " there is no further connexion between these degenerate grains and the uterus, than the word mutter (' uterus,') which is common to both." From his various experiments, Dr. Jorg infers, that ergot, when taken in small doses, produces little or no effect upon the functions, but when fresh dried in an oven, and given in large doses, it oppresses the stomach, occasioning nausea, vomiting, colic, and liquid evacuations ; destroys the appetite, and injures the digestive powers ; these effects being accompanied by a sense of weight in the head, vertigo, headache, and general torpor of the system. Under these circumstances, he thinks it not difficult to understand, that the connexion between the foetus and the uterus may be modified, and that abortion may ensue. But although, as elsewhere shown, ergot is capable of producing acro-narcotic effects, their supervention is not desired by those, who regard it to be possessed of peculiar powers by which it causes contraction of the uterine fibres of the parturient female, and who administer it with that view. When given in appropriate doses, the parturient efforts become more forcible, constant, and almost unremitting; but there is no bodily disorder. It has been very freely administered in this country, as well as in others, and it can scarcely be doubted, that although, in many cases, the uterine efforts might have returned, and probably did return, independently of it, —in the remainder the ergot must have exerted a special action on that viscus. From the results, therefore, of such 420 SPECIAL PARTURIFACIENTS. cases, we seem to be compelled to admit, that ergot is possessed of ecbolic properties by which it acts upon the parturient uterus; but that it is capable of producing any effect upon the unimpregnated organ, or upon the impregnated at any time except when parturition has commenced, is denied by most observers. The experiments, indeed, of Drs. T. Wright and De Gravina, exhibit the singular fact, that it appears to have the power of prolonging gestation in the guinea-pig and rabbit, when administered for a considerable period. The cases, in which ergot may be given with propriety, are those in which there is insufficiency of uterine effort, either in force or frequency, or both, — when the labour is somewhat advanced, and the os uteri moderately dilated; and when there is no mechanical obstacle to delivery, owing to deformity of the pelvis, rigidity of the os uteri, or preternatural presentation. It should, likewise, be used with more caution in first pregnancies. It is chiefly employed to increase the expulsive efforts in lingering labours, — to hasten de- livery on the occurrence of alarming symptoms ; to expedite the ex- pulsion of the placenta, when the uterine efforts fail; to facilitate the discharge of clots, hydatids, &c; to restrain uterine hemorrhage, especially when occurring in the puerperal or gravid state ; to facili- tate abortion, when it has once commenced ; and it has been strongly recommended for the prevention of uterine hemorrhage. In all these cases, the good effects result from the specific action of the drug on the uterus in action. It has been an objection, often urged against ergot, that the number of still-born has been augmented since its introduction; and that observation has shown, that whenever it is given to expedite delivery, more or less danger always accrues to the offspring, either by the induction of asphyxia, or of positive death, owing to the vio- lence of the uterine contractions, or to its deleterious agency on the foetus. It would not seem, however, that when it is prudently ad- ministered, there is sufficient reason for the belief, that it is injurious to the child. It has been already remarked, that ergot exerts its properties on the uterus in action. Such is the general opinion ; but there are some who think, that it is capable of originating uterine action, and of inducing premature labour at any period of utero-gestation ; whilst others are disposed to think, that the ecbolic properties of the drug are not exerted upon the impregnated uterus at an early period of utero-gestation ; but that at a certain stage of development, the uterine fibres are capable of being excited by it, so as to expel the foetus. It would be strange, however, were its agency to be thus restricted. A few cases of apparently good effects in amenorrhcea have been published; few, however, if any, believe it to be possessed of em- menagogue virtues. Ergot may be given in the form of the fresh powder, in the dose of ten to twenty grains in sugared water, and be repeated every ERG0TA. 421 twenty minutes, until the effect upon the uterus is elicited. Von Busch found the best results when it was given in the dose of ten grains every ten or fifteen minutes. In one case, it was requisite to repeat it eight times ; in four cases, six times ; in twelve, five ; in thirty-three, four ; and in the remainder of one hundred and seventy- five cases, three and less; the smallest quantity exhibited was a single dose of ten grains. The action of ergot on the uterus commences in some cases as early as seven minutes after its exhibition, whilst in others a much longer period is required. The average time appears to be about ten or fifteen minutes. Dr. Samuel Hardy, of Dublin, considers that it has always commenced within 25 minutes at the furthest, when the child has been expelled alive ; that if a longer time than this has elapsed, instruments have been necessary, and the child has been born dead. The beneficial effect of ergot is evi- denced by the pains running into one another without any apprecia- ble interval. In regard to the most advisable forms of preparation of er- got, such a difference of sentiment exists as to throw obscurity on the subject. Dr. Wright—it has been seen — regards the fixed oil, left after the evaporation of ether, in which ergot has been digested, to be the active matter: and he states, as the result of positive experiment, that it has the same affect in inducing power- ful uterine contractions as ergot itself; for which purpose, it is given in the dose of twenty to fifty drops, in tea, weak spirit and water, some aromatic water, or made into an emulsion with muci- lage and syrup. This would seem to be the most advisable form of exhibition, inasmuch as the oil retains its properties for several years, if kept in well closed bottles excluded from light. Frequently, however, ergot is given, by preference, in infusion; but it is not easy to see how the fixed oil can be taken up by hot water. Professor Hooker, of New Haven, who is of opinion that the parturifacient and the narcotic properties may be separated, recommends the clear infusion, which possesses, he conceives, the former property only. The powder, of course, must contain both. Dr. Hooker found, that when a quantity of pulverised ergot was macerated for several days in sulphuric ether, and the liquid was evaporated in a glass vessel, until it no longer afforded the smell of ether, there remained, at the bottom of the vessel, a small quantity of thick heavy oil, resembling, in appearance, fish oil; above this was a lighter oil, much more abundant than the former, of a light reddish-brown colour, and of a sweetish nauseous taste. This light oil was found to be possessed of decidedly narcotic properties; and similar effects resulted from its employment, in some experiments made with it at the suggestion of the author by Dr. McKee, of South Carolina, at the time resident physician in the Philadelphia Hospital. On the other hand, Mr. Lever prepared an ethereal tincture of vol. i.—36 422 SPECIAL PARTURIFACIENTS. ergot, by digesting four ounces of it in four fluid ounces of ether, for several days. This was poured off, evaporated to dryness, and the residue again dissolved in two fluid ounces of ether : of this solu- tion, from n\,xv to ttlxxx, were given for a dose. It was found to act powerfully on the uterus as a parturifacient; and Mr. Lever remarks, that whilst all the other preparations of ergot not unfrequently induce acro-narcosis, he has not once observed those effects from the use of the ethereal solution of ergot, — and he therefore thinks, that the acro-narcosis is caused by some constituent of the drug, which ether does not dissolve, — a view, which is wholly irreconcilable with the results of Professor Hooker's observations. The latter gentle- man, in his experiments, employed a lighter portion of the oil of ergot of Dr. Wright: Mr. Lever's preparation was nothing more than a solution of the oil in ether. When the infusion is employed, it may be made of one drachm of ergot to four ounces of water — one-third being taken for a dose. When, however, the object is to induce premature labour, much larger doses have been necessary. It has been given until the patient took in one case six drachms, and in another twelve; half a drachm being taken every three or four hours. The plan adopted by Dr. Hardy/is to infuse half a drachm of pow- dered ergot in three ounces of boiling water, and after straining to add ten or fifteen grains of fresh powder with a little sugar. The dose is re- peated in twenty minutes, and if the uterus does not contract well is given a third time. As the active properties appear to reside in fixed oil,-ihe alco- holic tincture ought to be an objectionable preparation ; and so it has been regarded. Occasionally, ergot is given in decoction ; one drachm of er- got bruised being boiled in six ounces of water for ten minutes in a lightly covered vessel, and strained. The dose is one-third — (For different forms of preparation, see the author's New Remedies, edit. cit. p. 263.) VINUM ER'GOLE, WINE OF ERGOT. (Ergot, contus. gij ; Vini, Oj.) This is the only officinal preparation of Ergot in the Pharmacopoeia of the United States. The dose may be f. 3J —f. Jij. 2. SOD/E BORAS -BORATE OF SODA. Many of the German writers ascribe to borax a specific influence over the uterus ; by which it is supposed to favour the catamenial secretion, the pains of parturition, and the lochial discharge, when their failure is dependent upon inactivity of the organ. It has been recommended strongly by an able English writer, Dr. Copland, in cases of abortion. " When the embryo only," he re- marks— " is expelled, the appendages being still retained, Or when the hemorrhage is great, the entire ovum still remaining in the uterus, the ergot of rye will often prove of inestimable service ; and when EXCITANTS. 423 given in the form of decoction with as much borax as will dissolve, will seldom disappoint our expectations." As it is prescribed, how- ever, by Dr. Copland, along with anunquestionedparturifacient, doubts may be entertained in regard to its agency in these cases. Of its effects, the author can say nothing from his own experience. It has been advised by one practitioner, Dr. D. Stahl, of Indiana, in dys- menorrhoea occurring in plethoric individuals, after blood-letting had been premised. The dose was nine grains every two hours in flax- seed tea, given for two days before the expected recurrence of the catamenia. SECTION VI. AGENTS THAT AFFECT VARIOUS ORGANS. I. EXCKPANTS. Stnon". Stimulants. Irritation, not debility, the great lethiferous agent — Causes of death in cases of exten- sive abscess, phthisis pulmonalis, &c. Debility in one organ may suggest irritation in another — Cases of really diminished action — Division of excitants — Definition of excitants—Carminatives — Chiefly derived from the vegetable kingdom—Simple direct action of excitants — General effect of excitants — Excitement and collapse defined — Excitants act also as revulsives — Therapeutical application of excitants — In gastric and intestinal affections — In fevers — In inflammatory diseases — Catarrhs — In the neuroses, hysteria, epilepsy, paralysis — In to, ical inflammation — Mental excitants —Special excitants. Although the doctrine — that debility is the cause of almost every diseased action — is now nearly exploded, there can be no doubt that, owing to morbific agencies, the vital manifestations of a part may be enfeebled, and that a plan of treatment, which will arouse them to greater activity, may occasionally be required. Even so late as the time of Cullen it was maintained, that the great indi- cation to be followed by the therapeutist, in cases of fever, was to obviate the tendency to debility and death. A better attention to physiology and pathology has shown that the great lethiferous agent, in such cases, is irritation, and that death often results from this cause, where its agency was at one time altogether unsuspected. It has often been observed, that where large collections of matter have formed, and been discharged by the surgeon, febrile irritation of the most fatal kind has rapidly supervened, yet little or none of this irritation was present before the matter was evacuated. It was accordingly supposed, at one time, by every surgeon, that the irritative fever was the result of debility induced by its discharge. It is obvious, however, that in such case, from the time that the pus 424 EXCITANTS. is secreted, it is as extraneous to the vital operations as after its dis- charge. The removal of that which is already secreted cannot add to the existing debility. The cause of the hectic fever, set up in such cases, and present to some extent from the moment that exten- sive suppuration begins to be established, reposes on the circum- stance, that when once the pus is discharged, a recuperative effort takes place in the vessels of nutrition of the inner paries of the ca- vity ; and the severe irritative fever, which follows, is owing to the constitution sympathising with the excited capillaries to such an ex- tent, that the system often sinks under the effects of its own repara- tory exertions. No one, at the present time, conceives, that the consumptive are worn away by the discharge that takes place from the substance of the lungs. Hectic fever occurs in phthisis pulmonalis, as in every other case where extensive mischief exists, and great recuperative effort has to be exerted ; and, under the irritation of this fever, the spark is gradually extinguished. It is not in these cases only, that the prevalent doctrine of debility has been exploded. The practitioner, when he observes signs of debility in an organ or in the system generally, inquires, whether the vitality of other organs may not be exalted, and whether there may not be a source of irritation existing somewhere, which, by detract- ing from the vital manifestations in other parts, may be the cause of the local or general evidences of asthenia or debility. A strong man, in a state of health, may be attacked with general fever, ac- accompanied by great languor and lassitude, with every sign, in- deed, of apparent debility—yet a very slight examination may ex- hibit, that an undue quantity or improper quality of diet is exciting gastric irritation, which is the source of all the asthenic phenomena. Again, a man, in a condition of rude health, may be exposed to febrific miasmata ; and, in due time, without much previous indis- position, may exhibit appearances of the greatest debility; and, although a short time before he might have been able to raise pounds, he may be now scarcely able to raise as many ounces. Yet, it is impossible to presume, that such debility is real; it is rather depen- dent upon the excessive irritation in certain parts of the organism detracting from the vital forces in others ; and the important point for the therapeutist is, — to direct his attention to the removal of this irritation, after which the effects — the asthenic feelings and symptoms — may cease also. Accordingly, at the present day, no practitioner, at the commencement of a febrile condition, is deterred from the use of evacuants by symptoms of languor and lassitude, — experience and reflection having sufficiently instructed him, that the proper employment of such agents is adapted to equalise the vital manifestations, by reducing the inordinate action existing in some part of the organism, and thus equalising the circulatory functions of the whole. Even in cases of cachexia, where general debility appears to be EXCITANTS. 425 unequivocally manifested, some lurking mischief is generally pre- sent ; and when, in such cases, we find a change of the atmosphe- ric, and other influences surrounding the patient, productive of sig- nal benefit, it is owing to the equalising influence of change of air, society, and scenery, which detracts from the local mischief, and ex- hibits its genial effects over every part of the frame ; hence, the wonderful recoveries we annually witness in chronic diseases from a visit to our trans-Alleghany or other watering places ; — the wa- ters having often had no agency in the cure, — frequently, indeed, not having been used at all. Still, there are conditions of the frame, in which the vital activity is diminished far below the healthy standard ; where the vascular system is in a state of anaemia, the blood less rich in globules and nutritive pabulum ; and the solids of loose coherence, so that the blood escapes through them with facility, or they rupture on the slightest mechanical violence, — or when, after violent exaltation of the vital forces, a corresponding depres- sion or state of collapse supervenes. In such cases, excitants, espe- cially those of a more permanent character, may be imperatively de- manded. / In the great division of excitants, those agents are usually in- cluded whose excitant action is local or general; in other words, is exerted upon some particular organ or tissue, affecting it by pre- ference, and comprising the class of local stimulants of Murray, — the local excitants of others, — whose operation is that of simple stimu- lation on the tissue with which they are placed in immediate con- tact, extending or not to the general system, so as to produce aug- mented action of the nervous and sanguiferous systems. The classes of medicinal agents, which act as general stimulants, are chiefly — Excitants, Tonics, and Astringents; those that are usually ranked as local stimulants are — Emetics, Cathartics, Em- menagogues, Parturifacients, Diaphoretics, Errhines, Sialogogues, Diu~ retics, and Expectorants, of all of which the author has treated sepa- rately. Excitants, Stimulants, or Incitants, may be defined — agents that increase the organic actions by impressing the contractility of the part to which they are applied ; — the excitation, thus induced, being extended, or not, to the rest of the system. The organ, whose contractility is generally selected to be first impressed, when excitants are administered, is the stomach, although the skin and mucous membranes — especially the Schneiderian membrane, and the lining membrane of the rectum — are at times chosen. The extensive sympathy, which exists between the stomach and the rest of the system — particularly the nervous and sanguife- rous portions— renders it best adapted for the receipt of the impres- sion, which excitants are capable of producing directly. In the classification of Murray, which is closely followed by Dr. Paris, there is no division of excitants. The latter writer has, in- deed, a class of Aromatics, which he defines — " Substances of a 36* 4-26 EXCITANTS. fragrant smell, which produce upon the organs of taste a peculiar sensation of warmth and pungency, and occasion, when swallowed, a corresponding impulse upon the stomach, which is rapidly com- municated to the remote parts of the body ;" but this definition is obviously insufficient to embrace the whole class of excitants ; as several agents of an exciting character, — caloric and electricity, for example, — can in no wise be regarded as aromatics. Aromatics can be looked upon only as a subdivision of excitants, whose modus operandi essentially resembles that of the whole class. Of old, aromatics were employed chiefly as carminatives — a sub- division not now admitted, although we still retain the term, which — as before remarked — is derived from carmen, 'a verse-charm,' and was introduced at a period of superstition, when magic and in- cantations were had recourse to, and when physiology and pathology scarcely existed. Carminatives were employed to expel flatus from the stomach and intestines, and they afford a good example of excitants, that produce their effect simply on the parts with which they come into immediate contact, or at least, without exciting the general system. When flatus accumulates to any extent in the alimentary canal, the muscular fibres become so far distended that atony is produced, and they are incapable of acting with sufficient energy to expel the air, or to diffuse it through the tube ; hence, the pain, which accompa- nies such over-distention in flatulent colic. But if, in this case, an aromatic or carminative be administered, the excitement produced by it in the mucous membrane, with which it comes in contact, is extended, by contiguous sympathy, to the muscular coat, which is aroused to greater contraction, and in this way, the flatus is com- pressed ; a part may escape through the cardiac orifice of the sto- mach, if that organ have been the seat of the affection ; or it may de- scend into the lower intestines. The older writers, not being able to comprehend how the sudden relief was accomplished in such cases, asserted its operation to be carminative, or like that of a charm. Most excitants are derived from the vegetable kingdom, and the property, on which their virtues are dependent, is usually volatile oil, or some analogous principle ; hence the action, and form of ad- ministration, of vegetable excitants afford but little difficulty to the student. In the generality, indeed, the active principle — the vola- tile oil—is separated by distillation, and is administered in this form, so that the plants and their products, whence the oil has been derived, are but little used in therapeutics. This is the case with carraway, aniseed, lavender, the mints, cinnamon, cloves, nutmeg, &c. In other cases, the oil is rarely separated, as in calamus,ginger, wood of sassafras, &c. Here, the sole care consists in not applying heat to such an extent as to drive off the volatile oil ; and accord- ingly those agents are either given in substance, or infusion, — not in decoction or extract. EXCITANTS. 427 The excitants, that are derived from the inorganic kingdom, exert their agency in various ways. They have, indeed, no principle in common to which their operation can be referred. The case of flatulent colic is one in which the simple direct action of excitants is desired; and it is manifest, that similar principles would lead to their adoption in affections of the stomach dependent upon debility of its muscular coat, — as indicated by flatulence, sense of distention, &c, unaccompanied by inflammatory or other irritation in the lining membrane. Accordingly, it is, and has been, a common custom with all nations, to use some alcoholic excitant after food difficult of digestion has been taken. That, which applies to food difficult of digestion, applies likewise to the cases above referred to, in which the digestive powers are en- feebled; and to those especially where the defect lies in want of due contractility in the muscular fibres of the stomach and small intestines, — particularly of the former. When hot water or dilute alcohol — pure, or medicated — is taken into the stomach, it produces two effects. It stimulates the mucous membrane to an increased secretion of those fluids, that are inservient to digestion ; and, by contiguous sympathy, the muscular fibres are aroused to greater activity, so that the contraction of the organ upon its contents is more marked; — hence the eructation, which follows the use of these excitants, and the absence of uneasy feelings of distention, which might have been experienced had they been withheld. Alcoholic liquors, moreover, have a chemical operation, not possessed by ordinary excitants. They coagulate the albuminous matters in the stomach, and may thus aid in giving the contents of the organ a texture better adapted for the accomplishment of digestion. But occasion will be afforded to refer to the particular examples of local stimulation, when the consideration of the therapeutical application of excitants occurs. At present, it is necessary to inquire into the general effects produced by excitants, when their action is not restricted to the part with which they come in contact, and when the object of the practitioner is to exhibit them so as to affect the whole system. The nervous susceptibility is, in such case, greatly augmented ; the action of the moving fibres increased ; the pulse rendered more frequent and forcible, and the function of calorification excited, — if the quantity of the agent be great, or its powers considerable. These effects must obviously require a larger dose of the excitant than where the object of the practitioner is merely to produce a local stimulation. The very different effects of excitants, according to the quantity administered, is, indeed, a circumstance of great interest to the practitioner. A small dose may stimulate the lining membrane of the stomach to a greater secretion of the digestive fluids, and the muscular fibres to greater activity, so that the food may be digested more readily and rapidly ; chylosis be facilitated ; the blood move with greater rapidity in the vessels; and the various secretions, and excretions be more readily effected; but, if the dose be carried far 428 EXCITANTS. bejond this, irritation mny be excited in the part with which the excitant comes in contact, or true inflammation may result, so that a general febrile condition may be induced, under which many of the functions enumerated, instead of being facilitated, may be retarded — especially the secretions and excretions, which are never pro- perly accomplished during fever. These, however, are the results of too strong a dose: the quantity of excitants, by careful attention, may be so tempered, that nothing but a salutary excitation may supervene; and this constitutes one of the great difficulties in the proper therapeutical employment of this class of agents. There is another important consequence of stimulating the whole, or any part of the organism beyond the due point,—-namely, that a corresponding state of depression succeeds; so that, after violent excitation, collapse, or almost total prostration may ensue. This kind of compensation of action appears to exist to a great extent in the organism. If any organ be greatly over-excited, other organs are often observed to be struck with debility, and hence it is, as we have seen, that the judicious pathologist— when he observes want of action, or apparent atony, in one organ — carefully investigates, whether the deficiency of vital manifestation may not be compen- sated by inordinate action elsewhere. This supervention of collapse on over-excitement renders it a matter of moment to be able to determine what are the healthy mani- festations, by which the evidences of exaltation or diminution of the vital forces may be determined. This, however, is not an easy matter, and the difficulty is greater in some individuals than in others. No two persons have the functions of circulation, innervation and calorification alike. A modern writer, Dr. A. T. Thomson, has attempted a solution of the question, by affirming, that " excitement implies every state of the nervous system in which the energy of the brain is greater than that, which, in the waking state of a healthy man, is exactly adequate to the ordinary functions of the system: Collapse that state in which the cerebral energy is so much diminished as to suspend the exercise of the functions of sense and volition — a state of defective activity of the brain, similar to that which causes sleep, only in an augmented degree. There can be no doubt, that a certain supply of blood to the brain is essential for the support and continuance of its functions; too great an increase of the momentum produces excitement; a diminished afflux, on the contrary, within certain limits, or an exhaustion of the moving powers from previous over-exertion, is productive of collapse." But these definitions do not solve the difficulty. The constitutions of individuals differ so much, that we cannot easily determine what are the healthy mani- festations in any particular person. Whenever, therefore, excitants appear to be indicated in disease, the therapeutist has to be cautious not to carry the excitation too far, lest the vital energies should be impaired or worn out; and for the like reason, it becomes important, when once the use of excitants has been commenced, that they should GENERAL EFFECTS. 