.W;! h> m * iMJl'H'1 i:lii}!r«t - '.-.'i'uh GENERAL THERAPEUTICS AND MATERIA MEDICA. WITH ONE HUNDRED AND TWENTY ILLUSTRATIONS. ADAPTED FOR A MEDICAL TEXT BOOK. BY ROBLEY DUNGLISON, M.D., PROFESSOR OF INSTITUTES OF MEDICINE, ETC., IN JEFFERSON MEDICAL COLLEGE OF PHILADELPHIA, Formerly Professor of Materia Medica and Therapeutics in the Universities of Virginia and Maryland and in Jefferson Medical College of Philadelphia. THIRD EDITION, REVISED AND IMPROVED. IN TWO VOLUMES. VOL. II. PHILADELPHIA: LEA AND BLANCHARD. 1846. QV $3(6 1846 v.z Entered, according to the Act of Congress, in the year one thousand eight hundred and forty-two, by ROBLEY DUNGLISON, M.D., in the clerk's office of the District Court for the Eastern District of Pennsylvania. CONTENTS OF VOL. II. CHAPTE R III. OF MEDICINES. SECTION VI. agents that affect various organs. II. Tonics.—Tonics differ from excitants—The former defined—Modus operandi—Tone, and want of tone, on what dependent—Tonics, direct and indirect—Bitter extractive the great tonic principle of vegetables__ Tonics given with two great views, to strengthen the system and to break in upon a morbid catenation—Therapeutical application of tonics —In febrile diseases—In inflammatory disorders—In the neuroses— Mental tonics—Special tonics ..... 13 Therapeutical application of tonics .... 20 Special tonics ....... 39 I. Simple tonics ...... 30 a. Bitter tonics that owe their tonic virtues to bitter principle singly- ...... 30 b. Aromatic bitter tonics, that possess, along with bitter principle, more or less aromatic property ... 40 c. Astringent bitter tonics, which have an astringent associated with the bitter principle .... 43 d. Mechanical tonics, or such as seem to act mechanically - 50 e. Mineral tonics ..... 53 2. Antiperiodic tonics ...... 71 III. Astringents.—Definition of astringents—Tannic acid, the great ve- getable astringent principle—Their modus operandi—Act best on parts with which they come in contact—Bad effects of astringents—Indirect astringents—Therapeutical application—In fevers, inflammations, he- morrhages, &c.—Astringents often used by the surgeon—Styptics— Special astringents 91 Therapeutical application of astringents ... 97 Special astringents - - - - - - -115 1. Vegetable astringents - - - - - 115 2. Mineral astringents ...... 134 IV. Sedatives.—General observations—Subdivision of sedatives—Defi- nition of sedatives—Modus operandi—Thomson's table of sedatives*— Mental sedatives—Blood-letting—Its effects—Cautions respecting its use—Arteriotomy, phlebotomy, local bleeding—Other sedatives—Con- tra-stimulants—Special sedatives - ... 146 Special sedatives - 180 IV CONTENTS. V. Refrigerants.—Definition of refrigerants—Modus operandi—Exter- nal and internal refrigerants—Refrigerant baths—Therapeutical applica- tion of refrigerants—In fevers—In the phlegmasia?, &c.—Special refri- gerants .....--- 203 Therapeutical application of refrigerants - - - 209 Special refrigerants -..---- 214 1. Saline refrigerants ------ 214 2. Topical refrigerants ------ 217 VI. Revellents.—Definition of revellents—Epispastics—Definition of epispastics—Rubefacients—Vesicants—Suppurants—Actual and poten- tial cauterants—Modus operandi—Permanent and intermittent revul- sions—Intensity of the revulsion—Blisters, as revellents in fever—Re- vulsion in the changeable phlegmasiae—Choice of situation for therevul- sion—Therapeutical application of revellents—In fevers—In the phleg- masise—In hemorrhage—In mental alienation, hysteria, tetanus, &c.— Special revellents ------- 218 Therapeutical application of revellents .... 235 Special revellents ------- 251 a. Rubefacient revellents - - - - - 251 b. Vesicant revellents ..... 262 c. Suppurant revellents ..... 267 d. Escharotic revellents ... 272 1. Erodents ...... 272 2. Actual cauterants .... - 274 3. Potential cauterants ..... 277 VII. Eutrophics.— Eutrophics defined — Alteratives—Modify the function of nutrition — Sorbefacients — Therapeutical application of eu- trophics— Pressure — Friction — Special eutrophics . . 281 Therapeutical application of eutrophics . . . 288 Special eutrophics ....... 290 Topical eutrophics . . . . , . 351 1. Eutrophic ointments . . . . . .351 2. Compressing eutrophics . . . . . 353 3. Eutrophic liniments ...... 254 SECTION VII. AGENTS WHOSE ACTION IS PROMINENTLY CHEMICAL. I. Antacids—Definition of antacids — Great generation of acid in dys- pepsia— Acids always in the healthy stomach — Morbid acidity, how induced — Predominance of acidity in children — Antacids only pallia- tives— Special antacids ••••.. 358 Special antacids ....... 353 II. Antalkalies. — Definition of antalkalies—Cannot often be need- ed— Alkaline state of the habit— Mode of improving defective nutri- tion— Special antalkalies - gg~ Special antalkalies ...... ogn III. Disinfectants. — Definition of disinfectants — Antiseptics__Mo- dus operandi of disinfectants — Bad effects of odorous fumigations__ Of heat, mineral acid vapours and the chlorides as disenfectants__Use of antiseptics — Special disinfectants . . . 370 Special disinfectants . . . . . 375 a. Disinfectants of apartments, clothing, &c. . . , 375 b. Disinfectants of the living body.—Antiseptics. . 373 V CONTENTS. SECTION VIII. AGENTS WHOSE ACTION IS PROMINENTLY MECHANICAL. Modus operandi of mechanical agents— May affect the vital operations — The least important of our therapeutical resources . . . 382 I. Demulcents. — Definition of demulcents — Of emollients — Not remedies of any activity—Therapeutical application — Are di- gested in the stomach — Therapeutical use of emollients — Special demulcents ....... 383 Special demulcents ...... 388 a. Internal demulcents ..... 388 b. External demulcents. — Emollients . . 401 II. Diluents. — Necessity for drinks — Therapeutical use—Their ab- sorption prevented by certain circumstances — Employment in dropsies, diseases of the urinary organs, &c. . . . 404 SECTION IX. OF DEOBSTRUENTS, ANTIDOTES, AND ANTIPARASITICS. Deobstruents — Are indirect agents. Alteratives — Their modus ope- randi—Only used in chronic diseases. Antidotes—Definition of — Are of two kinds—Division of poisonous agents — Therapeutics of poisoning, internal and external — Table of poisons and their antidotes — Antiparasitics ....... 408 I. Deobstruents. . ..... 408 II. Antidotes ....... 409 Table of poisons and their antidotes . . . 412 III. Antiparasitics ...... 421 Special antiparasitics ....... 421 SECTION X. MINERAL WATERS. Table of some of the principal mineral waters . . 429 SECTION XL ON THE COMBINATION OF THERAPEUTICAL AGENTS. Importance of a due attention to principles —Value of authority — Pro- fessional qualifications may be estimated by the prescription — Evils of complexity in prescribing —Rules for prescribing —Table of incom- patibles—Doses of medicines — Conclusion . . . 436 Table of chemical incompatibles .... 447 1* / J GENERAL THERAPEUTICS AND MATERIA MEDICA, CHAPTER III. OF MEDICINES. SECTION VI. AGENTS THAT AFFECT VARIOUS ORGANS. II. TONTCS. Stnox. Confortantia, Corrohorantia, Confirmantia, Roborantia. Tonics differ from excitants — The former defined — Modus operandi — Tone, and want of tone, on what dependent — Tonics, direct and indirect— Bitter extractive the great tonic principle of vegetables — Tonics given with two great views, to strengthen the system and to break in upon a morbid catenation — Therapeutical ap- plication of tonics — In febrile diseases — In inflammatory disorders — In the neu- roses— Mental tonics — Special tonics. The excitants, considered in the last division, are diffusible in their action, and transient in their effects — the stimulation being followed by a degree of depression proportionate to the extent ot such stimulation. They excite, therefore, beyond what may be con- sidered as the healthy standard. The substances, which are now to be investigated, as a general rule, operate silently and perma- nently. They are followed by no undue depression, when discon- tinued ; and they may be employed in states of the system in which the use of Excitants proper might be questionable. Accordingly, when the practitioner is in doubt, whether the case before him will admit of stimulation, and yet the weight of evidence urges him to vol. n.—2 14 TONICS. that course, he usually prefers commencing with a tonic — a slightly stimulating tonic — to beginning at once with the diffusible exci- tants ; — knowing that the former may be discontinued without de- triment, whilst the latter can only be cautiously pretermitted, espe- cially if their employment has been persevered in for some time. Tonics are usually denned to be — Agents, which give strength and vigour to the body. In this point of view, all strengthening aliments might fall under the division. These are, in reality, tonics; but, as before observed, the consideration of aliments is not com- prised in the objects of this work. It has been attended to else- where, (Human Health, p. 179). By many therapeutical writers, tonics have been conceived to act by improving the tonicity of the muscular system ; and, in the clas- sification of Dr. A. T. Thomson, they are separated from excitants proper, and classed with astringents, under the head of—"Vital agents, influencing the body generally by operating directly on the muscular and sanguiferous systems." Yet, he subsequently affirms, that tonics " act on the vital principle through the medium of the nerves, and as far as their mode of operating is understood, we may regard them as excitants." To elucidate his idea on the modus operandi of tonics, he has the following observations: — " When an individual is in good health and in vigour of body, the muscles or moving organs feel firm and tense ; they act regularly and powerfully, whether they are involun- tary muscles, or those under the control of the will. This is a state of healthful tone. On the contrary, when the muscles feel soft and flabby, when the action of the involuntary muscles is languid, and the voluntary do not rapidly respond to the wnll ; when there is a strong inclination for rest and indulgence ; and when the move- ments of the body or its parts are performed with difficulty, this is a state of deficient tone or debility. That both these states are con- nected with the condition of the muscular fibre maybe demonstrated by detaching a muscle from the bodies of two animals in these op- posite conditions, and ascertaining its strength by appending weights to it: the muscle taken from the healthy animal, or that in a state of tone, will sustain a much greater weight than that which is in the opposite state. Thence, to a certain extent, tone implies a difference in the mechanical condition of muscles ; a greater degree of den- sity and cohesion of their component fibres ; but this must be also joined with elasticity, that is, the power of resisting extension, and of restoring itself when the extending cause is removed, before the part can be said to be in the state of perfect tone. That this state is truly the result of vital energy is evident; for the same muscle loses the power of sustaining the weight, which it supported when first cut from the body, and this in proportion to the distance of time from that of its separation from the living body," — and he adds : " medicines or medical agents, which produce this state of heathful tone, and renew the tension and vigour of the muscular fibre are thence denominated tonics." MODUS OPERANDI. 15 Sir Gilbert Blane also asserts, that no muscle, whether voluntary or involuntary, can act unless its fibres are previously in such a state, that if divided they would shrink by their own resiliency, leaving an interval between the cut extremities; and Dr. Paris — after ciling the above remark of Sir Gilbert—observes : — "It appears, that there are certain medicinal bodies, that have the power of effecting this state of tension, and when their effects contribute to its restoration, they are properly demoninated tonics." Yet this resiliency, de- scribed by Sir Gilbert, is not necessarily even a vital manifestation. It may be independent of the vital properties. It continues for some time after the total extinction of life in all its functions : appears to be connected simply with the physical arrangement of the molecules : and is not affected until the progress of decomposition has become sensible. Hence, it has been properly regarded, by Haller and others, as a vis mortua. Flexibility, extensibility, and elasticity are variously modified, and combined in the different forms of animal matter, and they exist, to a greater or less extent, in every organ. Elasticity is only exerted under particular circumstances. The tissues, in which it is inherent, are so disposed through the body as to be kept in a state of exten- sion by the mechanical circumstances of situation, but, as soon as these circumstances are modified, elasticity comes into play, and produces shrinking of the substance. The gaping wound, produced by a cut across a cooked shoulder of mutton, is an example of this elasticity or resiliency, familiar to all. Previous to the division, the force of elasticity was kept neutralised by the mechanical circum- stances of situation — or, by the continuity of the parts ; but, as soon as this continuity was disturbed, or, in other words, as soon as the mechanical circumstances were altered, the force of elasticity was exerted, and produced recession of the edges. This property of elasticity has been called contractilite de lissu, and also tone or toni- city ; — names, which have probably suggested the modus operandi assigned to tonics, which we have been discussing. That diminished cohesion, like that adverted to, may occur as the result of disease, is doubtless. Pathology affords us numerous ex- amples of it, although not so many as is usually supposed ; and it i? by no means easy to see, that such a pathological condition must always exist, when tonics are indicated, or whenever they prove beneficial. The only way, it would seem, that these agents can act on the muscles, is on their contractility, like excitants, and indirectly on their nutrition, through the medium of the nerves distributed to the stomach ; —the irradiations being conveyed from thence to every part of the nervous system, and, therefore, to every portion of the frame endowed with nervous influence. Want of tone appears to depend, certainly, — in the majority of cases, — on exhaustion of muscular contractility, and on impaired nervous influx. Physiology and pathology afford us numerous ex- amples in support of this position, but it will only be necessary to refer to a few. 16 TONICS. The ccenctsthesis or common feeling, of many people, is so much influenced by the condition of the atmosphere, that they become almost barometers ; — feeling light and buoyant when the air is clear and dense, and gloomy, when it is moist and light. Again, it the bowels be loaded, the powers of the system are, at times, so de- pressed, that general languor and lassitude prevail, and the individual is incapable of the slightest muscular effort. In like manner, after continued exertion, fatigue is felt, and rest absolutely demanded, until the exhausted excitability has been recruited ; and, lastly, if a man, previously in perfect health, be struck with the contagion of a malignant fever, he finds his strength dissipated, and that he is inca- pable of raising as many ounces as he, a short time previously, could raise pounds. In none of these cases, can we presume that the me- chanical condition of the muscle is materially changed. In the cases of the varying atmosphere, the loaded bowels, and the impression of malignant fever, the feelings of debility must be regarded as wholly dependent on the condition of the nervous system ; and in that of great fatigue after protracted exercise, on the exhaustion of the mus- cular contractility under the perpetual excitement produced by the repeated efforts of volition;—the nervous influx exhausting the muscular contractility or excitability like any other stimulus. How strongly want of tone is connected with the state of the nervous system, is seen in the depressing influence of nostalgia or homesickness, where every voluntary function is carried on in languor and asthenia ; and, on the other hand we are equally struck with the evidences of strength, which the maniac exhibits. In such cases, the delicate muscles of the female execute feats, which the largely developed muscles of the athletic male would be incapable of ac- complishing — under the ordinary or healthy nervous influx. The effects, too, of the mental tonics, to which reference will be made, must manifestly be exerted on the brain, in the first instance, and, through the medium of the nerves, on the rest of the body. Under the salutary nervous excitation, which tonics are capable of effecting, the action of the capillaries over the whole system becomes augmented ; nutrition is increased, and the vis insita elevated to the full healthy standard. It is probable, that all tonics are obscurely stimulant ; but they differ, as before remarked, from excitants proper, in not stimulating to a marked degree, and in the excitation not being followed by corresponding depression. They exert, however, no perceptible stimulation : their action, though efficacious, is silent; and, if they be repeated at proper intervals, a permanent, healthy state of tone is induced. But all this is produced through the agency of the tonic upon the nervous system, and there does not appear to be any satis- factory reason for believing, with Dr. Chapman, of Philadelphia that tonics, " like every other class of medicines, are endowed with some properties peculiar and distinctive, among the most conspicuous of which is their specific affinity to the muscular fibre." Tonics may be either direct or indirect; — that is, they may be the GENERAL EFFECTS. 17 means of directly adding to the healthy tone of the system, in the mode described ; or, in particular conditions of the economy, other substances — belonging to different classes of therapeutical agents — may exert a tonic effect indirectly. In this way, blood-letting, cathar- tics, emetics, &c, may be indirect tonics. In the state of apparent debility, which accompanies febrile or other irritation, and in that in which the stomach or intestinal canal is loaded, and the nervous system oppressed and depressed, a remedy, which obviates these conditions, will remove the debilitant effects of such conditions, and prove tonic. When, however, we use the term tonic abstractedly, we never apply it to those indirect agents. It has been a question, occasionally agitated by therapeutists, whether there be any such thing in nature as a real tonic; or, in other words, whether any remedial agent can, by virtue of properties inherent in it, communicate tone where tone is deficient. It would appear, that no such properties are possessed by any agent; or, in other words, that no principle is infused into an asthenic organ or tissue, which can give strength to it. The whole effect is exerted, directly or indirectly, on the nerves of the stomach, whence it is distributed, by means of the nerves, to every part of the system. It is probable, too, that some of the articles of the class are absorbed, and act upon the organism through the altered character of the blood in the capillary blood-vessels. Such, it has been conceived, is the modus operandi of the preparations of iron in chlorosis and other affections. Some tonics, again, are insoluble, and pass, apparently unaltered, through the digestive tube, appearing to exert their influ- ence like certain condiments, which contain no nutriment, but place the chylopoietic organs in a condition for deriving a larger amount of nutriment from alimentary matters taken along with them than they would otherwise have been able to separate. When a tonic is administered in disease, its speedy operation is not to be expected. This is one of the essential points of difference between tonics and excitants proper. The effects—as already re- marked — are gradually, and almost insensibly exhibited ; and they afford as good specimens of the action of what have been termed alteratives as any that could be selected. They produce no sensible evacuation. Under their employment, the appetite gradually im- proves ; the impressibility of the nervous system — often induced by long protracted indisposition, or by a rapid reduction of the vital forces, as in acute diseases—lessens ; the action of the circulatory system assumes the healthy standard ; the general feeling exhibits itself buoyant and elastic ; and the muscular powers, under the im. proved nervous influx, resume their wonted energy ; but al] this denotes only a restoration to the healthy standard ; hence, the great use of tonics in convalescence ; but if administered in conditions of the system in which they cannot be expected to do good, they are devoid of the injurious consequences, that may follow the undue use of excitants proper, and their administration may be arrested at any 18 TONICS, moment, without fear of debility resulting. It has been already seen, that it is'the use of diffusible stimuli, which is alone followed by corresponding depression. Bitter extractive appears to be the great tonic principle of most of the vegetable tonics; aided, in some, by the presence of aromatic oil—which renders them more stimulating tonics—in others, by the presence of one or both of the great astringent principles of vege- tables. This bitter extractive is not affected by heat; but the aro- matic oil is, provided the boiling temperature be applied for some time. Decoction is, therefore, an improper mode of preparation, where the object is to retain the aromatic property. Infusion is the form most commonly prescribed, and hence the pharmacopoeias con- tain officinal infusions of all the principal vegetable tonics. Dr. Thomson asserts, that Dr. Chapman, and —following him — Dr. Paris, attempt to prove, that bitterness is essential to tonics; or, in other words, that it is the tonic principle ; but in this, he does those writers injustice. The latter gentleman affirms, that the tonics, derived from the vegetable kingdom, are generally bitter ; — whilst the former expressly says : — " Concerning the element, which gives the tonic power, some difference of opinion has been entertained. Cullen supposed it to be the same quality as that of bitterness. But though it holds to a considerable extent, there would seem to be no necessary connexion in all cases. Exceptions at least are not want- ing, as we see very strikingly in opium and digitalis, wThich are bitter, though not tonic ; and, conversely, in many of the metallic articles, which, though tonic, are not bitter in the slightest degree." Nor do we think Dr. Thomson more accurate in his opinion, " that part of all the vegetable tonics are [is] digested in the stomach, and the principle, whatever it is, which produces their tonic influence, is thus separated from the other parts ; and consequently it is enabled to act with more energy upon the nerves of the stomach." This explanation can scarcely apply to infusions of vegetable substances, and still less to the active principles of such substances ; nor can it well apply to them when given in the solid form, as in the state of powder, in which the active principle is combined with little more than lignin or woody fibre, in many cases. It is but necessary, that the fluids of the stomach, or any fluids, should come in contact with the substance in order to extract its tonic, virtue ; but nothing like digestion — as applied to the physiological process to which alimen- tary matters are subjected —- is necessary. Bitter extractive, as Dr. Paris has remarked, is a great natural tonic. It appears to pass through the body without suffering any diminution in its quantity, or change in its nature. No cattle will thrive upon grasses, which do not contain a portion of this principle ; a fact, which is considered to have been proved by the researches of Mr. Sinclair, gardener to the Duke of Bedford, in his " Hortus Gra^ mineus Woburnensis," where he remarks, that if sheep be fed on yellow turnips, which contain little or no bitter principle, they in- GIVEN WITH TWO VIEWS. 