429 be withdrawn with caution, lest a state of collapse, or of diminished action, should succeed, proportionate to the preceding stimulation. This is especially demanded in protracted fevers, in which excitants may still have been employed with propriety. The state of collapse, referred to above as supervening on over- excitement, differs essentially from that which attends spasmodic cholera. In this fatal malady, owing to the excited state of the lining membrane of the intestines, the watery portions of the blood are largely exhaled, and passed off in the evacuations, until ulti- mately the blood becomes too thick to circulate in the extreme ves- sels ; the nervous system does not receive its due supply of blood possessing the requisite properties, and even the central organ of the circulation, and the whole circulatory apparatus, have their functions impaired, and ultimately annihilated. But this state of collapse is not the immediate consequence of previous general excitement. It will be seen hereafter, that all tonics are excitants ; but that the former do not stimulate beyond the healthy standard, and are more permanent in their action ; whilst the latter are always employed to excite more or less beyond the healthy degree, and are more tran- sient in their operation, although their effects may be more speedily exerted. A valuable mode, in which some of the agents belonging to this class of medicines exert their efficacy, is by revulsion. The whole class of counter-irritants and epispastics are properly excitants; — but their intimate examination will be entered upon under a distinct head. (See Revellents.) Mercury and caloric are also employed with this view in disease; but the consideration of the modus ope- randi of the former, when carried so far as to affect the system, will also fall in another place. (See Eutrophics.) The catalogue of the Materia Medica furnishes us with a liberal choice of excitants; yet, so large a portion of them essentially re- semble each other in their properties, that the list might be much diminished without any disadvantage to science or humanity. There is scarcely an aromatic vegetable, the essential oil of which has not been admitted into the pharmacopceias of Europe, or of this coun- tiy, yet almost any one of them might be selected as a fit represen- tative of the whole. Therapeutical Application of Excitants. Gastric affections. — In the therapeutical application of the class of excitants we have always to reflect, whether the indication be simply to effect a local stimulation, or to have the excitation extend- ed to the general system; — whether, in other words, it be merely a morbid condition of the digestive functions, that has to be com- bated, or one involving the great systems — nervous, vascular or secretory. Where the mischief is purely gastric, and dependent apparently 430 EXCITANTS, on want of tone in the muscular coat of the stomach, or in the organ generally, the diffusible excitants are chosen, if the uneasiness be urgent — as where flatus is present. Ether, alcoholic liquors, hot water, the essential oils, &c, may be employed with this view, but any stimulation, thus induced, can only be momentary; the cause of the uneasy symptoms may still persist, and demand a treatment more permanent in its influence. Correct pathology may suggest, that, in these cases, recourse should be had to a combination of tonics and excitants, in order that, whilst the latter palliates the uneasy feelings, the former may radically remove the want of tone which gave origin to them. Accordingly, one of the bitter roots or barks is usually given in infusion, along with some aromatic ;— the bitter principle of the root or bark exerting its tonic influence, whilst the essential oil of the aromatic acts as an excitant. Care, however, must be taken to discover, whether the symptoms are really pro- duced by atony, for there is a variety of dyspepsia — indicated, at times, by pain of the epigastrium on pressure ; by uneasiness, when hot or cold fluids are taken, — by dryness and redness of the tongue; dryness and heat of skin, with sometimes quickness of pulse,— which consists, as the symptoms sufficiently indicate, in an irritated or inflamed condition of the gastro-enteric mucous membrane, and where, of course, the stimulant plan of treatment would be inju- rious. This very condition of mucous membrane may, indeed, be induced by the incautious use of excitants. It has been already re- marked, that excitation is followed by corresponding depression; and that excitants, in an overdose, exalt inordinately the vital ener- gies of the part with which they come in contact, so that if this course be persevered in, the irregular condition of the mucous sur- face — as to alternate excitation and depression — can scarcely fail to eventuate in irritation, if not in true inflammation; hence it is, that excitants alone are rarely used in affections of the digestive tube, unless for the removal of sudden attacks of disease, as of fla- tulent colic, especially in children, when a few drops of any essen- tial oil will usually remove the mischief, in the manner previously explained. In persons of the gouty diathesis, and occasionally in others, vio- lent attacks of a spasmodic character affect the stomach, causing the most excruciating pain, aggravated at intervals, but with no signs whatever of inflammatory excitement. In such cases, a new action must be produced in the nerves of the organ, by the administration of the most diffusible excitants — combined, or not, with narcotics — until relief is procured. The latter class of remedies affords us the most efficacious agents in these affections; accordingly, more trust is reposed in them. Ginger, capsicum, ammonta, ether, &c, are the excitants usually had recourse to in these cases; and the effect of internal agents is often aided by the application of stimu- lants to the epigastric region, which operate by exciting a new action in the nerves with which they are placed in direct contact, and thus IN FEVER. 431 detracting from the erethism in the nerves distributed to the sto- mach. This kind of revulsive impression or of new action is, in- deed, a main cause of the good effects derived from the administra- tion of the pure antispasmodics in diseases of a spasmodic nature. In cases of great irritability of stomach, especially in the vomit- ing of pregnant females, which sometimes proceeds to a distressing extent, a genial effect is produced on the stomach, by the new ac- tion, which gentle excitants occasion. Even the mild stimulation, afforded by carbonic acid contained in soda water, or extricated during the effervescence produced by the union of tartaric acid and carbonate of soda, often affords marked relief; and, in the worst cases, the exhibition of diffusible excitants, with the application of a sinapism or other excitant externally, hardly fails to palliate — if not to radically remove — the irritability of the organ, where it is only functionally deranged ; for, it need scarcely be said, that where or- ganic mischief exists; where inflammation, common or specific, or its consequences, are present, and the cause of the vomiting, these agents will not only fail in affording relief, but may be positively noxious, at least when exhibited internally. In such cases, the efforts of the practitioner are restricted to the use of narcotics as palliatives, and to the external application of excitants as counter- irritants. Constipation. — In like manner, in cases of constipation, unat- tended with inflammation, and, on the contrary, accompanied by great torpor of the digestive function, the addition of an aromatic excitant to the cathartic is beneficial, by stimulating the muscular coat through the mucous coat; whilst it may act as a corrigent to the cathartic, if the latter have any griping quality, by aiding it in its passage through the intestinal canal, in the mode already described. Fever. — It need scarcely be said, that excitants must be employ- ed with extreme caution in fever. At one time — as already re- marked— the great indication in these affections was supposed to D6)—.to obviate the tendency to debility and death, and, accord- ingly, antiphlogistics, especially of the depleting kind, were used with great fhesitation, and every thing was done to husband the strength so as to permit the patient to bear up in the last stages. A better system fortunately now prevails, and it is universally admit- ted, that few, if any, die from febrile debility, and that the fatal in- fluence is seated in the over-irritation of some tissue or tissues, under which the patient gradually succumbs. The efforts of the practitioner are, therefore, properly directed to the prevention of ir- regular action in organs, and to the removal of irritation, or inflam- mation, wherever existent. Under this philosophical treatment of fever, excitants are, of course, never employed during the early pe- riods, and it is only when the powers of life begin to flag, that a question can ari?e as to the propriety of their adoption. Even in the very lowest stages of the worst grades of typhus, this question 432 EXCITANTS, is not always very easily settled. There is generally more or less local irritation present — often in the lining membrane of the sto- mach and intestines — and many of the signs of debility are de- pendent upon the depressing influence exerted on other functions by the predominance of irritation. This depressing influence on the sanguiferous system is often sin- gularly evinced in diseases of the intestinal canal, especially such as affect the lining membrane ; and a striking example of it is seen in cholera. The author attended with his friend, Professor Smith, of the University of Maryland, one of the students of the University, who, after having been present at the lecture of the Professor of Obstetrics, in the evening, was attacked with violent vomiting, but without any abdominal or other uneasiness. On the following morning, there was some slight tenderness on pressure, and the vomiting persisted. He was cupped over the abdomen, although neither the state of the pulse, of the skin, nor the other symptoms appeared to indicate inflammatory action. During the day, he gra- dually sank, and expired the same evening. On examining the body, a portion of the ileum was found contracted for the space of several inches, but this contraction must have formed gradually. The lining membrane exhibited but slight signs of irritation. There is something, indeed, extremely unaccountable in these cases. The peristole of the digestive tube is but indirectly influenced by the brain and spinal marrow. The heart itself is equally abstracted from direct cerebro-spinal influence, and, indeed, from almost all nervous influence ; yet, in enteritis, the whole circulatory apparatus is oppressed, as it were; and this oppression, if not removed, ra- pidly terminates in depression ; whilst, in the comparatively harm- less disease—amygdalitis, or inflammatory sore throat — the action of the heart is inordinately excited, and the whole vascular system thrown into violent turmoil. It is generally considered proper to have recourse to excitants in fever, when the pulse and the beat of the heart become feeble and fluttering ; the tongue moist perhaps, but with a dark fur ; the teeth covered with sordes; the skin bathed in a cold, clammy sweat; or, if hot and dry, with concomitant symptoms of debility ; sinking down in the bed, and low muttering delirium ; the tongue tremu- lous, and protruded with difficulty, — indicating great debility of the nervous system; petechia? or vibices, produced by transudation of blood, rendered thin by disease, through the loosened parietes of vessels, &c, &c. But it is impossible to lay down any positive rules for the guidance of the practitioner, and it is better, that he should even allow the signs of prostration to become marked, before he passes to the too early use — as it may prove to have been — of ex- citants. Dr. Rush, as before remarked, considered, that there was a period in fevers, at which blisters might be applied as excitants with great advantage; but, if used before this period, they would IN INFLAMMATORY DISEASES. 433 be productive of mischief. It is, however, impossible to fix upon any such point with accuracy ; and in this, indeed, the main diffi- culty rests. If it could be decided on by any specific signs, it would be but necessary to apply the antiphlogistic, or the excitant medica- tion accordingly. Vesicants, are, however, by no means the best agents to be employed as excitants. In the low conditions of the frame, in which they are conceived to be indicated, the discharge of a quantity of the serous part of the blood cannot fail to add to the debility more than the excitant property can detract from it: they produce, moreover, excessive irritation, and are, withal, tran- sient in their operation. A more permanent excitant is, therefore, better adapted to these cases ; and internal stimulants— as wine — are preferred, the quantity being carefully regulated so as not to excite beyond the due degree. Under another head, it will be seen, that epispastics may be employed with decided advantage in fever, but not on the principle of inducing general excitation. (See Revellents.) Whenever excitants are esteemed necessary in fever, the fact, before adverted to, must be borne in mind, that their operation is apt to be followed by corresponding depression. They should be administered, consequently, so frequently, that the depression has not time to intervene, care being taken, that they are not given in such doses as to excite beyond the proper point; and, if their operation be salutary, they will be found to detract from, rather than add to, the febrile irritation : if, however, the febrile symptoms should be manifestly increased under their administration, they must be discontinued — but discontinued gradually — for the reasons mentioned. These general views will afford some guidance to the use of ex- citants in febrile complaints in general. The author has already said, that in such affections they are but little needed, and that they must, in all cases, be employed with a wise caution. The case, indeed, must be sufficiently hopeless, in which the elasticity of the frame is incapable of restoring it to its wonted energies without their agency ; and very often — too often — when they are determined upon, they occasion, at the most, a slight flickering of the flame prior to its total extinction. It is a common argument in favour of the administra- tion of excitants, that it is the duty of the practitioner to support the patient as long as life lasts ; and the belief is almost universal, that existence can be prolonged by the full use of stimulants ; but this appears to the author to be questionable There is, in these extreme cases, but a small amount of excitability remaining in the organism ; and this, it appears to him, must be sooner exhausted by exci- tants ; so that the patient may absolutely die more speedily under the use of agents administered with the view of protracting his existence. Inflammation. — What has been said of the impropriety of exci- vol. i.—37 434 EXCITANTS, tants in febrile affections applies equally to inflammatory diseases. They are, obviously, positively improper in all acute inflammations of internal organs of every kind. This, at least, is a general rule to which we ought to be cautious of admitting exceptions. Some sur- geons are in the habit of administering copaiba and cubebs during the inflammatory periods of gonorrhoea virulenta, and, they assert, with full success. In the experience of others, these agents have not been as successful, or as innocuous. Something may depend upon the peculiarity of the inflammation of mucous membranes to which the author has referred, and will have, again and again, to advert. His experience in these cases, and it has not been limited, leads him to treat the disease by antiphlogistics, especially in its early stages, and he has always found the plan successful. There is, however, a condition in these catarrhs, — as inflammations of the mucous membrane in general are often designated by the French pathologists,— in which excitants may be administered with signal advantage. It is when the violence of the inflammation has sub- sided, and when a discharge is still kept up, owing to the atonic or asthenic condition of over-distended extreme vessels, — hence, in the state of chronic inflammation of the intestines, constituting the latter stages of acute dysentery, or in the after stages of diarrhoea, that excitants may occasionally be used with benefit; but here recourse is had generally to those that belong to another class of medici- nal agents — astringents. In bronchitis, too, especially in the variety which affects old people, and which was, at one time, called catar- rhus senilis, excitants are employed with advantage, especially such as are inhaled, and, in this way, come in contact with the vessels affected. Hypertrophy of the heart. — Where hypertrophy of the heart ex- ists— as indicated by strong impulse, diminished sound, dulness on percussion, and other signs afforded by auscultation — excitants are, of course, improper. Modern pathology has shown, that where such a condition of the heart is present, the tendency is laid to hy- persemia in the brain ; and, hence, vertigo, depravation of vision, cephalalgia, &c, are its frequent attendants. There are, however, no morbid states of the heart, and none of the blood-vessels, — ex- cept such as are indicated by over-distension of the subcutaneous veins, and but few cases of these, — in which excitants can be era- ployed with propriety. Neuroses. — In some of the neuroses, excitants are demanded, but they must be used with due caution. Delirium tremens, in its severe forms, has been considered by some to imperiously demand the employment of powerful alcoholic excitants ; but, as the author has shown hereafter, they are by no means indispensable, and the disease admits of cure without the use of any of them. (See the article Alcohol, under Special Exci- tants.) In hysteria, excitants are frequently administered for the purpose IN PARALYSIS. 435 of exciting a new impression. The disease is manifestly neuro- pathic, and is usually dependent upon great excitability in the cere- bro-spinal and nervous system. The object of the practitioner is to break in upon this morbid irregularity of action by making a powerful impression elsewhere. (See Antispasmodics.) In epilepsy, chorea, tetanus, neuralgia, fyc, we have but rarely re- course to excitants, because the nature of the diseased action re- quires a more permanent medication, which tonics are better able to effect. There may, indeed, be cases,—as in every other class of diseases, in which they are generally to be avoided—that may re- quire their administration ; but all this must be decided by a refer- ence to general principles. Paralysis. — Perhaps there is no neuropathic affection, in which the whole train of symptoms would appear to suggest the adminis- tration of excitants more than paralysis. The name, (from •**!**»<,■, " I relax,") and the symptoms convey the idea of loss of power, and it might appear that in all cases attempts should be made to restore it by the use of excitants. They cannot always, however, be used with perfect safety. Paralysis is often, if not usually, in- duced by a hyperaemic condition of the encephalon, or of some por- tion of the cerebro-spinal axis ; and although this state of hypere- mia may disappear, and the resolutio nervorum •— as it was once called — continue; excitants, if incautiously exhibited, may en- danger the recurrence of the hyperaomia, and thus give occasion to another attack of the disease. Of course, the nearer to the period of the paralytic seizure, the greater the mischief likely to ensue from the injudicious employment of this system of medication. Yet although the incautious use of excitants has to be avoided in cases of paralysis, their careful administration is occasionally pro- ductive of much benefit, — both in hemiplegia, paraplegia, and in cases of partial palsy, such as that caused by the poison of lead, for example. The whole class of epispastics is here much employed. Electricity and galvanism, acupuncturation, moxa, &c, are applied to rouse the paralysed nerves to action ; friction, too, is recom- mended, along with the internal use of excitants,—such as affect the cerebro-spinal system more especially. With this view, nux vomica, and especially its active principle — strychnia—has been exhibited, and in a few cases apparently with partial success. It has been shown, that when this energetic agent is taken for a due time, and in an appropriate dose, it occasions tetanic convulsions in the muscles to which the paralysed nerves are distributed, and con- sequently, seems well adapted for exciting a salutary stimulation in these cases, (p. 385.) Too often, however, the cause of paralysis, seated as it is in the cerebro-spinal axis, baffles every effort for its removal, and is far beyond the reach of excitants— either internal or external. It ought not, indeed, to be expected, that the latter could have much influence. Friction, so often employed, blisters 436 EXCITANTS, and other external irritants can only exert their primary action on the parts secondarily affected. In this way, the encephalon, it is true, may receive the excitant irradiations, but the effect cannot be great, and, accordingly, external excitants are not regarded as effi- cacious agents in these diseases. In the paralysis of the seventh pair of nerves distributed to the face, as it is, generally perhaps, local — rarely encephalic — and therefore of comparatively favourable prognosis — the class of exci- tants may be had recourse to, with much prospect of advantage. Local inflammation. — In many cases of local inflammation — seated on the surface of the body, and affecting the skin more espe- cially — the application of excitants is often of unequivocal efficacy. It has long been a custom to expose a burnt part to the radiation of heat, or to hot lotions, and the success of the recommendation is often signal. Shakspeare alludes to the practice, and to the fancied law of the economy, in his " Romeo and Juliet." " Tut, man ! one fire puts out another's burning : One pain is lessened by another's anguish : Turn giddy and be holp by backward turning; One desperate grief cures with another's languish. Take then some new infection to thine eye, And the rank poison of the old will die." Romeo and Juliet, Act. 1. Scene ii. In like manner, in paronychia or whitlow, especially when super- ficial, the pain and inflammation are relieved by lotions of hot alco- hol or hot vinegar; and we have examples of the same modus ope- randi in the influence of capsicum and other stimulating gargles in inflammatory sore throat; — of stimulating applications in pernio or chilblain ; of hot lotions in mastitis; of oil of lemon dropped upon the inflamed conjunctiva, &c. It has been before shown, that, in the in- flammations of the dermoid system — cutaneous or mucous — as a general rule, the over-distended state of the capillary vessel predomi- nates over the excitation of the blood-vessel communicating with it, and that the capillaries are in a state of hyperaemia, which occasions the motion of the blood through them to be retarded, and, at times, absolutely arrested. Any thing, consequently, that will stimulate the over-dilated capillaries to resume their wonted calibre, may re- move the cause of the excited state of the vessels communicating with them, and, consequently, put a stop to the inflammation. We may thus account for the good effects of blisters in whitlow, and in cutaneous inflammations. Occasionally, too, excitants are employed to diminish the sensibility of particular nerves, — as in toothache. For this purpose, the strongest essential oils, — as the oil of origa- num, or the oil of cloves,—.are introduced into the hollow of the tooth, so as to come in contact with the exposed nerve. Friction is an excitant application, which is had recourse to espe- cially after the use of the cold bath, to excite reaction. It is also IN SURGICAL AFFECTIONS. 437 employed to modify the action of the vessels of nutrition, to occasion the absorption of effused or secreted matter: but, in this point of view, its effect is eutrophic, and will, therefore, engage attention in another place. (See Eutrophics.) Surgical affections. — In the hands of the surgeon, excitants are valuable agents. He employs them for inducing a new action min- dolent ulcers, and for exciting the action of the absorbents to take up parts that have been deposited. It is with this view, that white sugar is blown into the eye, in cases of specks of the cornea. (See Saccharum, under Revellents.) The same agent has likewise been recommended to be inhaled, finely pulverised, to aid in the disengage- ment of the adventitious membrane, formed in cases of diphtheritis of the mucous membrane of the trachea. For the like purpose, cer- tain astringents are employed occasionally. Lastly : — to the class of mental excitants belong certain emotions, whose effects on the economy are not less marked than those produced by physical agents. It has been the custom to separate the various emotions into two divisions, — the exciting and the depressing, — an arrangement which, in some measure, expresses the effects on the system which they are respectively capable of inducing. There is, however, as has been properly remarked by Dr. A. T. Thomson, a difference amongst excitants in the degree to which they stimulate the different functions. Some excite but little, and their action is more perma- nent, and not followed by the depression which supervenes on the use of the more powerful. They, consequently, belong rather to the class of tonics. The writer, just referred to, places, in the list of mental excitants, joy and impetuosity,— emotions, which — it will be generally agreed—belong properly to this division of therapeu- tical agents. There is not a general effect, which follows the ad- ministration of physical excitants, that they are not capable of in- ducing. It is obviously difficult, however, to have recourse to joy as a remedial agent. It has happened, that the communication of glad tidings has had the most salutary effect upon the hypochondriac, and the melancholic ; but the remedy is not easy of application, and the effect must be transient. Excessive joy may even arrest the functions of the brain, and there are cases on record, in which death has followed so rapidly on the emotion as to suggest the same ratio moriendi as in death from lightning ; —the sudden shock to the ner- vous system being too great for the vital functions to withstand. Allied to joy is a cheerful disposition, — hilarity, and its accom- paniment laughter. Every therapeutist has observed the aid, which such a disposition affords to the invalid, and the injurious influ- ence of depressing emotions. At the same time, care must be taken not to allow buoyancy of spirits to lead the individual into impru- dence, and to indulge in mental excitement to too great a degree. The stimulus, communicated to the whole frame in this way, where there is a tendency to irregularity of nervous or vascular action, is 37* 438 EXCITANTS. apt to lead to hyperaemia in some organ, and in this way to induce unpleasant cousequences. In febrile affections, and in the state of irritability, which occasionally exists for some days after delivery, the excitation, occasioned by exhilarating conversation, and the fatigue thus induced, react injuriously in many cases; and the wise therapeutist is careful to enjoin both mental and corporeal quietude, until the vital functions are more regularly exerted, and less liable to be deranged by excitant or other influences. When mirth is accompanied with laughter, we have, in addition to the excitant effects, derangements of another kind induced, pro- vided the laughter be immoderate or unduly protracted. Laughing is a convulsive action of the muscles of respiration and of the voice. It consists of a succession of short, sonorous expirations. The air is first inspired, so as to fill the lungs. To this, short interrupted expirations succeed, caused by convulsive contractions of the dia- phragm ; and, in very violent laughter, the respiratory muscles are thrown into such forcible contraction, that the hands are compelled to be applied to the sides to support them. The convulsive action of the chest interferes with the circulation of the blood through the lungs; that fluid, consequently, stagnates in the upper part of the body, and the face becomes suffused. From this explanation of the physiology of laughter, it can be understood, how injurious it may be, when immoderately indulged, to those, who are predisposed to apoplexy, of which it may be, in this way, occasionally an exciting cause. It is a symptom, likewise, in hysteria, and, in the hysterical, is apt to induce a paroxysm, if carried to too great a length ; but, on the other hand, in cases in which the functions of the abdominal viscera are torpid; where asthenic dyspepsia is present; or constipation, arising from a like cause ; or where the secretion from the liver is not properly effected, gentle laughter is a useful agent. It impresses a salutary succus- sion on those organs ; excites them from their condition of torpor ; improves chylosis, and the digestive function generally ; and is in- servient to the due nutrition of every part of the frame. Hence the old proverb — " laugh and grow fat" — which, like most proverbs, is in some degree bottomed in reason. Impetuosity, in which we include rage, or any sudden and in- tense mental excitation of any kind, acts like joy, which might, indeed, have been considered, with propriety, under the head of impetuosity. All the bad effects, described as likely to be induced by joy, may follow it; and many are the cases of chronic diseases of the heart and lungs, in which a sudden burst of passion has at once closed the earthly career of the sufferer. WTe know that although the heart does not appear to be directly influenced by either the brain or spinal marrow, its irritability is considerably affected by the various emotions, and when these are violent, and the organ is in a morbid condition, the effect on the irritability is so great, that the action of the heart may cease, and CINNAMOMUM. 439 there may not be a sufficient degree of reaction for it to resume its func- tions. Where the valves of the heart have been diseased, the fatal event has occurred at once under the influence of powerful mental excitation. Such are the chief therapeutical properties of the class of Exci- tants. The next class, which will be considered, does not differ essentially in intimate operation from them. Tonics, are, however, capable of being administered when excitants cannot, without danger of injurious consequences : occasionally, also, they are given with excitants, when the object is to produce more stimulation than pure tonics are capable of effecting. SPECIAL EXCITANTS Fig. 61. 1. CINNAMO'MUM. — CINNAMON. Cinnamon is the bark of Cinnamo'mum Zeylan'icum and C. aro~ mat'icum; Sex. Syst., Enneandria Monogynia; Nat. Ord. Lau- racese, (Lindley,) which are cultivated chiefly in Ceylon and Java, and likewise in the Isle of France, Bourbon, the Cape de Verds, Brazil, Cay- enne, several of the West India Islands and Egypt. In the cinnamon gardens of Ceylon, the bark is obtained from the three year old branches, which are lopped off, and peeled,—the peel- ing being effected by making Cinnamomum Zeylanicum. lllg UCUlg C11CLICU UJ muring, two opposite— or, when the branch is thick, three or four longitudi- nal — incisions, and then elevating the bark by introducing the peel- ing knife beneath it. , , . By far the greater part of the cinnamon brought to this country is said to be imported from China, which is entered at the custom house as Cassia, whilst the same article brought from other sources is said to be almost uniformly entered as Cinnamon. By an exan i- nation of the treasury returns, from the year 1820 to 1829, it ap- peared that the average annual import of this spice was, in round numbers 652,000 pounds from China ; 12000 pounds from England ; 9000 pounds from the British East Indies ; 3000 pounds from the West Indies, and an insignificant quantity from all other places, 440 SPECIAL EXCITANTS. with the exception of 12,758 pounds, brought in one year from the Philippines. (Wood & Bache.) It would appear, that in England, the consumption of cassia is much greater than that of cinnamon ; as in 1838, the quantity of cassia on which the duty of 6d. per pound was paid, was, according to Dr. Pereira, 88,971 pounds; whilst that of cinnamon was 16,605 pounds. Ceylon cinnamon has an aromatic odour, and a pleasantly pun- gent sweetish taste, which is dependent upon its essential oil. Its colour is a light yellow brown. The pieces are quilled within each other, and some of them not thicker than paper: they are pliable, and have a splintery fracture, especially in the longitudinal direction. The Chinese cinnamon or cassia resembles the Ceylon cinnamon in many respects. The odour and taste are similar, but not so deli- cate and agreeable. The quills, too, are coarser, and in single tubes. It is not, however, always quilled. It is, also, of a darker colour than the finest of the East India Company's cinnamon, and is thicker, rougher, denser ; and breaks with a shorter fracture. It is the kind of cinnamon generally kept in the shops of the United States; and possesses all the virtues of the finer cinnamons, and on account of its being much cheaper is to be preferred. The medicinal properties of cinnamon being dependent upon its essential oil, they are readily yielded to alcohol, and, to a certain extent, to water. Like the other spices, they are excitant; and, accordingly, an infusion of cinnamon — cinnamon tea — is some- times given in flatulence as a carminative, and wherever an agreea- ble aromatic is needed. It is rarely administered alone ; but forms part of numerous officinal preparations, to which it is added, either to render the preparation more agreeable, or to aid in the action of the principal and perhaps less agreeable ingredients. The dose of cinnamon in powder is from ten grains to a scruple. O'LEUM CMAMO'MI, OIL OF CINNAMON. This is the volatile oil of the bark of Cinnamo'mum Zeylan'icum, and C. aromat'icum. It is not distilled in this country, and is, therefore, placed amongst the arti- cles of the materia medica in the Pharmacopoeia of the United States. It is obtained altogether from the East. An inferior oil is obtained from the Chinese cinnamon, which is called Oil of Cassia, and is said to be frequently mixed with oil of cinnamon. Oil of cinnamon has the odour of the bark; and its taste is pun- gent and hot; it is of a pale yellow colour, and sinks in water. It is soluble in alcohol, with which it is said to be frequently adulte- rated, as well as with fixed oil. It has all the medical properties of the bark ; and is used in the* same cases as the other essentials oils — especially in gastrodynia, and enteralgia arising from flatulence. It is added, also, as an adjuvant to other medicines. As a powerful excitant it is sometimes used to allay the pain of dental caries, being ANISUM. 441 inserted into the hollow of the tooth. The dose is n\,i to rrLiij, dropped on sugar. AQUA CINNAMO'Ml, CINNAMON WATER. (01. cinnam. f. 3ss ; Magnes. car- bonat. 3ss ; Aqua destillatae, Oij.) Cinnamon water is chiefly used as a vehicle for other medicines ; but it is sometimes prescribed alone as a carminative. PULVIS AROMATICUS, AROMAT'lC POWDER; Pulvis Cinnamomi composi- tus. (Cinnam., Zingib. aa ^ij ; Car dam., Myristica, aa ^j.) Dose, as a carminative, from gr. x to xx ; but it is chiefly used as an ad- juvant or corrigent to other agents. TINCTU'RA CINNAMO'Ml, TINCTURE OF CIN'NAMON. (Cinnam. contus. |iij; Alcohol, dilut. Oij. It may also be prepared by the process of dis- placement.) Tincture of cinnamon is used as a carminative alone; but it is more commonly added to tonic and astringent mixtures. Dose f. 3j to siij. TINCTU'RA CINNAMO'Ml COMPOSITA, COMPOUND TINCTURE OF CIN'NAMON. (Cinnam. contus. ^j ; Cardamom, contus. ^ss; Zingib. contus. 3iij; Alcohol, dilut. Oij. It may, likewise, be prepared by the process of displacement.) Used in the same cases as the simple tincture. Dose, f. 3J tof. 3iij. CONFEC'TIO AROMAT'ICA, AROMAT'lC CONFECTION. (Pulv. aromat. §vss ; Croci, in pulv. ^ss; Syrup aurant. corticis, 5 vj ; Mellis despumat. ^ij.) Aromatic confection possesses the excitant virtues of the in- gredients that enter into its composition, and is adapted for cases in which a carminative is needed. It is adapted, also, as a vehicle for the exhibition of certain tonics — such as the subcarbonate of iron. Its dose is from 9ss to 3j^ Cinnamon enters into the composition of Acidum sulphuricum aromaticum, Confectio aromatica, Pulvis aromaticus, Spiritus lavan- dula compositus, Syrupus rhei aromaticus, Tinctura catechu, and Vinum opii of the Pharmacopceia of the United States. 2. ANISUM. —AN'ISE. Anise or An'iseed is the fruit of Pimpinel'la Anisum, Sex. Syst. Pentandria Digynia ; Nat. Ord. Umbelliferse ; a native of the Le- vant and Egypt, but cultivated in many parts of Europe, and occa- sionally in the gardens of this country. Germany and Alicant ex- port a large quantity of the aniseed, which is used in commerce. The Spanish variety, commonly called Alicant aniseed, is smaller and of a paler grayish-yellow than the rest, "and is the most esteemed. The shape of all the varieties is oblong-ovate. The odour is aromatie and familiar ; and the taste sweetish, warm, and grateful. Its medical properties are dependent upon the O'LEUM AN1S1, OIL OF AN'ISE, — which is obtained from the seeds by 442 SPECIAL EXCITANTS. distillation. Its odour is like that of the vegetable ; taste pungent and bitter, sweetish, and colour very pale-yellow. It congeals at a temperature of 50° Fahrenheit, and is soluble, in all proportions, in alcohol; but spirit, whose specific gravity is 0.84, dissolves only 0.42 of its weight. The oil of anise of the British shops is imported from Germany and the East Indies, and is used in considerable quantity, — duty having been paid, in the year 1839, on 1544 lbs. (Pereira.) The Oleum Badiani or Oil of Star anise (Illicium anisatum), which has the smell and taste of the oil of anise, is said to be sometimes sub- stituted for it. It is imported into this country from the East Indies. The oleum anisi is an officinal preparation in the Pharmacopceia of the United States, and enters into the composition of the Syrupus Sarsaparilla Compositus and Tinctura Opii Camphorata. The medical virtues of anise, as of all the aromatics, are gratefully excitant, and carminative. It is rarely used, however, except in cases of flatulent colic in children, or as a corrigent to medicines which are apt to cause tormina. The dose of the powder is twenty or thirty grains or more ; that of the volatile oil, from rt\,v to rr\xv, dropped on sugar, or rubbed up with it, and water, or camphor water. The infusion — aniseed tea — is occasionally taken sweetened, in cases of tormina; but it is not so effectual as the oil. Aniseed water may be made extemporaneously by diffusing the oil through water by the aid of sugar, or of carbonate of magnesia; and, in the latter case, filtering through paper. 3. CARUM. —CAR'AWAY. Caraway is the fruit of Canon Ca'rui; Sex. Syst. Pentandria Digynia; Nat. Ord. Umbelliferse — a native of Europe, which grows in meadows and pastures, and is naturalised in England, and cultivated in the gardens of this country. Caraway seeds are of an ovate oblong figure, and striated surface. Their odour is aromatic and peculiar ; taste warm, spicy and grateful. Their medical properties are wholly dependent upon the O'LEUM CARI, OIL OF CAR'AWAY, which is obtained from the seeds by distillation; and, accordingly, the virtues are yielded, as in the case of anise, to both alcohol, and — to a less degree however — to water. The medical virtues of Caraway are the same as those of anise. The dose of the dried seeds, powdered, is from a scruple to a drachm; that of the oil from one to ten drops. The latter is often added to cathartic pills and powders to correct their nauseating and griping tendency. Caraway seeds are used in considerable quantity on the continent of Europe, for seasoning bread, cheese, and other articles of food; and they are, sometimes, baked in cakes, to which — in the opinion CARDAMOMUM. 443 of perhaps most persons — they communicate an agreeable flavour, and, at the same time, gently excite the digestive function to greater activity. The seeds form part of the Spiritus Juniperi Compositus, and Tinctura Senna et Jalapa, of the Pharmacopceia of the United States. 4. CORIAN'DRUM. — CORIANDER. Coriander is the fruit of Corian'drum sativum, offd'inal Cori- ander, Sex. Syst. Pentandria Digynia; Nat. Ord. Umbelliferae, which is said to be a native of Tartary, the Levant and southern Europe, but has become naturalised in many parts of Europe, and is cultivated for medicinal purposes. It flowers in June, and the fruit is ripe in August. The fruit is of about the shape and size of white pepper. It is finely ribbed, and may be divided into two seeds, which are ad- herent by their concave surfaces. The smell is aromatic, and cha- racteristic, and is dependent upon a volatile oil, which is separable by distillation with water. Coriander possesses all the virtues of the aromatics. It is scarcely ever given alone ; but is employed as a corrigent to other remedies. It has been considered well adapted to correct the griping qualities of senna; and, accordingly, it enters into the composition of the in- fusion of senna; but its place might be taken with equal advantage by any of the other aromatics. It forms part of the Confectio Senna, the Infusum Gentiana Compositum, the Infusum Senna, the Tinctura Rhei et Senna, and the Tinctura Senna et Jalapa of the Pharma- copoeia of the United States. 6. CARDAMO'MUM. —CAR'DAMOM. Cardamom or Cardamom seed is the fruit of Alpin'ia Cardamo'- mum, Elettaria Cardamomum of Maton, the true or officinal car- damom : Sex. Svst. Monandria Monogynia ; Nat. Ord. Scitaminea-3, — a native of the mountainous part of the coast of Malabar. For- merly, there were three varieties known by the names lesser, middle, and greater cardamoms — the cardamomum minus, cardamomum medium, and cardamomum majus — the fruit of congenerous plants, regarding which there was confusion both botanically and commer- cially. This confusion has been in part cleared away by modern phar- macologists ; as, however, the lesser cardamom is the only variety recognised in the Pharmacopceia, it alone will receive attention here The dried capsule of the cardamom, as we receive it, is of an ovate, oblong, obtusely triangular shape, from 3 to 10 lines long ; rarely more than three broad, which contains many angular, black- ish or brown seeds — the cardamom of the Pharmacopoeia. These seeds are white internally, and have an agreeable aromatic odour, and an aromatic, warm, pleasant taste. Three varieties, accord- ino-toDr. Pereira, are met with in commerce, the shorts, short-longs, 444 SPECIAL EXCITANTS. Fig. 62. Cardamom. a. Shorts, b. Short-longs Long-longs. and long-longs, which are represented in the marginal figure. When subjected to analysis by Trommsdorff, they were found to contain an essential oil, 4.6 ; fixed oil, 10.4 ; a salt of po- tassa, combined with a colouring matter, 2.5 ; fecula, 3.0 ; nitrogenous mucilage with phosphate of lime, 1.8; yellow colouring matter, 0.4 ; and woody fibre, 77.3. The virtues are dependent upon the volatile oil. The properties of car- damom do not differ from those of other spices. It is rarely given alone, but forms a useful, and is a favourite adju- vant and corrigent to stomachic and cathartic medicines. It is an agreeable and grateful aromatic ; but is scarcely ever given alone. TINCTU'RA CARDAMO'MI, TINCTURE OF CAR'DAMOM. (Cardam. cont. f. ^iv ; Alcohol, dilut. Oij. It may likewise be prepared by the pro- cess of displacement.) The dose of this is from f. 31, to f. 3iij. It may be added to tonic or cathartic infusions or mixtures. Cardamom enters into the composition of the Extractum colocyn- thidis compositum, the Pulvis aromaticus, the Tinctura cinnamomi composita, the Tinctura gentiana composita, the Tinctura rhei, the Tinctura rhei et aloes, the Tinctura senna et jalapa, and the Vinum aloes, of the Pharmacopoeia of the United States. 6. CARYOPHYL/LUS. — CLOVES. Cloves are the unexpanded flowers of Caryophyl'lus Aromaticus ; Sex. Syst. Icosandria Monogynia, Nat. Ord. Myrtacese; a native of the Mo- luccas ; but extensively cultivated at Sumatra, Mauritius, Bourbon, Martini- que, St. Vincents, &c. They are col- lected by the hand, or separated from the tree by beating it with reeds; are re- ceived on cloths placed under the tree, and dried by the fire, or in the sun. The quantity of this spice consumed in vari- ous ways is great. In the year 1839, according to Dr. Pereira, duty was paid m England on 93,549 lbs. The supply of the United States is de- rived chiefly from the West Indies, and the European colonies in Guiana. Those from the East Indies — the Amboyna and Bencoolen Cloves — are the best, being the largest, plumpest, and most oily. The Cayenne are the least valued. J Fig. 63. Caryophyllus aromaticus. FCENICULUM. 445 Cloves resemble a small nail with a notched head — hence the name, from the French clou, ' a nail.' Their colour is a deep brown ; odour strong, aromatic, and peculiar; taste acrid and pungent. They were found, by Trommsdorff, to be composed, in the 100 parts, of volatile oil, 18 ; almost tasteless resin, 6 ; a peculiar kind of tannin, 4 ; gum, 13 ; woody fibre, 28 ; and water, 18. Unques- tionably, their active properties are dependent upon the volatile oil — O'LEUM CARYOPHYLLI, — which is in the materia medica list of the Pharmacopoeia of the United States, being obtained from cloves, on the large scale, in this country,—from seven to nine pounds of cloves yielding about one pound of oil. (Wood and Bache.) The oil of cloves, as procured by distillation and repeated cohobation, is of a reddish-brown colour, and heavier than water. The properties of cloves are similar to those of cinnamon and other aromatics, — and the essential oil is used in the same cases as the stronger essential oils. The dose of the powdered cloves is from five to ten grains; of the oil, from rn^ij to n\,vi. Water does not extract all their virtues, so that the Infusum Caryophylli of the pharmacopoeias is not so strongly aromatic and excitant, as the quantity of the spice employed might lead to expect. All the properties are extracted by alcohol; yet the tincture is not officinal in the Pharmacopceias of Great Britain and Ireland, or of this country. It is contained, however, in the Codex Medicamentarius of Paris. (Caryophyll. gj ; Alcohol, dilut. jiv). Oil of cloves, diluted with olive oil, has been used as an embro- cation in hooping cough ; but it possesses no virtues as a rubefacient over other essential oils of equal strength. INFUSUM CARYOPHYLLI, INFUSION OF CLOVES. (Caryophyll. cont., Jij ; Aquse bullient. Oj.) The dose of this, as an aromatic, is f. liss to f. Siij. Cloves enter into the composition of the Spiritus Lavandula com- positus, the Syrupus Rhei compositus, and the Vinum opii of the Pharmacopoeia of the United States. 7. FCENICULUM. — FENNELSEED. Fennelseed are the fruit of Foznic'ulum vulga're — Sex. Syst. Pen- tandria Monogynia ; Nat. Ord. Umbelliferae, a native of the south of Europe, Italy, Portugal, &c, but cultivated in the gardens of the United States. The whole plant possesses the odour of the seeds ; but they, alone, are officinal. They are of an ovate shape ; fragrant odour ; and warm, sweet, and, to most persons, agreeably aromatic taste. Their virtues are dependent upon an essential oil, which is separated by distillation —the O'LEUM FffiNIC ULI. The seeds contain about 2.5 per cent. Pe- reira states, on private information, that 19 cwt. yield 78 lbs. of oil. It congeals below 50° of Fahrenheit, and its s. g. is 0.997. That which is used in the shops of the United States is imported. vol. i.—38 446 SPECIAL EXCITANTS. Fceniculum vulgare. AQUAFffiNIC'UH, FENNEL WATER, has been admitted into the last edition of the Pharmacopceia Fig. 64. of the United States. It is rarely used except as a carminative in the bowel affections of infancy. It may be made by rubbing the oil with carbonate of magnesia, then adding water, and filtering through paper, as in the case of cinnamon water. Boiling water, however, extracts the essential properties, and Fennel tea is a com- mon preparation as a do- mestic carminative. The dose of the powdered seeds is from 9j to 3j; that of the oil from ttlij to n\xv. lennelseed enter into the composition of the Spiritus juniperi compositus of the Pharmacopoeia of the United States. 8. MENTHA PIPERITA__PEP/PERMINT. Peppermint, Sex. Syst. Didynamia Gymnospermia; Nat. Ord Labiatae ; is indigenous in Great Britain, and is found in various parts of Europe, and in Asia and Africa. It has also been intro- duced into this country, and, in some parts of it, is largely cultivated on account of its volatile oil. It is a perennial, but the cultivators have observed, that, in order to maintain its flavour in perfection it is necessary to transplant the roots exery three years. It is cut for medical use in August, about the period of the de- velopment of the flowers. The odour of peppermint is strong, and, to most persons, agreea- ble ; the taste is pungent and aromatic, and it produces a sensation of coldness in the mouth. Its virtues are essentially dependent upon volatile oil, which rises on distillation with water, along with an appreciable portion of camphor. Its constituents are like those of lavender. Like other aromatics, peppermint communicates its virtues to hot water, but less completely than to alcohol. Peppermint is much employed as an aromatic excitant and car- minative — in popular practice more perhaps than any of the others — as well as to correct the operation of cathartic and other agents' or to mask the taste of nauseous medicines "gem*, wWcnT, bC ^^.^ ^ f°rmJ°f ^^~ Peppermint tea- wiuch is a common domestic remedy, but is not officinal. The offi- cinal preparations are the following: M0NARDA. 447 O'LEUM MENTHA PIPERITA, OIL OF PEPPERMINT, obtained by distilling the fresh herb with water, is distilled in considerable quantity in this country ; the amount yielded by the plant varying according to the season, — a warm and dry season being the most favourable. The largest produce in Great Britain is said to be three drachms and a half of oil from two pounds of the fresh herb, — the smallest about a drachm and a half from the same quantity. (Brande.) It has a strong odour like that of the plant; an acrid, very hot, and biting taste, with a peculiar sensation of coldness; it is of a greenish yel- low colour ; and of a specific gravity, according to some, from 0.907 to 0.920, according to others, 0.899. As an excitant aromatic and carminative, it is taken in the dose of one to five drops, on sugar, dissolved or not in water. TINCTU'RA O'LEI MENTHA PIPERITA, TINCTURE OF OIL OF PEPPERMINT. (01. menth. piperit. f. ^ij ; Alcohol. Oj.) This tincture—long known and used under the name of Essence of Peppermint — is used in the same cases as the volatile oil. Dose, 10 to 20 drops on sugar. AQUA MENTHA PIPERITA, PEP'PERMINT WATER. This water may be dis- tilled from the herb, fresh or dried ; but, in the United States Phar- macopoeia, it is directed to be made like tfie Aqua Cinnamomi (p. 441), by rubbing half a fluidrachm of the oil with half a drachm of the carbonate of magnesia, adding gradually two pints of distilled water, and filtering. Peppermint water possesses, in a certain degree, the properties of the plant, but it is chiefly used as a vehicle for other remedies. Dose, f. ^i to ^iij. TROCHIS'CI MENTILE PIPERI'TiE, TROCHES OF PEP'PERMINT. (01. menth. piperit. f. z'i ; Sacchar. in pulv. ffcj ; Mucilag. tragacanth. q. s., to be divided into troches weighing ten grains each.) Peppermint lozenges are used as a gentle carminative, but they are rarely pre- scribed by the physician. 9. MENTHA VIR'IDIS. — SPEARMINT. Spearmint, occupying botanically the same place in the Sexual System and the same Natural Order as the last, has similar medi- cal virtues and composition, but it is not so agreeable, although by some considered more so. It is cultivated in the gardens of this country for its oil; and flowers in August. OLEUM MENTHA VIR'IDIS. OIL OF SPEARMINT—TINCTU'RA O'LEI MENTHiE VIR'IDIS, TINCTURE OF OIL OF SPEARMINT, Essence of Spearmint, and AQUA MENTILE VIR'IDIS, SPEARMINT WATER, are officinal in the Pharma- copceia of the United States. 10. MONAR'DA — HORSEMINT. Mo7iar'da Puncta'ta; Sexual System, Diandria Monogynia ; 448 SPECIAL EXCITANTS. Nat. Ord. Labiatae, is an indigenous plant, which grows on light gravelly or sandy soils, from New Jersey to Louisiana, and flowers from June to September. Fig. 65. The whole herb is offici- nal in the Pharmacopoeia of the United States. Its smell is aromatic ; taste warm, pungent and bit- terish. Like the other mints its properties are dependent upon volatile oil, which may be separated by dis- tillation with water. An infusion — horsemint tea — is a domestic remedy as a carminative ; but is rarely employed by the practitioner. OLEUM MONAR'DJ], OIL OF HORSEMINT, distilled from the fresh herb is of a reddish amber colour, of an odour like that of the plant, and a warm, very pungent taste. It is a powerful rubefacient, when applied to the cutaneous surface, exciting even ve- sication ; hence, it has been used in low fevers, ehronic pains, cholera in- fantum, and other diseases in which rubefacients are considered to be indicated. Dose, as an excitant, should it be desirable to administer it in- ternally, two to three drops on sugar. Monar'da Coccin'ea has similar virtues. Monarda coccinea. 11. HEDEO'MA.—PEN'NYROYAL. Hedeo'ma Pulegio'i'des, or Cuni'la Pulegio'i'des; Sex. Syst. Dian- dria Monogynia; Nat. Ord. Labiatae, is indigenous in the United States, in all parts of which it is common in dry grounds and pas- tures, — its presence being very perceptible from the strong odour exhaled by it. It is not the same as the European pennyroyal, which is Mentha Pule'gium, yet the virtues of the two are identical. Hedeoma has an agreeable aromatic odour, and a warm pungent taste, resembling that of mint. Like the mints, its medical pro- ORIGANUM. 449 an essential oil — O'LEUM HE- Fig. 66. perties are wholly dependent upon DEO'M.E, which is sepa- rated by distillation with water. They are readily yielded to hot water; and pennyroyal tea is a common do- mestic remedy, sup- posed to favour the ad- vent of the menses, but possessing no special virtues of an emmena- gogue kind. Like the aromatics in general, infusion of pennyroyal is given as a carminative in all cases in which a gently excitant agency on the stomach is needed. — When taken hot, like all the aromatics, it promotes perspiration. The oil, which has a light yellow colour, and the smell and taste of the herb, and is of the specific gravity 0.948, is used in the same cases as the aro- matic oils in general. The dose is from two to ten drops. 12. ORIG'ANUM. Orig'anum vulga're, or common Mar'joram ; Sex. Syst. Didyna- mia Gymnospermia ; Nat. Ord. Labiatae, is a native of America, Europe and Asia. In the United States, from Pennsylvania to Vir- ginia, it grows along the roadsides, and in dry stony fields ; and is in flower from June to October. It is rarely, however, employed medicinally. Its medical properties, which are dependent upon an essential oil separable by distillation with water, are the same as those of the mints, and the aromatic herbs in general; but it is very rarely used. O'LEUM ORIG'ANI, OIL OF ORIG'ANUM, Oil of Mar'joram, Oil of Thyme, when recently and properly prepared, is of a yellowish colour; but if too much heat be used in the distillation, it is said to be reddish, and to acquire the same hue bv age. It has the smell of the plant, 38* Hedeoma pulegioides. 450 SPECIAL EXCITANTS. Fig. 67. and a hot very acrid taste. Two hundred weight of the plant is said by Mr. Brande to yield, on the average, one pound of oil. It is scarcely ever given internally ; being generally employed as an exter- nal irritant in the same cases as the oleum monardae ; and in carious odontalgia, —a drop being introduced on cotton or lint into the hol- low of the tooth. The oil enters into the composition of the Linimentum Saponis Camphoratum of the Pharmacopceia of the United States. 13. MYRIS'TICA. —NUTMEG. Nutmegs are the kernels of the fruit of Myris'tica Moscha'ta; Sex. Syst. Dicecia Monadelphia ; Nat. Ord. Myristicaceae, a na- tive of the Moluccas. The fruit is round or oval, of the size of a small peach. The outer covering, which is at first thick and fleshy, and abounds in an austere astrin- gent juice, afterwards becomes dry and coriaceous; and, separating into two valves from the apex, discloses a yellow- ish or red reticulated membrane or arillus, which is the mace of commerce, closely investing a thin brown shell, which con- tains the kernel or nutmeg. The fruit is gathered by the hand, and the outside envelope is rejected. The mace is then carefully separated, flattened, and dried in the sun. The nuts are dried in the sun or in ovens, and exposed to smoke, until the kernel rattles in the shell. They are then broken open, and the kernels having been removed, and steeped, for a short time, in a mixture of lime and water, to protect them from the depredations of insects, they are cleaned, and packed in chests for exportation. The nutmegs are very liable to the at- tacks of an insect called the nutmeg insect. Nutmegs are imported into England from the In- dian Archipelago, either directly, or indirectly by the Cape of Good Hope, or Holland. In 1838, accord- ing to Dr. Pereira, duty was paid on 114,093 lbs. Into this country, they are brought either directly from the East Indies, or indirectly through England and Holland. They are occasionally exported in small quantities from the West Indies, into which their culture has been introduced. Nutmegs have a fragrant aromatic odour, and an agreeable pun- gent taste; are of a roundish or oval shape ; streaked ; of a grayish colour, yielding readily to the knife or the rasp, but not easily pul- Myrisiica inoschata. Nutmeg shell surrounded by the mace. MYRISTICA. 451 verisable. On analysis by N. E. Henry, they were found to con- tain volatile oil; red fat, soluble in alcohol; yellow fat, insoluble in alcohol; alcoholic extractive : amidin, and ligneous fibre, with lime. The volatile oil—O'LEUM MYRIS'TICJE— procured by submitting nutmegs to distillation with water, is always imported from the East Indies. It is colourless or pale yellow, and has the smell and taste of nutmeg. By agitation with water, it separates into two oils, — the one lighter, the other heavier than water. The Oleum Myristica of the former Pharmacopoeia of the United States, and of two of the British Pharmacopoeias, is the expressed oil, improperly called oil of mace, inasmuch as mace yields a volatile oil on distillation with water, similar to the volatile oil of nutmeg. The expressed oil is prepared by beating nutmegs to a paste, which is inclosed in a bag, exposed to the vapour of water, and expressed between heated plates. The nutmeg is said to yield 10 or 12 per cent, of this oil. The best is imported from India in stone jars. An inferior kind is in oblong cakes, covered with the leaves of some plant. It is composed, according to Dr. Pereira, of tallow-like oil, 7; yellow oil, 8|; volatile oil, §. An artificial preparation is said to be sometimes substituted for the genuine oil. It is made by mixing together various fatty matters, as suet, palm oil, spermaceti, wax, lard, &c, adding some yellowish or brownish colouring substance, and giving flavour to the mixture by the volatile oil of nutmeg. This expressed oil is never used internally ; and rarely as a gentle local excitant; and therefore it has been properly left out in the last edition of the Pharmacopoeia of the United States. Nutmeg possesses the virtues of all the aromatic excitants, of which it is one of the most agreeable ; and, therefore, most used. It is a well known spice to give flavour to alimentary substances, and is used therapeutically for the same purpose, as well as to mask the flavour of other less agreeable agents. It is said to have proved narcotic in India, when administered in large doses ; but, practically, no such effects are ever witnessed from it here. Dr. Pereira asserts, that he is acquainted with a case in which the narcotic effects of a whole nutmeg were several times experienced. Either nutmeg or mace, whose medical properties are analogous, may be given, in the dose of from :)j to gss, in powder obtained by grating: or the oleum myristicae may be employed in the dose of rry to tt\x. SPIR'ITUS MYRIS'TICJ, SPIRIT OF NUTMEG. (Myristic. contus. gij; Alcohol. dilut. cong. .Iqua, Oj. Distil a gallon.) It possesses the virtues of nutmeg; but is chiefly used as an agieeable adjunct to other agents. Dose, f. 3J to f. 3iij. Nutmeg enters into the composition of the Spiritus Lavandula com- positus, the Syrupus Rhei aromaticus, the Trochisci Creta, and tiro Trochisci Magnesia of the Pharmacopceia of the United States. 