19 stinctively seek for, and greedily devour any provender, which may contain it, and if they cannot obtain it they become diseased, and die. " We are ourselves conscious," Dr. Paris adds, " of the in- vigorating effects of slight bitters upon our stomach ; and their pre- sence in malt liquors not only tends to diminish the noxious effects of such potations, by counteracting the indirect debility, which they are liable to occasion, but even to render them, when taken in moderation, promoters of digestion. The custom of infusing bitter herbs in vinous drinks is very ancient and universal: the poculum absinthiatum was regarded in remote ages as a wholesome beverage, and the wormwood was supposed to act as an antidote against drunkenness. The Swiss peasant cheers himself amidst the frigid solitude of his glaciers, with a spirit distilled from gentian, the ex- treme bitterness of which is relished with a glee, that is quite unin- telligible to a more cultivated taste." Tonics may be given with one or two views ; — either to make a decided impression on the nervous system, so as to break in upon a chain of morbid phenomena that supervene in paroxysms, — as in in- termittent fever, — or to produce their silent but permanent opera- tion for the removal of debility. The same form of preparation is not equally adapted to the two cases. In the former, the lignin or woody matter of the vegetable may not be objectionable. On the contrary, it may assist the operation of the tonic principle, by excit- ing a new action in the nerves of the stomach; but, where the powers of the system — and of the digestive organs as a part — have been prostrated by long protracted indisposition, the vegetable tonics cannot be administered, with propriety, in powder,— as they are apt, by reason of the indigestible woody matter, to occasion great de- rangement of the stomach and bowels, and sometimes irritative fever. At other times, the bark accumulates in such quantity in the alimen- tary canal, as to be discharged, for several days consecutively, by the bowels. In a case of this kind, which fell under the author's care some years ago, the most disastrous results were produced — appa- rently by the irritation, excited in the system by the presence of this extraneous substance in the bowels. A young lady, of markedly scrofulous temperament, and predisposed somewhat to pulmonary consumption, was attacked with bilious fever, which was actively treated, and, in the course of three or four weeks, yielded: the re- sulting debility, however, was so great as to induce the practitioner to prescribe a tonic ; and the cinchona was selected, and adminis- tered in powder. After she had taken it for some days, vomiting and purging occurred, accompanied with occasional chills of the most distressing character. Bark was discharged in quantities in the evacuations; and, under the irregular actions thus excited, tubercles — already probably present in the lungs—proceeded to softening, and this most rapidly ; hectic fever, and every symptom attendant on the confirmed stage of pulmonary consumption, supervened, and she graduall) sank under the malady; — yet, no signs of phthisis 20 TONICS, were present prior to this derangement, produced, by the bark in powder, on a frame already debilitated by a previous malady. Where the object of the practitioner is simply to strengthen the de- bilitated gastric functions, the powdered tonics should not, therefore, be chosen. Modern chemistry has presented valuable gifts to thera* peutics, by separating the active principles from several of the tonics ; and where this has not been done, simple infusion will generally ex- tract all their virtues. The watery infusion is perhaps the best pre- paration ;— the spirituous combining an excitant principle, which mav not ahvays be indicated, where tonics are ; and it is well, where their administration has to be persevered in for a length of time, that the tonic should be varied. The system soon becomes habitu- ated to the same agent; and, if another be substituted in its place for a few days, the use of the former may be resumed with its pristine advantage. Therapeutical Application of Tonics. In the therapeutical employment of tonics, it is important to in- quire whether some may not be better adapted for fulfilling the indi- cations that may suggest themselves, than others. Fever. — In febrile diseases, tonics cannot often be needed, and, accordingly, are not much employed. The remarks made regarding the use of excitants in fevers are applicable to tonics, except, that the latter do not excite as much as the former, and, when cautiously used, not beyond the healthy standard. Simple tonics can, therefore, be prescribed, when excitants might be of doubtful propriety; and if the symptoms do not improve under their administration, they can be discontinued at once, without any apprehension of the evil that might supervene on the sudden discontinuance of excitants. The vital elasticity is generally sufficient to restore the patient from the depres- sion induced by fever, and when it is not, the use of excitants — and the same may be said of tonics — will not often be found effective. They can, indeed, act only on the excitability, which is present in the system. The practitioner, however, will never hesitate to have re- course to them in those malignant forms of typhus, sometimes met with in jails, camps, and in the filthy, unventilated houses of the destitute, as well as in every fever, whose symptoms approximate to such a condition. The sulphate of quinia, in the state of supersul- phate, formed by the addition of a few drops of sulphuric acid, is one of the most common agents prescribed in these cases ; although the watery infusion of many of the tonics, — as columbo, and gentian — is often also recommended. In the apyrexia of intermittents, tonics are the sheet anchor of the physician, to which he trusts implicitly. Their mode of operation, in preventing diseases characterised by periodicity, is by no means clear. The only plausible theory is, that they produce a new im- pression upon the nerves of the stomach, and through them on the ner- vous system generally; and that the new action, thus induced, is IN INTERMITTENTS. 21 sufficient to break in upon the morbid chain that has been establish- ed. This view is, at least, strengthened by the fact, that a powerful emotion produces a similar antiperiodic effect with the tonic ; may completely prevent an expected attack; and, even after its inception, remove it. Accordingly, fear is ranked, by many practical writers, amongst the antiperiodics to be employed in ague ; and the efforts of the tractoriser, and the animal masnetiser, exert their influence in the same manner. It is not easy to explain this effect on the mind, or, indeed, the ac- tion of any of the class of tonics, under the idea which Broussais en- tertained of the pathology of intermittents ; —that they are intermittent gastro-enterites. " Every regular paroxysm of intermittent fever," he remarks, "is the sign of gastro-enteritis, the irritation of which is afterwards transferred to the. cutaneous exhalants, which produce the crisis." Yet this state of gastro-enteritis is removed, and prevented by agents, which would scarcely seem appropriate for such a result; — for example, by the peppers, as well as by the whole class of aro- matic tonics. But, whatever objection may be made to the pathological views of Broussais on the subject of intermittents, his treatment is rational. It is, indeed, that which experience has shown to be most satis- factory. Intermittents, it is known, may wear themselves out; but, it is a long and a tedious process. Antiphlogistics simply have been found to have no effect in breaking in upon them. However useful they may have proved in lessening the duration of one of the stages of the paroxysm, they do not prevent the recurrence of the attacks. The employment of vegetable or mineral tonics is demanded, if the object of the physician be to put an end at once to the disease. The following proposition conveys aphoristically the ordinary treatment in intermittent fever, — a treatment which is sanctioned by the expe- rience of ages, and is no emanation from the ' physiological doctrine,' but rather opposed to its inculcations. " The surest method for the certain cure of inflammations with periodical exacerbations, is, to treat them at first by antiphlogistics during the hot stage, so as to render the apyrexia complete ; to continue this treatment after the paroxysm, if the apyrexia be not complete ; to give the cinchona, or rather the sulphate of quinia, and the other tonics, during the whole apyrexia ; to administer diffusible stimuli at the accession of the ri- gors, and to return afterwards to cooling drinks when the hot stage is developed." (Broussais.) It is only, however, when the apyrexia is complete, that tonics can be administered, with full advantage, for the cure of intermittents. If plethora exist, or if there be hypersemia in any organ, these must be removed, before the antiperiodics are had recourse to ; unless, in- deed, in those old obstructions of the parenchymatous viscera, which occasionally present themselves as evidences of former attacks of malarious disease. In the pernicious intermittents, too, which pre- vail in some countries to so great an extent— as in the Maremma dis- 22 TONICS, trict of Italy, and in some parts of this country — the cinchona seems to be required, before there is a complete apyrexia, for the purpose ot arresting, as early as possible, paroxysms which might prove fatal, by virtue of the irregular actions —the hyperemias —which they are apt to induce in important organs. It happens, fortunately, that in_ these cases, there does not appear to be as much mischief induced by the premature administration of the cinchona, or its active principle, as is often apprehended, although M. Broussais, in the propositions cited, has depicted some of the evils which he considers likely to be produced by it. There are many observing practitioners, who have administered the cinchona — even in substance — a form in which it is most likely to disagree, in consequence of the quantity of insolu- ble woody matter, and who have been satisfied, that it has not added even to the intensity of the hot stage. Still less would this be likely to accrue from some of the more advisable forms of preparation. The author has often administered cinchona in powder in mode- rate doses, both in the healthy and moderately excited state of the system, but without observing any augmentation of action induced by it. It is a good general rule to lay down, that, prior to the adminis- tration of tonics, all local mischief should, if possible, be removed ; for, even should these agents not augment the mischief, they cannot exert the necessary sanative influence upon the morbid catenation, which keeps up the fever. In the enlargements of the spleen, how- ever, that accompany, or succeed, intermittent fever, sulphate of quinia, and the subcarbonate of iron, in large doses, have been found excellent remedies. Remittent fevers have to be regarded much in the same light as the continued, in respect to the administration of tonics. Whilst the febrile irritation is nearly constant, or whilst there is no period, in which fever is nearly, if not wholly, absent, they cannot generally effect a cure. The nearer the remittent approaches to the intermit- tent, in its character, the more beneficial will be their action. During the inflammatory period of the disease, antiphlogistics have to be relied upon exclusively ; and as there is generally a strong disposition to hyperaemia in some important organ, during the continuance of the irregularity of functions, which characterises the remittent forms of fever, antiphlogistics have to be pushed to a greater extent than in cases of simple fever. There are cases, however, of remittent fever occurring in highly malarious districts, which demand the use of the bark, or quinia, comparatively early ; — the disease, from the first, not exhibiting any highly phlogistic character, and being apt to be attended with engorgements of internal organs, unless interrupted in its progress at an early period. In such cases, bark, or its active principle, has been found effectual. Inflammations. — It need scarcely be said, that tonics are not in- dicated in inflammatory disorders, unless it is in those forms, and stages, in which excitants may be advisable. It has, however, been IN INFLAMMATORY DISORDERS. 23 maintained, by men of no small distinction in science, that they may be given with advantage in every stage of erysipelatous inflammation, as well as of acute rheumatism. So far as the author's experience goes, these affections differ somewhat according to the climate, or locality in which they occur; and hence the diametrically opposite views of treatment, at one time inculcated in London and in Edin- burgh ;—the antiphlogistic medication being universally adopted in the one place, whilst the tonic was as universally had recourse to in the other. Much also depends upon the habit of the individual, — whe- ther healthy or modified by intemperance, &c. In the latter case, the inflammation may be of, what is termed, the most unhealthy cha- racter : adynamic fever may attend, and at times, indeed, every sign of absolute typhus, with tendency to gangrene. In such a condition, tonics are indispensable. The practitioner must, however, be always guided by the symptoms that present themselves, and by the nature of the lesion, in this way indicated ; and if he practises soundly, he will find, that, occasionally, it is requisite to push antiphlogistics considerably, whilst, at other times, the indications may be, to be equally active with tonics. The facts, in this case again, have shown, that tonics, although they may not always be productive of advan- tage, may still be administered with impunity. The remarks made on erysipelas apply generally to acute rheumatism, which is essen- tially arthritis, or an inflammatory condition of the fibrous structures surrounding the joints, accompanied by one singular anomaly, — that the skin, instead of being hot and dry, as in other fevers, is usually hot and bedewed with copious perspiration. In such case, tonics have been freely exhibited, and have been looked upon, by some practitioners, as more beneficial, from the commencement even, than antiphlogistics. The author has had numerous opportunities for witnessing the exclusive use of both these modes of treatment, and although he cannot agree, that the tonic medication has been always the best, he does not recollect having seen the symptoms, in a single case, aggravated under their prudent administration. A combi- nation of the two modes has appeared to him most advantageous; —treating the disease, during the earlier period, by the ordinary antiphlogistics, and afterwards endeavouring to modify the condition of the nervous system by the cautious employment of tonics, such as the sulphate of quinia. The whole disease is peculiar. It is not dangerous whilst the joints remain chiefly affected ; and it only be- comes so by the extension or translation of the rheumatic inflamma- tion to more important organs. It has been the opinion of many eminent observers, that copious depletion favours this extension, or metastasis, whichsoever it may be ; but proof is wanting. In our uncertainty, it is advisable not to be too officious, where, as already remarked, the disesae is not situate in parts of vital importance, and usually terminates favourably, except under the supervention of the accidents just mentionea. Hemorrhage. — As in inflammatory diseases gentle tonics are 24 TONICS, manifestly contra-indicated, so are they in the active forms of hemor- rhage, the management of which is essentially that adapted for in- flammatory disorders ; but in the less active varieties,— in those that have been termed passive, and in which there is loosened cohesion of tissue, and perhaps modified spissitude of the blood, so that it readily transudes through the coats of the vessels,-— the aid of all the forms of general excitants may be required. Tonics, on this prin- ciple, are employed in scurvy, and in febrile and other affections, accompanied with strong evidences of a passive hemorrhagic ten- dency. JVeuroses. — Many of the neuroses, being attended with consider- able debility and mobility of the nervous system, require the em- ployment of tonics. This is the case with epilepsy, which is more frequently dependent on this condition of the nerves than on any inflammatory state of the system. Not unfrequently, however, the disease is organic in its nature, or, in other words, arises from some lesion of the encephalon. In such cases, tonics are not adapted to afford relief; but they are not easy of discrimination, and a plan of treatment, adapted to the general cohdition of the system, is usually had recourse to. This, as the author has said, is generally required to be of a tonic kind. The vegetable tonics are, in these cases, not equal to the mine- ral ; and, of the latter, the nitrate of silver is to be preferred, per- haps, to any of the others. The author has succeeded in removing many cases of epilepsy by its means ; but it requires to be perse- vered with for a considerable time. It will rarely be found to exert any decided efficacy before the end of the first month. The preparations of zinc, copper and iron, are likewise employed, but they are not usually as efficacious as the salt of silver. In chorea, the hopes of the practitioner are placed, almost en- tirely, on the appropriate use of tonics, combined with cathartics to remove the torpid state of the intestinal canal, which prevails in the disease. Here, again, the mineral tonics are preferred, as wrell as in chlorosis, which commonly occurs in those in whom there is much torpor, of the system, — characterised by pale and lurid com- plexion ; languor; listlessness ; depraved appetite ; indigestion ; palpitation, &c. In neuralgia,— employed as a generic name for a number of dis- eases,— the principal symptom of which is a very acute pain, exa- cerbating, or intermitting, following the course of a nervous branch, extending to its ramifications, and seeming, therefore, to be seated in the nerve,—the plan of treatment by chalybeates has been found the most satisfactory. In this distressing disease — one variety of which has been long known under the name tic douloureux__the greatest diversity of agents has been made use of: — bleeding gene- ral and local; emetics ; ; purgatives ; rubefacients ; vesicants ■ cau- terants ; anodynes ; mercurial frictions ; electricity ; division of the nerve, and excision of a portion of it, &c, &c. ; but one of the most IN LOCAL DISEASES, ETC. 25 successful remedies is, undoubtedly, the subcarbonate of iron, given in large doses,— for instance, in thirty or forty grains twice or thrice a day. This course of treatment, continued for a month or two, will often relieve, and ultimately remove the much dreaded affection. The mode in which it operates is by no means clear. It is, of course, through the nerves of the stomach, that any new action must be in- duced in the nervous system generally, and in the nerves affected with neuralgia in particular, ^ince its first introduction into practice for this purpose, by Mr. B. Hutchinson, of Southwell, England, up- wards of twenty years ago, the author has had repeated opportunities for exhibiting it, and often with the most happy results. In one case, a lady had suffered under the most excruciating hemicrania, — essentially an intermittent neuralgia of one-half the encephalon, — for which depletion, anodynes, counter-irritants, &c, had been used in vain. She was confined to bed more than half her time, and suffered intensely; yet the affection was completely removed by the use of the subcarbonate, and although it is now nearly twenty years since the cure was effected, the symptoms have not recurred. He could allude to many similar cases. Worms. — Bitters, and, indeed, the whole class of tonics, are an- thelmintic, or unfavourable to the generation of entozoa within the body; but this subject occupies a distinct section. (See Anthel- mintics.) They are likewise found to be serviceable in many Chronic cutaneous diseases, unaccompanied by febrile excitement, as in some varieties of strophulus, lichen, prurigo, psoriasis, &c, in which their efficacy is mainly perhaps exerted through the changes they induce in the blood, and, through that fluid, on the vessels of the affected parts,— acting, therefore, as eutrophics, (q. v.) rather than tonics. Local diseases, fyc.— The surgeon, where gangrene is about to take place in any part of the frame, places his main reliance upon the employment of tonics, administered internally, as well as applied to the gangrenous part, where this is practicable. For this purpose, the cinchona, or its active principle, is found most effectual. In short, in all cases, in which the powers of the system appear to be below the due standard ; or, where the action of the nervous system is particularly impaired ; where the skin is pale ; the pulse feeble ; the solids loosely cohering; and where the ordinary indications of cachexia are present, tonics are demanded ; and even in cases where the practitioner, owing to evidences of general febrile or local irritation, is doubtful whether they may be productive of advan- tage, he may venture upon their administration, when he would be afraid to use excitants. Too much dread is, indeed, generally inculcated, and entertained regarding them. The remarks of a modern writer,Dr. A. T. Thomson, on this point, are extremely just, and apposite. "Upon the whole," he says, "it is necessary that tonics should not be confounded with stimulants; and although it is proper to prescribe them with caution in any form of fever compli- 26 TONICS. tared with local inflammation, yet, we ought not to be prevented by the dread of inflammatory symptoms from employing a class of reme- dies, so well calculated to restore the strength and vigour of the nervous system, essential for carrying on the functions of life. We must recollect that tone is not excitement, nor strength increased vas- cular action" The abstraction of caloric from the body, by the application of cold to the surface, — as by cold bathing, — has long been ranked amongst tonic agencies — with what propriety the author has con- sidered elsewhere, [Human Health, p. 361). The direct effect of such abstraction is certainly sedative, and, therefore, when the vital en- ergies are too strongly exerted, it may, by reducing these, be indi- rectly tonic ; but if it be exhibited, when languor, and diminished action pervade the frame, during existing disease, in the state of con- valescence, or in feeble infancy, the depressing effects of the appli- cation will be rendered manifest. In this respect, the cold and the hot bath are opposed to each other, — the former exerting a seda- tive, the latter an excitant action. The judgment is often misled by the feeling of glow over the wThole surface, wThich follows immersion in the cold bath, when a healthy individual has recourse to it. This feeling is fallacious : the reaction is not really as great as it appears to be, owing to the mind instinctively contrasting the existing sen- sation with the one immediately preceding it, as it does indeed on all occasions. If we descend into a cellar in winter, and again in summer, we have, in the former season, the impression of warmth, and, in the latter, that of cold, although the temperature of the cel- lar may be nearly the same at both seasons, — a comparison being instinctively instituted between the temperature felt, in both cases, immediately previous to the descent; and as, in the one case, the air above was colder, and, in the other, warmer than that of the cellar, the feeling experienced in the room was, in the former case, that of augmented, and in the latter of diminished temperature. Exercise is likewise a tonic, that may be employed with much advantage in disease. When combined, indeed, with mental amuse- ment—such as travelling exercise affords—its salutary results are sometimes astonishing. When we regard the effects which active exercise is capable of inducing, and the degree of effort which is necessarily required, we can readily appreciate the cases in which it may ;be found advan- tageous, or the contrary. It is, of course, singularly inappropriate du- ring acute diseases of any kind ; and as one of its chief effects is to augment the energy of the circulation, and to cause the blood to circulate through every portion of the capillary system, — if hyper- aemia exist in any part of the frame, it may increase it; whilst if obstructions be present to a trifling extent only, the impetus afforded by the exertion may tend to remove them. But even where active exercise is improper, the passive form may be adopted ; and the change of air and scene, thus afforded, unites with the motion in im- TRAVELLING EXERCISE. 27 pressing a salutary influence on a frame debilitated by disease. The author has elsewhere entered into the physiology of the different active and passive exercises in a hygienic point of view, and has suggested the various remedial and injurious results, that may be induced by any and by all of them. He will, therefore, confine himself, at present, to a few general observations for the guidance of the therapeutical inquirer. It is in the great class of nervous diseases that we find exercise — especially travelling exercise — so markedly beneficial; and it is surprising what an amount of exercise a feeble individual, under such circumstances, is capable of enduring without fatigue. Allu- sion has already been made to the surprising feats of strength exe- cuted by the maniac, and by those whose encephalic functions are inordinately exalted. The cases of resistance afforded by the vale- tudinarian, whilst toiling over steep ascents in situations new, but of engrossing interest to him, must be accounted for in a similar man- ner. This has been forcibly illustrated by a modern writer, Dr. James Johnson. " In the month of August, 1823," he says, " the heat was excessive at Geneva, and all the way along the defiles of the mountains, till we got to Chamouni, where we were at once among ice and snow, with a fall of forty or more degrees of the thermo- meter, experienced in the course of a few hours, between midday at Salenche, and evening at the foot of the glaciers in Chamouni. There were upwards of fifty travellers here, many of whom were females and invalids; yet none suffered inconvenience from this rapid atmospheric transition. This was still more remarkable in the journey from Martigny to the great St. Bernard. On our way up through the deep valleys, we had the thermometer at ninety-two de- grees of reflected heat for three hours. I never felt it much hotter in the East Indies. At nine o'clock that night, while wandering about the Hospice of St. Bernard, the thermometer fell to six de- grees below the freezing point, and we were half frozen in the cheer- less apartments of the monastery. There were upwards of forty travellers there — some of them in very delicate health ; and yet not a single cold was caught, nor any diminution of the usual symptoms of a good appetite for breakfast next morning." This resistance to deranging influences is more striking than strange. It is fortunate for us, that the condition of the functions, during an elevated temperature, still continues for a time after the temperature becomes depressed. Were it otherwise, the worst con- sequences would follow an immersion in the cold bath, after the sys- tem had been violently excited by the application of heat — as is the practice with the Russians in their vapour baths — as well as the sudden vicissitudes, to which the climate of the United States is lia- ble. The same disadvantage might apply, though to a less extent, to a change of climate. The excited condition of the capillaries of the surface, induced by excessive heat, subsides gradually when the temperature is suddenly reduced, and in such a manner, that a 28 TONICS. power of resistance remains for a time; hence it is, that we pass with impunity from a hot room, in the depth of winter, to the exter- nal air largely perhaps below the freezing point; and a similar power of endurance continues for some time after a person has quit- ted a torrid, to reside in a temperate or frigid region — and con- versely. It is obvious, from what has been said, that the occupation of the mind by a succession of pleasing objects—constituting amusement — must be regarded as a tonic influence, and many a valetudinarian, who quits the town during the summer, suffering under dyspepsia, or hypochondriasis, or worn down by some corroding or protracted malady, finds his uneasy feelings disappear, and himself almost re- novated, before he reaches the end of his journey towards some of the fashionable watering places. A great deal of this effect is owing to simple change of air — so beneficial to the civic resident in a hy- gienic respect; — much also to exercise, and to change and ap- propriate regulation of diet; but the chief part, perhaps, to the men- tal occupation afforded by varied scenery, and society, on the way. The whole physical circumstances surrounding the individual are changed ; and he abandons himself to new impressions, which break in upon the monotony of the old. Confidence and hope must likewise be esteemed valuable tonics. The author has previously described the influence exerted by con- fidence in the physician on the action of his remedial agents, — as well as the great advantage to the patient, in several malignant dis- eases, that he should not give up hope, —' the sick man's health,' — but that, on the contrary, he should cherish it as one of the most influential agencies in his recovery. It has been properly said by a distinguished poet — himself a physieian — that " whatever cheerful and serene Supports the mind, supports the body too ; Hence, the most vital movement mortals feel Is hope ; the balm and lifeblood of the soul; It pleases, and it lasts." Armstrong. Every practitioner must have observed the tonic effect of hope, where it has been enthusiastically indulged ; and, on the other hand the blighting results of hope deferred, or lost. It is a common say- ing, that the physician might as well destroy a patient as tell him there is no hope ; and in certain affections, this is an approximation to the fact. Where the functions are already greatly depressed such a communication is likely to add to the depression. Perhaps in no case was the corroding effect of mental anxiety and doubt more ex- emplified than in the nostalgia, which was so common during the domination of Napoleon, when the young conscripts were torn from their families and friends, and forced into foreign and far distant countries ; — a disease, which has been said so frequently to affect MENTAL TONICS. 29 the Swiss, who have left their homes and their country to dwell in some other clime. Rogers has a beautiful allusion to this Heimweh, or ' Homeache,' as well as to the influence of association, in his ' Pleasures of Memory: — " The intrepid Swiss, who guards a foreign shore, Condemn'd to climb his mountain cliffs no more, If chance he hear the song so sweetly wild, Which on those cliffs his infant hours beguiled, Melts at the long lost scenes that round him rise, And sinks a martyr to repentant sighs." The effects of mental tonics on the system — especially those of hope and confidence — are well exhibited in the following extract from Dr. A. T. Thomson's work, to which the author has so often referred. " Were any thing requisite to prove the power of mental tonics in disease, it would only be necessary to refer to their influ- ence in sustaining the body under fatigue which could not otherwise be borne. What is it but hope and confidence, which enable a mother, night after night, to watch at the bedside of a sick infant ? to bear up, even with a weak and delicate frame of body, under fa- tigues which no stranger could sustain, and yet, if the object of her solicitude recover, to suffer no inconvenience from the exertion : — take away the tonic powers of hope and confidence, or let all her attentions prove unavailing and her infant fall a victim to the malady, then her health will give way, she will feel the exhaustion which naturally follows exertions too powerful for the strength of her body to sustain with impunity, and fall a victim of the anxiety and watch- ing, under which hope and confidence had so long borne her up, and which could alone sustain her by their tonic powers. Nothing can exceed the truth, as well as the beauty of the passage in Milton's description of the Lazar-house, in which the greatest evil is the ab- sence of hope : — ' A lazar-house it seem'd wherein were laid Numbers of all diseased, all maladies Of ghastly spasm, or racking torture, qualms Of heartsick agony, all feverous kinds, Convulsions, epilepsies, fierce catarrhs, Intestine stone and ulcer, colic pangs, Demoniac phrenzy, moping melancholy, And moonstruck madness, pining atrophy, Marasmus, and wide-wasting pestilence, Dropsies, and asthmas, and joint racking rheums. Dire was the tossing, deep the groans ; despair Tended the sick busiest from couch to couch ; And over them triumphant death his dart Shook, but delay'd to strike, though oft invoked With vows, as their chief good and final hope.' Despair, indeed, in every instance where disease falls upon mortality, may be regarded as bearing the standard in the van of death." 3* 30 SPECIAL TONICS. SPECIAL TONICS. It has been before remarked, that tonics are given with one of two views, — either to make a decided impression on the nervous system, so as to break in upon a chain of morbid phenomena that supervene in paroxysms, — as in intermittent fever, — or to produce a silent but permanent operation for the removal of debility; and, although some of them are capable of acting in both ways, there is convenience in classifying them separately ; — into first, simple tonics; and secondly, antiperiodic tonics. The former may admit again of farther subdivision, according to the principles which they contain; — into first, such as owe their tonic virtues to bitter prin- ciple singly; secondly, those that possess, along with the bitter prin- ciple, more or less aromatic property; thirdly, such as have an astringent associated with the bitter principle -, fourthly, such as seem to act mechanically; and fifthly, mineral tonics. I. Simple Tonics. a. Bitter Tonics that owe their tonic virtues to bitter principle singly. 1. COLOM'BA. —COLUM'BO. This is the root of Codcuius palma'tus; Sex. Syst. Dicecia Hex- andria ; Nat. Ord. Menispermaceae; a climbing plant, which inhabits thick forests on the shores of Oibo and Mozam- bique, and fifteen or twenty miles inland. It has been cultivated both at Madras and the Isle of France. The roots are dug up in the hot season in March; the tubers only being generally removed, without injuring the primary root. These are cut into slices and dried on cords in the shade. Columbo is imported largely into England, but the quantity seems to fluctuate greatly in different years. Thus, in 1838, ac- cording to Dr. Pereira, duty was paid on 19,805 | lbs; and in 1839, on only 9,384 lbs. Columbo or Colomba root — as met with in Cocculuspalmatus. ,1 1 a . • i ■, (Male plant.) the shops — is in flat circular or oval pieces, from half an inch to three inches in diameter, and from one to three or four lines thick. The epidermis is of a yellowish-gray or brownish colour; smooth or irregularly wrinkled. The flat surfaces are of a greenish or grayish-yellow colour, depressed in the centre from shrinking during drying, and are frequently marked with concentric circles and lines radiating from the centre. Columbo readily imparts its principles to alcohol and water. The tonic principle or Columbin is obtained by evaporating an ethereal tincture until crystals are obtained, which are most intensely bitter. GENTIANA. 31 Ihe root contains, also, a third of its weight of starch, which renders it an easy prey to insects. On the continent of Europe, it is said that the root of Frase'ra Wal'teri has been sold for Columbo; but they differ so much from each other in appearance that the fraud is readily detected. Columbo is one of the very best of the bitter tonics, and is greatly used as a stomachic in all cases, in which a simple bitter is needed. The best form of preparation is the infusion, but should it be desired to administer it in powder, the dose may be from gr. x to 3ss and more. INFU'SUM C0I0HTBJ!, INFUSION OF COLUMBO. (Colomb. contus. |ss; Aqua bullient. Oj.) Boiling water dissolves some of the starch in which columbo abounds; and, hence, the Edinburgh College directs the infusion to be made with cold water, which thoroughly exhausts the root, if used in the way of percolation or displacement, and makes an infusion, that keeps longer without becoming mouldy. The in- fusion, made in the ordinary way, soon spoils. The infusion is often given along with alkalies, and forms the excipient, if not the basis, of numerous tonic mixtures. The dose is f. ^iss — f. ^ij. TINCTU'RA COLOMBO, TINCTURE OF COLUMBO. (Colomb. cont. giv; Al- cohol, dilut. Oij; made either by maceration or displacement.) This tincture is agoodadjuncttobitter infusions, as the infusion of columbo; and is, occasionally, taken alone, mixed with water. Its dose is from f- 3.1 t0 f- 5»j- 2. GENTIA'NA. - GENTIAN. Gentian — the root of Gentia'na lu'tea, common or yellow gen- tian ; Sex. Syst. Pentandria Digynia; Nat. Ord. Gentianaceas — may be regarded as the best of the simple bitters. Accordingly, it is received into the various pharmacopoeias, and its officinal prepa- rations are more numerous than those of any article of the class. The plant is an inhabitant of Alpine grassy slopes and meadows throughout the middle regions of continental Europe, and abounds in the Pyrenees, the mountains of Vosges and Auvergne, and the Alps of Austria and Switzerland, thriving best at an elevation between 3000 and 5000 feet above the sea. It is said to be particularly abundant on Mount Jura. (Christison.) It is a beautiful plant, evolving its splendid yellow flowers in July. The root, which is the only officinal part, is brought to this country from Germany. Into England, it is said to be imported from Havre, Marseilles, &c. In 1839, duty, according to Dr. Pereira, was paid on 470 cwt. As met with in the shops, gentian is in pieces of various sizes ; and, if large, is split lengthwise. It is yellowish-brown externally, and of a brownish-yellow within; and is tough and flexible ; but, when thoroughly dried, is readily reduced to a yellowish-brown 32 SPECIAL TONICS. powder. Its odour is feeble and peculiar; taste at first sweet, but af- terwards intensely bitter. It yields its virtues readily to water, alco- hol, and wine, which are therefore used as menstrua, in certain offi- cinal preparations. When subjected to analysis, it is found to consist mainly of bitter extractive, traces of volatile oil — oil of gentian — gum, and uncrystallisable principle, and gentistic acid or gentisin. Henry and Cavertou believed, that they had succeeded in separating, by means of ether, an active neutral crystalline principle of a yellow colour, in which the bitterness of the root was concentrated, and to which they gave the name Gentianin ; but this has since been shown to be impure gentisic acid ; and when the crystals are entirely free from impurites, they are devoid of bitterness. (Leconte, Tromms- dorff.) The bitter principle of gentian— or gentianite — has not yet been isolated. Gentian, as already remarked, is one of the bitters most extensive- ly prescribed. It is, indeed, calculated to fulfil all the objects for which the simple bitter tonics are employed. Accordingly, in atonic dyspepsia, simple or complicated, — as well as in convalescence from acute diseases, and in want of tone, howsoever induced, it may be given. It is an ingredient of the celebrated Duke of Portland''s pow- der for the Gout, which consisted of equal quantities of the roots of gentian and birthwort (Aristolochia rotunda,) the tops and leaves of germander (Chamsedrys,) ground pinefChamxpitys,) and lesser cen- taury (Chironia centaurium,) powdered, and mixed together. This powder, as well as gentian itself, was at one time thought to possess the power of arresting a paroxysm of gout, and of eradicating the dis- ease; and, as the affection is connected with derangement of the gas- trointestinal functions, it may, doubtless, often be serviceable, but it need scarcely be said, that it does not merit the high encomiums that have been passed upon it. The dried root is sometimes used by the surgeon as a tent to dilate apertures. The powder is, also, occasion- ally employed to promote the discharge from issues. INFU'SUM GENTIAN COMPOS'ITUM, COMPOUND INFUSION OF GENTIAN. (Gentian, cont. Ess; Aurant. corticis, cont., Coriandr. cont. aa 3j; Alcohol, dilut. f. %iv ;. Aqucef. 3xij.) This is really a weak Tincture of gentian, with the addition of certain aromatics, which adapt it better for a stomachic. The alcohol, too, enables the infu- sion to keep better, than if water only were the menstruum. The dose is f. 5J to f. ^iss. TINCTU'RA GENTIA'NJ! COMPOSTTA, COMPOUND TINCTURE OF GENTM (Gentian, cont. |ij; Aurant. Cort. 3j ; Cardamom, cont. 5ss Alcohol dilut. Oij ; prepared either by maceration or by displacement ) This is an excellent stomachic, which is either added to bitter infusions like the one above, or is taken alone, mixed with water The aro matics and alcohol cause it to be excitant; and suggest caution in its employment, where there is hyperemia of the mucous membrane of the stomach. It is apt, too, to be indulged in by hard drinkers GENTIANA. 33 whose gastric functions become impaired, and who, in this manner, may take considerable quantities of alcohol. The dose of the tincture is f. 3j or f. sij. EXTRAC TIM GENTIA'NA, EXTRACT OF GENTIAN. — Extract of gentian may be made either by evaporating a decoction of the root, or, the cold infusion, made by percolation or displacement. The latter is the plan recommended in the Pharmacopoeia of the United States. Good gentian yields, by the former method, about half its weight of ex- tract. (Brande.) Extract of gentian may be prescribed alone as a tonic ; but it is more frequently used as a vehicle for other tonics, as the preparations of iron. When given alone, the dose is from gr. x to gr. xxx. Gentian also forms a part of the Tinctura Rhei et Gen- Fig. 2. tianse of the Pharmacopoeia of the United States. Other species of gentian — as Gentia'na bi'loba or G. puncta'ta ; G. purpurea; G. macrophyl'la; G. Pan- non'ica, and G. chirayita, possess properties analogous to those of gentiana lutea ; and the roots of some of them are occasionally sub- stituted for it. Gentia'na Chirayi'ta, or Agatho'tes chiray'ta, or Chiretta, of the Edinburgh Pharmacopoeia— is a native of India, and is much employed there. It is prescribed both in infusion and tincture. The dose of the powder is a scruple. One other species is officinal in the secondary list of the Pharmacopoeia of the United States, the 3. Gentia'na Catesb^'i, Blue Gentian. This species of gentian is indigenous in the swamps of the Carolinas, where it flowers from Sep- tember to December. Its properties resemble those of Gentiana lutea ; and it may be given in the same cases, dose, and forms of preparation. Gentiana Catesbsei. 34 SPECIAL TONICS. 4. Gentia'na Chirayi'ta, Henrice'a Pharmorcear'cha, Swer'ha chiray- i'ta, Agatho'tes Chirayi'ta, Chiretta, Chirayi'ta. This species is a native of India, whence it is imported into England tied up in bundles. It has been long in use there. The herb and root are intensely bitter. They strikingly resemble officinal gentian, and are employed in the same cases either in infusion, (Gent. Chirayit. 3ij; Aq. bulhent. Oss; or in tincture, Gent. Chirayit. Iv ; Alcohol, dilut. Oij.) Dose, one or two teaspoonfuls. The dose of the powder is a scruple. 