452 SPECIAL EXCITANTS. 14. SAS'SAFRAS RADPCIS CORTEX.—BARK OF SAS'SAFRAS ROOT. Laurus Sas'safras, Sex. Syst. Enneandria Monogynia ; Nat. Ord. Lauraceae, (Lindley,) is an indigenous tree, common throughout the United States, which blooms in the Middle States in the beginning of May. The wood is used in Europe, whither it is sent in billets; but it is not much employed in this country, —the bark of the root being the officinal portion given as an excitant. The bark, as found in the shops, is generally in small irregular pieces, invested, at times, with a brownish epidermis; of a reddish colour; very brittle, and presenting, when freshly broken, a lighter colour than that of the exposed surfaces. Its odour is fragrant, and has been compared to that of fennel; and the taste aromatic and sweetish. The virtues are dependent upon a volatile oil, which is separable by distillation with water. They are yielded readily to water, so that the infusion is occasionally employed as an excitant. Sassafras tea has, indeed, been used in some parts of the country in place of Chinese tea. Flavoured with milk and sugar, it is sold at day-break in the streets of London, under the name of Saloop. The medical properties of sassafras are those of the Lauraceae in general. It is rarely, however, used as an excitant. It is employed, mainly as an adjunct to diet drinks in syphilis and syphiloid affec- tions ; but, in this respect, has by no means the reputation it enjoyed formerly. O'LEUM SAS'SAFRAS, OIL OF SAS'SAFRAS. —the oil obtained by distillation with water,— is one of the heaviest of the volatile oils ; s. g. 1.094. The bark yields from 1.25 to 2 per cent. It is of a yellow colour, turning reddish by age, and has the odour of ihe sassafras, and a warm, pungent, aromatic taste. By agitation with water, it separates into two oils; one lighter, the other heavier, than water. Sassafras oil possesses the virtues of all the aromatic oils; but it is rarely given. Dose, try to rr^x. Sassafras bark enters into the composition of the Decoctum Sarsa- parilla compositum, of the Pharmacopoeia of the United States; and sassafras oil into that of the Syrupus Sarsaparilla compositus. 15. LAVAN'DULA. —LAVENDER. Lavan'dula vera, Common or Garden Lavender; Sex. Syst. Didy- namia Gymnospermia; Nat. Ord. Labiatae, is a native of southern Europe, but is largely cultivated in Great Britain, and also in the gardens of this country, where it flowers in August. All the plant possesses the same properties; but the flowers or spikes are alone officinal, which should be cut when they begin to bloom. Lavender flowers are of a bluish-gray colour ; and have a fragrant, agreeable odour, and a warm bitterish taste. When subjected to analysis, they afford volatile oil, resin [?], tannic acid, a bitter prin- ciple, and woody fibre ; but the oil is the active constituent. It is obtained by distilling the flowers with water. The medical virtues of lavender are those of an excitant like other ROSMARINUS. 453 aromatics, but as its taste is not as agreeable as man of them, it is rarely prescribed alone. It is more frequently used as an ad- junct to other remedies administered in cases of nervous debility ; or to articles whose disagreeable odour it is desirable to conceal or mask. OLEUM LAVANDUL E, OIL OF LAVENDER, is of a lemon colour, has a fra- grant odour — that of the flower — and a warm taste. Its specific gravity varies from 0.877 to 0.905 — the lightest oil being the purest. The oil obtained from the whole herb has a specific gravity 0.9206, but the odour of the oil is considerably deteriorated when the stalks and leaves are used in the distillation. One pound of oil is obtained from fifty to seventy pounds of the flowers. Like the other essential oils, it is soluble in alcohol of a certain specific gravity. That of 0.830 dissolves it in all proportions; that of 0.887 dissolves only 42 per cent. The oil is chiefly used as a perfume ; but occasionally it is em- ployed as a carminative, especially in nervous headache, hysteria, &c, in the dose of from one to five drops on sugar. SPIR'ITUS LAVAN'DULiE, SPIRIT OF LAVENDER. (Lavandul. recent, ftij ; Alcohol, cong. ; Aqua Oij ; distil a gallon.) This preparation is rarely employed alone. It is chiefly used for the formation of other officinal compounds. It is often made by adding the oil of lavender to rectified spirit. SPIR'ITUS LAVANDULl COMPOSITUS, COMPOUND SPIRIT OF LAVENDER, Com- poundtincture of lavender, Lavender drops, Red lavender drops. (Spirit. lavandul. Oiij ; Sp. rosmarin. Oj ; Cinnamom. cont. ^j; Caryophyll. cont. 5ij ; Myristic. cont. ^ss; Santal. resur. 3iij.) This is one of the most common remedies prescribed by the practitioner ; and is em- ployed by the unprofessional in nervous and hysterical affections, and in cases of faintness or depression. It is also added, occa- sionally, to other excitants and to tonic mixtures. The dose is from f. 3J to f. 31J, dropped on sugar. Lavender water — as it is termed in the shops — is a solution of oil of lavender, and other scents in spirit. It is chiefly used as a perfume. 16. ROSMARINUS. — ROSE'MARY. Rosmarinus officinalis or common rose'mary: — Sex. Syst. Dian- dria Monogynia ; Nat. Ord. Labiatae, an evergreen shrub, grows spontaneously in southern Europe, and Asia Minor, and is cultivated in the gardens of Great Britain and this country. The tops or flower- ing summits are the officinal portion. Their odour is fragrant and grateful ; taste, aromatic and bitterish. The medical virtues of rosemary, which are dependent upon essential oil, are communicated partially to water, wholly to alco- hol. They are those of the labiate plants in general, — as the 454 special excitants. mints, many of which have been supposed to be possessed of em- menagogue -properties ; but probably only through the excitant in- fluence of the essential oil. It is rarely given internally ; and when it is so, it is usually as an adjunct. Dose of the powder, gr. x to 3SS. OLEUM ROSMARI'NI, OIL OF ROSEMARY, is procured from rosemary by distillation with water. The fresh leaves afford the oil in consider- able quantity, yet great discrepancy exists as to the precise amount: some, asBaume, cited by Wood and Bache, stating it at 26 per cent. others, as Mr. Brande, holding, that one pound of the fresh herb yields about a drachm of the oil. The former estimate is evidently an exaggeration. Oil of rosemary is transparent and colourless, having a very fragrant odour, and taste like that of the plant. Its specific gravity is about 0.85. WTien long kept, it deposits a substance identical with camphor. It is rarely prescribed internally, although calculated to act as a nervine as well as the Oleum lavandulx. It is generally associated with other substances as a topical excitant, and hence forms part of various rubefacient liniments. If administered internally, it may be in the same dose as the other aromatic volatile oils, — three to ten drops. SPIR'ITUS ROSMARI'NI, SPIRIT OF ROSE'MARY. (01. Rosmarin. 31J; Alcohol. cong.; Aqua, Oj ; distil a gallon.) It is rarely employed internally, but is added to lotions and liniments, as the Linimentum Saponis ; and to one compound excitant tincture — the Spiritus Lavandula compositus. The Queen of Hungary's water is formed extemporaneously by a mixture of spirit of lavender and spirit of rosemary, (Sp. Lavand. f. ^xii; Sp. Rosmarin. f. |iv.) It is chiefly used as a perfume ; and, also, as an excitant in the same cases as the compound spirit of la- vender,— for example, in nervous depression, fainting, &c. It makes, likewise, a good excitant liniment. Oil of rosemary enters into the composition of the Linimentum Sa- ponis comphoratum, and the Tinctura Saponis camphorata of the Pharmacopoeia of the United States. 1?. GAULTHE'RIA. — PARTRIDGE BERRY. Gaulthe'ria procum'bens, Sex. Syst. Decandria Monogynia; Nat. Ord. Ericeae, is indigenous from Canada to Georgia, growing in mountainous tracts, in large beds, and in dry, barren and sandy plains, beneath the shade of shrubs and trees, and especially of other evergreens. It has various names in different parts of the United States such as deerberry, teaberry, wintergreen, and mountain tea, berried tea, grouseberry, &c; some of the names being owing to the circumstance, that the fruit is a favourite article of food with par- tridges, deer, and grouse. It flowers from May to September juniperus. 455 The leaves, which are the officinal part of the plant, owe their virtues to an essential oil, —O'LEUM GAULTHE RLE—separable by distilla- tion with water. They contain, FiS-69- also,tannic acid, which gives them marked astrin- gency. The oil has a brownish yellow colour, a sweetish, pun- gent, peculiar taste, and an agreeable and peculiar odour. It is heavier than any of the essen- tial oils ; its spe- cific gravity be- ing 1.17. The medical properties of gaultheria, are those of the aro- matics in gene* Gaultheria procumbens. ral. It possesses at the same time a slight astringency, which may adapt it to certain cases of diarrhoea ; but it is chiefly used, on account of its agreeable flavour, as an adjunct to other medicines. Hot water extracts its virtues, and, therefore, it may be used irt the form of infusion or tea. The oil is, however, most commonly employed. It is an ingredient of the Syrupus Sarsaparilla composi- tus of the Pharmacopoeia of the United States. 18. JUNIP'ERUS. — JU'NIPER. Ju'niper or ju'niper berries is the fruit of Junip'crus commu'nis; Sex. Syst. Dioecia Monadelphia ; Nat. Ord. Coniferae -— a native of the north of Europe, but introduced into this country, in some parts of which it has become naturalised. In the Pharmacopceias of Europe, not only the berries, but the tops and wood are officinal ; but as the berries possess all the virtues, they alone are officinal in the Pharmacopceia of the United States. They are round, of about the size of a pea, and more or less shrivelled ; of a blackish purple colour, and covered with a glaucous bloom. The taste is sweetish, with a terebinthinate flavour. The property on which their virtues are dependent is a volatile oil separable by distillation with water; and these are Communicated 456 SPECIAL EXCITANTS. to water and to alcohol. Fig. 70. Juniperus communis. They are, consequently, excitant, yet neither they, nor any of the prepara- tions, are much exhibited as excitants. They are chiefly prescribed as diu- retics, under which class some of the preparations are mentioned. The essential oil is the only one that needs comment here. O'LEUM JUNIP'ERI, OIL OF JU'NIPER. The oil, used in this country, is chiefly obtained from Europe. Its odour is similar to that of turpen- tine ; its taste acrid, hot, and like that of the juniper; and its colour light greenish yellow; s. g. 0.911. It is said to be adulterated occa- sionally with oil of turpentine, which renders it of considerably less spe- cific gravity. The dose of the oil, as an excitant, is from five to fifteen drops. Juniper berries enter into the com- position of the Spiritus Juniperi com- positus of the Pharmacopoeia of the United States. 19. LIMO'JNIS CORTEX. — LEMON PEEL. The outer rind of the fruit of Citrus Limo'num, Lemon tree; Sex. Syst. Polyadelphia Icosandria; Nat. Ord. Aurantiaceae, is officinal in most of the pharmacopoeias. The lemon tree has been considered t?nl7nf°L a.Xt " now> however, naturalised throughout the Z In f ^S°Uth °f Eur°pe' in northern Africa> Asi* M^or, and in many of the more temperate regions of the tropics. It is largely wfoW ]\Spam' Port„gal'Ita1^ S-ily, and southern France ;U nfS™ * ' occasionally, fostered and protected in our own gar- dens The lemons that are used in England are imported chiefly from Spain, Portugal, Italy, and the Azores; those^sed in this I^onTlT1117 ^ the WeSt IndieS and the Mediterranean maticTttSr fliM Vra?r ■* Wel known o^ur, and a warm, aro- and odour It u\drymS> lM°SeS a §°0d a deal of its w^mth mil^ °r dlstlllation an essential oil, n LLLtl L1VIU MS, which is obtained on the lame sralp w ™t w +vJ apothecary, and is, therefore, placed in th/ Mater a' M dl lilt o the Pharmacopoeia of the United States ivxeaica list oi The virtues of lemon peel are yielded to water and to alcohol. AURANTII CORTEX. 457 Lemon peel is indebted to its essential oil for its excitant virtues. It forms an agreeable adjunct to excitant or tonic infusions, but is rarely given alone. It enters into the composition of the Infusum Aurantii of the Edinburgh and Dublin Pharmacopceias, and of the Infusum Gentiana Compositum of the Dublin and London Pharma- copoeias. O'LEUM LIMO'NIS, OIL OF LEMONS. This, as remarked above, is obtained either by expression or distillation. In the former process, the rind is grated from the fruit, and then expressed in hair sacks. The oil is suffered to remain at rest until it deposits some of its impurities, after which it is decanted and filtered. Thus obtained, it is turbid, and, owing to its containing mucilaginous matter, does not keep so well as that obtained by distillation, but its flavour is said to be more plea- sant and sweet. It possesses, in a high degree, the flavour of the fruit. It is of a pale yellow colour, and is said to be sometimes adulterated with fixed oil, and with alcohol. The former adultera- tion can be detected, as in the case of volatile oils in general, by its leaving a stain on paper, when dropped on it and evaporated by a gentle heat: the latter is known by agitation with water pro- ducing milkiness. Oil of lemons has the same excitant properties as other volatile oils ; and, like them, may be given as a carminative dropped on sugar, or rubbed up with it. It is generally, however, used as a perfume to cover the objectionable odour of other substances. Its employment in certain cases of conjunctivitis has been referred to in an early part of this volume. Oil of lemons is a constituent of the Unguentum Veratri albi of the Pharmacopoeia of the United States. 20. O'leum Berga'mii, Oil of Bergamot' — the volatile oil of the rind of the fruit of Citrus Limet'ta, Citrus Limetta Berga'mium^ Citrus Berga'mia, or Bergamot Citrus, which is cultivated in the south of Europe — is in the Materia Medica list of the Pharmacopoeia of the United States. It is imported from the south of Europe. It is only used as a scent to cover nauseous substances; and, with this view, it is made to form part of the Unguentum Sulphuris compositum of the Pharmacopoeia of the United States. 21. AURAN'TII CORTEX.—ORANGE PEEL. Orange peel is the outer rind of the fruit of Citrus vulga'ris, Bigarade or Bitter Orange Tree ; and of Citrus Auran'tium, Com- mon or Sweet Orange Tree; Sex. Syst. Polyadelphia Icosandria; Nat. Ord. Aurantiacese. The orange is a native of Asia. It grows wild in various parts of northern Africa and Eastern Asia, and is cultivated in the warmer parts of the globe almost every where. In the southern portions of the United States, it is extensively cul- vol. i.—39 458 special excitants. tivated, but the fruit is chiefly brought from the West Indies, the Western Isles, and the south of Fig. 71. Europe. Various parts of the orange tree, besides the peel of the fruit, are used in medicine. The leaves have a slightly bitter taste, and are aromatic and tonic. They contain a volatile oil, which is obtained by distillation, and constitutes the Essence de Petit Grain, of the French Pharmaciens. The flowers have an agreeable odour, depend- ent upon essential oil — which has been termed Neroli Oil; 550 pounds of the flowers yielding about an ounce. It is used altogether in perfumery. The distilled water of the flowers, called Orange-flower Water, is much prescribed by the French as a nervine. The immature oranges, which fall off, are aromatic and bitter, and are used for flavouring curacoa; hence they are called Curagoa Oranges. When smoothed by a lathe, they form the best issue peas of the shops. The rind of the fruit, like that of the lemon, yields a volatile oil, which resembles, in odour, the rind itself; but it is directed to be separated by distillation by many of the colleges. Orange peel possesses similar properties to lemon peel, and is applicable to the same cases. It is an aromatic excitant, and is prescribed as an adjunct to tonic and excitant infusions, chiefly with the view of communicating flavour to them. The bark of the bitter, or Seville orange, is to be preferred where it is advised as a tonic adjunct or adjuvant. It is never, perhaps, given in substance. CONFECTIO AURANTII, CONFECTION OF ORANGE PEEL. (Aurant,. cort. recent. [separated by grating] foj ; Sacchar. ffeiij.) This confection is not much used. It possesses the aromatic virtues of orange peel, and may be employed as a vehicle for bitter powders, or for some of the preparations of iron, as the subcarbonate. SYRUPUS AURAN TH COR TICIS, SYRUP OF ORANGE PEEL. (Aurant. cort. contus. |ij; Aquabullient. Oj ; Sacchar. ifeiiss.) This syrup is chiefly employed to give an agreeable flavour to excitant and tonic infusions: f. 5iij of it may be added to f. Jvi of any of these. It enters into the composition of the Confectio oromatica of the Pharmacopoeia of the United States. 22. CAM'PHORA. —CAMPHOR. Camphor is a peculiar concrete substance, derived from Laurus CAMPH0RA. 459 Cam'phora, and purified by sublimation. It is not properly an essential oil, and yet it agrees in many of F- 72 its properties with it. It differs, how- ever, in its solidity at ordinary temperatures, and in its not being converted into resin by the oxygen of the air, or by nitric acid. Laurus Cam'phora—Sex. Svst. Enne- andria Monogynia, Nat. Ord. Lauraceae— is a native of China, Japan and Cochin China, and is said to have been introduced from Japan into Java. In China, it is af- firmed, the chopped branches are steeped in water, and afterwards boiled, until the camphor begins to adhere to the stick used in stirring. The liquid is then strained, and, on standing, the camphor concretes: alternate layers of finely powdered earth, and of this crude camphor, are then placed in a copper basin, to which another, inverted, is luted. Heat is now applied and the camphor sublimes. In Japan, the process is somewhat different; the roots and wood are chopped up, and boiled with water, in an iron vessel, to which an earthen head containing straw is adapted. On the application of heat, the camphor sublimes and condenses on the straw. Two kinds of crude camphor occur in commerce, one called tub camphor, from being imported in tubs. It comes from Batavia, but is said to be the produce of Japan ; it is, also, called Dutch camphor, and Japan camphor. The other kind — common crude camphor, China camphor, Formosa camphor, is imported from India, in square chests. It is chiefly produced in the island of Formosa. This crude camphor is in small grains, or granular masses, of a dirty white colour, but is never found in the shops. It is refined by sublimation. Formerly, all the refined camphor was obtained from abroad ; but now the pro- cess is effected on a large scale in this country, and the camphor is considered equal to any that was formerly imported. The crude camphor is mixed with a small proportion of quicklime, and exposed, in a glass or earthenware vessel, in a sand-bath, to a gradually in- creased heat, by which it is melted, and ultimately converted into vapour which is condensed in a suitable vessel. (Wood & Bache.) The refined camphor of the shops has the form of the vessel in which the sublimation has been accomplished, and is, therefore, generally in the form of large hemispherical cakes; convex on one side, concave on the other, and perforated in the centre. It is of a white colour, semi-pellucid, brittle yet easily pulverisable, and of a crystalline texture. Its odour is strong, peculiar, and fragrant; taste bitterish and aromatic, accompanied by a sensation of coldness. It evaporates in the air at ordinary temperatures; and in closed vessels, as in the bottles in the shop of the apothecary, which are exposed to light, it evaporates, and crystallises on the sides. It is 460 SPECIAL EXCITANTS. soluble to a slight extent only in water; but is soluble in alcohol, ether, the oils, both fixed and volatile, &c. If water be added to the solution in alcohol, the camphor is immediately precipitated. Its specific gravity is 0.9857. There are few articles of the Materia Medica, regarding the effects of which on the animal economy there has been greater diversity of sentiment. In respect, however, to its excitant action in certain doses, there is but little disagreement; and it is this action only, that has to be considered here. When it is applied endermically, it excites pain, and if held in the mouth occasions heat, redness and other signs of hypersemia in the mucous membrane of the mouth; and when swallowed in substance, the sensations experienced in the epigastric region are similar to those induced by the essential oils in general. It is asserted by some, that depression has preceded the excitation induced by it; but although the author has administered it in nume- rous cases with the view of carefully observing its effects, he has never witnessed this preceding sedation. In regard to its deleteri- ous effects on the nervous system when taken in large doses, and the discordant views in relation thereto, opportunity may be afforded to treat in another place. It may be remarked here, that whilst strangury has been ascribed to it by some ; it is the main remedy on which many others depend in cases of strangury, — in that especially which is induced by can- tharides. The author has neither observed the influence of camphor in one case nor in the other. He is not disposed to place much value upon it as an excitant in those cases in which it has been so much extolled by many. It is chiefly in adynamic and long pro- tracted fevers that it has been prescribed ; but almost always associ- ated with some other agent, as with opium, where the object has been to allay restlessness and irritation, and, at the same time, to induce — as it has been conceived—some tendency towards the skin;—or with carbonate of ammonia, where the prostration has been more considerable. In none of these cases, perhaps, does the practitioner look solely to the excitant agency of the camphor; but rather to that narcotic influence which has been ascribed to it by some. Whatever properties it has appeared to possess as a diaphoretic— and the belief in which has led to its use in other diseases, as chro- nic rheumatism, gout, &c. — have been probably owing to its gently excitant agency ; but farther reference has been made to this subject under another head. Of old, camphor was esteemed to be possessed of antaphrodisiac properties, and many of the modeHis have ascribed to it the same. Esquirol is stated to have cured by it hysteric nymphomania ; and F. Le Gros affirms, that he found it the most active remedy he could use for blennorrhagic erections and chordee. As an antaphrodisiac the author has had no experience with it. CAMPHORA. 461 Wonderful virtues have been ascribed to it of late by M. Ras- pail — a fanciful therapeutist — who, for years, has been in the habit of smoking and inhaling it under the form of cigar, both day and night. He also placed under his bolster a certain quantity of purified camphor; in consequence of which, he says, his nights, in- stead of being agitated, were passed in calm and uninterrupted sleep. Whenever he awakes he chews from three to four grains at least, which he afterwards swallows with a little water. In the course of the night the quantity sometimes amounts to as much as 12 grains. In the day time, he takes a similar dose ; and em- ploys frictions with camphorated spirit on rising and going to bed, or whenever he experiences the least lassitude of spirit or the slightest exhaustion of body. " Under this treatment," he says, "I have — so to speak — shed the old skin of disease. I have grown young again in physical and moral strength. I am more disposed to la- bour, and am less inconvenienced than ever by it." Raspail's ciga- rettes have been much used, but it need hardly be said with no such advantages as he has experienced. Camphor forms part of many of the officinal and other liniments, of different pharmacopoeias and formularies, as well as of those of do- mestic use. In such cases, it is usually combined with other excitants. The medium dose of camphor, in substance, is generally stated at from five to ten grains ; which may be given rubbed up with sugar, or — what is preferable—in the form of pill. An objection has been urged against the pilular form— that as, in this state, the cam- phor is with difficulty dissolved in the gastric fluids, it may float on the top, and be apt to excite nausea, or pain and uneasiness at the upper orifice of the stomach. (Wood & Bache). The author has never witnessed any of these results, which probably occurred, in the cases where they have been met with, in consequence of the dose having been large. At the same time, with the opinion, which he possesses of the value of camphor as an excitant, he is disposed to place as much reliance on an ordinary dose of the Aqua cam- phora of the pharmacopceia, which contains a very small amount of camphor, as on a larger dose administered in pill or powder. As an antaphrodisiac it has been given in the dose of a drachm. AOJJA CAMPHORS, CAMPHOR WATER. (Camphor. 5 ij; Alcohol, r^xl; Mag. nesia carbonat. 3J ; Aqua destillat. Oij.) The alcohol is added to break down the cohesion of the camphor, and the carbonate of mag- nesia facilitates its solution. Each fluidounce of the water is com- puted to contain three grains of camphor. The usual dose is from f. §ss to f. 5), and more. TINCTU'RA CAM'PHORJ, TINCTURE OF CAMPHOR. (Camphor. 5V ; Alco- hol. Oij.) This is the " camphorated spirit of wine," of the older pharmacopoeias. It is rarely given internally. If desirable, how- ever from 10 to 60 drops may be rubbed up with sugar, and water be added to make a draught. Should the water be added without 39 * 462 SPECIAL EXCITANTS. this precaution, the greater part of the camphor would be separated. Water must, consequently, be regarded as an incompatible. Tincture of camphor is generally employed as an excitant lini- ment in sprains and bruises, in cases of deep-seated pains, of a rheumatic or neuralgic kind, in which it is desirable to excite revulsion on the surface ; and to modify the nutritive actions of a part, as in cases of tumours. LINIMENTUM CAMP'HORJ], CAMPHOR LINIMENT. (Camphor. |ss; OH oliva, f. ^ij.) LINIMEN TUM SAPONIS CAPIIORA'TUM, CAMPHORATED SOAP LINIMENT, OPO- DELDOC. (Sapon. vulgar. |iij; Camphor. 3J; 01. rosmarin., 01. origan, aa f. jj ; Alcohol. Oj.) TINCTU'RA SAPONIS CAMPIIORA'TA, CAMPH'ORATED TINCTURE OF SOAP, Soap Liniment. (Sapon. in rasur. 31V; Camphor. 3ij ; 01. rosma- rin. f. ^ss; Alcohol. Oij.) These various liniments are employed under the same circum- stances as the Tinctura camphorae.. They are better adapted, how- ever, for prolonged friction, by reason of the admixture of soap, or oil, or both; and, consequently, are generally prescribed where the object is to discuss tumours ; or to occasion the taking up of any solid or fluid deposition. Camphor forms part of the Tinctura Opii Camphorata of the Phar- macopoeia of the United States. 23. CANEL'LA. Canella is the bark of Canella alba, Laurel-leaved Canella, or Wild Cin'namon ; Sex. Syst. Dodecandria Monogynia ; Nat. Ord. Meliaceao ; — Guttiferse (Jussieu), a tree, from ten to fifty feet high, which is indigenous in the West India Islands, and the neighbour- ing continent of America. Canella of the shops is the inner bark of the stem and branches, occurring in quills, but sometimes in flat pieces of considerable size. It is of a pale orange-yellow colour, and of an odour and taste in- termediate between those of cloves and cinnamon. It is confound- ed at times with Winter's Bark (q. v.), and hence has been called spurious Winter's Bark. It certainly resembles it in taste, but not much in appearance. When subjected to analysis, canella yields volatile oil, which is its active ingredient; a little bitter extractive, which communicates to it what tonic property it possesses; besides other matters of less importance. Alcohol extracts all its virtues. Canella possesses the ordinary excitant virtues of the aromatic barks, and may be prescribed in the dose of gr. x to 3ss. It is rarely, however, given alone ; but is added to cathartic and tonic agents, to act as a corrigent to the former, and an adjuvant to the latter. It enters into the composition of the Pulvis Aloes et Canella of the Pharmacopceia of the United States. CALAMUS. 463 24. WIN/TERA. — WINTER'S BARK. This article is in the secondary list of the Pharmacopoeia of the United States. It is the bark of Win'tera Aro- Fig> 73 mat'ica, Drymis Win'teri, Winter's Bark Tree ; Sex. Syst. Polyandria Tetragynia ; Nat. Ord. Magnoliaceae; an evergreen tree, which is in- digenous along the straits of Magellan, Chili, Peru, and New Grenada. The bark of the shops is in quills or rolled pieces; of a pale yellowish or dull reddish- gray colour externally, with red elliptical spots. Internally, it is of a reddish-brown colour ; whilst the inner surface of canella, with which it has been confounded, is of a pale co- Drymi3 Winteri- lour. Like canella its main constituent is volatile oil; but unlike it, it contains tannic acid and oxide of iron. Its medical virtues are essentially those of canella, than which it is much less used. Dose of the powder, gr. x to 3SS. 25. CAL'AMUS.