5. QUAS'SIA. Quassia wood was at one time obtained from Quas'sia ama ra ; Sex. Syst. Decandria Monogynia ; Nat. Ord. Simarubaceae, a tree, which inhabits Surinam, Guiana, and Colombia, and is cultivated, as an ornamental plant only, in Brazil and the West Indies. Its wood is light, yet close and tough, of a pale yellowish white colour, without smell, and of an intensely bitter taste. It is probable, however, that this — the true quassia wood — is never met with in commerce. Dr. Christison states, that he has often tried to obtain it from wholesale dealers in London, but none of the billets sent to him corresponded with the true quassia. The quassia, now met with in the shops, is the wood of a different species — Quas'sia excel'sa or Picrcena excelsa, Lofty Bitterwood Tree, or Bitter Ash, a tall beautiful tree, nearly 100 feet in height, which inhabits Jamaica, and other West India islands. The wood is gene- rally in cylindrical billets of various sizes ; is very tough, yellowish, without odour, and of an intensely bitter taste, and is kept in the shops either split into small pieces or rasped. Quassia is said to be sometimes adulterated with other woods ; but these are detected by their not possessing the intense bitterness of the genuine article. When subjected to analysis it affords traces of volatile oil, a bitter principle, termed quassite, or quassin, gummy extractive, pectin, woody fibre, and various salts. The crystalline principle, called quassite, which was discovered by Wiggers in some of the quassia woods, does not appear to be contained in the true quassia, although this last has a large amount of bitter principle. The virtues of quassia are yielded to alcohol and water. Quassia possesses the medical properties of the simple bitters, and is adapted for all the cases in which the class are indicated ; hence, it is largely prescribed, and especially in asthenic conditions of the digestive organs. It is often used in place of hops in the preparation of beer, although prohibited by the statutes of various countries. It does not, however, communicate any noxious property to the beer but does not preserve it as well as hops, or make as agreeable a beverage. Like the other bitters, quassia is best given in the form of infusion. It is extremely difficult to reduce it to powder, and the powder__ PRUNUS VIRGINIANA. 35 as remarked of the simple bitter tonics in general—is an objection- able form in cases of gastric debility. If it be desired, however, to exhibit it, the dose may be 9j to 3j, three or four times a day. INFU'SUM 0.UASM, INFUSION OF QUAS'SIA. (Quassia rasur. 31J ; Aqua, Oj.) Cold water makes a clearer infusion than hot. The dose of the infusion is f. giss to f. 3iij. TINCTU'RA QUAS'SIA, TINCTURE OF QUASSIA. (Quassia rasur. ^ij ; Al- cohol, dilut. Oij, prepared either by maceration or displacement.) Alcohol is said to make a better tincture than the dilute alcohol di- rected by the pharmacopoeias. . . . This tincture is employed chiefly as an addition to bitter infusions. When given alone, the dose is f. 3J or f. 31J, in a little w^ater. EXTRAC'TUM QUAS SI1, EXTRACT OF QUASSIA. This preparation is ob- tained by boiling down the cold infusion, made by displacement, to the proper consistence. Its chief use — like the extract of gentian — is as an incipient for the administration of the mineral tonics. In the dose of five grains, it may be prescribed by itself as a bitter tonic. 6. SIMARU'BA. Simaruba is the bark of Simaru'ba officinalis, S. ama'ra, Quas'sia simaru'ba, Bitter simaru'ba, or Mountain damson; of the same class and order, and the same natural order as Quassia amara. Ihe tree is common in Jamaica, and in other West India Islands, and in Guiana and Cayenne. The bark of the root is the officinal portion. As met with in the shops, it is in pieces of various sizes, sometimes very long, and some inches in breadth, folded lengthwise, which are rough externally, warty, and of a grayish-yellow colour; within of a yellowish brown, and on the inner surface of the bark of a pale yellowish-white. It is light and tough ; devoid of odour and of a very bitter taste. When subjected to analysis, it is found to contain a bitter principle analogous to quassite, with a trace of volatile oil, &c Water and alcohol extract all its virtues. in large quantities, simaruba is said to excite vomiting and purg- ing • but in the ordinary medicinal doses, it is a bitter tonic, re- sembling in its properties the article last described. It has, like- wise, been given in dysentery, and the Germans-it appears-term it Ruhrrinde or dysentery bark. It can, only, however, be service- able in that disease in chronic cases ; and then its action is proba- bly altogether that of an ordinary bitter tonic It is rarel>;§ pre- scribed in this country ; and the Pharmacopoeia of the United Mates contains no officinal preparation of it. The dose of the powder is from a scruple to a drachm. 36 SPECIAL TONICS. 7. PRUNUS VIRGINIA'NA. —WILD CHERRY BARK. Prunus Virginia'na, Cer'asus seroti'na or Cer'asus Virginia'na; Sex. Syst. Icosandria Monogynia ; Nat. Ord. Amygdalaceae — an indigenous tree, which is common throughout the United States — yields the officinal Wild cherry bark. On the banks of the Ohio, it is a much larger tree than in the Eastern states. The inner bark, which is the part of the Prunus employed in me- dicine-— as met with in shops — is in pieces of various sizes, of a bright cinnamon colour; brittle, and readily reducible to powder, which is of a fawn colour. The taste is agreeably bitter and aro- matic, with the flavour of the bitter almond. Its virtues are readily communicated to hot or cold water ; but they are impaired, and the flavour injured by decoction,—partly, in consequence of the vola- tilisation of principles on which they are dependent, and partly of a chemical change effected by the heat. (Wood & Bache.) On distil- ling the same portion of water successively, from several different portions of the bark, a volatile oil, associated writh hydrocyanic acid, was obtained by Mr. W. Procter, of Philadelphia, the former having properties analogous to those of the oil of bitter almonds: and, like it, not pre-existent, but resulting from the reaction of water upon amygdalin. The medical virtues of Prunus Virginiana, are those of a tonic; and, also, of a sedative, owing to the hydrocyanic acid, which is formed ; — the tonic virtue being dependent upon the bitter prin- ciple, and — it has been suggested — on phloridzin, which, it has been presumed, exists in it. In this country, it is much prescribed in the debility accompanying phthisis, in which it has been supposed to act as a sedative on the accompanying hectic; whilst at the same time it impresses a tonic influence on the stomach. It need scarcely be said, however, that but little — even temporary — benefit can be expected from it in such cases, which— when in their confirmed stage — proceed onward to their fatal termination, unmodified, per- haps, by any agency. In many of our hospitals, the prunus is a routine prescription; but, although the author has carefully watched its effects, he has not been able to say, that any evident relief was afforded by it. He has certainly never witnessed the sedative action that has been ascribed to it. It may be given in all cases in which a mild unstimulating tonic is needed. As in the case of other bitter tonics, the infusion is a better pre- paration than the powder, but should it be desired to exhibit the latter, the dose may be from 3ss to 5J. INFU'SUM PRUNI VIRGINIANS, INFUSION OF WILD CHERRY BARK.— (Prun. Virginian, cont. §ss ; Aqua, Oj.) Cold water is used in the preparation of this infusion, to avoid the disengagement of any vo- latile matter that may be possessed of activity. The dose is f. ziss — f. ^iij, three or four times a day. FRASERA. 37 8. FRASE'RA.— AMERICAN COLUM'BO. The root of Frase'ra Wal'teri, Amer'ican Colum'bo or False Co- lum'bo ; Sex. Syst. TetrandriaMonogynia; Nat. Ord. Gentianaceae, is officinal in the secondary list of the Pharmacopoeia of the United States. The plant is one of the most beau- Fig. 3. tiful indigenous produc- tions of the vegetable kingdom, flowering from May to July ; and flourish- ing in the southern and western portions of the Union, especially in Arkan- sas and Missouri. The root, it is advised, should be col- lected in the autumn of the second, or the spring of the third year, and before be- ing dried should be cut into transverse slices. (Wood & Bache.) The dried root is gene- rally in transverse circular segments, about an inch in diameter, and an eighth of an inch or more in thick- ness. Some years ago, it was introduced into France, and sold for Columbo ; but if attention be paid to the pieces, they will be found to be more uniform in their internal structure; and not to have the concentric and radiating lines, which are generally seen in Columbo. They are of a purer yel- low too, without a greenish tinge,and contain no starch. Frasera has the same pro- perties as Columbo and the other simple bitters, and is n-asera waiteri. applicable to the same cases. It is not, however, much used. It may be given in infusion ; (Fraser. 3J ; Aquabullient. Oj. Dose,f. |iss—Jij ;) or in tincture (Fraser. §j; Alcohol, dilut. Oj. Dose f. gj—f. 3iij,) neither of which is offi- cinal. Should it be desired to give the powder, the dose may be gr. xx to $j. vol 11.—4 38 SPECIAL TONICS. 9. SABBA'TIA.—AMER'ICAN CEN'TAURY. The herb Sabba'tia angula'ris ; Sex. Syst. Pentandria Monogynia ; Nat. Ord. Gentianaceae, grows extensively in the Middle and Southern states of the Union, in low ground sespecially ; flower- ing in July and August. The herb is col- lected whilst in flower. It has a strong bitter taste ; and its virtues are extracted by both alcohol and water. It may be prescribed in the same cases as gentian ; and, like all the bitters, has been given in the apyrexia of intermittents ; but its powers are not such as to entitle it to be classed amongst the antiperiodic to- nics. It is generally given in infusion. (Sabbatia, ^j ; Aq. bullient. Oj. Dose, f. |iss.) Should it be desired to prescribe it in powder, the dose may be from 3SS to 3J. 10. COPTIS. —GOLD-THREAD. Gold-thread is the root of Coptis trifo'- lia; Sex. Syst. Polyandria Polygynia; Nat. Ord. Ranunculaceae, a small indigenous evergreen, resembling the strawberry, which inhabits the northern parts of Ame- Fig.4.—sabbatia annularis. rica ; and is found, likewise, in Asia Greenland, and Iceland ; flowering in May. The whole of the plant is bitter ; but the root most so. It is, therefore, the officinal portion; and is admitted into the secondary list of the Pharmacopoeia of the United States. Asseen in the shops, gold- thread is inloose mass- es, formed by long, filiform, orange yel- low roots, frequently mixed with the stems and leaves. The taste is purely bitter, and, like the other bitters, its virtues are com- municated to water and to alcohol. The bitter extractive F\g. 5.—Coptis trifolia. precipitated by nitrate of silver, and by acetate of lead. is ALETRIS. 39 IS Gold-thread quassia; and may a simple bitter, which has been compared to be used in all cases, where the simple bit- ter tonics are indicated. Like them, it may be given in infu- sion (Copt, ^j ; Aqua bullient. Oj: dose, f. ^iss — f. 5ij); or tinc- ture, (Copt, ^j ; Alcohol, dilut. Oj : dose, f. 3j—f. 3iij ;) but neither of these is officinal. Should it be desired to exhibit the powder, the dose may be from gr. x to 3SS. Besides the simple bitter tonics already described, the secondary list of the Pharmacopoeia of the United States contains the following: 11. Ale'tris, Star-grass. The root of Ale'tris farino'sa ; Star- grass, Blazing Star, Mealy Starwort; Fig. 6. Sex. Syst. Hexan- dria Monogynia; Nat. Ord. Aspho- deleae ; an indige- nous plant, which is found in almost all parts of the United States, in fields and about the edges of woods, flowering in June and July. Dr. Bigelow states, that he knows of no plant, which surpasses it in genuine, intense and permanent bitter- ness. The bitter- ness is owing to bit- ter extractive, but the root likewise contains resin ; for wrhen water is added to the alcoholic tinc- ture, it becomes milky. It may be given as a tonic in infusion or tincture. In large doses, it is said to disturb the stomach. 12. Xanthorrhi'- za, Yellow-root. The root of Xanthor- rhi'za apiifo'Ua or Aletris farinosa A. tincto'ria, Sex. Syst. Pentandria Polygynia ; Nat. Ord. Ranunculaceae — which 40 SPECIAL TONICS. grows in the Southern and Western states, flowering in April — is so called in consequence of its colour, which, as well as its bitter taste, it yields to water and alcohol. It is a simple bitter, resembling columbo, and is prescribed in the same cases. It may be g^ven in infusion. (Xanthorriz. ^j ; Aqua bullient. Oj. Dose, f. Jiss to b. Jlromatic Bitter Tonics, that possess, along with bitter principle, more or less aromatic property. 13. AN'THEMIS. —CHAM'OMILE. The most important constituents of chamomile flowers— as else- where remarked (i. 129) — are volatile oil, and bitter extractive. They contain likewise a little tannic acid. In large doses— as has been seen—the infusion acts as an emetic ; in smaller quantities, as an aromatic bitter, — the volatile oil communicating the aromatic or ex- citant property ; the bitter extractive and tannic acid, the tonic. In all cases, consequently, that require the~ union of an excitant and bitter, as in atonic dyspepsia, an infusion of chamomile is a good prescription ; and, accordingly, it is largely used both in professional and in popular practice. Powdered chamomile — for reasons often referred to — is rarely given as a tonic ; but should this be considered advisable, the dose may be from gr. x to 3ss, or more. An extract, -prepared from the decoction, is directed in some of the pharmacopoeias ; but it cannot possess the virtues of an aromatic bitter, in consequence of the volatile oil being driven off during the decoction. It has, consequently, been very properly omitted in the last edition of the Pharmacopoeia of the United States (1842), — the extracts of the simple bitters, Gentian and Quassia, possessing all its properties. 14. CASCARILLA. Cascarilla is the bark of Croton Eleuthe'ria ; Sex. Syst. Monoecia Monadelphia; Nat. Ord. Euphorbiaceae; a small tree or shrub, which is indigenous in the West Indies, especially in the Bahama Islands, and in Jamaica ; from the former of wrhich it is chiefly ex- ported. In the year 1840, duty, according to Dr. Pereira, was paid in England, on 14,490 lbs. ; but the whole of this was not used in medicine. It is a constituent of most of the fumigating pastilles, on account of the agreeable aromatic odour exhaled by it when burning. Cascarilla is met with in pieces seldom exceeding from four to six inches in length, which are commonly quilled, but sometimes almost flat; of a gray colour externally, with some portions almost white, and others yellowish-brown; of a brown colour internally, and usual- ANGUSTURA. 41 ly shining. The epidermis is intersected by numerous longitudinal and transverse cracks or fissures. It is compact, hard, and readily re- ducible to powder. The taste is warm, aromatic, and bitter, and the smell peculiar and agreeable, and increased by heat. Alcohol and water readily extract its medical virtues, which are dependent on a bitter principle, associated with volatile oil. It is, consequently, well adapted for cases which require the aromatic to- nics, as asthenic dyspepsia, and, indeed, debility in general. At one time, it was used as an antiperiodic, but it is now never given with this view. Should it be desired to prescribe powdered cascarilla, the dose may be from ^j to ^ss. __ INFU'SUM CASCARIL'L/E INFU'SION OF CASCARILLA. (Cascarilla contus. 3J ; Aqua bullient. Oj.) The dose of this infusion—the form in which cascarilla is usually prescribed — is f. giss to f. 511J. 15. ANGUSTU'RA.— ANGUSTU'RA BARK. Angustu'ra or Angostu'ra or Cuspa'ria Bark, is obtained from Galipe'a ofiicina'lis ; Sex. Syst. Diandria Monogynia; Nat. Ord. Rutaceae ; which is indigenous in the neighbourhood of the Orinoco. Humboldt and Bonpland, however, assert, that Galipe'a Cuspa'- ria, Bonplan'dia trifolia'ta, or Cuspa'ria febrif'uga, yields the bark ; and there is reason to believe, that from both trees a bark is obtained much alike in medical virtues. The framers of the last edition of the Pharmacopoeia of the United States refer the officinal bark to Galipea officinalis. As seen in the shops, Angustura bark is in flat pieces, slightly I'urved, but rarely entirely quilled ; of various sizes, covered by a yellowish-gray, or grayish-white spongy epidermis, which is readily scraped off with the nail; the inner surface is brownish ; the trans- verse fracture short and resinous. The powder is a pale yellow, somewhat like that of rhubarb. The odour is peculiar, and the taste bitter, acrid, and aromatic. Its medical virtues are imparted to water and to alcohol. The bark has been subjected to analysis, and found to contain a volatile oil, to which it owes its acrid aromatic taste; and a peculiar bitter principle called Angosturin and Cusparin, to which it is indebted for its tonic properties. At one time a serious fraud was committed on the continent of Europe, by substituting for it the bark of the nux vomica, wrhich was then termed false, spurious, or East India angostura, before its true character wTas known. It is now generally admitted by pharmacologists, that it must be refer- red to strychnos nux vomica. The characteristics of the true and the false barks are given in a tabular form by Dr. Pereira. Angustura bark is a valuable aromatic tonic ; but, in consequence partly of its liability to adulteration with so poisonous an article as the bark of strychnos nux vomica, it has fallen into disuse. More- 4* 42 SPECIAL TONICS. over, it was found not to possess the febrifuge or antiperiodic vir- tues for which it had been extolled ; and it is now never used except as an aromatic bitter, in cases in which articles of the class are indi- cated. In very large doses it is said to prove emetic and cathartic ; but it is never prescribed in this country with any other view than as a tonic, nor is it extensively used in that relation. Should it be desired to administer the powder, the ordinary dose is gr. x to 3ss ; but the most common and the best form of prepara- tion is the following : — _ INFU'SUM ANGUSTU'RA, INFU'SION OF ANGUSTU'RA BARK. (Angustur. cont. §ss; Aq. bullient. Oj.) The dose of this infusion is f. |issto f. 31J. 16. SERPENTA'RIA. — VIRGIN'IA SNAKEROOT. Virginia snake-root is the root of Aristolochi'a Serpenta'ria ; Sex. Syst. Gynandria Hexan- dria ; Nat. Ord. Aristolo- chiaceae — an herbaceous plant, flowering in May and June, and growing in rich shady woods, throughout the Middle, Southern, and Western states. It is collected in western Pennsylvania and Virginia, in Ohio, Indi- ana and Kentucky; is usually in bales, con- taining one hundred pounds; and is often mixed with the leaves and stems of the plant, and with dirt from which it was not well freed at the time when it was collected. The roots of the Aristolo- chi'a tomento'sa and A. has- ta'ta, which scarcely differ from those of the A. ser- pentaria, contribute indis- criminately to furnish the snakeroot of commerce, al- though the last is the only one received as officinal. (Wood & Bache.) Aristolochia serpeniaria Snakeroot, as met with in the shops, consists of the rootstock whence proceeds a tuft of long, slender, yellowish or brownish fibres'. ABSINTHIUM. 43 The colour of the powder is grayish. The smell of the root is aro- matic and agreeable, and the taste warm and bitter. It yields its virtues to water and to alcohol. Its main active constituents are volatile oil — the odour and taste of which have been compared to that of valerian and camphor combined,— and bitter principle,— the former being the source of the aromatic and excitant, the latter that of the tonic properties. * Serpentaria has had great reputation as an excitant tonic ; and, at one time, was employed to arrest intermittents; but now that we possess more potent agents, it is rarely given except in associa- tion with those. It is much prescribed to support the powers in adynamic conditions of the frame. Should it be desired to exhibit it in powder, the dose may be gr. x to 3SS, and more; but the fol- lowing preparations are to be preferred. _ INFU'SUM SERPENTA'RIA, INFUSION OF VIRGINIA SNAKEROOT. (Serpentar. 3ss ; Aqua bullient. Oj.) The dose is f. ^iss to f. ^ij.^ TINCTU'RA SERPENTA'RIiE, TINCTURE OF VIRGINIA SNAKEROOT. (Serpentar. contus. ^iij; Alcohol, dilut. Oij ; prepared either by maceration or by displacement.) The tincture is rarely prescribed alone; but is added to tonic infusions, especially to the infusion of cinchona. The dose is f. 3J to f. 3iij. Serpentaria forms part of the Tinctura cinchona composita of the Pharmacopoeia of the United States. 17. ABSIN'THIUM.—WORMWOOD. The tops and leaves of Artemis'ia absin'thium, or common worm- wood, are officinal in the Pharmacopoeia of the United States. The plant is indigenous in Europe, in the southern part of which it grows abundantly. It is also met with on roadsides and rubbish-heaps in Great Britain ; but the druggist is supplied with it from gardens near London. It is raised in the gardens of this country, and has been naturalised in the mountainous regions of New England. The plant is in flower in July or August, at which time the tops and leaves should be gathered. Wormwood has a penetrating, peculiar and disagreeable smell, and a very bitter, aromatic taste. It imparts its virtues to water and to alcohol. Its active constituents are volatile oil, which gives it its aromatic character; and bitter principle, on which its tonic vir- tues are dependent. Wormwood is a nauseous bitter, and not now much employed, although it is adapted for cases in which the aromatic bitters are in- dicated. It is more used, perhaps, in atonic dyspepsia than in any 41 SPECIAL TONICS. other affection. Like all the simple and compound bitters, it was once much given in intermittents. Infusion is the best form of preparation. (Absinth. 3J ; Aq. bul- lient. Oj. Dose, f. 3iss to f. §ij.) The dose of the powder is ?J to 9ij. 18. ARTEMISIA VUfcGA'RIS.—MUGWORT. All the species belonging to the genus Artemisia possess bitter and aromatic properties. Artemisia vulga'ris, Sex. Svst. Synge- nesia superflua; Nat. Ord. Compositae Corymbiferae, was, like the others, employed at one time as an aromatic tonic, but it fell into disrepute, until revived, in Germany, in modern times, as a remedy in epilepsy. It has not, however, been much given as such in other countries of Europe or in the United States. The root is the part employed, which should be dug up in autumn, after the stalk has become dry, or in the spring before the stalk has shot up. Burdach recommends many precautions in its preparation. To remove epilepsy, he found it most efficacious, when given in the dose of a tea-spoonful — from fifty to seventy grains — in warm beer, about half an hour before the paroxysm. Should this be im- practicable, it may be administered as soon as the patient can swal- low. He must be put to bed immediately; be covered up warm, and allowed warm small beer to drink, so as to occasion diaphoresis. This plan may be repeated according to circumstances. Burdach has entered into details on this subject, which the author has given elsewhere. (Mew Remedies, 4th edit. p. 78.) In general, it may be sufficient to prescribe a drachm of the pow- der three times a day, gradually increasing the dose ; or it may be given in infusion or decoction. (Artemis. vu?g. rad. concis. ^j; Aqua, Oiss ; boil for half an hour. Dose, half a tea-cupful every two hours in cases of epilepsy.) It is to be feared, however, that the assertions of the German physicians are too strong, and that the advantages to be derived from the artemisia in epilepsy have been exaggerated. Where there is no organic disease of the encephalon, substances, which, like the artemisia, are nauseous, bitter and aromatic, may be productive of advantage as tonics and revellents ; and the author has seen one or two cases, in which beneficial effects have resulted from its use. It has likewise been given in other diseases, in which aromatic tonics are indicated, but it possesses no virtues over others of the class. Besides the aromatic bitter tonics, above described, the Pharma- copoeia of the United States has the following in its secondary list. 19. Angel'ica. — The root and herb of Angelica atro-purpu'rea purple angel'ica or mas'terwort; Sex. Svst. Pentandria Digynia ; Nat. Ord. Umbelliferae, a plant which grows between Carolina and CONTRAYERVA. 