— SWEET FLAG. Calamus, of the Pharmacopoeia of the United States, is the rhizoma of Ac'orus Ca'lamus ; Sex. Syst. Hexandria Monogynia; Nat. Ord. Aroidese ; — Acoraceae (Lindley) — an indigenous plant, which grows abundantly in this country, in low, damp places, and along the sides of ditches and streams, and flowers in May and June. It also grows abundantly in many parts of Europe and Asia. Theroots, as they are met with in the shops, are of various lengths, flattened, and of the breadth of the fingers ; they are of a yellowish- brown colour, and, on the under surface, there are numerous dark points, whence the roots arise: the texture of the rhizoma is spongy or corky, and the fracture short and rough. The odour is strong and rather fragrant; the taste aromatic, warm, and bitterish. On distillation with water, it yields an essen- tial oil — the oleum calami aromatici of the shops — on which its medical virtues essentially depend; but it is never used in medi- cine. It is said to be employed by the wholesale dealers in per- fumery, and to be bought by snuff-makers, with the view probably of scenting snuff". In addition to the essential oil, calamus has been found also to contain resin and extractive, the latter of which has an acrid and sweetish taste. Calamus is not much used in medicine ; it appears, however, to have risen in estimation with the framers of the Pharmacopceia of the United States, who, in the last edition, (1842), have ele- vated it from the secondary to the primary lisf. Its properties, being mainly dependent upon essential oil, its virtues are yielded to water ; and in the form of infusion, (Calam. 5j ; Aq. bullient. Oj : dose, a wine-glassful,) it may be given as a stomachic and carminative in atonic conditions of the digestive 464 SPECIAL EXCITANTS. organs, — but it does not seem to be possessed of any virtues, Fio., 74, not equally pos- sessed by the other articles of the class. A re- cent writer, Dr. Pereira, considers it to be especially serviceable in gouty subjects. The dose of the powder is from gj It need scarcely be repeated, that a decoction is ob- jectionable in every case, where the medical pro- perties are de- pendent wholly or in part on essen- tial oil. 26. PIMEN'TA.— PIMENTO. Pimento, All- spice, or Jama'ica Pepper, is the un- ripe berry of Myr- tus Pimen'ta, or Euge'nia Pi- men'ta ; Sex. Svst. Icosandria Monogynia; Nat. Ord. Myrtacese— a native of the West Indies, and particularly abundant in Jamaica, whence one of its names. It is a native likewise of Mexico and South America. WThenthe fruit has attained its full size, but is yet green, it is gathered and dried. The quantity on which duty was paid in England, in 1339, was, according to Dr. Pereira, 277,185 lbs. The taste of allspice, which is a familiar spice, is pungent, slightly astringent, and mixed, like the odour, which is aromatic and resembles a mixture of cinnamon, nutmeg and cloves. It imparts its flavour to water, and all its virtues to alcohol. The analysis of the berries by Bonastre furnishes a variety of consti- tuents, but those on which the medical properties are dependent are a volatile oil — separable into two oils, one lighter and the Acorus Calamus. PIPER. 465 other heavier than water; and a green oil or resinous matter, which has an acrid burning taste, and contributes to the activity of the pimento. Except in odour, the properties of the volatile oil appear to be almost identical with those of the oil of cloves. Pimento possesses the medical properties of the other spices. It is a warm aromatic excitant; — not often administered alone; but chiefly used as an adjunct to other medicines, to communicate fla- vour, or to correct griping or nauseous properties. It is in exten- sive use as a condiment. The dose of the powder is from 10 to 40 grains. O'LEUM PIMEN'TO, OIL OF PIMEN'TO, is obtained by submitting allspice, bruised, to distillation with water. The allspice, according to Dr. Pereira, yields about 1.37 per cent, of oil — heavy and light toge- ther. Its colour is reddish-brown ; its odour very fragrant, and both that and the taste are those of the pimento, but in an increased de- gree. Its specific gravity is greater than that of water, averaging 1.021. It is employed medicinally in the same cases as the other aroma- tics and volatile oils. Dose from rt\ij to ^x. Aqua Pimenta may be formed with the oil in the same manner as Aqua Cinnamomi (q. v.) SPIR'ITUS PIMEN'TJ, SPIRIT OF PIMEN'TO. (Piment. cont. gij; Alcohol. dilut. cong.; Aqua, Oj ; distil a gallon.) It has the same medical qualities as the ordinary aromatic spirits. Dose, f. 3j to f. 5iij. 27. PIPER.—BLACK PEPPER. The berries of black pepper — Piper nigrum — Sex. Syst. Diandria Trigynia ; Nat. Ord. Piperacese, Fi(r 75 (Kunth) — are the only officinal pepper in the Pharmacopceia of the United States. They possess, however, all the virtues of the class. The plant is cultivated in va- rious parts of India, and the Islands, and likewise in the West Indies ; but Europe and America derive their main supplies from Sumatra and Java. In 1840, the quantity which paid duty on importation into England was, according to Dr. Pe- reira, 2,271,174 lbs. pu™ n.,™.. The berries are gathered before they are perfectly ripe; and, on being dried, become black and wrinkled ; but this applies only to the outer surface ; which, when removed, leaves the white pepper- piper album, which is a more delicate spice, not containing the same proportion of active ingredient. Pepper-corns are of the size of small peas, have an aromatic odour, and a fiery, pungent taste, which is dependent upon essential oil. Accordingly, their virtues are yielded to alcohol, and — in a less Aecrree —°to water. On analysis, they have been found to yield, o 466 SPECIAL EXCITANTS. 1. Resin of Pepper, a very acrid substance, possessing in a great degree the acrid properties of the peppers, soluble in alcohol and ether, but not in volatile oils. 2. Volatile Oil of Pepper — having the odour and taste of pepper. 3. Piperin, found in all the peppers, and described under the head of Tonics. The medical properties of pepper are essentially those of capsicum, than which it is less acrid. Like it, it is extensively used as a con- diment. In atonic conditions of the stomach, as in the gouty, it is occasionally given to check nausea, or to remove flatulence, but it is not often prescribed — partly, perhaps, owing to familiarity with it as a condiment constantly on the table having prevented it from receiving as much attention as it otherwise might have done. It has been prescribed occasionally in place of cubebs in gonorrhoea, and the other mucous inflammations for which the latter remedy has been advised. A watery infusion has been found serviceable in relaxed sore throat, and it has occasionally been, employed as an excitant in pa- ralysis of the tongue. Formed into an ointment, it has been used in tinea capitis, and with this view an Unguentum Piperis Nigri, (Adipis, ffvj ; Piper, nigr. in pulv. 3iv.) is officinal in the Dublin Pharmacopoeia, but it has to be employed with caution, and is scarcely ever used on this side the Atlantic. The dose of black pepper is from gr. v. to gr. xv. It may be ad- ministered either in the berry or in powder. In the latter case, it may be made into pills. A nostrum, called Ward's Paste, acquired much celebrity in piles, fistulse, and chronic affections of the rectum ; and, in consequence, a substitute was introduced into the British Colleges under the name Confectio Piperis nigri. It has received high testimony in its favour, and would seem to have been beneficial in diseases of the lower part of the bowels, in which an excitant is indicated. Sir Benjamin Brodie asserts, that it has sometimes proved successful in severe cases of piles, by mixing with the faeces, and coming in con- tact with the diseased parts. It consists of black pepper, elecam- pane root, fennel seed, honey, and sugar. 28. CAP'SICUM. —CAYEN'NE PEPPER. Cayenne Pepper is the fruit of Cap'sicum an'nuum ; Sex. Syst. Pentandria Monogynia; Nat. ORD.Solanese; — Solanaceae,(Lindley,) — a native of the warmer regions of Asia and America, and^exten- sively cultivated in Europe and this country. The recent fruit, called Chillies, is sold for pickling; and the dried fruit of the drug- gists bears the same name. There are different varieties of capsicum, which produce a fruit varying in shape ; but the oblong varieties are those that are chiefly used medicinally. The fruit, when perfectly ripe, dried, and re- duced to powder, forms red pepper or Cayenne pepper. The odour of capsicum is aromatic and pungent; the taste very CAPSICUM. 467 biting, hot, and aromatic. Its virtues, which have been considered to be dependent upon a peculiar principle, called capsicin, are yielded to ether, alcohol and water. The following is the analysis of Bra- connot: —Acrid oil, (capsicin,) 1.9 ; wax, with red colouring mat- ter, 0.9 ; brownish starchy matter, 9.0 ; peculiar gum, 6.0 ; animal- ised matter, 5.9 ; woody fibre, 67.8 ; salts, (citrate of potassa, 6.0 ; phosphate of potassa, and chloride of potassium, 3.4 ;) — 9.4. — Total, 100. The action of capsicum, taken internally, is excitant; and when applied to any portion of the cutaneous surface, it is rubefacient, and, consequently, revellent. If taken in an overdose, it may cause in- flammation of the stomach; but it is not easy to conceive, that a sufficient quantity to produce this effect could be readily taken, in consequence of its acrid action upon the mouth. It is a well known condiment; and, in the East Indies, is used in very large quantities, without any disagreeable results. A friend of the author has seen one, who had resided for a long time in Hindusthan, eat it upon bread and butter — the layer of the pepper being as thick as that of the latter. In those climes, the effect of the elevated temperature has an injurious influence on the function of innervation ; digestion is accordingly imperfectly performed, and excitant condiments are greatly indulged in. Capsicum is not often administered as a general excitant; but it is highly appropriate, wherever there is defective impressibility of the stomach. In cases of malignant cholera, and in the low stages of fever, it is occasionally prescribed by some; but it is more fre- quently employed in asthenic dyspepsia—as in that, which occurs in atonic gout, or in the habitual drunkard. It has, also, been pre- scribed in paralytic and lethargic cases; but the internal use of excitants must be used in such cases with caution, — for fear, that the pathological condition, which is usually hemorrhage into the encephalon, or vascular hypersemia, should be augmented by it. It has likewise been advised as an adjunct to sulphate of quinia in intermittents, in which there is great want of gastric impressibility. It is most commonly, however, used as a local excitant, especially in cases of malignant or sluggish sore throat; and its good effects in scarlatina maligna have been deposed to by many excellent observers. The author has occasionally seen asthenic or sluggish sore-throat aggravated by it; but, at other times, benefit has resulted. In cynanche maligna — including in the term the cynanche of scarlatina maligna — it is given by some internally at the same time. The following form is one that is often used as a gargle. (Capsic. in pulv. 3j; Sodii chlorid. gj ; Aceti, f. §ss ; Aqua ferventis, f. ^yj. Infunde et cola.) In relaxed conditions of the throat or uvula, it may be applied also in the form of tincture by means of a camel's hair pencil. As a rubefacient, capsicum is used wherever cutaneous revellents are considered to be indicated, — as in the delirium or coma of 468 special excitants. fever; but in such cases sinapisms are generally preferred. It may be made into a cataplasm in the same manner as mustard and be applied to the lower extremities; or it may be mixed with heated spirit, and used as a lotion. In similar cases, as well as when the circulation does not go on actively in the lower limbs, as shown by cold feet, woollen socks may be dusted with the powder. In neu- ralgic pains, the same applications are often beneficial; and in the cold stage of cholera, where frictions were indicated, the cayenne pepper was often added to the ointments used for this purpose. It formed a common adjunct to the Unguentum hydrargyri. The capsicum cataplasm is not so apt to vesicate as the sinapism. The dose of capsicum powder is from three grains to ten, which may be made into pills with crumb of bread; or—especially in cases of atony of the stomach — with extract of gentian. (Pulv. capsic, Ext. gentian., aa 9J ; Aqua, q. s.; ut fiant pilulse xij. Each pill will contain about two grains of capsicum.) In cases of cynanche, the gargle before recommended may be used, or a simple infusion of capsicum. (Capsic. in pulv. 3ss; Aqua ferventis, Oj); or a mixture of the tincture of capsicum and water. (Tinctura capsici, f. ^ss; Aqua, f. §viij.) TINCTU'RA CAPSICI, TINCTURE OF CAYENNE PEPPER. (Capsic. 3J; Alcohol. dilut. Oij.) The dose of the tincture of cayenne pepper is from m„x to f. 3j or more, in the cases before mentioned. It is likewise em- ployed occasionally to cover the taste of oil of turpentine, as well as to prevent the nausea which the oil might induce; and is sometimes used as a rubefacient, when evaporated to the consistence of an extract, and spread over the part. 29. CUBEB'A.— CUBEBS. Cubebs are the berries of Piper cubeb'a; Sex. Syst. Diandria Trigynia; Nat. Ord. Piperacese. This species of pepper is a native of Java and Prince of Wales Island, but flourishes, also, in India and Guinea. It is the dried unripe fruit. It resembles black pepper, except that it is lighter coloured, and each pepper-corn is furnished with a short stalk, which has given it the name Piper cauda'tum. Within the hard shell is a spherical seed, which is whitish internally, and oily. The odour of cubebs is aromatic; the taste pungent like pepper, and camphoraceous. The active ingredient of cubebs is the volatile oil, — O'LEUM CUBEB'.E — which is separated by distillation, is officinal in the Pharmaco- poeia of the United States, and is regarded by some as the best and most convenient preparation of cubebs. (Pereira.) The analysis of cubebs by Monheim afforded the following results — green volatile oil, 2.5; yellow volatile oil, 1.0; cubebin, probably the same as piperin, 4.5; balsamic resin, 1.5; wax, 3.0; chloride of sodium, 1.0; extractive, 6.0; lignin, 65.0; loss, 15.5.— total, 100.00. CUBEBA. 469 The action of cubebs on the economy is, in many respects, like that of copaiba. It has also the general excitant properties of the peppers, but it is rarely administered except in disease of the genito-urinary mucous membrane, on which its action is like that of copaiba, probably through the operation of its essential oil, which is separated from it, passes into the mass of the blood, and is sepa- rated along with the urine by the kidney. Like copaiba too, in over- doses, it is apt to induce urticaria, and to excite inflammation of the gastro-enteric mucous membrane. In gonorrhoea, it is given under the same circumstances as copaiba ; and like that agent, in violent inflammatory cases, and in the early stages of ordinary cases, it may be injurious. There are numerous instances on record, in which unpleasant circumstances — as orchitis, and cystitis— have resulted from its improper administration. Many practitioners, however, give it in every stage of the disease. In gleet, and chronic inflammation in general of the mucous mem- brane of the urinary organs, its employment is more appropriate. It has been advised, also, in the gonorrhoea of the female, as well as in leucorrhoea ; but here its efficacy is more limited, aud some, in- deed, deny it to have any. It is affirmed, that in abscess of the prostate, benefit has resulted from the gentle stimulus it has afforded ; and, in hemorrhoids, its agency has been likewise found beneficial. In most respects, in- deed, its action resembles that of copaiba, (q. v.) In one respect, there would appear to be a difference between them. Copaiba is said to have induced chronic rheumatism, whereas, cubeba has been administered in that disease, and, it is said, advantageously. Cubeba is commonly prescribed in gonorrhoea in powder, and in doses of one, two, and even four drachms, repeated once or oftener in the day. In affections of the bladder and prostate, the dose is generally less,—from .ten to thirty grains. Electuaries, lozenges, and boluses, have likewise been prepared with it; but there seems to be no great advantage in these formulae. In consequence of the gastric irritation sometimes produced by it, it has been proposed, that, like copaiba, it should be given in enema, to the amount of one or two drachms or more of the powder, suspended in five or six ounces of an oleaginous mixture. It is advisable to keep the bowels open during its use, for when hardened fseces are permitted to accumulate, the spice, according to Dr. Paris, insinuates itself into the mass, and occasions excoriations of the rectum. TINCTU'RA CUBEB'iE TINCTURE OF CUBEBS. (Cubeb. contus. §iv ; Alcohol. dilut. Oij. It may also be made by the process of displacement.) The dose of this tincture is one or two fluidrachms. It is occasion- ally, though rarely, used as a carminative; but it is not unfrequently employed in gonorrhea. The volatile oil —OLEUM CUBEB'JK — is likewise much used by vol. i.—40 470 SPECIAL EXCITANTS. many practitioners in the same disease. Its dose is 10 or 12 drops, suspended in water by means of mucilage, or dropped on sugar. On the continent of Europe, an oleo-resinous extract of cubebs, — prepared by adding the oil to the resinous extract of cubebs, which is made by digesting the cake left after the distillation of the oil in alcohol, and distilling off the spirit — is occasionally used in gonor- rhoea ; as well as an ethereal hydro-alcoholic extract of cubebs; but they do not seem to be preferable to the preparations already indicated. 30. SINA'PIS. —MUSTARD. Mustard is a well-known acrid stimulant, used as a condiment to facilitate the digestion of other substances, but rarely employed in- ternally as a therapeutical agent. It is chiefly used in the form of cataplasm as a revellent; and frequently as an excitant to the wrists ankles, or epigastrium, where the powers of the system are much prostrated, as in adynamic fevers, and other diseases of a simi- lar character, in which it is greatly preferable to blisters ; as the latter abstract from the system a quantity of serum, which can scarcely fail to antagonise the good effects, that might follow from the exci- tation. Occasionally, too, mustard is added to pediluvia, to render them more excitant. The mode of formation and application of the cataplasm is given elsewhere. (See Revellents.) When it is desired to exhibit mustard internally as an excitant, mustard whey may be given, which is prepared by boiling half an ounce of the bruised seeds or powder in a pint of milk, and strain- ing. The dose is f. ^iv., two or three times a day. The volatile oil— Oleum Sinapis — has been occasionally used as a local excitant; but more frequently as a rubefacient and vesicant. 31. ZIN'GIBER —GINGER. The rhizoma of Zin''giber officina'le, Amo'mum Zingiber or narrow- leaved Ginger ; Sex. Syst. Monandria Monogynia ; Nat. Ord. Zin- giberacese (Lindley), is officinal in the various pharmacopceias of Great Britain and of this country. Its native soil is doubtful, — supposed to be Asia ; but it is now cultivated in most tropical re- gions throughout the globe. The young shoots put forth in the spring are used in the preparation of the well-known preserve — preserved Ginger. At the end of the year, or beginning of the next, when the herb has withered, and before the root becomes too woody, the rhizoma is in the fittest state for yielding the ginger of the shops ; which is prepared by picking and cleaning the rhizomes, and then either scalding them in boiling water, and drying them with artificial heat, or by peeling and drying them in the sunshine without immer- sion m hot water. In the former mode, Black Ginger is said to be obtained ; in the latter White Ginger. Dr. Pereira, however, thinks, that this mode of preparation is insufficient to account for the dif- ference between the black and the white ginge-, and is disposed to suspect the existence of some difference in the plants themselves. When imported into England, the common kinds are bleached by ZINGIBER. 471 washing them in a solution of chlorinated lime, and, sometimes, by exposing them to the fumes of burning sulphur, — processes which, as remarked by Dr. Pereira, cannot fail to injure the aromatic. Black ginger is imported into this country almost exclusively from Calcutta, and is called by the druggists East India ginger : white ginger is imported from England, where it is said to undergo some preparation. It is generally termed Jamaica ginger, and is the more prized. (Wood & Bache.) In England, the quantity of ginger on which duty was paid, in the year 1840, was, according to Dr. Pereira, 9,063 cwt. ; of which 7,528 cwt. were imported from the British West Indies ; and 1,535 from the East Indies. Black ginger, as found in the shops, has a wrinkled epidermis, and is of a dirty grayish-brown colour externally. The outer portion is horny ; the centre of a whitish colour, and somewhat farinaceous. White ginger is destitute of the epidermis; of a pale grayish-yellow colour, and of a more farinaceous texture. When subjected to analysis, ginger has afforded, as main consti- tuents, a volatile oil, and a soft resin. Its starch has been separated, of fine quality, and perfectly white, to the amount of more than 25 per cent., by the ordinary process of procuring arrow-root. Ginger is one of the most prized of the aromatics, and as such is used as a condiment. It is rarely given alone, except in domestic practice, when it is often taken in the form of ginger tea, in tormina, and in gastric and intestinal flatulency. Therapeutically, it is more frequently used than any other aromatic, as a corrigent to sub- stances which are apt to excite nausea, gastrodynia or tormina. It is occasionally used as a collutory and gargle in relaxation of the uvula, and in relaxed sore throat ; and, at times, is applied as an excitant and rubefacient to the skin ; but it is inferior to mustard, and is, therefore, rarely applied. The dose of the powder, as an excitant, is from gr. x to gr. xx, or more. The infusion — ginger tea—maybe made of from 31J to 3iv of ginger to Oss of boiling water ; sweetened, and taken in doses of one or two table-spoonfuls. TINCTU'RA ZINGIBERS, TINCTURE OF GINGER. (Zingib. contus. gviij; Al- cohol. Oij, — prepared by maceration or by displacement.) Tincture of ginger is an excellent carminative. It is rarely, however, given alone ; but is an excellent adjunct to tonic and cathartic mixtures. It is chiefly used in the preparation of the SYRUPUS ZINGIB ERIS, SYRUP OF GINGER. (Tinct. Zingib. f. |iv; Syrup, cong.) A syrup may also be made extemporaneously by mix- ing tincture of ginger with simple syrup. It is added to tonic and cathartic mixtures to prevent flatulence, and give flavour. It is much used, likewise, as an addition to the common soda water as drunk at the fountain. Ginger enters into the composition of the Acidum Sulphuricum aromaticum the Pulvis aromaticus, the Tinctura Cinnamomi com- posita and the Vinum Aloes of the Pharmacopoeia of the United States. 472 SPECIAL EXCITANTS. 32. ARMORA'CIA. — HORSE'RADISH. Horseradish whose general properties have been described else- where (p. 263) —is a well known excitant condiment, when fresh ; and is adapted therefore to act as an internal, as well as an external excitant: it is likewise, to a certain extent, diuretic ; but it is rarely employed in medicine ; and Dr. Christison has remarked that " on the whole, it might be expunged from the pharmacopceias with little inconvenience." The dose, as an excitant, when scraped into shreds, is 3ss or more. The Pharmacopceia of the United States has an lNFU'SUM ARMORA'CIJ, INFUSION OF HORSE-RADISH. (Armorac. incis., Sinapis, contus. aa ^j ; Aq. bullient. Oj.) The infusion is rarely pre- scribed. It has been advised in chronic rheumatism, paralysis, and in dropsies of an asthenic kind. The dose is f. ^ss to f. ^ij, two or three times a day. 33. TEREBIN'THINA. — TUR'PENTINE. The term turpentine is usually given to vegetable juices, liquid or concrete, which consist of resin, and a peculiar volatile oil, sepa- rable by distillation, called Oil of Turpentine. The only turpentines, that are officinal in the Pharmacopceia of the United States, are TEREBIN THINA, TUR'PENTINE, the juice of Pinus Palustris, Long-leaved Pine, Yellow Pine, Pitch Pine, Swamp Pine, and other species of Pinus. Sex. Syst. Monoecia Monadelphia ; Nat. Ord. Coniferse ; and TEREBIN'THINA, CANADENSIS; Can'ada Tur'- pentine, Canada Balsam, or Balsam of Fir, the juice of A'bies Bal- same'a, Cana'dian Balsam Fir, Balm of Gilead Fir, Amer'ican Silver Fir. 1. TEREBIN'THINA, of the Pharmacopceia of the United States, American, or White Turpentine — the juice of Pinus Palustris chiefly, is not identical with the common European turpentine, which is the pro- duce of Pinus Sylves'tris, Wild Pine, or Scotch Fir. It is chiefly obtained from Virginia and North Carolina, and is procured as follows. In the winter months, holes are made in the trunk of the tree, three or four inches from the ground, which are capable of holding two or three pints, or more, into which, in the spring, the juice begins to flow, and continues through the summer and autumn. The juice is removed from these holes as they fill, and is transferred into casks, in which it acquires the consistence of a soft solid. The quantity of raw turpentine used by the turpentine distillers of Wilmington, N. C, alone, is astonishing It is stated in the North Carolina Chronicle' published in that town, that there are three establishments, which work up about 200 barrels a day, making between 62,000 and 63,000 barrels per annum. 75,000 or 80,000 barrels, it was ex- pected, would be used in the year 1843. Besides, nearly 100,000 barrels were shipped from Wilmington in the year ending the first of July, 1842. TEREBINTHINA. 473 Turpentine, procured as above, has the odour that is charac- teristic of all the terebinthinates ; a warm, pungent, bitterish taste, and a white colour tinged with yellow. Its consistence varies with the temperature. 2. TEREBIN'THINA CANADENSIS; or Can'ada Turpentine — the juice of A'bies Balsame'a — is collected in Canada and the State of Maine. Between the bark and the wood of the trunks and branches are vesi- cles, which contain the turpentine. This exudes when they are broken, and is received into a bottle. When fresh, it is of the con- sistence of thin honey, but, by time and exposure, it becomes more and more solid. It is yellow, transparent, very tenacious, possessing the terebinthinate odour in an agreeable form, and having the taste of those substances. In this country, it is usually brought to market in bottles, but it is exported to England in casks. In 1838, the quantity imported into England was, according to Dr. Pereira, 7259 pounds. Both these turpentines yield 17 or 18 per cent, of volatile oil on distillation. Besides these turpentines, which are officinal in this country, there are others — as 1, the Common Europe'an Turpentine—Tere- binth'ina Vulga'ris—which, as already remarked, is procured from Pinus Sylves'tris; 2. the Larch, or Venice Turpentine — Terebinth'- ina Ven'eta — obtained from Larix Europa'a, or Common Larch ; 3. The Chian, or Cyprus Turpentine — Terebinth'ina Chia seu Cyp'ria— obtained from Pista'cia Terebinth'us, or Tur'pentine Pis- ta'chia ; Sex. Syst. Dioecia Pentandria ; Nat. Ord. Terebinthacese ; 4. The Bourdeaux' Tur'pentine, from Pinus Pinas'ter, or P. Maril- ima, the Pinas'ter or Cluster Pine; 5. the Strasburg Turpentine, Terebinth'ina Argentoraten'sis, from A'bies Pice'a, or Silver Fir of Europe; 6. the Common Frankincense—Abie'tis Resi'na, Thus, from A'bies Commu'nis; 7. the Damar'ra Tur'pentine, from Pinus Damar'ra, which grows in the East India Islands ; and 8. the Dom- bey'a Turpentine, the produce of Dombey'a Excelsa, a native of Chili. All the terebinthinate oleo-resins resemble each other in smell and taste. They soften and become liquid by heat, readily take fire, and burn with a white flame, giving off much smoke, which, in a confined space, occasions a copious deposition of lampblack. They yield, by distillation, a large quantity of volatile oil, leaving a residuum con- sisting of resin. They are readily soluble in alcohol and ether, and unite with the fixed oils. Water extracts only a small portion of the volatile oil, but becomes largely impregnated with its flavour. All the terebinthinate preparations owe their medical properties to their volatile oil, which, like other volatile oils, is excitant, — occa- sioning, when swallowed, a sense of heat in the stomach, and, in large doses, nausea, and augmentation of the peristaltic action of the bowels. The essential oil is absorbed into the blood-vessels, operat- 40* 474 SPECIAL EXCITANTS. ing on the system as an excitant, and passing to the kidneys — partly changed and partly unchanged — where it is separated along with the urine—in small quantities increasing the secretion from those organs, and in larger, giving rise, at times, to nephritic symptoms, to hematuria, and to strangury. It is also exhaled from other secern- ing surfaces, as the skin and mucous membranes generally. Hence it is, that the turpentines have been administered in affections of the mucous membranes in general, and of the urinary organs in par- ticular. None of the turpentines are, however, much used, in consequence of their virtues being wholly possessed by the volatile oil, under which the diseases will be mentioned in which they are prescribed. The dose of the turpentines is from a scruple to a drachm. They may be made into pills with powdered liquorice ; into an emulsion with mucilage of gum arabic or yolk of egg, sugar, and mint water ; or into an electuary with honey or molasses. If the Bourdeaux turpentine be mixed with about one-twenty-eighth part of its weight of calcined magnesia, it solidifies in about twelve hours,— the acid resins combining with the magnesia, and forming solid resinates, which absorb the volatile oil. An emulsion of the turpentines may also be thrown into the rec- tum as an excitant injection, when it is advisable to induce catharsis and revulsion at the same time, as in comatose affections. The turpentines enter into the composition of certain plasters. a. O'LEUM TEREBIN'THINJ!, OIL OF TUR'PENTINE. This oil is prepared on the large scale, and is, consequently, not in the list of prepara- tions, but in that of the materia medica of the Pharmacopceia of the United States, as well as of those of Europe. All the turpentines yield it, but in this country it is prepared chiefly from Pinus Palus'- tris, which affords about 17 per cent., and from which it is distilled in large quantities in North Carolina, not only for home consumption, but for exportation. The residue in the still, after the distillation of the oil, is resin. In the British colleges, oil of turpentine is directed to be re- distilled ; but in this country, it can always be had sufficiently pure for medical use; so that the apothecary rarely has recourse to a hazard- ous process ; and, accordingly, no formula for its rectification is given in the Pharmacopoeia of the United States. Pure oil of turpentine is limpid and colourless, having a peculiar penetrating odour, and a hot, pungent, bitterish taste. Its specific gravity is about 0.86. It is highly volatile and inflammable ; less soluble in alcohol than most other volatile oils, and very slightly so in water, and in dilute or hydrated alcohol. It is readily soluble in sulphuric ether. Oil of turpentine is a powerful excitant, diuretic, anthelmintic and in large doses cathartic ; but its excitant properties alone fall under consideration here. In small doses — from a few drops to a drachm — it causes a feeling of warmth in the stomach ; is absorbed, OLEUM TEREBINTHINJE. 