45 Canada, flowering in June and July. The plant has a strong smell, ind an acrid and aromatic taste. It is used as an aromatic tonic, like Angelica Archangelica or garden angelica, of Europe. Its aro- matic powers adapt it for cases of atonic dyspepsia, and flatulent colic. The author has, however, never seen it used. It may be given in infusion (Angelic. 3J; Aq. bullient. Oj. Dose, f. 5iss to f- 5»J0 20. As'arum, — Can'ada snakeroot, wild ginger. The root of As'arum Canadense; Sex.Syst.Dodecan- Fig. s. dria Monogynia ; Nat. Ord. Aristolo- chiacese; which grows in old woods and shady places from Canada to Ca- rolina, has an agree- ably aromatic taste, considered to be in- termediate between that of ginger and that of serpentaria; qualities, which have given it the names of wild ginger and snakeroot in differ- ent parts of the coun- try. It has, also been called CoWs foot. The proper- ties seem to be de- pendent upon vola- tile oil, and a bitter resinous matter; both of which are extrac- ted by dilute alco- hol. It resembles ser- pentaria in its pro- perties ; and is Some- Asarmn Canadense. times used as a sub- stitute for ginger ; so that it might, with propriety, be classed amongst Excitants. 21. Contrayer'va. — The root of Dorste'nia Contrayer'va; Sex. Syst. Tetrandria Monogynia; Nat. Ord. Urticaceae — a native of Mexico, the West Indies, and certain parts of South America — is 46 SPECIAL TONICS. imported chiefly from the West Indies, and the Brazils. Its odour is aromatic and peculiar; taste warm, bitterish and slightly acrid. Its virtues, appear to be dependent upon volatile oil, and bitter ex- tractive. It is considered to resemble serpentaria; and has been prescribed in the same cases, but it is rarely used in this country, or indeed anywhere. The dose of the powder is 9j to 3ss; but it is best given in infusion (Contrayerv. §j ; Aq. bullient. Oj. Dose, f. §iss.) 22. Cot'ula, Mayweed.— The herb An'themis Cot'ula, Mayweed or wild chant'o- Fig. 9. mile, which growTs abundantly both in the. United States and Europe; flowering from the middle of summer till late in the au- tumn, has proper- ties essentially the same as chamo- mile ; but its smell is so disagreeable, that it is rarely substituted for it. By the physician, it is seldom or never prescribed. The flowers are less disagreeable than the leaves, and may be given in infusion. 23. Eryn'gium, Button snake- root. The root Anthemis Cotuia. of Eryn'gium aquat'icum, But- ton snakeroot or water Eryn'go; Sex. Syst. Pentandria Dio-ynia • Nat. Ord. Umbelliferae, which grows in Virginia and Carolina' flowering in August, has a bitter, aromatic pungent taste; resembling apparently, in its action, the ordinary aromatic tonics. In large doses it is said to be emetic. The author knows nothin"- of its vir- tues from his own experience; nor is he acquainted with many who do. 24. Magno'lia. This is the bark of Magno'lia glauca, White Bay Sweet Bay, Swamp Sas'safras, Beaver tree ;— of M. acumina'ta Cu'- MARRUBIUM. 47 Magnolia glauca. inaugural essay presented Philadelphia, and published Fig. n. before in the cumber tree, and of M. tripet'da, Umbrella tree; Sex. Syst. Polyan- dna Polygynia ; Nat. Ord. Magnoliaceae; all of which are indigenous in the United States, and admired for the beauty of their foliage; and the size and fragrance of their flowers. The bark of the root is considered to be most active, but that of the trunk and branches is officinal also. It has a bitter, combined with a spicy, pungent taste. Dr. Stephen Procter, in an Jefferson Medical College of American Journal of Phar- macy for July, 1842, has given as the principal consti- tuents of the bark of Magno'- lia Grandiflo'ra,—green resin, volatile oil, (upon which its remedial virtues, he thinks depend,) and a peculiar crys- tallisable principle resembling lirioden'drin, (q. v.) The aromatic property is impaired by drying, and wholly lost when the bark is long kept. Magnolia has been used in intermittents; but it is not so now. It possesses the proper- ties of the class in which it is placed; and may be given as a gently excitant tonic. All its virtues are imparted to dilute alcohol. The infusion is less efficient; but is a good tonic. The dose of the bark, in pow- der, is from 3ss to 3j. 25. Marru'bium, Hore- hound. The herb of Mar- ru'bium vulga're, or white horehound ; Sex. Syst. Didynamia Gymno- spermia ; Nat. Ord. Labiatae,— which is indigenous in Great Britain, but grows in most parts of Europe and also in Asia and America ; flowering in July, — has a strong aromatic odour and a bitter taste ; the bitterness depending upon extractive ; and the aromatic properties Magnolia inacrophylla, 48 SPECIAL TOXICS. on volatile oil. Boiling water extracts its virtues ; and, hence, it is given in infusion (Marrub. gj ; Aqua bullient. Oj. Dose, f. giss to f. |iij) as a tonic ; but it has had more reputation as an excitant expectorant and emmenagogue. It enters into the composition of a candy, which is much used — horehound candy — in catarrh. 26. Matrica'riA) German Cham'omile. This belongs to the same family as Anthemis or Chamomile ; and resembles it in all its pro- perties. The flowers are smaller, less agreeable, and feebler ; but it may be prescribed in the same cases. 27. Polyg'ala Rubel'la, Bitter Polyg'ala. The root and herb of Polygala Rubella, P. Polyg'ama ; Sex. Syst. Diadelphia Octandria ; Nat. Ord. Polygaleae, — wdiich is indigenous in many parts of the United States ; flowering in June and July, — are both used. It is a strong and permanent bitter, and has been esteemed both tonic and excitant; and in large doses diaphoretic, by virtue of its latter operation. It may be given in infusion or tincture. c. Astringent Bitter Tonics, 'which have an astringent associated with the bitter principle. 28. GEUM.—WATER AVENS. This is the root of Geum riva'le; Sex. Syst. Icosandria Polygynia; Nat. Ord. Rosaceae; which is indigenous in the United States, and is in the secondary list of their Pharmacopoeia. It flourishes in Canada, and in the northern and middle States ; sending forth its flowers in June and July. The root, as met with in the shops, is hard and readily re- duced to powder ; is of a reddish or purplish colour; devoid of smell, and of an astringent and bitter taste. It has not been sub- jected to analysis, but, doubtless, contains tannic acid and bitter principle on wdiich its medical virtues are dependent. Water avens is tonic and as- tringent, and is, consequently, in- dicated in cases where such a joint agency is needed, as in passive hemorrhages, and chronic dis- charges from mucous membranes. It is, also, used in atonic dyspepsia; and in various adynamic cases. It may be given in the form of infusion or of decoction (Gei, z\ • Fig. 12. Grum V irginianum. PRIN0S. 49 Aqua, Oj ; dose, f. §iss to f. §ij); and should it be desired to pre- scribe the powder, which can never be necessary, the dose may be from 9j to 3J. A weak decoction is sometimes taken by valetudi- narians in New England, as a substitute for tea or coffee. 29 PAULLIN'IA. This is an extract from a plant of the same name in Brazil. It is prepared by the Indians. A new alkali has lately been separated from it which'—as well as the extract—is very bitter. Paullinia is prepared from P. sor'bilis ; Family, Sapindaceae ; and its active constituents appear to be tannic acid and bitter principle. In Brazil, paullinia is mixed with cocoa, and given as a tisane in diarrhoea and dysentery ; and it has been used successfully in France in asthenic cases, — as in chlorosis, convalescence from severe ma- ladies, &c. According to Von Martius, an extract is prepared from Paullinia sorbilis, which is called there Guara'na, and is used in similar morbid cases. The secondary list of the Pharmacopoeia of the United States contains the following articles, which may also be referred to this division of simple tonics. 30. Hepat'ica, Liver- wort ; — the leaves of He- pat'ica America'na, an in- digenous plant. They have no aroma ; their taste is mucilaginous, somewhat astringent, and slightly bit- ter ; and they possess no other properties than those of a demulcent tonic, not- withstanding the clamour that prevailed in their fa- vour, in this country, some years ago, as a valuable re- medy in chronic bronchitis, haemoptysis, &c. Infusion is the best form of adminis- tration. (Hepatic, ^j ; Aq. bullient. Oj. Dose, f. ^iss to f. giij.) 31. Prinos, Black Alder. vol. ii.—5 Hepatica Americana. This is the bark of Prinos verticilla'tus, 50 SPECIAL TONICS. or Black Alder; Sex. Syst. Hexandria Monogynia ; Nat. Ord. Ifli- cineae, (Lindley)—Rhamni, (Jussieu) ; an indigenous shrub, which grows every where in the United States; flowering in June. The dried bark is inodorous ; its taste bitter and slightly astringent. It imparts its virtues to boiling water. Black alder has long been used as a popular remedy in intermit- tents, and in other affections, as a substitute for cinchona. It is rarely, however, prescribed by the physician. The dose of the powder may be stated at from 3ss to 3j. It may, also, be given in infusion, (Prin. ^j ; Aquabullient. Oj); decoction and tincture. The berries have similar properties with the bark and are sometimes made into tincture. d. Mechanical Tonics, or such as seem to act mechanically. 32. CARBO LIGNI.—CHARCOAL. Charcoal is obtained by burning wood in such a manner as to ex- clude the access of atmospheric air. It is black, devoid of odour and of taste, having the texture of the wTood from which it has been obtained. It is easily reduced to powder, and is insoluble. When perfectly dry, it absorbs many times its own bulk of certain gases; abstracts from liquids, in which they are dissolved or diffused, dif- ferent colouring and odorous matters ; and hence is used as an anti- septic ; and also — although to a less extent than animal charcoal — to deprive liquids of their colours. Charcoal has been administered occasionally in intermittent fever, and it has succeeded, — not probably in consequence of its possessing any intrinsic medical virtues, for it would seem to have none, but owing to the impression made on the stomach by the insoluble wroody matter. It is, also, used as a tonic in dyspepsia ; and, when com- bined with magnesia, is well adapted for cases in which there is re- dundant secretion of the gastric acids, and constipation. Probably, as a tonic, its action is mechanical, by the new impression it excites on the lining membrane of the stomach and intestines exciting the chylopoietic organs to increased activity. In the same manner it proves cathartic in large doses. In addition to this tonic action, by virtue of its antiseptic properties it corrects nidorous eructations, and the fetid secretions, often evacuated in diarrhoea and dysentery. The dose of charcoal is from gr. x to Jss, or more. Ten or fif- teen grains, united with ten of magnesia or carbonate of magnesia, may be given in the cases above mentioned, and repeated two or three times a day, should the case require it. INDIGO. 51 33. IN'DIGUM—IN'DIGO. The well known colouring material Indigo is obtained by fermen- tation from several species of the genus Indi- gof'era, — /. tincto'ria, I. anil, I. disper'ma, F'g- 14- /. argen'tea, and I. hirsu'ta ; Sex. Syst. Dia- delphia Decandria; Nat. Ord. Leguminosae. During the fermentation, the indigo — wdiich is an educt of the process — is deposited as a feculent matter. It is chiefly brought from the East Indies ; but a considerable quantity is derived from Guatemala and other places. As we receive it, it is generally in small, solid, brittle masses, of a deep azure colour, without smell or taste, and assuming a copper colour on being rubbed. Of late, indigo has been prescribed in various spasmodic diseases, and especially in epilepsy ; and many individuals have deposed to the services it has rendered. Others, however, have not testified so favourably. Some trials, made with it at the Philadelphia Hospital, were favourable ; and others not at all so. The results are detailed by the author in another work. (JVew Remedies, 4th edit. p. 361, Philada. 1843.) It is obvious, however, as there stated, that a wide difference must exist amongst cases of epilepsy, and that where the organic modifications are considerable, but little can be expected from any remedy ; but even in such hopeless cases, the number of paroxysms would seem to have diminished under its use. Where the cerebral affection is slight, and more functional than organic, indigo — like artemisia, and some other remedies extolled in epilepsy — may be useful. It certainly, — from the doses in which it may be administered,—-appears to be nearly inert, and perhaps its main efficacy — as the author has said of the Ferri subcarbonas—con- sists in the new impression, which it makes, in adequate doses, upon the nerves of the stomach, and through them upon those of the whole system; but to effect the revulsion to the necessary ex- tent, it is important that the dose should be augmented day by day, and the remedy be continued, in large doses, for a sufficient length of time. Indigo may be begun with in the dose of3j, and this maybe doubled daily, until the patient takes ^ij in the day, which may be continued for weeks. As the powder is very light, it has been pro- posed to give it in the form of electuary, with simple syrup as the constituent. Some aromatic — as the Pulvis aromaticus — may be added to it, to prevent it from exciting nausea, which it probably does from quantity only. 52 SPECIAL TONICS. e. Mineral Tonics. FERRI SALES.--SALTS OF IRON. The effects of the preparations of iron — commonly called Chalyb'- eates or Ferru'ginous preparations — are known to all — profes- sional and lay. They are, in proper doses, tonic ; and but few of them in any dose are very poisonous. They vary, however, in their precise action on the economy, some possessing—along with the tonic power— decided astringency, so that they may not be adapted for certain cases in which others of the class might be appropriate. In many cases in which they are prescribed — as in the neuroses — their operation seems to place them decidedly under the class of tonics ; but in other cases, where great impoverishment of the blood has taken place, as in different forms of anapmia, and the defective and perverted nutrition thereon dependent, their action would seem to be on the blood itself, and, through it, on the tissues; hence they fall properly under the class of Eutrophics. Such would be their action in cancer. It has been supposed, indeed, that certain cachexiae are connected with a deficiency of iron in the system, which the use of chalybeates is well adapted to supply. Of the use of iron as an emmenagogue, the author has spoken elsewhere, (vol. i, p. 407,) and has endeavoured to show, that its operation is altogether indirect; and that as amenorrhcea is most commonly connected with an asthenic condition of the system in general, and of the uterus in particular, chalybeates become proper remedies. In certain of the neuroses, they have been found very serviceable, — especially in chorea and neuralgia ; and in the latter disease, one of the preparations has been more successful than, perhaps, any other remedy ; yet in all such cases — indeed in all cases— their use has to be persevered in for a length of time. Although none of the preparations of iron are now used as anti- periodic tonics, they have been so. They are still prescribed in the sequelae of intermittents, and have exhibited important properties in the dispersion of enlargements of the spleen, which are generally, however, easily removed by the sulphate of quinia. A recent writer, M. Cruveilhier, affirms, that by the aid of iron he has obtained the re- solution of enlargements which have occupied half or even two- thirds of the abdomen. The general properties of the chalybeates adapt them, consequently, for asthenic conditions of various organs, and of the system generally ; and some— it will be seen— are possessed of astringent powers that adapt them for cases of chronic diarrhoea and dysentery. The special cases, however, that require their use, will be readily appreciated by an examination into their individual properties. FERRI SUBCARBONAS. 53 34. FERRI SUBCAR'BONAS.—SUBCARBONATE OF IRON. This preparation, called also Sesquiox'ide of Iron, red Oxide of Iron, and Carb'onate of Iron, is obtained by mixing solutions of sulphate of iron and carbonate of soda together, stirring the mixture, and setting it by, that the precipitate may subside. This is then washed with hot water and dried. When the two solutions are mixed together, the sulphuric acid of the sulphate of iron lays hold of the soda of the carbonate of soda, whilst the carbonic acid of the latter lays hold of the oxide of iron of the former. We thus have carbonate of protoxide of iron ; but, in the process of drying, the protoxide attracts oxygen from the air, and carbonic acid is disengaged, so that there ultimately remains sesqui- oxide of iron, with a trace of carbonic acid. Subcarbonate of iron is a rust-coloured powder, possessing a marked chalybeate taste. It is sometimes adulterated with brick- dust, which is detected by exposing it to the action of dilute chloro- hydric acid, which dissolves the whole of the subcarbonate, and leaves the impurities. This is one of the most used of the preparations of iron, and is adapted for most cases in which chalybeates in general are needed. it was much employed by Mr. Carmichael as a remedy in cancer; but although the cachectic condition appeared to be occasionally bene- fitted by it, the results have not been encouraging. In neuralgia, and especially in neuralgia faciei, it was introduced, many years ago, to the notice of the profession, by Mr. Benjamin Hutchinson, who published numerous successful cases of its employ- ment ; and, since that time, many testimonials have been adduced in its favour. In the author's hands, in one or two inveterate cases, it has proved signally successful. The novelty of Mr. Hutchinson's plan was to give it in very large doses: 3\j> and even ^ss and more, in the course of the twenty-four hours. Should it disagree with .the stomach, an aromatic may be added — for example, five grains of ginger powder, or of the Pulvis aromaticus, to each dose. If signs of polyaemia or hyperaemia exist, these should be first removed ; and, should they supervene on its employment, antiphlogistics may be needed, and the subcarbonate be resumed after their removal. It may, likewise, be necessary to give, occasionally, a brisk cathartic The ordinary dose of subcarbonate of iron, as a tonic, is from gr. v to gr. xx, twice or thrice a day, in honey or molasses. Subcarbonate of iron is used in the preparation of the Ferri et potassce tartras, and of the Tinctura ferri chloridi, of the Pharma- copoeia of the United States. 5* 54 % SPECIAL TONICS. 35. FERRI OX'IDUM HYDRA'TUM.—HY'DRATED OXIDE OF IRON. This preparation—called also Hy'drated sesquiox'ide of Iron, Hy'drated per ox'ide of Iron, Hy'drated tritox'ide of Iron, and Fer- ru'go — has been introduced, within the last few years, as an anti- dote to arsenic. It is prepared by converting common green vitriol, or sulphate of protoxide of iron, into sulphate of the sesquioxide by means of nitric acid, aided by heat. The nitric acid is decomposed, nitric oxide gas is disengaged, and part of the oxygen of the de- composed nitric acid unites with the protoxide of iron to convert it into sesquioxide. As, however, there is too little sulphuric acid in the sulphate of the protoxide to keep the iron in solution, when it becomes sesquioxide, sufficient sulphuric acid is added to form the sulphate of the sesquioxide — namely, half the amount of acid con- tained in the sulphate of iron employed. Solution of ammonia is then added in excess to decompose the sulphate of the sesquioxide, by uniting with the sulphuric acid of the sulphate. The precipi- tated sesquioxide is washed with wTater, until the washings cease to yield a precipitate with chloride of barium, or, in other words, are freed from sulphuric acid ; and the sesquioxide is kept in close bot- tles with water sufficient to cover it. This oxide is of a reddish or yellowish brown colour, and is much more readily dissolved in dilute acids than the anhydrous ses- quioxide. It is wholly soluble in chlorohydric acid without effer- vescence. Hydrated oxide of iron is possessed of the same properties as the subcarbonate or anhydrous sesquioxide, and might be given in the same cases. A recent writer, indeed, (Dr. Christison,) considers that it must be preferable from its superior solubility. The evidence in favour of its action as an antidote to arsenic, has been given at length elsewdiere. (New Remedies, 4th edit. p. 298, Philad. 1843.) It would appear to render the poison insoluble, and would seem to be worthy the reliance of the practitioner. It must be administered, however, in very large doses — a table-spoonful every five or ten minutes, or as often as the patient can swallow it. For ordinary cases, as a chalybeate, the dose may be the same as that of the sesquioxide or subcarbonate. 36. FERRI CHLO'RIDUM. — CHLORIDE OF IRON. The only officinal form, in which the chloride or muriate of iron is used is that of the TINCTU RA FERRI CHL0R1DI, TINCTURE OF CIILORIDE OF IRON, Tincture of Muriate of Iron. (Ferri subcarb. ffcss; Acid, muriat. Oj ; Alcohol. Oiij.) Subcarbonate or sesquioxide of iron dissolves in chlorohy- MINERAL TONICS___FERRI ET POTASS.dE TARTRAS. 55 dric or muriatic acid with slight effervescence, and the sesquichlo- ride of iron results; so that the tincture is really a tincture of ses quichloride of iron, and is so named in the London Pharmacopoeia. The tincture is of a reddish brown colour, has a sour styptic taste, from excess of muriatic acid, and an odour of chlorohydric ether, which exists in it in small quantity, owing to the action of the chlo- rohydric acid on the alcohol. This excess of acid is necessary for keeping the protcchloride of iron, of which there is a small portion in the tincture, in solution ; as the protoxide of the protochloride, when the tincture is exposed to the air, is converted into sesquiox- ide, and a part is deposited. Tincture of chloride of iron possesses the general properties of the chalybeates, and is extensively prescribed in asthenic affections. Its virtues as an astringent are referred to elsewhere. The dose is from rr\,x to n^xxx, gradually increased to f. 3i or f. 3ij, two or three times a day, in water. The solution of the sesquinitrate of iron, (q. v.)possesses ana- logous properties, but it is almost wholly prescribed as an astringent. 