475 and passes off by the kidneys, and the different emunctories; so that the cutaneous and pulmonary transpirations have a marked terebin- thinate — and the urine a violet — odour, the latter supposed to be owing to a portion of the oil being decomposed. Owing to its excitant operation, it proves beneficial in chronic in- flammations of mucous membranes accompanied by discharges ; and, not unfrequently, even in small doses, causes hsematuria, and great irritation of the urinary organs. These effects are still more marked, when the dose is larger— from f. 3j, for example, to f. 3ij- In still larger doses, from f. 3ij to f. ^iss, and even more, it induces much concentration of action towards the abdominal viscera ; purging at times, and passing off freely by all the excretions, so as to impreg- nate the air of the chamber; — in some cases, disordering the en- cephalic functions, but not causing any permanent ill effects. It has been given to the extent of three ounces without injury. Oil of turpentine is used as an internal excitant in protracted fevers accompanied by typhoid symptoms, especially if, at the same time, there be meteorism or ulceration of the intestines. On most respect- able authority, that of Dr. Wood, of Philadelphia, it is affirmed that there is a particular state of fever, usually attended with much dan- ger, in which the remedy has been found uniformly successful: — this is in the latter stages of typhoid fevers, or lingering remittents, " in which the tongue, having begun to throw off its load of fur in patches, has suddenly ceased to clean itself, and become dry and brownish. The skin is at the same time dry, the bowels torpid and distended with flatus, and the patient sometimes affected with slight delirium. Under the use of small doses of turpentine, frequently repeated, the tongue becomes moist and again coated, the tympanitic state of the bowels disappears, and the patient goes on to recover as in a favourable case of fever." Dr. Wood is disposed to ascribe the effect to a healthy change produced by the oil on the ulcerated sur- face of the intestines; but the author has seen its excitant influence exhibited in similar cases, when there was no reason to believe in the presence of intestinal ulceration. In similar conditions in yellow, puerperal, and eruptive fevers, the internal use of the oil has been found beneficial. Like copaiba, oil of turpentine has been found serviceable in cases of chronic dysentery and diarrhoea; in chronic blenorrhoea and leu- corrhoea — less so, however, in the last affection, as has been shown to be the case with copaiba (q. v.), and in chronic inflammation of the bladder; but in the last disease its administration requires cau- tion, as it is apt — especially if the quantity be too great— to excite increased irritation. In chronic rheumatism, it has been more largely employed than any other remedy ; and in sciatica, and other neuralgic affections, the benefit obtained from it is often marked. It acts probably, in such cases as a revellent, by its excitant effect upon the kidneys and urinary apparatus in general. It is occasionally, but rarely, given as a carminative; the ordinary 476 SPECIAL EXCITANTS. essential oils appearing to be productive of as much service, whilst they are agreeable, and consequently are preferred. It can be readily seen, that its excitant action, like that of other essential oils, and local stimulants, may be invoked in many cases, where it is desirable to induce a revellent action, with the view of breaking in upon any diseased condition. Externally, oil of turpentine is employed extensively as a rubefa- cient. In protracted and typhoid fevers, it is applied hot or cold to the extremities; and in chronic rheumatism, paralysis, cynanche, puerperal peritonitis, and, whenever it is desirable to excite cuta- neous revulsion, it is constantly prescribed, either alone or associated with olive oil, which renders its action milder. In those cases of extensive burns and scalds, that are accompanied by much constitutional depression, oil of turpentine has been found a most valuable local excitant; as well as in gangrenous conditions in general, where the object is to restore the part from a state of sus- pended animation. Oil of turpentine is the principal ingredient in Whitehead's essence of mustard, which consists of it, camphor, and a portion of spirit of rosemary, to which is added a small quantity of flour of mustard. This is a celebrated rubefacient application in chronic rheumatism, neuralgia, &c. St. John Long's liniment, which acquired so much notoriety about twenty years ago, is said to have consisted of oil of turpentine and acetic acid, held in suspension by yolk of egg. United with olive oil, (01. terebinthin. 3J ; 01. oliva, 3V1J ;) and introduced into the meatus auditorius externus on cotton, it occa- sionally acts beneficially as an excitant, where there has been a de- ficient secretion of cerumen. Oil of turpentine is likewise administered in many cases, with marked advantage, in the form of enema. In amenorrhcea, its ex- citant influence has, in this way, been beneficial by contiguous sym- pathy. In fevers, accompanied by meteorism, it is often highly ser- viceable ; and in comatose affections, where it is desirable to induce a revellent action on the lower part of the intestinal canal. Its em- ployment in thisform has, however, fallen under consideration already, when treating of Cathartics. The ordinary dose of oleum terebinthinse, as an excitant in fever, or chronic catarrh of the mucous membranes, and in chronic rheu- matism, is from r^v to f. 3j ; but even in the smallest doses, it gives occasion, at times, to bloody urine, and to nephritic and vesical irri- tation. Some, however, administer it in those diseases to the extent off. 3Jtof. 3ij. It may be taken in molasses, or dropped on some aromatic water, to which a hot aromatic or bitter tincture has been added— as the tincture of capsicum or tincture of gentian — to conceal its taste. It is more commonly, however, given in emulsion, as in the following prescription : (01. terebinthin. f. 3J — £iij ; Vitell. ovi, seu Mucilag. acacia, f. ^iij ; Aqua mentha piperita, f. giv. M. Dose, a fourth part.) When given in enema, the quantity of the oil may be increased, RESINA. 477 and water may be substituted for the aqua menthae piperita?. A form for an enema of this kind — Enema Terebinthtxje — is officinal in the Pharmacopoeias of London, Edinburgh, and Dublin. LINIMENTUM TEREBIN TIIIN/E, LIN IMENT OF TUR'PENTINE. (01. terebin- thin. Oss ; Cerat. resin, fbj.) This was the liniment originally pro- posed by Kentish for the treatment of burns and scalds. It is spread upon lint, and kept on until the peculiar inflammation excited by the fire has been removed. It may then be continued, or milder dress- ings be substituted, as the case may seem to demand. It may, also, be applied in cases of gangrenous or sloughing ulcers, or wherever a topical application of the kind is needed. b. RESI'NA, RESIN or ROSIN. This is the residuum after the distilla- tion of the volatile oil from the turpentine of Pinus palustris, and other species of pinus. When the distillation is not carried too far, the resin contains a little water. This is the officinal article — Re- sina— of the Pharmacopoeia of the United States — the Resinaflava or yellow resin or rosin. If, in a state of fusion, it be strongly agi- tated with water, it acquires a distinct appearance, and is called Resina alba or white rosin. This, according to Christison, is the resin of pharmacy ; but it is not so in this country. A more con- tinued heat than that prepared in making the yellow rosin, expels the water, and produces transparent rosin ; and if the process be pushed as far as it can be, without producing a complete alteration of properties, the residue acquires a deeper colour, and is termed brown or black rosin, colophony, and fiddler's rosin. If melted rosin be run into cold water, contained in shallow tanks, and a supply of cold water be kept up until the rosin has solidified, a pale yellow product is obtained called Flockton'spatent rosin. (Pereira.) Resin and the resins in general are insoluble in water, but are dissolved by alcohol, ether, and the essential oils, — the solutions in alcohol and ether affording precipitates on the addition of water. They unite with wax and the fixed oils by fusion, and form soaps with the caustic alkalies. Yellow resin, as usually met with, is opaque, and of a yellow or yellowish white colour. White resin differs from the yellow in being opaque and whitish, — properties which are owing to the water with which it is incorporated, and which gradually escapes on exposure, leaving it more or less transparent. Resin is never given internally. Its main use is to form plasters and ointments, to which it is an excitant ingredient, and renders them more adhesive. CERA TUM RESIDE, RESIN CERATE, Basilicon ointment. (Resin, gv; Adipis Iviij ; Ceraflava, sij.) A mild excitant ointment, to in- dolent ulcers ; to blistered surfaces to keep up a discharge, and to ulcers which follow burns. CERV'TLM RESIXE COMPOS'ITUM, COMPOUND RESIN CERATE. (Resin., Sevi, Cera flava,™ Ibj ; Terebinth. Ibss ; 01. iini, Oss.) This ointment 478 SPECIAL EXCITANTS. is somewhat more excitant than the preceding. It is employed in some parts of the United States, under the name of Deshler s salve. 34. COPA'IBA. — COPA'IBA. The juice of Copaifera officinalis, and other species of copaifera, Sex. Syst. Decandria Monogynia; Nat. Ord. Leguminosse, natives of South America, is commonly known under the name Balsam of Copa'iva, or Copa'iva Balsam. It is obtained by making incisions into the stems of the trees, from which it flows copiously; and the incisions are repeated several times in the course of the season. It would seem to be collected in greatest quantity in the province of Para, in Brazil, and is imported into the United States almost wholly from the port of Para, in small casks or barrels. (Wood & Bache.) A considerable quantity, according to Dr. Pereira, is im- ported into England through New York. Copaiba is a yellowish transparent liquid, of the consistence of syrup or olive oil, and of a specific gravity varying from 0.950 to 1000 ; rarely, perhaps, as high as the latter, unless after long keeping. Its odour is peculiar, and taste somewhat pungent, bitterish and nauseous. It is not soluble in water, but is wholly so in alcohol, ether, and the fixed and volatile oils. With the alkalies it forms a soap, which is insoluble in water. The tests of its purity, as laid down by the Edinburgh College, the following; " transparent; free of turpentine odour when heated ; soluble in two parts of alcohol; it dissolves a fourth of its weight of carbonate of magnesia, with the aid of a gentle heat, and continues translucent." It is not, however, often adulterated in this country. The chief constituents of copaiba are volatile oil and resin. It contains no benzoic acid, and is, therefore, not properly a balsam, under the modern definition of the word. It more nearly resem- bles, in its chemical and medicinal properties, the turpentines. By distillation, a volatile oil—Oleum Copaib^e — is obtained from it, which is officinal in the Edinburgh Pharmacopoeia, and is pre- ferred by some, as a medicinal agent, to any other form of preparation. The quantity of volatile oil varies according to the specimen of copaiba, but the average produce has been estimated at from 40 to 45 per cent. (Pereira). After the oil has passed over, a resin of copaiba remains, which consists of two resins — one called Copa'- ivic acid, and the other Viscid resin of Copa'iva; but these last constituents are of no pharmacological interest. The following analyses are cited by Pereira : STOLZE'S ANALYSIS. GERBER'S ANALYSIS, Fresh Balsam. Old Balsam. Volatile oil, Yellow hard resin (Copaivic acid,) Brown soft resin, Water and loss, Balsam of Copaiba, 100.00 100.00 10O63 38.00 41.00 31.70 52.75 51.38 53.68 1.66 2.18 11.15 7.59 5.44 4.10 COPAIBA. 479 It is not many years since it was discovered, that if magnesia be triturated with copaiba, and the mixture be set aside, it will gradually assume such a consistence as to admit of being made into pills ; a formula for which is officinal in the Pharmacopoeia of the United States. The effect of copaiba on the human frame, like that of the oleo- resins — as the turpentines — is unquestionably excitant. It occa- sions, when swallowed, a sense of heat in the pharynx, oesophagus and stomach, giving rise to eructations of the characteristic flavour of copaiba, and in over doses, to nausea and vomiting. With some per- sons, indeed, the smallest quantity produces those effects, which is a strong objection to its administration in an uncombined form. It is also apt to induce a form of urticaria through sympathy with the gastro-enteric irritation which it occasions. This passes away however, when the copaiba is discontinued. The action of copaiba is not confined to the gastro-enteric mucous surfaces. It is presumed, by many, to affect, more or less, all the mu- cous surfaces, and, accordingly, is extensively employed in chronic inflammations of those expansions. The oil is likewise taken up into the blood-vessels of the stomach and intestines, and proceeds to the kidneys, where it is separated along with the urine ; and excites, at times, nephritis, hsematuria, and ischuria, with occasional irritation of the urethral mucous membrane. It is, likewise, exhaled along-with the pulmonary transpiration, as its odour is distinctly perceptible in the breath. Where unusual doses of copaiba are taken, all those symp- toms are greatly aggravated. It is affirmed, too, that under its use pains of a rheumatic character have supervened, which there was great reason to ascribe to its agency. The principal therapeutical employment of copaiba is unquestion- ably in inflammatory affections of the genito-urinary organs, and especially in gonorrhoea. In the last disease, it probably acts mainly as a revellent by the impression which it makes on the mucous mem- brane of the stomach and intestines, and likewise, on the kidney ; and it is not improbable, in the more chronic form of mucous dis- charge, that the excitant virtue of the oil, which becomes separated with the urine, may exert a beneficial agency on the diseased sur- face with which it comes in contact. With most modern writers, indeed, copaiba is one of the main agents in the revellent treatment of gonorrhoea. The author has elsewhere stated (Practice of Medi- cine, 2d edit, ii., 381, Phila. 1844, that after the active symptoms of gonorrhoea have passed away under a simple antiphlogistic manage- ment the revellent treatment becomes advisable, which consists in the administration of substances, that, either by their operation on the kidneys, or on the diseased mucous membrane itself, induce a new action in it. Many practitioners as are in the habit, however, of administering copaiba freely from the very first, paying no regard whatever-to any antiphlogistic treatment; but although this plan may prove successful occasionally, it has been found at times to augment the inflammatory symptoms, and the discharge. Its efficacy, 480 SPECIAL EXCITANTS. is, doubtless, more appropriate, and its employment more philso- phical,when prescribed after an appropriate antiphlogistic treatment. In the gonorrhoea of females, copaiba and the different revellent antigonorrhoeal remedies appear to be of limited efficacy. Gonor- rhoea in the female, in reality, affects the vagina rather than the urethra, and we can, therefore, comprehend, that the effect of its revulsive agency on the kidney may be less marked than when the disease is confined to the lining membrane of the urethra, as in the male. In chronic inflammation of the bladder, copaiba has been pre- scribed, but its effects have to be watched, or it may add materi- ally to the inflammation. As in gonorrhoea of the female, so in leucorrhoea it cannot be ex- pected, that copaiba could afford essential benefit. Cases, indeed, are recorded of advantage from it, but it is not much relied on. The same may be said of its use in chronic bronchitis, in which it has been extolled by many practitioners. Its agency, in such cases, also, is probably revellent by exciting the lining membrane of the stomach. It can scarcely be expected, that the small quantity, exhaled along with the bronchial or pulmonary transpiration, can exert much agency. This is a topic, however, which is investigated under the head of Expectorants. In cases of chronic inflammation of the mucous membrane of the bowels, more effect may be expected from it, inasmuch as it can come into immediate contact with the seat of the disease. It is true, that where this is low down in the bowels, the copaiba will be probably despoiled of the greater portion of its oil, before it reaches it ; but still sufficient may remain, and the resin of copaiba will certainly pass through the bowels. Strong testimony has been adduced by a respectable physician, Dr. La Roche, of Philadelphia, in favour of its beneficial influence in cases of chronic inflammation of the colon and rectum, and it is said to have been useful in hemor- rhoids, both when employed in small doses internally, and when applied to them externally, after the activity of the inflammatory stage had passed away. Like the balsams, it has Occasionally been used as an excitant to ulcers, but at the present day is rarely, if ever, employed. It has also been found serviceable as a topical application in chilblains, by Dr. Ruschenberger, U. S. N. These are the chief cases in which its excitant agency has been employed. The ordinary dose of ccpaiba is from Tt\x to f. 3J, and even more, two or three times a day. It is commonly given dropped on sugar; but its taste is so repulsive, that it is often advisable to adopt other forms with the view of concealing it, and at the same time of cor- recting its effects upon the digestive organs. The following is an unpharmaceutical compound, which has often been prescribed in gonorrhoea ; the spirits of nitre and lavender being added to correct the taste, and the opium, to prevent nausea or catharsis. (Copaiba., copaiba. 481 Sp. JElher. nitric, aa f. 3ss ; Acacia pulv., Sacchari, as^j ; Sp. Lavan- dul. comp.f. pij; Tinct. opii, f. 3J ; Aqum destillat. f. 31V. — M. The dose of this is a table-spoonful three times a day.) Many of the more recent writers, however, prefer to give it alone, in wine or lemon- ade, or dropped in a wine-glassful of water, to which a little com- pound tincture of gentian has been added. \\ here copaiba is given from the commencement of the disease, it is usually prescribed in the dose of a fluidrachm or more, two or three times a day ; and with the view of cutting it short at the very onset, it has been proposed to administer as much as from f. 31J to f. ^j, for a dose. Occasionally, it is administered in the form of emulsion, made with mucilage, not too thick ; or yolk of egg,— the vehicle being cin- namon, peppermint or other aromatic water. PIL'ILE COPATBiE, PILLS OF COPA'IBA. (Copaib. §ij ; Magnes. recente prseparat. 3J ; mix and set aside, till the mixture concretes into a pilu- lar mass, to be divided into 200 pills.) Each of these pills contains between four and five grains of copaiba, so that from two to six or more may be given for a dose, two or three times a day. In the Edinburgh Pharmacopceia, the Oleum Copaiba is officinal. This is preferred, by some, to any preparation of copaiba. The usual dose is from ten to twenty drops, but Dr. Pereira states, that he has known f. 31J taken at once without any injurious conse- quences. It maybe dropped on a lump of sugar ; but it is not much used in this country. Capsules made of gelatin and inclosing copaiba have been intro- duced, with the view of obviating the taste. Each of these usually contains about ten grains of the copaiba; and is of a size, which can generally be swallowed without difficulty. The capsule is digested. The process for their formation is a secret. Copaiba has also been administered in enema, and it is affirmed on good authority, that of M. Velpeau, that this form may be substituted in all cases, in which its employment is considered to be indicated. The author has never used it in this manner. It has been proposed to introduce the gelatinous capsules into the rectum, but it is not easy to see, why a comparatively expensive form of preparation should be employed,— seeing that the reasons, which suggested the use of the capsules, cannot apply to the administration of copaiba by the rectum. 35. O'LEUM CAJUPU'TL — CAJ'EPUT OIL. Cajeput oil is the volatile oil of the leaves of Melaleu'ca cajupu'ti; Sex. Syst. Polyadelphia Icosandria; Nat. Ord. Myrtacese. It is in the secondary list of the Pharmacopceia of the United States. The species of melaleuca, from which the oil is obtained, is a native of the Moluccas. The oil is procured from the leaves by distillation, chiefly at Amboyna and Bourou, and is usually imported from India in green glass bottles, similar to long necked beer bottles. vol.i.—41 482 SPECIAL EXCITANTS. In the year 1834, it was much extolled in England in cases of cholera, in consequence of which a great demand was caused for it, and the price rose from two to fourteen shillings an ounce. Various imi- tations accordingly appeared in the market. One of these consisted of oil of rosemary, flavoured with camphor and oil of cardamom, and coloured. (Pereira.) It would not seem, however, that it is often adulterated. The appearance of the oil is limpid, and of a green colour; but, when rectified, it is colourless. Its odour is strong and penetrating, and resembles that of a combination of camphor, rosemary and carda- mom. The taste is warm and pungent. Like the other essential oils, cajeput oil is excitant; but as its impression is more powerful on the gustatory nerves than the aro- matic oils in general, it has been employed, likewise, as an excitant antispasmodic. It acts as a diffusible stimulant, and hence is adapted not only for cases of flatulent colic and tormina, like the essential oils in general, but both in India and in Europe and this country has been used in low protracted fevers, and in paralytic affections: it is not much employed, however, and appears not to be possessed of any virtues that especially recommend it as an internal excitant. As a local excitant, it is more frequently used; — in cases, for example, of paralysis of the tongue; and is introduced into the hollow of the tooth, in carious odontalgia. It is, likewise, used as an embrocation, when mixed with an equal portion of olive oil, in chronic rheu- matism, and painful affections in general, local paralysis, &c; but even for this purpose, it does not appear to possess any virtues over other excitant agents — as the terebinthinates. The dose of the oleum cajuputi is from one to five drops or more, on sugar, or formed into a mixture. 36. SUC'CINUM. — AMBER. Amber is found in various parts of the world, but the principal portion of that which is met with in commerce is cast ashore on the coast of the Baltic between Kiinigsburg and Memel. It is supposed to be disengaged from lignite by the action of the sea. It has been found in Maryland and New Jersey, — in the former state, associated with iron pyrites and lignite. The amber, however, which is used in this country, is imported from the shores of the Baltic. (Wood & Bache.) Amber usually occurs in irregularly shaped pieces, of a pale golden yellow, but, occasionally, of a reddish-brown, and even deep-brown colour. It is insipid, and inodorous, except when heated or rubbed, when it exhales a peculiar, aromatic, not disagreeable smell. It is usually translucent; at times, opaque or transparent. Its specific gravity is about 1.078. It is brittle, having a conchoidal fracture. It is insoluble in water, and very slightly acted on by alcohol. When subjected to examination, its proximate constituents are found to be volatile oil, two resins, a bituminous substance, and a peculiar acid, called the succinic. SUCCINUM. 483 Amber is possessed of excitant properties, and was formerly given in the dose of 10 grains to 9j in powder. It is never, however, used in this country, except in pharmacy and the arts. O'LEUM SUCC1N1, OIL OF AMBER. {Succin. in pulv. q. s. Put the amber, previously mixed with an equal weight of sand, into a glass retort, which is to be only half filled; distil by means of a sand bath, with a gradually increasing "heat, an acid liquor, an oil, and a con- crete acid impregnated with oil. Separate the oil from the other matters, and keep it in well stopped bottles.) O'LEUM SIC CIM RECTIFICA TUM,RECTIFIED OIL OF AMBER. (01. succin. Oj ; Aqua Ovj. Distil until four pints of the water have passed with the oil into the receiver ; then separate the oil, and keep it in well- stopped bottles. Oil of amber, as found in the shops, has a strong, peculiar odour, and a pungent acrid taste. It is nearly colourless, when first redistilled, but gradually becomes brown. It is soluble in absolute alcohol in all proportions, and imparts its properties, in some degree, to water. It is a nauseous excitant, and possesses the usual properties of the essential oils ; but on account of the powerful impression it makes on the gustatory nerves also, it has been prescribed as an anti- spasmodic, in the dose of from rr^ij to n^x. It is occasionally used as a rubefacient, in paralysis, chronic rheu- matism, and wherever excitant embrocations are indicated. Succinic Acid, obtained in the distillation of the oil of amber, possesses similar properties to the latter, and is officinal in the Dublin Pharmacopoeia. It was at one time used as an excitant in rheuma- tism, but is now never employed. Besides the vegetable excitants already mentioned, the Pharma- copoeia of the United States has the following in its secondary list. 37. Cata'ria, Catnep. The leaves of Nep'eta Cata'ria, Catnep or Catmint; Sex. Syst. Didynamia Gymnospermia ; Nat. Ord. Labiatae ; are well known in the United States, and much used in domestic practice. They have a strong, peculiar odour, and a bitter, aromatic taste, their properties being mainly dependent upon essen- tial oil. Catnep readily yields its virtues to water, and hence the infusion — catnep tea. — is the form in which it is usually given. Catnep tea is a common domestic remedy in cases of colic in infants, and some nurses are in the habit of feeding them upon it for the first day or two. It is also used in cases of amenorrhcea. It is scarcely ever prescribed by the physician. 38. Heracle'um, Masterwort. The root of Heracle'um lana'tum, sometimes called Cow-parsnip; Sex. Syst. Pentandria Digynia; Nat. Ord. Umbelliferaj, is a common umbelliferous plant, from Ca- 484 SPECIAL EXCITANTS. nada to Pennsylvania, which flowers in June. The root resembles parsley, has a strong disagreeable odour, and an acrid taste. It is excitant when applied to the skin. Masterwort is an excitant, and has been used as such in cases of want of tone in the stomach, accompanied by flatulence. It has likewise been prescribed in epilepsy, accompanied by the same gas- tric condition. It may be given in powder or infusion. The author has never used it. 39. Souda'go, Golden Rod. The leaves of Solida'go odo'ra, or sweet-scented Golden Rod ; Sex. Syst. Syngenesia superflua ; Nat. Ord. Compositse Corymbiferse; a plant, which grows in woods and fields throughout the United States, and flowers in September, have an agreeable fragrant odour. They yield on distillation a volatile oil, which possesses the taste and aroma of the plant in a high de- gree, and on which its therapeutical virtues are dependent. Golden rod has all the excitant virtues of the aromatic herbs, — being carminative, and an excitant diaphoretic when given in warm infusion ; in which form it is also administered as an excitant to the gastric functions. An essence, made by dissolving the essential oil in dilute alcohol, is used in the Eastern States as a remedy in com- plaints arising from flatulence, and as a vehicle for disagreeable me- dicines of various kinds. The dried flowers are said to be a sub- stitute for common tea. 40. AL'COHOL. Alcohol, in pharmacy, means rectified spirit, of the specific gravity 0.835: — dilute alcohol, AL'COHOL DILU'TUM consists of equal portions, by measure, of alcohol and distilled water. Its specific gravity is 0.935. These are the menstrua, which are employed in the forma- tion of tinctures and other preparations, referred to in the course of the present work. In this place, the use of the various alcoholic liquors, as excitants, has to be treated of. These may be divided into three classes ; Ardent Spirits, Wines, and Malt Liquors. a. ardent spirits. Ardent spirits are obtained from the distillation of vinous liquids ; and the resulting spirit differs according to the precise vinous liquid that may be employed in the distillation. For example, the spirit obtained from the distillation of the fermented juice of the grape is Brandy; that which is obtained from molasses is Rum; that from a fermented infusion of grain, Corn spirit : from one of rice or tod- dy, Arrack ; from, peach juice fermented, Peach Brandy ; from cider fermented, Apple Brandy*' whilst Gin, Hollands, Scotch and Irish Whisky, are corn spirit flavoured. All these contain various proportions of alcohol, volatile oil, water ; and, frequently — as in brandy and rum — colouring matter, — the volatile oil commu- nicating to the particular spirit the aroma by which it is distinguished. These different spirits vary greatly from each other, as to the quantity ALCOHOL. 