37. FERRUM AMMONIA'TUM. — AMMO'NIATED IRON. In the preparation of Ammo'niuret of Iron, Ammoniated Chlo- ride of Iron, Ammo'nio-chloride of Iron, according to the processes of the Pharmacopoeias of London and the United States, subcarbo- nate or sesquioxide of iron is dissolved in muriatic acid, by which means a sesquichloride is obtained. A solution of muriate of am- monia, of definite strength, is then added, and the filtered liquor is evaporated to dryness. The residue is rubbed to powder, which appears to consist of the two chlorohydrates or muriates; as, not- withstanding the nomenclature of the London College, no chemical combination seems to take place between them. Ammoniated iron is a yellow powder, which is deliquescent, and soluble both in water and alcohol. The quantity of iron in the ferrum ammoniatum is much less than in most of the other preparations of iron, and it is by no means the same in all cases. On this account, although it was at one time used extensively in asthenic cases, and especially in some of the neuroses, — as epilepsy and chorea — it is now rarely employed. The dose is from gr. iv, to gr. xii, or more, in pill; or in solution. Astrin- gent vegetable substances decompose it. 37. FERRI ET POTAS'S^E TARTRAS—TARTRATE OF IRON AND POTAS'SA. Tartrate of Potass and Iron, Ferro-tartrate of Potas'sa, or Potas'sio- tartrate of Iron, according to the Pharmacopoeias of London and the 56 SPECIAL TONICS. United States, is made by dissolving subcarbonate or sesquioxide of iron in muriatic acid, so as to form a sesquichloride, throwing down the hydrated sesquioxide by caustic potassa; and digesting this in a solution of bitartrate of potassa, so that the excess of acid in the bi- tartrate may be neutralized by the sesquioxide. This is digested for some time at a moderate heat; and, afterwards, the solution is filtered, and evaporated to dryness. Tartrate of iron and potassa is an olive-brown powder, and has a ferruginous taste. It is slightly deliquescent, — perhaps from the tartrate of potassa it contains, — and is wholly soluble in water. It is slightly soluble in alcohol. The solution in water is not liable to decomposition for a considerable period. In commerce, an imperfectly prepared compound is frequently met with, in which none, or only part, of the sesquioxide of iron is in chemical combination with bitartrate of potassa. The following are the characters of the salt, when properly prepared according to the process of the Pharmacopoeia of the United States: " Tartrate of iron and potassa is wholly soluble in water. Its solution does not change the colour of litmus, and at common temperatures does not yield a precipitate with potassa, soda, or ammonia. Ferrocyanuret of potassium does not render it blue unless an acid be added." Tartrate of potassa and iron has all the virtues of the chalybeates, but to a much milder degree. Its taste is, however, more agreeable, and its solubility ready; so that it affords a pleasant chalybeate in diseases of childhood. The dose is from ten grains to half a drachm. 39. FERRI FERROCYANURE'TUM. — FERROCYAN'URET OF IRON, PURE PRUS'SIAN BLUE. Ferrocyan'uret of Iron, Ferrocy'anate of Iron, Percy'anide of Iron, Ferro-sesquicy'anide of Iron, Cyan'uret of Iron, is prepared on the large scale for purposes of the arts, and was, therefore, com- prised in the materia medica list of the first Pharmacopoeia of the United States. In the last revision, however, a preparation is given for a pure article,'such as is well adapted for medicinal ad- ministration. It is prepared, as an article of commerce, by fusing animal matters with corbonate of potassa, so as to form cyanuret of potassium, and treating the solution of the product with sul- phate of alumina and potassa, and sulphate of iron. The greenish precipitate, formed in this manner, acquires, under exposure to the air, a beautiful blue colour. In this state, ferrocyanuret of iron is impure ; — containing alumina, sesquioxide of iron, and ferrocya- nuret of potassium. To purify it, it is digested in diluted sulphu- ric acid. The pure article of the United States Pharmacopoeia is formed by the reaction of ferrocyanuret of potassium on sulphate of the ses- quioxide of iron, washing the precipitate with boiling water, until MINERAL TONICS___FERRI PH0SPHAS. 57 the washings pass tasteless; then drying the precipitate, and rub- bing it into powder. Pure Prussian blue is of a rich dark blue colour; without smell or taste ; and it has been regarded as devoid of action on the ani- mal economy. It is certainly questionable, whether it exert any more influence than indigo. It is insoluble in w7ater and alcohol, and when broken has a bronzed tint, resembling that of indigo, but distinguishable from it by being removed when rubbed with the nail. The test of its purity—as given in the London and United States Pharmacopoeias—is, that if it be boiled with dilute chloro- hydric acid, and ammonia be added to the filtered liquor, no pre- cipitate is produced. Ordinary Prussian blue, containing—as al- ready remarked, alumina and sesquioxide of iron, by boiling the article in chlorohydric acid, both substances will be dissolved, and ammonia will throw them down. Although ferrocyanuret of iron appears to exert no influence on man or animals in health, it has been regarded not only as a simple, but as an antiperiodic ttonic. It has, accordingly, been given in atonic conditions in general, especially of the intestinal canal; but, like indigo, it has been more extolled in epilepsy and chorea ; and has been prescribed in intermittent fever, on the recommendation of Dr. Zollickoffer, of Maryland, and others. It has likewise been found of service in facial neuralgia; and in some cases of scrophu- losis. The author has given it in all these cases, but has not been satisfied with its effects. Dr. Zollickoffer considers it to be espe- cially adapted for intermittents and remittents occurring in children, on account of the smallness of the dose required, and its want of taste. The detailed evidences, adduced in its favour, are given in another work, (New Remedies, 4th edit. p. 276, Philad. 1843.) It has been used in the form of ointment, (Ferri Ferrocyanuret. 3j ; Ung. cetacei, ^j ;) to ill conditioned, torpid, and foul ulcers. The dose is five grains three or four times a day, gradually in- creased. Ferrocyanuret of iron is used in the preparation of the Hydrargyri Cyunuretum, of the Pharmacopoeia of the United States. 40. FERRI PHOSPHAS.—PHOSPHATE OF IRON. Phosphate of Iron—which is peculiar to the United States' Phar- macopoeia—is formed by the double decomposition of Sulphate of Iron and Phosphate of Soda: the sulphuric acid of the sulphate of iron lays hold of the soda of the phosphate of soda ; and the resulting sulphate of soda remains in solution, whilst the phosphoric acid of the phosphate of soda combines writh the protoxide of iron of the sul- phate of iron, and forms phosphate of iron, which is precipitated. Phosphate of iron is of a slate colour, and is insoluble in water. 58 SPECIAL TONICS. It possesses the general virtues of the chalybeates; but, like many others of the preparations of iron, does not appear to possess any special virtues to occasion its retention as an officinal preparation. The dose is from gr. v to gr. x. It is, however, but little used. The cause of its admission into the United States' Pharmacopoeia is stated to have been " the suggestion of Dr. Hewson, of Philadelphia, who found it, after an extensive experience, to be a valuable chaly- beate." (Wood & Bache.) 41. FERRI SULPHAS.—SULPHATE OF IRON. Commercial sulphate of iron, commonly called Green Vit'riol or Copperas, is usually prepared on a very extensive scale by exposing iron pyrites to the air for several months ; moistening it either by rain or artificially; and so arranging the bed on which the pyrites is placed, that the water may run into a reservoir, whence it can be withdrawn, to be evaporated for obtaining the sulphate of iron formed. Iron pyrites is a native sulphuret of iron; and, by the above treat- ment, the pyrites attracts oxygen, and becomes converted into sulphate of protoxide of iron. This is too impure, however, for medicinal use; and, accordingly, the London and United States' Pharmacopoeias direct it to be made by the action of dilute sulphuric acid on iron wire or iron filings. When thus prepared, the crystals are transparent, and of a bluish-green colour, but on exposure to air, they effloresce, absorb oxygen, and change colour, by the formation of sulphate of sesquioxide of iron. It is very soluble in water, but insoluble in alcohol, and iron does not produce with its solution a precipitate of copper. It has a strong inky, astringent taste, and reddens litmus. Sulphate of Iron is a powerful chalybeate, possessing, at the same time, astringent properties, and, as will be seen hereafter, employed in many cases on account of these. In very large doses, it acts as an irritant to the stomach and bowels, occasioning nausea, gastrodynia and vomiting, yet it can be scarcely ranked as a poison. As a tonic, it is given in all cases in which chalybeates are indi- cated. By some, indeed, it is regarded as probably one of the best, as it is the most uniform, of the preparations of iron. The dose is from one to five grains in the form of pill. Sulphate of Iron enters into the formation of the Ferri Ferrocya- nuretum, the Ferri Oxidum hydratum, the Ferri Phosphas, the Ferri Subcarbonas, the Mistura Ferri Composita, and the Pilula Ferri Composita, of the Pharmacopoeia of the United States. MINERAL TONICS__FERRI PR0T0-CARB0NAS. 59 42. FERRI PROTOCAR'BONAS.—PROTOCAR'BONATE OF IRON. When protocarbonate of iron is thrown down from sulphate of iron by carbonate of soda, it readily absorbs oxygen, carbonic acid is given off, and the protocarbonate becomes converted into sesquioxide of iron. It has been long desired, that some mode should be dis- covered, by which the salt could be maintained in the state of proto- carbonate. The addition of sugar was found to effect this object in a great degree, checking the oxidation of the iron, but not wholly preventing it. Accordingly, a preparation has been introduced into the Edinburgh Pharmacopoeia under the name Ferri Carbonas Sac- charatum, in which the precipitated protocarbonate, obtained by the decomposition above mentioned, is triturated with sugar, and dried at a temperature not much exceeding 120°. The powder, thus ob- tained, is considered to be carbonate of protoxide of iron in an un- determined state of combination with sugar, and sesquioxide of iron. It is of a grayish green colour, and is readily soluble in chlorohydric acid with brisk effervescence. Protocarbonate of iron has been highly extolled in cases in which the chalybeates in general are indicated. It is readily soluble in acids, and in the fluids of the stomach ; and is, therefore, easily absorbed. In the dose of fifteen grains it has produced, in the ex- perience of some, nausea, headache, and a sense of fulness in the head, whilst the subcarbonate of iron or sesquioxide is often given in very large quantities, without any such results. The author has not, however, observed these in a single instance. Its dose is from gr. v to 3SS, two or three times a day. PILULiE FERRI CARBONA'TIS, PILLS OF CARBONATE OF IRON, YALLET'S FERRUGINOUS PILLS. These have been introduced into the last edition of the Pharmacopoeia of the United States, (1842.) They are form- ed of sulphate of iron, carbonate of soda, clarified honey, syrup, and boiling water ; the process being essentially that for the formation of protocarbonate of iron, — the mixture, after the addition of honey, being subjected to heat, until it attains a pilular consistence. These pills have been prescribed in most of the diseases in which chalybeates in general are considered to be indicated, and espe- cially in chlorosis and amenorrhoea. The author has given them freely, but has had no reason for assigning them any pre-eminence over the other preparations of the metal. The objection, urged against the preparation to be next described, is, that the protocar- bonate becomes converted into sesquioxide, but it remains to be proved whether the objection have any force. It has, indeed, been unhesitatingly affirmed by M. Blaud, that it has not. The dose of these pills — weighing three grains each, and there- 60 SPECIAL TONICS. fore containing somewhat less than a grain and a half of the pro- tocarbonate— is eight or ten daily. Mr. Donovan advises that protocarbonate of iron should be pre- pared in the following manner for extemporaneous use. Blue sul- phate of iron, in fine powder, 3ss ; Calcined magnesia, 9ij ; Water, f. ^vi; Tincture of quassia, f. 3ij. Divide into six draughts. One to be given night and morning. MISTU RA FERRI COMPOSITA, COMPOUND MIXTURE OF IRON, This mixture was suggested by a preparation, which was long knowm as Grif- fith's Mixture, from the name of the physician who introduced it into notice, and it still bears the appellation with many. It is com- posed as follows : — Myrrh, 3j ; Potassa carbonat. gr. xxv ; Aqua rosa, f. ^viiss ; Ferri sulph. in pulv. gj ; Sp. Lavandul. f. gss; Sacchar. 3j. This mixture, when recently prepared, is a solution of protocarbonate of iron ; but when exposed to the air, it attracts oxygen, parts with carbonic acid, and deposits sesquioxide of iron. It has been long celebrated as a tonic, and especially in cases of amenorrhoea, — the myrrh and spirit of lavender being added on ac- count of their reputed emmenagogue virtues. It has likewise been largely prescribed in anaemia, chlorosis, and in nervous affections in general. It is not easy to see on what grounds it has been so often given in the hectic of phthisis, and in chronic catarrh. In such cases, it certainly possesses no virtues over other admixtures of to- nics and excitants. The ordinary dose of the mixture is f. gi to f. 31J, two or three times a day. P1LM FERRI COMPOSITE, COMPOUND PILLS OF IRON. (Myrrh., pulv. 3ij ; Soda carbonat., Ferri sulph. aa 5j ; Syrup, q. s. Make into 80 pills.) These pills, called also Griffith's Pills, resemble the last pre- paration in the same kind of double decomposition taking place ; so that, if it be desired to administer the protocarbonate, they should be prepared extemporaneously, and not kept in the shops. The dose is from two to six pills, two or three times a day. A medicine, which resembles the Pilulae Ferri Compositae, has lately acquired great celebrity in the south of France. It is called from its inventor, Blaud's Pills. In it carbonate of potassa, or the bicarbonate, is used instead of carbonate of soda. The objection made to these pills— as in the case of the Mistura Ferri Composita, and the Pilulae Ferri Compositae — is, that the protocarbonate of iron becomes converted into sesquioxide ; but Blaud properly asks__ " What signifies it to practitioners that my pills contain little or no protoxide of iron, provided they cure chlorosis:" and in testimony that they do so, he adduces a long list of cases in which a cure was obtained in three or four weeks. These pills M. Blaud calls his " antichlorotic pills." MINERAL TONICS___FERRI IODIDUM. 61 43. FERRI IOD'IDUM. — I'ODIDE OF IRON. Iodide, Proti'odide, Iod'uret, Hydri'odate or Todohy'drate of Iron, is made by gradually adding iron filings to a mixture of iodine and water. Heat is then applied, through the intervention of which a union takes place between the iodine and the iron, which is denoted by the liquid assuming a greenish colour. By evaporation to dry- ness, the iodide is obtained, which must be kept in a closely stopped bottle. Iodide of iron is of an iron-gray colour, foliated texture, brittle, and exhibits a crystalline arrangement similar to metallic antimony, except that it is darker. In the dry state, it is devoid of smell, but when moist exhales an odour of iodine: when dry, it has a strong styptic chalybeate taste; and when moist, an acrid taste precedes the other. It dissolves, in all proportions, in water, forming a greenish solution ; and, by exposure to air, forms, by the absorption of oxy- gen, the sesquioxide and the sesquiiodide of iron; the former of which is insoluble, the latter soluble. To prevent these changes a coil of soft iron wire should be kept immersed in it. The iodide is decom- posed by heat, with the disengagement of violet vapours, and the production of sesquioxide of iron. Iodide of iron has been frequently given by the author, in public and in private practice, and he has considered it especially adapted for cases in which there appears to be torpor in the system of nutri- tion,—as in asthenic dropsy, old visceral engorgements, and, indeed, in hypertrophy of any kind, accompanied by deficient action in the intermediate system of vessels. In anaemia or oligaemia, where there is paucity of red globules in the blood, and the fluid is altogether too thin, it would seem to be especially indicated, from the property which it possesses of promoting the coagulation of the blood, and therefore of inspissating it. It appears, indeed, to be the best remedy we possess whenever a eutrophic and tonic is indicated. It has been given with advantage, as a tonic, in chlorosis, in atonic amenorrhoea, atonic dyspepsia, and, indeed, in all cases that are accompanied by debility. In such affections, Dr. A. T. Thomson conceives the iodide to act more efficiently than any of the other preparations of iron. In atonic gastric dyspepsia, the same gentleman found it serviceable, when combined with bicarbonate of potassa, and taken at the moment of admixture, in the dose of three to eight grains or more. The dose of the iodide is three or four grains two or three times a day. It may be given in the form of Pills of Iodide of Iron, which may be prepared in the following manner, after a formula communi- cated by Mr. Robert Leslie, of Glasgow, to Dr. Christison. Take of Iodine, 127 grains ; iron wire, of about the thickness of a thin quill, half an ounce; distilled water, 75 minims. Agitate them briskly together in a strong ounce phial, provided with a well-fitted glass stopper, vol. n.—6 62 SPECIAL TONICS. until the froth which forms becomes white. This will happen in less than ten minutes. Pour the liquid upon two drachms of finely pow- dered loaf sugar in a little water, and triturate immediately and briskly for a few minutes: add gradually a mixture of the following powders, viz. liquorice powder, half an ounce ; powder of gum arabic, a drachm and a half; flour, one drachm: divide the mass into 144 pills. Each pill will contain about a grain of iodide of iron. LIQUOR FERRI 10D1DI, SOLUTION OF IODIDE OF IRON. The preparation under this name, introduced into the last edition of the Pharmacopoeia of the United States, (1842,) is founded on the principle, that to protect the solution of the iodide from decomposition, it is advisable to associate it with sugar or honey, which appears to exert the same protective agency, as it does on the protocarbonate of iron. The solution is made after a form proposed by Mr. William Procter, jun., of Philadelphia. The first steps of the process are the same as for the preparation of Iodide of Iron, until the liquor assumes a light greenish colour; honey is then added, and distilled water to make the quantity of so- lution required. The dose of the officinal solution is ten drops three times a day. The tests of its purity, according to the Pharmacopoeia of the United States, are, thaj it be " of a pale greenish colour, but on the addition of sulphuric acid becomes brown, and emits violet vapours if heated. It has little or no sediment, and does not communicate a blue colour to starch." A syrup of iodide of iron, prepared in an analogous manner, is directed in the Edinburgh Pharmacopoeia. 44. FERRI LACTAS. —LACTATE OF IRON. This preparation has only been introduced of late into medicine. It is formed by treating pure iron filings with lactic acid diluted with water. It is in the form of crystalline plates, very white, and changing but little in the air. It is sparingly soluble in water, red- dens litmus paper, and possesses the ferruginous taste in a tolerable degree. When dissolved in water, it attracts oxygen, and quickly becomes yellow. Lactate of iron has been prescribed in cases in which the proto- carbonate of iron is employed, and chiefly in chlorosis. MM. Gelis and Conte are, indeed, disposed to refer the beneficial effects of the latter to its becoming lactate of iron in the stomach, by uniting with the lactic acid, which, they think, is one of the gastric acids. This idea led them to administer lactate of iron ready formed. It would seem, however, that in health there is no lactic acid in the stomach. The testimonials in favour of its good effects in chlorosis are already numerous. MINERAL TONICS__FERRI FILUM. 63 45. FERRI CITRAS. — CITRATE OF IRON. Two^citrates of iron have been introduced, of late years, by M. Beral— the citrate of the sesquioxide of iron, and the citrate of the protoxide; the former of which is chiefly used. It is formed by treating hydrated oxide of iron with citric acid dissolved in water. It is in thin pieces, of a beautiful garnet-red colour; dissolves slowly in cold wrater, but readily in boiling water; or in cold when a few drops of liquor ammoniae are added, which convert it into the am- monio-citrate. Citrate of Iron greatly resembles the tartrate and the lactate in its properties. It is an elegant chalybeate, and has been much and satisfactorily prescribed by the author, where chalybeates in general have been indicated. The dose is from five grains to twenty; either in pill or solution. A citrate of iron and quinia, formed by the union of four parts of citrate of iron with one part of citrate of quinia, has also been intro- duced by M. Beral, and is given in the form of pill, where a com- bination of these tonics is indicated. 46. FERRI FILUM, IRON WIRE ; and FERRI RAMEN'TA, IRON FILINGS. Iron wire and iron filings are used in pharmaceutical preparations. Iron filings are also given internally; in which case, they may act as mechanical tonics — like other insoluble substances; and, like granular tin, may thus prove indirectly anthelmintic. Some change, however, takes place on iron filings in the stomach. They become oxidized by the decomposition of water, and hydrogen escapes, which gives rise to the unpleasant eructations experienced under their use. Like all the preparations of iron, too, they blacken the alvine discharges. When metallic iron is oxidised, in the manner mentioned above, a portion of it is doubtless dissolved by the acids, which are almost always present in the stomach. Iron filings — as obtained from the shop of the blacksmith — are very impure ; but they are readily purified by placing a sieve over them, and applying a magnet, so that the filings may be drawn upwards through it. Their dose is from five to twenty grains, in molasses or honey ; but they are not often prescribed, as there are preparations of iron, which are far more effective. Iron wire is used in the preparation of the Ferri Sulphas; and iron filings in that of the Ferri lodidum, and the Liquor Ferri lodidi of the Pharmacopoeia of the United States. An impalpable powder of iron has been strongly recommended by 64 SPECIAL TONICS. M. Raciborski in chlorosis and different forms of anaemia. It is pre- pared by passing a stream of hydrogen over an oxide of iron in a gun- barrel exposed to a red heat. The hydrogen attracts the oxygen, and leaves the metallic iron in a state of extremely minute division. Owing to its great liability to oxidation, it should be kept in a well- stopped bottle. From ten to thirty grains may be given in the course of the day in honey or molasses. ZINCI SALES.