4S5 of alcohol which they contain. From experiments on some of them by Mr. Brande, the following was the average quantity s. g. 0.825, obtained at 60° Fahr. Alcohol by measure. Alcohol by measure. 100 parts by measure of Brandy contain 55.39 Rum " 53.68 Gin " 51.60 100 parts by measure of Whisky (Scotch) 54.32 Whisky (Irish) 53.90 b. wines. Of the varieties of wine in regard to their dietetic uses, and the marked differences that exist between them, the author has tretaed at length in another work, to which the reader is referred. (Human. Health, p. 308, Philad., 1844.) It will be sufficient here to point out their relative qualities as excitants. When subjected to analysis, they afford nearly the same products. They contain much water ; alcohol in variable quantity ; mucilage ; tannic acid, a blue colour- ing matter, which becomes red, when it unites with acids ; a yellow colouring matter; bitartrate of potassa; tartrate of lime; acetic acid, and, at times, other salts, — as chloride of sodium, and sul- phate of potassa. It is to the alcohol that they owe their strength ; the more abundant it is, the more generous the wine. The mucilage communicates no particular property to them ; the tannic acid gives them a kind of roughness, and the power of being clarified by a solution of glue, or of white of egg ; the bitartrate of potassa, and the acetic acid give them tartness ; so that they acquire value by being kept, not only because their principles undergo modification in their combination, but because tartar is deposited. The following table was drawn up by Mr. Brande from the results of his experiments on various wines. It is proper, however, to re- mark, that many of them were prepared expressly for the London market, and are more brandied or " reinforced" than the same va- rieties sold in the United States. This is strikingly the fact with port. Dr. Henderson, too, has remarked, that some of the wines, analysed by Mr. Brande, were mixed with a considerable quantity of adventitious alcohol. His additions and corrections have the letter H. affixed. Proportions of Alcohol, S. G. O.S'35, in one hundred parts by measure of the folio-wing ■wines, and mal! and spirituous liquors. 1. Lissa, . . 26.47 26. Malmsey Madeira, ■ - ie.4o do. . . 24.35 27. Lunel, - - - 15.52 Average, . -(«) 25.41 28. SSclieraaz, - ■ - - 15.52 2. Raisin Wine, - . 26.40 29. Syracuse, - - • - 15.^8 do. . . 25.77 30 Sauterne, - - - - K.52 do. . . 23020 31. Burguruly - - - 16.60 Average . - 25.12 do. - - - 15.22 3. Marsala, - . . 26.03 do. - - - 14.53 do. . . 25.05 do. - - - 11.9& Average - .(b) 25.09 Average, - ■ 11.57 4r 486 SPECIAL EXCITANTS. 8. 9. 10. 11. 12. 13. 14. 15. 20. 21. 22. 23, 21 25. Port— average of six do. — highest,. do. —lowest, - Madeira, • do. do. (Sercial,) do. - . . Average Currant Wine, - Sherry, do. do. do. Average, Teneriffe, Colares, - Lachryma Christi, Constantia — white, red, Lisbon, Malaga, Bucellas - Red Madeira, do. Average Cape Muscat Cape Madeira, - do. do. Average Grape Wine Calcavella, do. Average Vidonia - Alba Flora, Malaga, - White Hermitage Roussillon do. Claret, do. do. do. Average, Average, (ay 15.90 H. kinds, 23.48 25.83 21.40 24.42 23.93 21.45 19.24 22.27 20.55 19 81 19.83 18.79 18.25 19.17 19.79 19.75 19.70 19.75 - (c) 18.92 18.94 18.94 18.49 22.30 18.40 20.35 18 25 22.94 20.50 18.11 20.51 18.11 19.20 18.10 18.65 19.25 17.26 17.26 17.43 19.00 17.26 18.13 17.11 16.32 14.08 12.91 - (d) 15.10 (A) 18.40 H. 32. Hock, - do. .... do. (old in cask,) Average, - Rudesheimer, (1811) - - H. do. (1800) - - H. Average, - - H. Johannisberger, - - - H. 33. Nice, .... 34. Barsac, - 35. Tent, .... 36. Champagne, (still) do. (sparkling) do. (red) do. Average, 37. Red Hermitage, 38. Vin de Grave, - do..... Average, - 39. Frontignac, 40. Cote Rotie, 41. Gooseberry Wine, 42. Orange Wine — average of ~) six samples made by a V- London manufacturer, j 43. Tokay, .... 44. Elder Wine, - Rhenish Wine, - - H. Cider — highest average, - lowest, Perry — average of 4 samples, Mead, ... Ale, (Burton,) do. (Edinburgh.) do. (Dorchester,) Average, - Brown Stout, ... London Porter, (average,) - do. Small Beer (average,) 52. Brandy, .... 53. Rum, .... 54. Gin, .... 55. Scotch Whisky, 56. Irish do. ... 50. 51. 14.37 13.00 8.88 12.08 10.72 12.22 11.47 8.71 14.63 13.86 13.30 13.80 12.80 12.56 11.30 12.61 12.32 13.94 12.80 13.37 12.79 12.32 11.84 11.26 9.88 9.87 8.71 9.87 5.21 7.26 7.32 8.88 6.20 5.56 6.87 6.80 4.20 1.28 53.39 53-68 51.60 54.32 5390 (c) 14.50 H. (rf) 12.91 H. All wines are necessarily excitant by reason of the alcohol which they contain, but some are more so than others. There are but few, however, which are employed therapeutically, as excitants. These are chiefly Sherry, Madeira and Port ; the first being the only- one that is officinal—the VINUM of the Pharmacopoeia of the United States—-on account of its greater uniformity, and, therefore, better adaptation for pharmaceutical purposes : it is the Vinum Album Hispanicum of the British pharmacopoeias ; is almost wholly free from acidity, and consequently well adapted for the dyspeptic and gouty. Madeira wines are more acid ; and those of Oporto or Port WINES. 487 abound in astringency ; they are, therefore, preferred in diseases, in which an astringent and excitant agency is needed. They are very apt to disagree with the dyspeptic, owing, perhaps, to the gallic acid which they contain. The brisk wines of Champagne ; the heady wines of Burgundy ; the light wines of Bordeaux, and of the Rhine and Moselle, are not often given with us as excitants ; yet Dr. Henderson affirms, that in certain species of fever, accom- panied by a low pulse, and great nervous exhaustion, they have been found to possess considerable efficacy, and may be given with more safety than most other kinds. C MALT LIQUORS. Malt liquors differ from wines chiefly in the following points. They contain a much greater proportion of nutritive matter, and less alcohol; but they have, in addition, a peculiar bitter and perhaps narcotic principle, derived from the hop. Without the hop, the ale would not keep, especially that intended for the warmer climates ; and hence the pale ale, intended for the India market, is always made intensely bitter with the hop. Independently of the flavour and tonic properties, which hops communicate, they precipitate by means of their astringent principle, the vegetable mucilage, and thus remove from the beer the active principle of its fermentation ; consequently, without hops, malt liquors would have to be drunk either new and ropy, or old and sour. (Paris.) Malt liquors are unquestionably nutritive, where they agree ; and in the system of " training" for athletic exercises, which consists in raising the powers of the individual to the full extent of which he is capable, about three pints a day of mild home-brewed ale are re- commended for drink. Malt liquors do not digest well, however, with those of weak powers. The extractive is apt to produce flatu- lence and heartburn. In regard to alcohol, it is rarely administered internally as an ex- citant. When it is indicated, some form of ardent spirit is usually chosen; and of these brandy is most commonly selected. Fre- quently, however, in remote country situations, it is not to be met with. In such case, whisky, or peach or apple brandy is employed. In small quantities, it is taken in certain forms of dyspepsia, espe- cially where articles difficult of digestion have been eaten, and gas- trodynia results. Occasionally, too, it checks sickness of the sto- mach, especially sea-sickness; although no permanent good effect can be expected in the last, until the individual becomes accustomed to the motion of the vessel. In the latter stages of fever, and in adynamic conditions of all kinds, it is much employed ; but in fever it is less adapted than wine, — the stimulus of the latter being more permanent and manageable. It may be given in such cases in the form of toddy, or spirit and water sweetened, or in that of milk punch, where the stomach will bear it; but care must be taken not to hurry too much the organic actions. In old drinkers, a small al- 488 SPECIAL EXCITANTS. lowance — two to four ounces in the twenty-four hours —is some- times advisable in the course of ataxic and adynamic diseases, but the quantity should be gradually diminished, until it is abandoned. It need scarcely be said, that the case must be bad indeed, in which the hopes of the practitioner are placed on the excitement, which alcohol is capable of inducing. It may be a question, indeed, whether it be not calculated to exhaust the slight amount of excita- bility still existing in the system. Perhaps in delirium tremens it is most largely depended upon by some practitioners ; yet, — as elsewhere remarked, — the disease is certainly, in the generality of cases, best treated eclectically. The recuperative powers of the sys- tem are usually sufficient to restore the individual. Some, however, give ardent spirit freely — an ounce or two every hour ■—and, doubtless, under this stimulation, the individual may be restored to the condition in which he was prior to the withdrawal of the stimu- lus which gave rise to the disease. Externally, alcohol is much employed as an excitant to inflamed parts, where the hypersemia affects the skin more especially, — as in erysipelas, burns and scalds when the epidermis is not removed, and in sprains and bruises. Not only does it act as an excitant in such cases, when first applied, but during its evaporation it causes an agreeable sense of coolness in the affected parts. Largely diluted with water, it forms an excellent collyrium in chronic conjunctivitis. Owing to its excitant properties, when applied to vessels that are the seat of hemorrhage, it coagulates the albumen, at the same time constringing the vessels, and thus acts as a styptic ; and it is occa- sionally used as an excitant injection for the radical cure of hydro- cele. Rubbing the limbs or body with spirit — as with whisky—is not unfrequently had recourse to, in order to arouse the powers of the system generally or those of some internal organ. In regard to the therapeutical use of wine, it is decidedly the best stimulant in long protracted fevers. It is much more permanent in its action than ardent spirit, and its strength can be regulated, so that, under careful watching, no bad effects can easily result from its use. The phenomena, that render it advisable in fevers, are — signs of great prostration ; and those that show that it is proper for the patient are, its being relished by him ; agreeing with the sto- mach, not increasing the heat of the skin, or dryness of the tongue ; and the general feelings and condition becoming ameliorated. Any of the three stronger wines — Sherry, Madeira or Port — may be prescribed ; but unless there be a morbid complication, which requires the astringency of the last, Sherry is to be preferred. It maybe given mixed with an equal quantity of water, and sweetened, if the patient prefers it, or in the form of wine whey. Four ounces, in the course of the twenty-four hours, may be prescribed, should doubt exist as to the propriety of its administration ; and if it aorees. the quantity may be gradually increased. In highly adynamic slates^ as in malignant typhus, a bottle or two may be given in the day with manifest advantage. Should it appear to disagree, it may be dis- -ETHER SULPHURICUS. 489 continued gradually. Great caution is, however, needed in the ex- hibition of this, as well as of other excitants, in fever; and upon the whole we may say of it — with a modern writer, Dr. A. T. Thom- son — as of every other potent article, that " it is a medicine or a poison, according to the discretion and moderation with which it is used, and the skill and judgment which direct its medicinal employ- ment." Malt liquors are not much employed therapeutically as excitants; but bottled porter is occasionally given in adynamic conditions, which fall under the care of the surgeon more especially, as in local gangrene, sloughing ulcers, &c. Occasionally, this liquor agrees with the dyspeptic,— apparently owing to the carbonic acid, which it gives off,— when the still malt liquors could not be taken with impunity. 41. ^ETHER SULPHU'RICUS.—SULPH'URIC ETHER. Ethers are formed by the action of various acids on alcohol; and they differ in their sensible, but not materially in their medical pro- perties, according to the acid employed. Hence, but two are con- tained in the Pharmacopoeia of the United States — the Sulphuric and the Nitric. Sulphuric ether is formed by the action of sulphuric acid on alco- hol ; but when prepared in this manner, the distilled liquor contains alcohol, water, sulphurous acid, and oil of wine. To rectify it, potassa, or carbonate of potassa was directed to be added to it, and that it should be redistilled. The product was the jEther Sulphu'- ricus Rectifica'tus, of the former edition of the Pharmacopceia of the United States, and of the British Colleges. In the last edition, however, of the Pharmacopoeia of the United States, the addition of the potassa is a part of the process, so that the iETHER SULPHU'RICUS of that edition corresponds with the JEther Sulphu'ricus Rectifica'tus of former editions. In this state it wholly evaporates in the air, and, when agitated with an equal bulk of water, loses about one tenth of its volume. The theory of etherification is very complex, and has occupied the attention of many chemists of distinction. Alcohol, in its pure state, is generally regarded as a compound of ether and water; conse- quently, if the water be separated by any agency, as by that of sul- phuric acid, the ether will remain ; but for the mode in which this, and the various accessory reactions are effected, the reader is referred to the works of Liebig, Turner, Pereira, and others. Sulphuric ether is a colourless, transparent fluid, of a peculiar penetrating and fragrant odour, and a hot pungent taste, followed by a sense of coolness. The specific gravity of that of the United States Pharmacopceia is 0.750 ; hence it is extremely volatile. It boils at about the temperature of 96°. When pure and recently prepared, it is neither acid nor alkaline, but by exposure to air and light it absorbs oxygen, by which acetic acid and water are formed. It is sparingly soluble in water,—ten volumes, as already remarked, dissolving in one 490 SPECIAL EXCITANTS. of it. By alcohol it is dissolved in all proportions. It dissolves the volatile oils, and most of the fatty and resinous substances. The action of ether on the economy is more diffusibly excitant than that of any other article, and, accordingly, its operation is very- transient. Hence, it is better adapted than alcohol, where the ob- ject is to stimulate the stomach, without, at the same time, augment- ing the action of the heart and arteries. Accordingly, it is given with great advantage in severe gastrodynia and flatulence. In large doses, it produces intoxication like alcohol, and, in still larger, nar- cosis. It appears to pass readily into the circulation, and is co- piously exhaled with the pulmonary transpiration. Like alcohol, it has been detected in the brains of those who have died after it has been exhibited in large quantity. The author has treated elsewhere of the use of sulphuric ether in spasmodic diseases, for which it is better adapted, than for diseases of debility ; although it is often given in the latter, when the powers of life are flagging; and, too often, where but little expectation of benefit can be expected from the use of any remedies. The dose is f. >>ss to f. 3ij, incorporated with water by rubbing it with spermaceti, in the proportion of two grains to each fluidrachm of ether. The SPIR'ITUSH'THERIS SULPHU'RICI COMPOSITUS, or COMPOUND SPIRIT OP ETHER, (p. 380,) and the SPIR'ITUS JE'THERIS M'TRICI, or SPIRIT OF NITRIC ETHER, (p. 273,) may be used in the same cases as the sulphuric ether. By reason, however, of their containing more alcohol, they are less diffusible in their action, and, therefore, better adapted for cases in which a more permanent stimulus is needed. The dose is f. gss to f. 3iij, repeated as the case may seem to require. 42. CREASO'TUM.—CRE'ASOTE. Creasote, in the Pharmacopoea of the United States, is defined to be " a peculiar substance obtained from tar." It is produced artifi- cially during the destructive distillation of organic substances, and is found in pyroligneous acid, Dippel's oil, wood smoke, &c. Its most abundant source is the tar or pyroligneous acid, obtained from the wood of the birch. In the neighbourhood of Edinburgh it is pro- cured, according to Dr. Christison, in large quantity, and of fine quality, from Archangel Tar. It is not prepared by the apothecary, and, therefore, is not amongst the preparations in the Pharmacopceia of the United States, (1842,) but in the list of the Materia Medica. All the processes for obtaining it are complex ; many of them are given by the author in another work. (New Remedies, 4th edition, p. 201, Philad. 1843.) Creasote is a colourless, transparent, and oleaginous liquid, of an odour which is highly characteristic. It is entirely soluble in acetic acid, alcohol, and caustic potassa ; and coagulates the albumen of eggs, of the blood, and of albuminous fluids. When dropped on paper, and exposed to heat, it is entirely volatilised, and does not CREASOTUM. 491 leave a greasy stain. It is powerfully antiseptic, whence its name from *g«*c '' flesh, " and «-»T«g, "preserver." Its specific gravity is generally stated at 1037, as given by Reichenbach, who discovered it some years ago ; but Dr. Christison states, that he has never found it lower than 1065, or higherthan 1067. Water dissolves j1— th part of it, and acquires a peculiar acrid taste, and a powerful smoky smell, which is perceptible when the creasote only forms jo^-0th part of it. Creasote, when applied locally, is an unquestioned irritant. When put upon the tongue, it causes an excessive burning sensation. When applied to a part whence the epidermis has been removed, or to a wound, —instantaneously, an extremely violent burning pain is experienced, which is continued for eight or ten minutes, but, if the part be carefully washed, it gradually ceases. The surface also be- comes white, as if nitrate of silver had been applied to it, owing to the action of the creasote on the organic matters. Given internally in large doses, it occasions considerable irritation in the gastro-enteric mucous membrane; and, when it destroys, death is preceded by more or less narcosis; hence it has been ranked as an acro-narcotic poison. (Christison.) In three experiments which were made with it on dogs by Dr. Cormack, of Edinburgh, twenty-five drops of pure creasote were injected into the veins. All the animals died : and in every case, the following phenomena were observed. Its first deleterious action was a powerful one of sedation on the heart; the vital energies of that viscus seeming to be instantaneously para- lysed. In some instances, hurried and sonorous respiration went on for more than a minute after the heart had ceased to beat. In general, one or two convulsions, resembling the tetanic, preceded death. In every instance, the atony of the heart immediately after death was very striking. In the case of a patient of the author, who took ten drops of it by mistake, great vertigo, headache, and a sensation as if the head were about to burst by expansion, supervened, with vomiting, and much gastric distress. When taken for a length of time, it appears to com- municate a blackish-hue to the urine, and, in some cases, can be de- tected in that fluid, i-ixi Creasote is used as an internal excitant in cases of gastrodynia andfla* tulence of the stomach and bowels ; but it does not seem to possess any advantage over the essential oils and other diffusible excitants, whilst it has the objection of being exceedingly disagreeable. It has been tried — it is not easy to see on what principle — in diabetes melli- tus • but the encouragement is not great to repose any confidence in it Nor has its efficacy been more marked in gouty and rheumatic cases, in which it has been prescribed by some. Of its value in in- ternal hemorrhages, mention has been made under the proper head. (See Astringents.) ... • i •* . Externallv it has been used in various cases as a topical excitant, _ for example in the form of wash or ointment, in burns, in chafing of the integuments—intertrigo ; in sore nipples ; chilblains ; in fissures 492 SPECIAL EXCITANTS. of the skin ; and ulcers, especially of the sluggish, atonic kind ; and, indeed, in every form in which it seems advisable to change the ac- tion of the parts by an appropriate excitant, — or, where, from the offensive nature of the discharge, an antiseptic or disinfectant is need- ed ; in cancerous affections of the uterus and other parts ; in lupus, and various other chronic cutaneous affections ; in ophthalmia tarsi; prolapsus vaginas, &c. It has likewise been applied in cases of toothache, by means of a camel's hair pencil passed into the hollow of the tooth, or of cotton dipped in a mixture of equal portions of creasote and alcohol. In deafness, connected with a deficiency of ceruminous secretion, it has been used with advantage, in the propor- tion of one part of creasote to six or eight parts of olive oil, or lard. It may be introduced into the meatus by means of a camel's hair pencil. As a caustic, it may be applied undiluted. Besides its excitant properties, it possesses others, which have been described in the proper places. Creasote is sometimes given in the form of pill, which greatly masks its disagreeable characters. (Creasot. n\,x; Pulv. Glycyr- rhiz. 3j ; Mucilag. acacia, q. s. ut fiant pilulffi xx. Two for a dose.) Or, one or two drops may be diffused by means of mucilage in some aromatic water. The strength of lotions may vary from n\,ij to rr^vj to the ounce of water. The ordinary strength of Creasote water is, however, one part of creasote to eighty of water. It may, also, be added to poul- tices, in cases of foul or gangrenous ulcers. UNGUENTUM CREASO'TI, OINTMENT OF CREASOTE. (Creasot. 3ss; Adi- pis, ^j.) This ointment is of a good strength for ordinary cases of cutaneous disease. The author has succeeded in removing lupus, and porrigo of the scalp by means of it, after other topical agents had failed. 43. AMMO'NIA. The different preparations of ammonia are excellent excitants, and well adapted for the relief of certain morbid conditions. Ammoni'acal gas is obtained for medicinal purposes by the decom- position of the Muriate of ammonia, by means of lime, which has a stronger affinity for the chlorohydric acid than the ammonia, and consequently displaces it. The ammonia is given off in the gaseous state. It is too excitant, however, under almost any form of manage- ment to be employed therapeutically; and as it is very soluble in water, it is allowed to combine with that fluid and form the officinal 1. LIQUOR AMMO'NLE, SOLU'TION OF AMMO'NIA, or WATER OF AMMO'NIA. The specific gravity of this preparation — as directed in the Pharma- copoeia of the United States, (1842) — is 0.96 ; and 100 grains of it saturate 30 grains of officinal sulphuric acid. It is a transparent colourless liquid, of a highly pungent odour, and caustic alkaline taste ; sometimes, it contains carbonate of ammonia, which may be detected by lime water, which occasions a milky precipitate of car- bonate of lime, if carbonic acid be present, and it effervesces with AMMONIA. 493 dilute acids. When exposed to the air, it quickly parts with ammo- nia, and also absorbs carbonic acid, so that it must be kept in well stopped bottles. It unites with oil, so as to form soaps or liniments. Liquor ammonias of the United States Pharmacopoeia is not often prescribed internally in its uncombined state. When properly diluted, however, it may be given in cates of heartburn, accompanied by- atony of the digestive organs ; its alkaline properties neutralising the acid already in the stomach, whilst its excitant agency tends to pre- vent the generation of more. The carbonate of ammonia is, however, usually preferred. Liquor ammonias is held to the nose in cases of fainting, that its vapour may impress the olfactory nerves ; and its excitant effects are often, in this way, beneficial. It is said, that an attack of epilepsy has been prevented in this manner. It has been occasionally used in cases of asphyxia, as from drowning ; the epiglottis being touched with the finger, or a feather dipped in a little of it; and it is said with success ; care, however, must be taken, lest the spark be extinguished by it. It is most commonly employed to induce rube- faction in a variety of affections, especially in those of a rheumatic or neuralgic naiure. It has been suggested as an excitant in amenor- rhcea, and in chronic leucorrhcea, — a few drops being added to milk ; but it need scarcely be said, that so powerful an excitant should be used with caution. The various preparations of ammonia have been extolled, too, in the bites of poisonous serpents and insects, and they certainly are often of decided advantage. The dose of liquor ammonias is from gtt. v to gtt. xx or xxx, properly diluted with milk. 2. LIQJJ0R AMMO Nil FOR'TIOR, STRONG SOLUTION OF AMMO'NIA. An aque- ous solution of ammonia of the specific gravity 0.882, is directed in the Pharmacopoeia of the United States : as, however, it is prepared by the druggist, it is not placed amongst the preparations, but in the Materia Medica list. This stronger solution of ammonia may be employed to make the Liquor Ammonia — the preparation last de- scribed— by mixing one part by measure of the stronger solution with two parts of distilled water. Strong solution of ammonia has been introduced into the pharma- copoeias mainly on account of its counter-irritant properties, to excite rubefaction and vesication of the cutaneous surface. When two parts of Liquor ammonia are united with one part of suet, and one part of oil of sweet almonds, the mixture forms the Pommade ammoniacale ofGondret, which has been used for a long time to excite a speedy revulsion in chronic affections of the brain, incipient cataract, amau- rosis, &c, as well as to cauterise the integuments deeply. It also forms the basisof the counter-irri'r.nt or " ankdynous lotions" of Granville, which were brought forward a few years ago with high pretensions by Dr. Granville, of London, and in a manner not calcu- lated to enhance his professional reputation. The stronger, and the milder lotion were composed as follow.*: — vol. i.—42 494 SPECIAL EXCITANTS. Stronger ammoniated lotion. — R. Liq. ammon. fort. f. 3X ; spirit. rosmarin. f. 3ss ; camphor. 3ij. — M. Milder ammoniated lotion. — R. Liquor, ammon. fort. f. |j ; spirit. rosmarin. f. ^vj ; tinct. camphor, f. gij.— M. The stronger of these lotions is a powerful agent. They are both employed as cutaneous revellents, and their special application will be considered elsewhere. (See Revellents.) 1. SPIR'ITUS AMMO'NIA, SPIRIT OF AMMO'NIA. Thisprepationismadeinfhe same manner as liquor ammonias, by decomposing muriate of ammo- nia by means of lime, and causing the ammoniacal gas-to pass into alcohol in place of water. It is, therefore, ammonia dissolved in al- cohol, and possesses the properties of the ammoniacal preparations in general. It is chiefly, however, used in the preparation of the ammoniated tinctures, but may be given as an excitant in the dose of 20 to 60 drops, in a wine-glassful of water. 4. SPIR'ITUS AMMO'NliE, AROMAT'lC SPIRIT OF AMMO'NIA, (p. 402.) The spirit of carbonate of ammonia, in this preparation, is rendered more agreeable by the addition of the aromatics, and is much used in faintness and flatulence ; — in the former case, both as an excitantheld to the nose ; and in most cases administered internally. The dose is the same as that of the spiritus ammonia. §. AMMO NLE CAR'BONAS, CAR'BONATE OF AMMO N1A, called also Sal vo- latile and Hartshorn salt, is prepared by subliming a mixture of mu- riate of ammonia and chalk, (carbonate of lime.) The muriatic acid lays hold of the lime, and the carbonate of ammonia sublimes. Carbonate or sesquicarbonate (London Pharmacopoeia) of ammonia is in whitish translucent fibrous masses, of a powerfully ammoniacal odour, and a pungent alkaline and ammoniacal taste. It is wholly soluble in water, and entirely dissipated by heat. When exposed to the air, it falls into powder, becomes opaque, and loses ammonia. It forms soaps with oils, and is freely soluble in dilute alcohol, but very slightly so in alcohol. Carbonate of ammonia possesses all the excitant properties of the ammoniacal preparations, tempered by the combination with carbonic acid. It is, therefore, more frequently given as an excitant, where the object is to support the powers, than any of the others. In long protracted fevers, particularly of the typhous class, it is frequently prescribed alone, or along with other excitants, as wine whey. It is also given in heartburn dependent upon an asthenic condition of the digestive organs. Under the name smelling salts, it is in constant domestic use in fainting. Usually, in such cases, an aromatic oil, as oil of bergamot or of lavender, is added ; and at times, its strength is increased by the addition of a little of the stronger solution of am- monia. The dose, as an excitant, is from five to ten grains every few hours, in the form of pill, or mixed with a little syrup, which masks its taste. It is sometimes used, mixed with oil or lard, or dissolved in water, as a topical excitant and revellent, in rheumatic pains, &c, but the ammonl-e murias. 