-- SALTS OF ZINC. The salts of zinc are not extensively employed as tonics. 47. ZINCI OX'IDUM. — OXIDE OF ZINC. The oxide of zinc of most of the pharmacopoeias is prepared by decomposing sulphate of zinc by means of carbonate of ammonia : the sulphuric acid of the sulphate of zinc lays hold of the ammonia of the carbonate of ammonia, forming sulphate of ammonia, which remains dissolved in the distilled water employed ; whilst the carbonic acid unites with the oxide of zinc, and forms carbonate of zinc, which is insoluble and precipitated. The carbonic acid is then driven off by exposing the carbonate to a strong heat. The Dublin College pre- pares the oxide by burning zinc in atmospheric air. Oxide of zinc is a white powder, which is insoluble in water, and devoid of taste and smell. It dissolves in dilute sulphuric and chloro- hydric acids without effervescence ; whilst if carbonate of lead, or carbonate of lime, be present, effervescence will ensue. Ferro- cyanuret of potassium and sulpho-hydrate of ammonia throw down white precipitates. Oxide of zinc has been used as a tonic in various neuroses, — as epilepsy, chorea, neuralgia, gastrodynia, &c, but especially in the first of these diseases. It is now, however, not much employed, although well adapted for cases in which nitrate of silver, or some other of the mineral tonics has been prescribed, and it is necessary to omit them for a time, and substitute another. The dose is from two to five grains two or three times a day, gra- dually increased. 48. ZINCI SULPHAS. —SULPHATE OF ZINC. Sulphate of zinc is, at times, used as a tonic in dyspepsia; and is, occasionally, associated with antiperiodics — as cinchona or sul- phate of quinia — in intermittents. It is more frequently, however, prescribed in the same neuroses as the oxide of zinc, over which it possesses no advantages. Its dose is from one to five grains, in the form of pill, made with the extract of gentian, for example, as an excipient. MINERAL TONICS__ZINCI ACETAS. 65 49. ZINCI CHLO'RIDUM. —CHLORIDE OF ZINC. Chloride of Zinc or Butter of Zinc is readily formed by adding pure oxide of zinc to any given quantity of pure muriatic or chloro- hydric acid, applying a gentle heat until solution is effected, filtering the solution, and evaporating to dryness ; rubbing the resulting chloride to powder, and preserving it in a closely stopped bottle. In the Pharmacopoeia of the United States (1842), it is directed to be made by putting metallic zinc in sufficient muriatic acid to dis- solve it; then adding a small quantity of nitric acid, and evaporating to dryness ; dissolving the dry mass in water ; adding chalk to neu- tralise any acid ; filtering ; and again evaporating to dryness. Chloride of zinc is of a whitish colour, deliquiescent, and wholly soluble in water, alcohol and ether. It is chiefly used as a caustic, but has been sometimes given internally, in the same affections as the oxide of zinc. It may be prescribed in the dose of a grain, two or three times a day ; or a solution in a spirit of ether may be made. (Zinci chlorid. gr. j ; Sp. Aether, sulphuric. 3ij ; —Dose, five drops every four hours in sugared water, gradually increasing the dose to terj drops or more three or four times a day.) 50. ZINCI CYANURE'TUM. —CYAN'URET OF ZINC; and 51. ZINCI FERROCYANURE'TUM. — FERROCYAN'URET OF ZINC. Neither of these preparations is officinal in the Pharmacopoeias of Great Britain or of this country. The former is made by the de- composition of sulphate of zinc by cyanuret of potassium, or cyanuret of lime; the latter by the mutual decomposition of boiling hot solu- tions of sulphate of zinc, and ferrocyanuret of potassium. They have both been used in the same class of cases as the other preparations of zinc. The dose of the cyanuret is from T'? to j^th of a grain several times a day, gradually increasing the dose to a quarter of a grain. Of the ferrocyanuret, the dose is from one to four grains. 52. ZINCI ACE'TAS. — AC'ETATE OF ZINC. Acetate of zinc is usually formed by the double decomposition of sulphate of zinc and acetate of lead;—the sulphuric acid of the sulphate of zinc uniting with the lead of the acetate of lead, and forming an insoluble compound; whilst the acetic acid of the ace- tate unites with the oxide of zinc of the sulphate, and remains dis- solved in the distilled w-ater employed. The solution is then eva- porated to crystallisation. This was the process adopted in former editions of the Pharmacopoeia of the United States; but in the last, acetate of lead is dissolved in water, and metallic zinc, granulated, is added to the solution, and shaken with it until the liquid yields 6* 66 SPECIAL TONICS. no precipitate with iodide of potassium. The solution is then eva- porated to crystallisation. Acetate of zinc is in white crystals, which have a silky lustre, dissolve readily in water, and are slightly efflorescent. It is devoid of odour, and has a bitter metallic taste. It is hut little prescribed internally, and possesses no advantages over the other salts of zinc already described. It may be given in the same diseases, in the dose of one or two grains, gradually increasing the quantity. The excipient may be the extract of gentian. Valerianate of Zinc has been extolled by some of the Italian physicians as a remedy in several nervous diseases. It is formed by adding protoxide of zinc to the vegetable acid to saturation, and then slowly evaporating the solution. A note on the mode of pre- paring the salt has been recently published in the American Journal of Pharmacy, by Mr. Wm. Procter, Jun., which may be consulted with advantage by the pharmacien. Valerianate of zinc is given in the dose of one or two grains in the form of pill. It has been used with marked benefit in neu- ralgia. 53. ARGEN'TI NITRAS—NITRATE OF SILVER. Nitrate of silver, — prepared for the purposes of pharmacy, by dissolving silver in dilute nitric acid; heating the solution and gra- dually increasing the heat until the resulting salt may be dried ; melting this in a crucible and continuing the heat until ebullition ceases, and immediately pouring it into suitable moulds, — is at first white, but becomes dark on exposure to light. It is wholly soluble in distilled water; and the solution yields with chloride of sodium a white precipitate, which is wholly soluble in ammonia. Nitrate of silver has been employed as a tonic in diseases of the nervous system; but chiefly in epilepsy and chorea ; and the au- thor is disposed to think, that he has seen more efficacy from it in the former disease than from any other agent. Of course, it can only be serviceable, where there is no serious disease of the nervous centres. There is, however, a striking objection to its use, in the fact, that, when long continued, it has produced a slate colour of the whole cutaneous surface, which has continued for the remainder of existence ; but it is said, in one case, to have been diminished by washes of dilute nitric acid. This coloration is, however, rare, for although the author has prescribed it largely, and for a long period, he has never witnessed a single case of it. When it does occur, it would appear to be owing to the nitrate of silver being converted MINERAL TONICS__ARGENTI NITRAS. 67 into chloride by the chlorohydric acid of the stomach; passing into the blood in this state, and being deposited in the corpus papillare. If chloride of silver be moistened, and exposed to the air, it ac- quires the colour in question. (See vol. i. p. 81.) In explanation of the colour produced in the skin by nitrate of silver, and supposed by some to depend on the decomposition of the tissue, Professor Krause has recently stated, that if thin cut layers of epidermis soaked in a solution of nitrate of silver be exposed to the light, and then made transparent by acetic acid, their texture may be seen to be unaltered ; but there are very dark granules from ToT6tn to iTo~otft °f a ^ne m diameter, on the outside of the larger cells, which are, no doubt, chloride of silver and reduced silver, and to these, not to a decomposed tissue, the change of colour is due. It has been affirmed, that a combination of nitrate of silver with iodine prevents the discoloration ; and a form for the purpose has been prescribed by a recent writer — Dr. Patterson, of Scotland. (R. Argent, iodid., argent, nitrat. aa gr. x. Rub into a subtile pow- der, and add glycyrrhiz. pulv. 3SS, sacchar. 9i; mucilag. acacia q. s. ut fiant pi], xl. Dose, — one, three times a day.) Experience is wanting to decide as to the iodine possessing the property ascribed to it. As nitrate of silver may possibly induce this colour, it becomes the physician to state this to the patient, especially if a female, in order that if she consent to take it, she may have no cause of com- plaint afterwards. There is little or no danger, however, of its oc- curring under two months use of the article. In chorea, as well as in another neurosis — angina pectoris — this tonic has proved of ser- vice ; and it has succeeded in allaying morbid sensibility of the sto- mach, even when it has arisen from cancer. In such cases, it is of course only a palliative. The dose of the nitrate, as a tonic, is a quarter of a grain, three times a day, gradually increased to four or five grains. It may be made into a pill with extract of gentian or of dandelion. Crumb of bread has been objected to as an excipient on account of its con- taining chloride of sodium ; but this objection is only plausible, in- asmuch as it must'meet with chlorohydric acid in the stomach. The disagreeable taste of the nitrate prevents it from being given in solution. Mr. Lane is of opinion, that when the chloride is conveyed to the cutaneous surface, it is converted into an oxide by the action of light and its strong affinity for albumen ; and under the view, that the oxide of silver may serve the purposes of the nitrate he has prescribed it as a tonic in half grain doses, twice a day, especially in cardialgia, gastrodynia and irritability of the stomach. It does not seem in any of the cases to have caused discoloration of the skin ; but sufficient trials have not been made with it to determine that it is less likely to induce coloration than the nitrate. 68 SPECIAL TONICS. Of late, Sir James Eyre has highly extolled the oxide, in half grain doses, which, he says, uniformly succeeded in curing pyrosis. It has been recently affirmed by Dr. Branson, of Sheffield, that when nitrate of silver has been given for some time it produces a blue discoloration of the gums similar to the effects of lead. Chloride of silver has the same tonic properties as the oxide and nitrate. Its dose is from one to three grains or more two or three times a day. 54. BISMUTHI SUBNITRAS. — SUBNI'TRATE OF BISMUTH. Subni'trate of Bismuth, White Bismuth, or Trisni'trate of Bis- muth is prepared by dissolving bismuth in dilute nitric acid; and pouring the solution into distilled water. The powder that sub- sides is the subnitrate. In this process, a part of the nitric acid is decomposed and furnishes oxygen to the bismuth ; the oxide of bismuth is then dissolved by the remainder of the nitric acid. On the addition of water to the solution of this nitrate, it is decomposed into subnitrate and supernitrate, — the former being precipitated, and the latter remaining in solution. The subnitrate is a white powder, without taste or smell, and very slightly soluble in water. It is blackened by sulpho-hydric acid. Should it contain carbonate of lead or earthy carbonates, it will effervesce on the addition of nitric acid ; and if lead be present, sulphuric acid, added to the solution in nitric acid, will throw down a white precipitate. Subnitrate of bismuth has been employed in various neuroses,— as epilepsy, nervous palpitation and spasmodic diseases in general. It is most frequently administered, however, in neuropathic affections of the stomach, — as the various forms of cardialgia and gastrodynia, in which it is said to have been found efficacious by many; but it has not answered any very satisfactory purpose in the author's prac- tice. The dose is five grains gradually increased to a scruple or more, two or three times a day, in pill, or in honey or molasses. In large doses it induces considerable gastric and encephalic disorder, like that which is caused by acro-narcotic poisons. CUPRI SALES.-- SALTS OF COPPER. Three of the salts of copper are used as tonics, and in analogous cases — the acetate, the sulphate, and ammoniated copper. 55. CUPRI SUBACE'TAS.—SUBACETATE OF COPPER. Subac"etate of Copper, Mru!go, or Ver'digris, is an impure subace- tate, which is prepared on a large scale, in the south of France, by i MINERAL TONICS__CUPRUM AMMONIATUM. 69 allowing the refuse of grapes, in making wine, to ferment with sour wine, and then placing them between plates of copper. In the course of a fortnight, the plates become covered with subacetate of copper. In Great Britain it is made by interposing between the plates of copper cloths steeped in pyroligneous acid. The verdigris used in this country is imported from the south of France. The appearance of verdigris is well known. It is of a pale bluish green colour, has a disagreeable acetous odour, and a coppery taste. It is insoluble in alcohol, and water resolves it into a soluble acetate, and an insoluble subacetate. In consequence of its powerful action in an over dose, subacetate of copper is rarely given as a tonic. It may, however, be prescribed in the same cases as the other salts of copper. Its dose, as a tonic, •s from one-eighth to a quarter of a grain given in pill. 56. CUPRI SULPHAS. — SULPHATE OF COPPER. Sulphate of copper has been given as a tonic in the same neuroses as the nitrate of silver, and especially in epilepsy and chorea, in which it would appear to have occasionally rendered essential ser- vice. It is not as often prescribed, however, as the next article. The dose, as a tonic, is a quarter of a grain three times a day, made into a pill with extract of gentian, or extract of dandelion; and the quantity of the sulphate may be gradually increased to a grain and a half, or two grains, so as not to occasion vomiting. 57. CUPRUM AMMONIA'TUM. — AMMO'NIATED COPPER. Ammo'niated Copper, Ammo'nio-sulphate of Copper, Cupro-sul- phate of Ammo'nia, or Ammo'niuret of Copper, is made by rubbing together Sulphate of Copper and Car'bonate of Ammo'nia, until effer- vescence ceases; the ammoniated copper is then dried and kept in a well stopped glass bottle, — as, when the salt is exposed to the air, ammonia is given off, and a green powder is left, composed of sulphate of ammonia and carbonate of copper. When sulphate of copper and carbonate of ammonia are rubbed together, a reaction takes place between them; they give out a part of their water of crystallisation, so that the mass becomes moist; and, at the same time, a part of the carbonic acid of the carbonate of ammonia is evolved, which causes effervescence. The precise theory of the process, and character of the product are not, however, known; and in the uncertainty, the framers of the Pharmacopoeia of the United States have given the preparation the name at the head of this article. Ammoniated copper is of a deep blue colour; with a strong odour of ammonia, and a styptic metallic taste. When exposed to the air, it loses ammonia, and becomes of a green colour. It is soluble in 70 SPECIAL TONICS. water, but if the solution be much diluted it is decomposed, and subsulphate of copper is thrown down. Ammoniated copper resembles in its remedial action the sulphate; and has been given in the same cases, especially in epilepsy, and chorea. In the former disease, it has been highly extolled by many. When taken in too great quantity it produces the same effects as the other salts of copper. The dose is from a quarter to half a grain, two or three times a day, gradually increased to four or five grains and more. It is best given in the form of pill, with crumb of bread, or with the extract of gentian as an excipient. 58. AC/'IDUM SULPHU'RICUM.—SULPH'URIC ACID. Sulphuric acid is obtained by burning sulphur, united with nitrate of potassa, over water in an appropriate chamber. The sulphur, if burnt alone, would yield sulphurous acid; the nitrate of potassa is added to furnish by its decomposition, the oxygen necessary to form sulphuric acid. The precise steps in its preparation, and the theory of the process, belong properly to chemistry. Sulphuric acid is always prepared on the large scale by the manu- facturing chemist, and, therefore, is in the materia medica list of the Pharmacopoeia of the United States, which directs, that it should be of the specific gravity 1.845; be colourless; volatilised by a strong heat; and, when diluted with distilled water, be not coloured by sulphohydric acid. Should it be so, it contains sulphate of lead. Sulphuric acid, properly diluted, is used as a tonic in the same cases as nitric acid. It is often given alone, or associated with bit- ters, in convalescence from fever, as well as in the course of long protracted fevers. In cases in which there is a deficiency of acid in the stomach, as in what has been called neutral or alkaline indiges- tion, it is very often serviceable, and has even been found of more advantage than the muriatic acid, although the latter is one of the acids secreted by the stomach in health. It is also prescribed in the phos- phatic diathesis, in which its tonic agency is, doubtless, of service. The acid, in its state of concentration being so highly corrosive, a formula is contained in the pharmacopoeias for a diluted acid. AC IDUM SULPHU'RICUM DILU'TUM, DILUTED SULPHURIC ACID. (Acid, sul- phuric, f. ^j; Aq. destillat. f. ^xiij.) The specific gravity of this acid is 1.09. It may be given in the dose of from ten to thirty drops, three times a day, in a wine-glassful of sweetened water. As the teeth are apt to be injured by the mineral acids, they may be sucked through a glass tube or quill. AC'IDUM SULPHU'RICUM AROMAT'ICUM, AROMATIC SULPH'URIC ACID, Elix'ir of Vitriol. (Acid, sulphuric, f. Jiiiss ; Zingib. contus. |j ; Cinnam. cont. Jiss; Alcohol. Oij.) The aromatics and the alcohol render the ANTIPERIODIC TONICS. 71 sulphuric acid more excitant, and greatly more agreeable. Accord- ingly, it is far more frequently prescribed as a tonic than the diluted sulphuric acid. Its dose is from ten to thirty drops, two or three times a day, in a glass of water. 59. A"CIDUM NI'TRICUM.—NITRIC ACID. Nitric acid is obtained by the action of sulphuric acid on nitrate of potassa; the sulphuric acid laying hold of the base of the nitrate, and the nitric acid being disengaged, and collected in an appropriate receiver. It is an article, wdiich is always prepared, in this coun- try, by the manufacturing chemist; and, therefore, in the Pharma- copoeia of the United States, it is placed in the list of the materia medica, with the direction that it must be of the specific gravity 1.5; be colourless ; entirely volatilised by heat; dissolve copper wTith the disengagement of red vapours — which is owing to the escape of binoxide of nitrogen; and, when diluted with distilled water, yield no precipitate with nitrate of silver, or chloride of barium; — thus showing that it contains neither chlorohydric nor sulphuric acid. When in its state of concentration, nitric acid is so corrosive as not to be very manageable ; a formula is, therefore, given in the pharmacopoeias for a diluted acid. It has been much used as a tonic, alone, or associated with bitter infusions, in adynamic fever; and in cases of phosphatic depositions from the urine, has been sup- posed to act beneficially through its tonic powers. Dr. Christison affirms, that the urine has never been rendered acid by it in his hands, so that whatever good it accomplishes must, he thinks, be through some other means than its rendering the morbid urine acid. He supposes, also, that the benefit ascribed to it in hepatitis may be through its tonic action. It is not much used, however. The dose of the strong acid is five to ten minims in a wine-glass- ful or more of wTater. AC'IDUM NI'TRICUM DILU TUM, DILU'TED NITRIC ACID. (Acid, nitric, f. §j; Aq. destillat. f. |ix.) The dose of this is from forty minims to f. 3iss in water. Its specific gravity is 1.08. In cases in which the British and American practitioners employ the sulphuric and nitric acids, the Germans prescribe the phosphoric acid. II. Antiperiod'ic Tonics. Under this head are comprised tonic agents, which are chiefly employed with the view of preventing those diseases, that are dis- tinguished by marked periodicity. It has been before observed, that 72 SPECIAL TONICS. most of the tonics, already considered, have been occasionally em- ployed as antiperiodics in intermittent fever; but, at the present day, they are rarely given with that view; whilst those, which will be described under this head, are almost exclusively relied upon. Again, most of the antiperiodic tonics may be employed in asthenic cases, in which tonics in general are indicated ; but in this relation they offer perhaps no pre-eminence. 