495 liquid preparations of ammonia are employed more readily, and quite as satisfactorily. Carbonate of ammonia enters into the formation of the Cuprum am- moniatum, and the Liquor ammonia acetatis of the Pharmacopoeia of the United States. 6. AMMO'NliE MURIAS, MU'RIATE OF AMMO'NIA. Mu'riate of ammo'nia, llydrochlorate or Chlorohydrate of ammonia, or Sal ammoniac, is a natural production, being found in and near volcanoes, and occasion- ally the salt of commerce has been obtained from this source. It is now, however, principally prepared by decomposing sulphate of am- monia by means of chloride of sodium or common salt; and at the present time, in England, is manufactured from the impure ammo- niacal liquors, obtained as secondary products. The various modes for preparing it are well given by Dr. Pereira. In this country, it is obtained from abroad in two commercial va- rieties — the crude and the refined; the former of which is imported from Calcutta and is used in the arts ; the latter is derived from England. As met with in the shops, muriate of ammonia is white and trans- lucent ; occurring generally in concavo-convex pieces, which have the shape of the vessel into which the salt is sublimed. It is wholly vola- tilised by heat, and is dissol ved by water. Its taste is saline and acrid, but it is devoid of smell. It is soluble in about three parts of cold, and one of boiling water, and cold is produced during the solution. It dissolves, also, in alcohol. Its specific gravity is 1.450. Muriate of ammonia is scarcely ever employed in this country as an internal agent; but in Germany, it is used in the most opposite cases ; some esteeming it to be excitant; others refrigerant and sedative. It is unquestionably excitant, both when employed internally and exter- nally. As a lotion, it is sometimes used in cases of encephalic affec- tions, owing to the cold it induces. With such view, it ought, of course, to be applied at the moment of solution. It need scarcely be said, however, that we have in iced water a far more available and effective application. As an excitant, it is employed in cases of sprains and contusions ; in indolent tumours, inflammation of the eyes, chil- blains ; in chronic cutaneous affections, as scabies ; and as an injection in gonorrhoea, leucorrhoea, &c. An ounce ortwo of the salt may be dis- solved in a pint of water, to which an ounce or two of alcohol may be added, where it is desired to apply it as a discutient. Solutions of the strength of 3J to Jss of the salt to Oj. of water, maybe used as washes in cutaneous affections, or in injections in the diseases above mentioned. In pleuritic affections, according to Sir George Lefevre, it is usual to combine the tartrate of antimony and potassa with it, according to the following formula : — B. Ammon. Muriat. 3J. Antim. et Potass. Tart._, gr. ij. Decoct. Glycyrrhiz^. f. ^vij. Syrup. AlthreaB, f, 5J. M, 496 SPECIAL EXCITANTS. A table-spoonful of this mixture is given every two hours, and continued in spite of the nausea, and occasional vomiting, which the few first doses seldom fail to produce. When prescribed by itself, with the same view as the nitrate of potassa, Sir George Lefevre states, that as far as his own experience is concerned, he should give it a decided preference. Its salt unpleasant taste, according to Sir George, is best disguised by liquorice root in the form of decoction, or by a solution of the extract in water. Generally, after the first few doses, patients take it without disgust. 44. PHOS'PHORUS. Phosphorus is made by adding sulphuric acid to bone ashes, which consist principally of phosphate of lime. In this way sulphate and superphosphate of lime are formed. Water is added to this, and after standing for some time, the solution is filtered. It is then evaporated until it has the consistence of syrup, when it is mixed with charcoal, dried, and distilled in an earthen retort. By this process, the char- coal abstracts oxygen from the phosphoric acid of the superphos- phate; the phosphorus is consequently set free, volatilised and con- densed in water, in a proper receiver. It may be purified by pressing it through chamois leather under water. It is afterwards moulded into cylinders. Phosphorus, when pure, is devoid of colour, but has usually a reddish hue. It has no taste, but has an alliaceous odour; is flexible at ordinary temperatures ; and of a specific gravity 1.77. It is in- soluble in water, but soluble in ether, and in the fixed and volatile oils. Phosphorus is, in small doses, a powerful diffusible excitant; and in large doses, an acrid poison. It has been esteemed adapted for cases of great prostration of the powers, no matter what may be the accompanying disease. It is very rarely used, however, in this country. It is affirmed, from the personal experience of A. Leroy, Chenevix, Bouttatz and others, to be aphrodisiac, and has therefore been used in the impotence of old and debilitated subjects. Phosphorus is shown by Liebig to be an essential constituent of the neurine, and we shall not be surprised to see it prescribed in nervous diseases particularly, on the hypothesis, that want of nervous power may depend upon a deficiency in the uue propciCon of that element! Phosphorus is generally administered dissolved in ether or oil. The Tinctura oEtherea cum Phosphoro of the French Codex con- sists of Phosphorus 4 parts, Sulphuric Ether 300 parts, by weight. Each ounce contains about four grains of phosphorus; and the dose is from five to ten drops. It has been suggested as an objection to this preparation, that the ether might evaporate, and the phosphorus ignite in the stomach. The Prussian Pharmacopoeia has an Oleum Piiosphoratum, which consists of twelve grains of phosphorus dissolved in an ounce of CALORIC. 497 almond oil. The solution is of the same strength as the ethereal solution, and consequently, may be prescribed in the same doses. Both the preparations may be given in some mucilaginous liquid, to which any aromatic water or oil may be added. It need hardly be said, that the greatest caution should be used in the administration of this powerful agent; nor does it appear to possess any properties that might not be as well supplied by agents that are more manageable. 45. CALOR'IC. Under Diaphoretics the effect of Caloric of a lower temperature than that of the human body was considered. We have here to regard it at a higher temperature, and one in which it is excitant. a. hot air bath. When air is heated to 98° — the temperature of the body — and upwards as far as 130°, it acts as a powerful excitant to the organic actions; and hence is adapted for congestive cases, in which the blood has accumulated in the internal organs, and has left the surface of the body. Accordingly, in certain cases of congestive intermittents and remittents, it may be advisable. It has, likewise, been used in the algid period of cholera. Dr. Pereira affirms, that it is highly useful in asphyxia from drowning and from some other causes; yet the best opinion would seem to be, that exposure of one labouring under as- phyxia to very elevated temperature can scarcely fail to be injurious. The excitant and revellent action of the hot air bath is likewise exhibited in cases of chronic rheumatic and neuralgic affections. Sometimes, it is rendered more excitant by being impregnated with essential oils, or with sulphurous acid gas or chlorine; and it has proved beneficial in certain chronic cutaneous diseases. b. hot vapour bath. The vapour bath, at a temperature of from 120° to 140°, is an excitant to all the organic actions, and is, therefore, adapted to the same class of cases as the hot air bath. In addition, however, it re- laxes the skin, and is accompanied by profuse sweating. Hence, it can be employed with great advantage in long protracted diseases of the rheumatic or neuralgic kind ; and in debilitated individuals, in whom it is desirable to produce an excitation of the cutaneous sys- tem, and thus detract from mischief that may be existing internally. It has been successfully employed in rheumatic and other affections, which have completely crippled the sufferers; and by some cures of this nature that have been effected, it has attracted attention to a class of ignorant empirics, who employ it largely, combined or not with other excitants. The regular practitioner has too much ne- glected this potent agent: no hospital, indeed, should be without an apparatus for the purpose. It is certainly more efficacious in some affections than the ordinary aqueous, baths arc in any. 42* 498 special excitants. In Russia, the vapour bath is used as a luxury, and the author has elsewhere referred to the impunity with which the bather leaves a temperature of 137° to pass into one not above 32°. This form of bath is becoming introduced into other countries. The vapour of hot water is sometimes applied topically, in af- fections of the joints, for example ; and a douche or stream of hot va- pour is sometimes made to impinge on a part affected with neuralgia with advantage. Occasionally, too, aromatics are volatilised, and mixed with the watery vapour, as well as sulphurous acid gas and chlorine. c. hot water bath. The hot water bath is one in which the temperature of the water ex- ceeds 98° of Fahrenheit's scale. It differs essentially in its effects upon the system from the warm bath : whilst the latter is soothing, and disposing to mental and corporeal quietude, the former is ex- citant, stimulating the nervous and vascular systems to a degree which, in particular predispositions and habits, and during the exist- ence of certain diseases — those of nervous and vascular erethism, for example — is positively injurious. This is readily understood, when we reflect upon the effects occasioned by immersing the healthy body in a bath of this kind : the bulk of the extremities is increased, so that rings become too small for the fingers ; the fluids expand ; and hence the supervention of the most manifest signs of polyasmia. The pulse becomes quick; the respiration accelerated and embar- rassed ; the carotid and temporal arteries beat violently; a feeling of anxiety is experienced in the precordial region; and these phenomena are, at times, accompanied or followed by palpitations, fainting, vertigo, and occasionally, by apoplexy. All these effects are more marked, the hotter the bath; the longer the person remains in it, and the greater the degree of plethora. It ought, consequently, to be employed with caution, where there is a predisposition to apoplexy, or any other form of hemorrhage, or to violent internal inflammation. The hot water bath is not much used therapeutically, but is adapt- ed for the same cases as the hot vapour bath, and particularly for rheumatic and neuralgic affections. Astonishing cures have been effected in such cases by immersion in the hot springs of Virginia, the highest temperature of which is 107°; and which have the ad- vantage, possessed by no artificial bath, that the water is always main- tained at the same heat, no matter ho w prolonged the immersion may be. Caloric is employed topically as an excitant. Hot bricks, bottles filled with hot water, &c, are applied to the feet to excite irritation in diseases that are attended by cold extremities, as in the cold stage of intermittent, &c. The same agents, or hot flannels, or hot salt, or hot sand, are used in cases of abdominal pain, in which their action is also revellent. 46. ELECTRICITY. Electricity, in all its forms, is excitant, and has been employed ELECTRICITY. 499 extensively, at various times, in the treatment of disease. The ap- paratus necessary for the medical electrician is sufficiently simple. It consists of a cylindrical or plate machine—one or two Leyden jars— an electrometer to regulate the strength of the shock from the jars — a discharging rod, that allows a ball to be unscrewed, leaving a point in its place ; and an insulated stool. These are always attainable ; they form part, indeed, of the ordinary electrical apparatus for ex- periments, as well as for the therapeutical application of electricity. The subjoined figure from Pereira exhibits the electrical apparatus for medical purposes, in ordinary use. Fig. 76. Electrical Apparatus for Medical purposes. Friction Electricity. a. Cylindrical Machine. t. Medical Electrometer. c. Insulating Stool. d d. Leyden Jars. etc Insulated Directors. /. Discharging Rod. g. Glass Tube traversed by a wire, which ter- minates at one end by a loop, at the other by a brass ball. Voltaic Electricity. h. Cruickshank's Wooden Trough. 11. Directors, each consisting of a glass tube tra- versed by a wire, one extremity of which is connected with one end of the trough — while the other extremity is surmounted by sponge or flannel moistened with salt and water. Magnetic Electricity. k. Clarke's Magneto-electric Machine. I. Directors. When it is desirable to subject the patient to the influence of the electric bath, he is placed on the insulated stool, and lays hold of a chain communicating with the prime conductor of the electrical ma- chine, so that when the machine is in action, he forms really a part of the conductor. Positive electricity is, consequently, discharged by him at all points, and if an uninsulated metallic knob be brought near him, a spark is communicated to it in the same manner as if it approached the prime conductor. The effect of this electric condi- tion is excitant; but no very marked influence is exerted on the functions, in the generality of cases. Dr. A. T. Thomson, however, states, that a clergyman — in whom he never could produce perspira- tion by any of the ordinary diaphoretics, and who never perspired by exercise, or the heat of summer — when insulated and electrified perspired freely. If when the patient is placed upon the insulated stool, and the machine is in action, an uninsulated metallic point be held near any part of his person, the electric aura may be drawn from him. Or if 500 SPECIAL excitants. an insulated metallic director, or wire connected with the prime conductor, be held near the part to be electrified, the electric aura or a current of electrified air will pass from the point to him. A sensation, resembling that produced by a stream of air, is felt on the part, and it acts as a gentle excitant to delicate structures, as the eye or ear, and to excoriated or ulcerated surfaces. If we are desirous of employing a greater amount of excitant in- fluence, recourse is had to the electric spark; which is applied either by placing the individual on an insulated stool, and bringing the knuckle, or the ball of an uninsulated director near him ; or by pre- senting to the part to be electrified the knob of an insulated direc- tor connected with the prime conductor. In the former case, the spark is drawn from the patient; in the latter it is conveyed to him; yet the therapeutical effect is alike in both cases. The sparks will be more or less powerful according to the distance at which the knob is held ; and, in all cases, if they be of any size, a pungent sensa- tion is experienced ; and if a succession of sparks be drawn, the part may be made red, and a small spot or wheal be induced, which soon, however, disappears. Where it is desired to electrify deep- seated parts — as the uterus through the vagina, or the meatus audi- torius internus — the conducting wire, terminating in a small knob, is made to pass through a glass tube. The sparks may be greatly diminished in size if the part be co- vered with flannel; and this is a favourite mode of applying elec- tricity with some. The patient being on the insulated stool, the knob of an uninsulated director may be placed in close contact with the flannel, moving it steadily and rapidly, so as to draw a multi- tude of small sparks. This plan has been termed, by some, electric friction. But the most violent effect is produced by the shock. In this case, the part of the body, to be electrified, is made to form a portion of the circuit, through which the electric discharge has to pass from one side of a Leyden jar to the other. The jar is charged from the prime conductor ; and around its exterior, and communicating with the tinfoil surrounding it, a chain is placed, which is again con- nected with the ball of an insulated director. This ball, thus com- municating with the exterior of the jar, is brought in contact with one side of the part to be electrified, whilst the knob of the jar, which communicates with the inner coating, is brought in contact with the opposite side. The discharge then takes place instanta- neously with a shock; and by means of the "medical electro- meter"— as it is termed — the strength of the charge can be gra- duated. The effects, produced by the shock, vary greatly accord- ing to the intensity of the charge. They may merely consist in a slightly disagreeable sensation ; or may be extremely painful ; and, when very intense, may destroy life. This method of electrifying, consequently, requires more circumspection than the others ; and may not be at all adapted for those who are very impressible. The electric current, as it is termed, consists in connecting a part GALVANISM. 501 of the patient's body with the prime conductor in action, so that the electricity shall pass through the body to the ground. This is, how- ever, so feeble an agency as to be scarcely worthy of the attention of the therapeutist. Electricity is employed as an excitant in a variety of affections. In paralysis, it has been most extensively used, and especially in cases of the partial form. Where the mischief is encephalic, it need scarcely be said, that much good cannot be expected from it; yet favourable testimony has been adduced even in these cases, by Dr. GoldingBird. In nervous deafness, sparks have been given to, or taken from, the mastoid process, and around the meatus audito- rius externus, and the bottom of the meatus. The same agency, as well as the electric aura, has been employed in amaurosis, but it too often fails. It has also been largely used in chronic rheumatism, and in the stiffness and rigidity that follow sprains or bruises. Of its use as an emmenagogue, mention is made elsewhere, (p. 415.) It has likewise been prescribed in the form of electric friction or of slight shocks, to promote the biliary secretion, and to modify the function of nutrition, so as to discuss indolent tumours; and recent obser- vers have afforded testimony as to its advantages in chorea and other neuroses, in the form of electrification or of slight shocks along the spine. At one time, it was much more largely used than at pre- sent ; and, although a stimulus has been afforded to its re-employ- ment by the testimony of recent observers, as of Messrs. Addison and G. Bird, the cases in which it can be productive of much benefit are probably very limited. 47. GAL'VANISM. The therapeutical effects of galvanic or voltaic electricity are like those of ordinary electricity ; and it has been used in the same cases — in paralysis, general and local; in amaurosis ; deafness and dumbness of recent duration, rheumatism, &c. The apparatus, usually employed, (p. 499) consists of— 1. Two Cruickshank's batteries, each containing fifty pairs of copper and zinc plates, three inches square ; 2. of copper-wire communicating with each end of the battery ; and 3. of two insulated directors, consisting of a glass tube, through which the wire from each end of the battery passes — the free extremity, which has to be brought in contact with the part to be galvanised, being covered with sponge or flannel, moistened with a solution of common salt. When the battery is to be put in action, it may be charged with a solution of common salt, or with a weak acid liquor, consisting of not more than l-500th part of muriatic acid ; and where the skin is very sensible, water alone may be used. (Pereira.) The wire or electrode communicating with one pole of the battery is then applied to the part to be galvanised ; and the other electrode at a distance from it so as to include the affected part in the circuit. The circuit may be rapidly broken or completed, as the operator considers proper. A different mode of application has been introduced; to which 502 SPECIAL EXCITANTS. the name Mansford's Plates has been occasionally given, after its proposer. It consists essentially in removing the cuticle from two parts of the cutaneous surface ; applying a plate of silver to one ex- coriated surface, and a plate of zinc to the other, and connecting the two by means of a copper wire. The exact steps of the process the author has given elsewhere. (New Remedies, 4th edit. p. 326: Philad. 1843.) Under the idea, that the galvanic and nervous fluids are identical, Dr. W. Philip employed galvanism successfully in asthma ; trans- mitting the influence from the nape of the neck to the pit of the sto- mach, with a power varying from ten to twenty-five pairs of plates. In these cases, it probably acts as a revellent, its excitant agency making a new impression on the nerves, which detracts or derives from the erethism in the respiratory nerves. In cases, too, which are dependent upon paralysis of those nerves, the excitant influence of galvanism may be beneficial. In the same way, we explain the salutary agency of the plates in epilepsy ; in angina pectoris, and in neuralgic affections of the chest especially, and in paraplegia. Cases of good effects from the action of the galvanic battery in amaurosis have been published by Dr. Hays, of Philadelphia, the galvanic current being made to pass from the mastoid process to the superciliary ridge. Galvanism has likewise been suggested as a remedy in cases of asphyxia, and the suggestion is good. It has, however, very often failed; and as the cessation of the heart's action is the cause of death, and galvanism exerts little or no influence on that organ, it is probable that it may not render as much service as was at one time anticipated. The battery forms part of every perfect resuscitating apparatus. 48. The Electro-Magnet'ic Appara'tus was brought forward as a valuable excitant a few years ago ; but it did' not appear to have any advantage over the ordinary mode of employing galvanism by the battery ; whilst the shocks in rapid succession were often extremely disagreeable. It is now rarely employed, and, indeed, the same may be said of galvanism in general. For some of the other inventions of a galvanic nature, proposed by different individuals — as the anodyne metallic or galvanic brush of Von Hildenbrand ; and the galvanic suppositories, &c, of Harrington, the author may refer to the work just cited. (New Remedies, p. 328.) They are no longer used. 49. A'CUPUNCTURE. The operation of acupuncture, or acupunctura 'tion, is performed by fine, well-polished, and sharp-pointed needles. These are usually from two to four inches long; and at the blunt extremity of the needle, a head of lead or sealing-wax is attached to prevent it from being forced entirely into the body. To introduce the needle the skin is stretched, and it is inserted by a movement of rotation, aided by gentle pressure. The number of needles to be used, and the length of time they should remain, must be determined by the nature of the case, and the judgment of the practitioner. ACUPUNCTURE. 503 Acupuncturation is an old Japanese remedy, which was used in Europe a long time ago, and has been revived of late years in the same kin-d of cases, in which electricity and galvanism are employed; — for example, in rheumatic, spasmodic, and convulsive affections, amaurosis, paralysis, &c.; and it has even been proposed to pass them into the heart in cases of asphyxia! In rheumatic affections its success has been marked, Dr. Elliotson having cured thirty out of forty-two cases by it. It has also been used in gout. When acupuncture is conjoined with electricity or galvanism, it constitutes Elec'tropuncture or Gal'vanopuncture. The opera- tion consists in employing acupuncturation in the usual way, either with a single needle, or with two or more, and making a communi- cation between them and the prime conductor of an electrical ma- chine ; or they may be made to form part of the circuit in the dis- charge of a Leyden jar. In this way, the electrical influence may be graduated from the simple aura to a full shock. Both it and galvanopuncture have been used in the same Cases, as acupunctura- tion, and especially in rheumatic and neuralgic affections. Galvanopuncture has been employed in cases of asphyxia: it has even been suggested to pass the needles, on each side, between the eighth and ninth ribs, until they reach the fibres of the diaphragm, and then to establish a galvanic current between them, by means of a pile of 25 or 30 pairs of plates, an inch in diameter. Some- times the circle was interrupted, at others continuous. This plan was tried by Leroy d'Etiolles on animals asphyxied by submersion ; and, when they had not been under water more than five minutes, they were often restored. As an aid, therefore, — as the author has elsewhere said, — to pulmonary insufflation, galvanism, combined or not with acupuncturation, might be employed in asphyxia ; but it cannot often, perhaps, be available ; certainly, no time should be lost in adopting the other energetic and indispensable measures that are demanded. It has been recommended that as only a very small apparatus is necessary, batteries, consisting of a few plates, might be kept wherever there are station-houses for the reception of per- sons in a state of asphyxia. This suggestion also is good, and they might form a part of the cabinet apparatus of the private prac- titioner ; but whilst an assistant is preparing the apparatus for ac- tion, the practitioner should be assiduously engaged in employing other means of resuscitation. ' 50. EXCI'TANT GAS'ES. Of the gases, whose effects, when inhaled, are excitant, but two have been used,— Oxygen and Protoxide of Azote ; but neither is much employed a- a therapeutical agent at the present day. a. ox'ygen gas. This gas, which is so essential to respiration as to have been termed vital air, has been subjected to numerous experiments, the general results of which are,—that it acts upon the human organism in 504 special excitants. a positively deleterious manner; and that although an animal may live in a limited portion of it for a considerable time longer than in the same quantity of atmospheric air, its respiration becomes hu^ied and laborious before the whole is consumed, and it dies, although a fresh animal of the same kind is capable of sustaining life for some time in the residuary air. Oxygen gas, for therapeutical administration, may be made from black oxide of manganese, exposed to a full red heat in an iron retort, the gas being transmitted through water. It has been advised as an excitant inhalation in chronic debility of all kinds ; and especially in anasmia, chlorosis, paralysis, &c. It should be diluted with from ten to twenty times its bulk of at- mospheric air, increasing the proportion of oxygen according to the effects induced. From one to two quarts of oxygen may be breathed in the course of the day. It is said to augment the force and velo- city of the pulse. 6. protox'ide of a'zote. This gas, called also Nitrous Oxide Gas, Protox'ide of Nitrogen, Par'adise, Intox'icating and Laughing Gas, in now rarely used ex- cept for purposes of exhibition. It may be obtained for medicinal objects by decomposing nitrate of ammonia by means of heat, and transmitting the gas through water. The hydrogen of the ammonia attracts part of the oxygen of the nitric acid, and forms water ; and the remaining oxygen, combining with the azote both of the acid and the ammonia, forms the protoxide. The effects of this gas, when inhaled, are usually singular and delightful. It was breathed by Sir Humphry Davy, Mr. Southey, Mr. Wedgwood and others, whose sensations have been detailed by Sir Humphry. The effects are most exhilarating and excitant, and they are not followed, in the generality of cases, by depression. It is apt, however, to disagree with those whose nervous systems are very impressible, and might be dangerous to such as are predisposed to encephalic or cardiac disease. On some few its effects are by no means agreeable, or transient. Possessed of these powers, it was not surprising, that the inhala- tion of this gas should be regarded with interest as a therapeutical agent. It has not, however, answered the expectations of experi- menters. It has been inhaled in paralysis, and apparently with advantage ; but it is difficult to say how much of the benefit was owing to the inhalation, and how much to the effect on the mind of the patient. (See page 31.) The quantity required to produce its effects is usually from four to nine quarts, which may be inhaled pure or mixed with an equal quantity of atmospheric air. It cannot be breathed undiluted, it is affirmed by Dr. J. Murray, for more than four minutes and a half, consequently its effects must be watched. It is hardly ever used at the present day. end of volume i. NATIONAL library of medicine nlm D3nai2s i NLM031929229