60. CINCHO'NA. —PERUVIAN BARK. The terms Cincho'na, Peru'vian Bark, and Bark, are employed pharmacologically for the bark of different species of cinchona; Sex. Syst. Pentandria Monogynia; Nat. Ord. Rubiaceae, (Jussieu) — Cinchonaceae, (Lindley,) obtained from the western coast of South America. Of these, the Pharmacopoeia of the United States has ad- mitted three varieties—1. Cincho'na fiava, Yellow Bark, the variety known in commerce under the name Calisay'a Bark; 2. Cincho'na pallida, Pale Bark ; the variety called in commerce Loxa Bark; and 3. Cincho'na rubra, Red Bark, the variety known in commerce under the latter name. Each of these will require a separate consideration; but it may be well to premise a few observations, which are appli- cable to the whole. Although the botanical history of so interesting a subject as that of the cinchona barks has been attentively studied, it is by no means understood even at the present day: until recently, indeed, the most erroneous views were entertained in regard to it, owing to the jealousy of the Spanish government, who appear to have thrown every obstacle in the way of the inquiring naturalist. Even now, in the London Pharmacopoeia, the three varieties, yellow, pale, and red bark, are referred respectively to Cincho'na cordifo'lia, C. lancifo'lia, and C. ob- longifo'lia; yet it has been sufficiently showTn, that w-e are still igno- rant of the source of the two last varieties, and that the pale barks are derived from different species. Twenty-six species of cinchona are now pointed out by botanists, of which twelve, at least, are thought to furnish a part of the barks that are used. (Lindley.) All the spe- cies are either tall shrubs, or large forest trees; are commonly ever- green, and of great beauty, both in foliage and flower. They inhabit the Andes at various elevations from 11° N. L. to 20° S. L. The best bark is said to be obtained from the trees that grow on a dry rocky soil. The bark peelers or Cascarillos commence their opera- tions in May, when the dry season sets in, and end in November. The quantity of bark exported is enormous, — to such an extent, in- deed, that scarcity has been apprehended, and under such a feeling, the government of Bolivia, in 1838, issued a proclamation forbidding the collection of bark in its territory for five years. Cinchona is shipped from various ports of the Pacific, — the most common being Arica, Valparaiso, Lima, Callao, and Payta. The quantity received into England in different years has varied greatly. ANTIPERIODIC TONICS___CINCHONA. 73 In 1830, 556,290 lbs. were imported, of which 56,879 lbs. were re- tained for home consumption. This appears to have been the largest quantity imported in any one year. In 1841, according to Dr. Pe- reira, 81,736 lbs. paid duty. The arrangement of the cinchonas, adopted in the Pharmacopoeia of the United States, is according to the colour of the barks ; for al- though— as has been correctly remarked—dependence cannot be placed upon this property alone, as barks of a similar colour have been found to possess very different virtues; and between the various colours considered characteristic there is an insensible gradation of shade, still the most valuable barks may be arranged in three groups -— the yellow, pale, and red, between which there is, in general, a Well-marked distinction. I. Cincho'na flava, Yellow Bark. —Yellow Bark — it has been said — is generally known in commerce under the name Calisay'a Bark. The London College refers it to Cincho'na cordifo'lia, but the precise species that yields it is unascertained. It is produced most abundantly, if not exclusively, in the province of La Paz or its neigh- bourhood in Bolivia, whence it is conveyed to the Pacific and shipped at Arica. Two varieties are met with in commerce, the quilled and the flat; the former is in pieces, generally from nine to fifteen inches long, from one to two inches in diameter, and from an eighth to a third of an inch in thickness. Some quills are considerably'smaller; but such fine quills are not seen in it as form a considerable proportion of the pale barks. The external surface of the quills is marked by longi- tudinal wrinkles and furrows, and by transverse cracks, which cause the external surface of the bark to be very rough. The colour of the epidermis is of a more or less light gray. This epidermis yields a dark red powder; is tasteless, and possesses none of the virtues of the bark. The outer surface of the bark, where the epidermis is want- ing, is of a brown colour. The^a^ calisaya or flat yellow bark possesses the characters of the quilled variety, except that the pieces which are stripped of their epidermis have externally the cinnamon-brown colour of their inner surface, and are free from cracks and wrinkles. They are in pieces either quite flat or but slightly curved. When the epidermis exists, the bark presents the same external appearance as the quilled variety. The inner surface of both varieties is smooth and of a cinnamon colour. In commerce, the flat variety is divided into the coated and the uncoaled. Yellow bark resembles in taste and smell the pale variety, but it is stronger. It yields more sulphate of quinia than any other kind of cinchona bark, and hence is more largely consumed than any other. In the year 1827, M. Pelletier used 2000 quintals, equal to 200,000 lbs., in the manufacture of 90,000 French ounces of sulphate of quinia, about three drachms of the sulphate to one pound of bark. vol. ii.—7 74 SPECIAL TONICS. Chemical analysis would seem to have shown that the flat variety of the yellow bark is to be preferred; and it is stated that one French pound of uncoated yellow bark yields from 30 to 50 grains more of the sulphate than the coated variety. II. Cincho'na Pallida, Pale Bark. —The finest specimen of this is the Crown, or Loxa Bark, or Crown Bark of Loxa, of com- merce, which is referred by the London College to Cinchona Lancifolia. It is the Cincho'na Coro'na of the Edinburgh Pharma- copoeia, and is the bark of Cincho'na Condamine'a. It is collected in the provinces about Loxa. Under the name Loxa Bark, how- ever, in the United States, are included all the pale barks. (Wood and Bache.) As met with in the shops, pale bark is in quills, in length from six to fifteen inches, single or double, straight or nearly so, and varying in diameter from the size of a crowquill to that of the thumb, or somewhat larger, and in thickness from one-third of a line to two lines. The epidermis is always on ; so that in the case of the pale bark, there are no two varieties, the coated and the un- coated, as in the case of the yellow bark. The epidermis has nu- merous transverse cracks. In the fine quills, these are hardly visi- ble ; but longitudinal furrows are observable as well as in the larger quills. The external surface of the epidermis is of a grayish colour, owing chiefly to the lichens that cover it, and sometimes inclining to liver-brown. Gray, or grayish-brown is the predominant tint. The inner surface, and the powder, are of a deep cinnamon brown co- lour ; — the former, in the finer kinds, is smooth ; in the coarser, rough occasionally. It has a bitter, aromatic and astringent taste, and a smell somewhat resembling that of tan. The finest quills are most prized, but those of the middle size are considered by Dr. Christison to be really the best. The pale barks differ from the yellow in containing cinchonia in the place of quinia. In this country they are much less used than they wTere formerly —the red bark being preferred by many physi- cians ■—whilst the yellow, as already shown, is employed for the formation of the sulphate of quinia. III. Cincho'na Rubra. Red Bark. — The botanical origin of this variety of cinchona is unknown. The London and Dublin Colleges refer it to Cincho'na oblongifo'lia, but the Edinburgh considers it to be the bark of an unascertained species. Like yellow bark, it is im- ported in quills, and in flat pieces — the latter being the more com- mon of the two, and, occasionally, very large, as if taken from the trunk of a tree — being from two inches to two feet in length, and one to five inches in breadth, and from one quarter to three quarters of an inch in thickness. It is generally coated, or covered with epidermis, which is rough, wrinkled longitudinally, furrowed, and often warty. The colour is reddish brown, with a grayish hue in the hollows, owing to adhering lichens. The inner surface is of a deep cinnamon brown, inclining to reddish brown ; and the colour ANTIPERIODIC TONICS__CINCHONA. 75 of the powder is so much redder than that of the preceding varieties as to render the epithet red bark appropriate. The taste is bitter, somewhat aromatic, and astringent. *■ he quilled variety is in pieces of about the same size as quilled yellow bark. These are of a paler reddish brown externally than the flat pieces, and internally of a clearer cinnamon brown colour, ap- proaching that of yellow bark. On the epidermis are frequent patches of pale gray efflorescence from lichens. The colour of red bark in genera] is faint reddish brown, and the odour is feebly tan-like. It is distinguished from the varieties already considered by containing both quinia and cinchonia in considerable quantities. This fact ought to cause it to be more largely used ; yet in Europe it is so little em- ployed that it receives scarcely any attention. (Pereira.) Such are the varieties of cinchona that are officinal in the Pharma- copoeia of the United States. There are many other varieties, how- ever, which are genuine cinchona barks, and yet have not been con- sidered wrorthy of an officinal position. The Edinburgh Pharmaco- poeia admits, indeed, Cinchona cine'rea, Gray Bark, Silver Bark, or Huanu'co Bark, which is obtained around Huanuco, in Peru, and belongs to the class of pale barks. Amongst the genuine, but infe- rior barks, are the Carthage'na Barks, which are brought from the northern Atlantic ports of South America : the characters of these, and, indeed, of all the cinchonas, have been well and fully described by Dr. Pereira. It was to be expected, that so valuable a bark as genuine cinchona should be subject to adulteration. It would not seem, however, that such adulterations are common in this country or in Great Britain. The most important spurious barks are the Piton or St. Lucie Bark, from Exoste'ma floribun'dum of the West Indies ; the Caribe'an Bark, from Exoste'ma Cariba'um, likewise of,the West Indies ; and the Pitay'a Bark, also supposed to be the bark of an exostema. They contain neither quinia nor cinchonia. The most common sophistica- tion is in the case of the powder, which may be adulterated with spurious barks or inert matter, and require a very experienced indi-. vidual to detect the fraud. The chemical investigations in regard to cinchona are extremely interesting, and the results have furnished most valuable aids to therapeutics. It is only, however, within the last quarter of a cen- tury, that our knowledge of them has been rendered precise, and chiefly through the labours of two skilful French analytical che- mists, MM. Pelletier and Caventou. The following, according to Dr. Pereira, may be regarded as the constituents of the three vari- eties of genuine barks — the pale, the yellow and the red. Pale. Yellow. Rod. 1. Kinate of cinchonia, ....+ + + 2.---------quinia, .... + + + 3. Soluble red colouring matter, (tannin,) + -f _l. 76 SPECIAL TONICS. Pale. Yellow. Red. + 4- + + + + + + + + + + + + + + 0 0 + + + 4. Insoluble do. (red cinchonic,) + 5. YellowT colouring matter,, 6. Green fatty matter, .... 7. Kinate of lime, .... 8. Starch, ...... 9. Gum, ...... 10. Lignin, ...... The cinchonia and quinia, the alkalies on which the chief medical virtues of cinchona are dependent, exist in the bark in combination with kinic acid. The quantity yielded by the different varieties differs, and it would appear, that the same variety may yield differ- ent quantities, which may account for the discrepancy in the results obtained by different chemists. Thus, Dr. Christison states that an English manufacturer informed him, that 100 pounds avoirdupois of good yellow bark afforded him sometimes 50, sometimes only 25 ounces of sulphate of quinia — that is from 31.25 to 15.6 parts in 1000 ; or from 23.4 to 11.7 of quinia. Besides the cinchonia and quinia, another alkali has been dis- covered in Arica or Cusco cinchona, to wThich the name Aricina has been given. It is not, however, of any therapeutical interest. Other alkaloids are, likewise, said to have been found, but their existence is not considered to be established. The tannic acid which gives the astringency to bark, and which is contained in greatest quantity in the red variety, is, doubtless, also concerned in its therapeutical action. Cinchonia and quinia, the latter of which is an officinal preparation, will receive a distinct consideration hereafter. The active ingredients of cinchona are imparted to water, alcohol and dilute acids, and, accordingly, these menstrua are employed in the formation of different officinal preparations. Cold water makes an excellent infusion, but does not extract the virtues, unless by the operation of displacement, as well as hot; but the qualities of the different officinal preparations will require a separate mention. As an evidence of the value of the discovery of quinia, it may be stated, on the authority of a respectable druggist of this city, (Philadelphia,) that although the best cinchona bark could not be purchased, at the time, for less than a dollar and thirty-seven and a half cents per pound, and in powder for less than one dollar and fifty cents; cinchona powder — so called—could be obtained for ten cents a pound. This consisted of an admixture of the false and other barks with the cinchona or true barks ; and generally, perhaps, not a particle of the latter could be detected in it. Yet the appear- ance of the true and the spurious powder was so nearly alike, that no difference could be observed even by an experienced eye. Cinchona has been long celebrated as a tonic and antiperiodic ; and its efficacy in arresting the paroxysms of intermittents has ac- quired it the name of a febrifuge. It is aot such in reality ; for ANTIPERIODIC TONICS__CINCHONA. 77 it seems to exert no influence over the excited organic actions as they exhibit themselves in ordinary fever. Its great power is in the period of apyrexia ; in which it seems to act upon the nervous system in the same manner as other agencies that affect the nerves in a revellent manner, and thus — as elsewhere remarked of anti- periodic tonics in general — breaks in upon the chain of associated actions, that constitute the disease. But it is not only in intermix tent fever that it operates in this beneficial manner. In other dis- eases, not characterised by any excited condition of the organic ac- tions, it equally destroys the morbid catenation; and therefore the epithet antiperiodic is more appropriate to it than febrifuge. Cinchona is an admirable tonic as well as antiperiodic ; and, as such, is largely employed. Most, however, of its medical virtues are comprised in the salts of its alkaloids — especially the sulphate of quinia, which has, therefore, almost supplanted it. Still, as stated in the general consideration of tonics, there are cases in which the sulphate of quinia fails as an antiperiodic, and in which the pow- dered cinchona succeeds ; partly, perhaps, on account of its con- taining, along with the alkaloid, an astringent principle ; and partly owing to the lignin or woody matter; all of which combined may impress the nerves of the stomach more powerfully than the sulphate of quinia alone. As a tonic, it may be prescribed in the same cases as tonics in general ; and the same observations as were applied to them, in regard to the best forms for administration, are equally ap- plicable to it. Of these, the cold infusion is !to be decidedly pre^ ferred. Like tonics in general, apprehension need not be enter- tained, in doubtful cases, that the cinchona may act injuriously as an excitant; for when it has been administered in the hot stage of intermittents, it has not appeared to add to the excitement. Before its administration in intermittent fever, it is generally cus« tomary to prescribe an emetic of tartrate of antimony and potassa, or of ipecacuanha, or of both combined, and to follow this up by a brisk cathartic ; but in very malignant intermittents, time may scarcely be afforded for the latter. As a general rule, this course appears ad- visable, the cinchona usually making a more powerful impression, after the alimentary canal has been cleared of its contents, When it excites nausea, or runs off by the bowels, the addition of an ex-. citant — as of five grains of ginger powder, or of the Pulvis aroma- ticus, or a few drops of laudanum, may act as a corrigent. In cases in which it cannot be retained by the stomach, it has been adminis-. tered in enemata, and in children especially has proved effectual; three times the quantity that would be given by the mouth being thrown up into the rectum. It was formerly, also, the practice to apply it to the surface of the body in the form of cataplasms, pedilu- via, bark jackets, &c, but these are never directed at the present day by the physician. In a simple case of intermittent, the cinchona is generally sufficient to prevent the paroxysm, Should the disease, however, be compli-. 7* 78 SPECIAL TONICS. t cated with plethora, hyperaemia of any organ, or gastric or intestinal derangement, it becomes necessary to remove these complications, before the remedy can exert its full powers. Intermittent and remittent fevers are not the only diseases in which, as before remarked, the cinchona acts beneficially as an anti- periodic. In all affections that observe any thing like a distinct periodical character, and recur at regular intervals, it often exhibits its powers most signally ; whilst in those that are very irregular, and where of course it is difficult to anticipate the precise period of at- tack, little or no reliance can be placed upon it. The dose of powdered cinchona, — which is the most effectual form when it is desirable to make a decided, impression, — is one drachm, repeated more or less frequently. If given every hour, for eight hours before the anticipated paroxysm, a sufficient quantity may be taken to have a decided antiperiodic effect upon an ordinary ague ; and should this not prevent the paroxysm, its repetition in the subsequent interval may wholly arrest the disease. In asthenia, either of the stomach or of the system generally, the watery or alcoholic preparations of cinchona are preferable, but should it be desired to exhibit the cinchona in powder, in these cases, the dose may be from ten to thirty grains. The taste of cinchona, when mixed with milk, according to Dr. A. T. Thomson, is completely covered, provided the mixture be taken directly ; but if not taken immediately, the medicine soon communicates its taste to the milk. ^ INFU'SUM CINCIIO'NJI, INFU'SION OF PERUVIAN BARK. (Cinchon. cont. gj ; Aqua bullient. Oj.) This may be prepared by maceration ; or an infusion with cold water may be made by displacement or by maceration. Infusion of cinchona contains only a part of the vir- tues of the drug,—a large portion of the kinates of the active prin- ciples remaining in the mass that is left on the strainer. It is the form generally used when the remedy is given as a tonic. As an antiperiodic, it is not sufficiently potent. The dose is f. ^iss to f. ^ij three or four times a day. INFU'SUM CINCHONJE COMPOS ITUM, COMPOUND INFU'SION OF PERUVIAN BARK. Cinchon. in pulv. ^j ; Acid, sulphuric, aromat. f. 2j ; Aqua, Oj.) The addition of the sulphuric acid decomposes the kinates of the alkaloids, and probably secures the separation of the greater portion of active matter. Its dose is the same as the last. _DEC0C'TUM CINCHONA, DECOCTION OF PERU'VIAN BARK. (Cinchon. cont. £j ; AqucB, Oj.) If cinchona be boiled for a great length of time, the alkaloids form compounds with other constituents, which are sparingly soluble in hot water, and less so in cold ; so that as the decoction cools, they are deposited.. This would be prevented by the addition of the aromatic sulphuric acid, as in the last prepara- ANTIPERIODIC TONICS__SULPHATE OF QUINIA. 79 tion. The decoction contains much more of the active matter of the cinchona than the simple infusion ; still, it is rarely used as an antiperiodic. The dose is f. ^ss to f. ^iij. TINCTT RA CINCHO'NA, TINCTURE OF PERUVIAN BARK. (Cinchon. in pulv. 3yj ; Alcohol, dilut. Oij ; prepared either by maceration or displace- ment.) The tincture of cinchona is rarely given alone, on account of the quantity of alcohol that is combined with an ordinary dose. It may however be prescribed in the dose of from f. 5J to f. ^ss in cases of atonic dyspepsia, and where the ordinary bitter tinctures are considered to be indicated. Usually, it is added to tonic infu- sions or decoctions, — as to the Infusum cinchona, or Decoctum cin- chona ; in the proportion of from f. 3j or f. 3U *° £ 3iss of either of these preparations. TINCTU'RA CINCHO'NA COMPOSITA, COMPOUND TINCTURE OF PERU'VIAN BARK. (Cinchon. in pulv. |ij ; Aurant. corticis, contus. §iss; Serpentaria, contus. 3iij ; Croci, incis., Santal. rasur. aa 3j; Alcohol, dilut. 3xx; made either by maceration or displacement*) This preparation is commonly sold as Huxham's Tincture of Bark. The addition of the orange-peel as an excitant, and of the Virginia snakeroot as an aro- matic bitter tonic, renders this preparation more agreeable and exci- tant than the simple tincture. It may be given in the same cases. The dose is f. 5J to f. ^ss. EXTRAC'TUM CINCHONA, EXTRACT OF PERUVIAN BARK. This extract, in the Pharmacopoeia of the United States, is made by exhausting cin- chona by means of alcohol, by the process of displacement, distilling off the alcohol, afterwards treating it with water ; mixing the infu- sions, and evaporating to form an extract. The extract contains most of the principles of cinchona, but it is rarely used. The dose is from gr. x to gr. xxx or more. QUl'NIJE SULPHAS.--SULPHATE OF QUl'NIA. Qui'nia, Quina or Quinine' — as already remarked — is one of the alkaloids, to which cinchona owes its antiperiodic properties. The mode in which it is obtained will be apparent from considering the process for procuring the sulphate — the only officinal preparation in the Pharmacopoeias of Great Britain and the United States. It is generally in the form of powder; has a very bitter taste, and is very sparingly soluble in cold water. It possesses the same virtues as the sulphate, and is, indeed, preferred by some as an antiperiodic. It may be given in the form of pill, in the same dose as the sulphate, or in alcoholic solution. SULPHATE OF QUI MA, Disulphate of Qui'nia, Subsulphate of Qui'nia, or Sulphate of Quinine, is prepared from yellow bark by the follow- 80 SPECIAL TONICS. ing process. The bark is boiled in water and muriatic acid, by wdiich the kinate of quinia is decomposed, and muriate of quinia is formed; the boiling is repeated on the residuum; the decoctions are mixed, and, whilst hot, lime is added, which unites with the muriatic acid, forming muriate of lime or chloride of calcium: this remains in solution, the quinia being precipitated. The precipitate is well washed with distilled water, pressed and dried and digested in alco- hol, in fresh and fresh portions, until the spirit is no longer rendered bitter. The liquors are then mixed, an alcoholic solution of quinia obtained. The alcohol is now distilled off; upon the brown viscid mass remaining, distilled water is poured, and the mixture being heated to the boiling point, as much sulphuric acid is added as is necessary to dissolve the impure alkali. In this way, a sulphate of quinia is formed. Animal charcoal is now added to the hot fluid to deprive the salt of any colouring matter; and, after filtering the li- quor whilst hot, it is set aside to crystallise. The salt may be ren- dered still more pure, by dissolving the crystals, thus formed, in boiling water slightly acidulated with sulphuric acid, adding a little animal charcoal, filtering, and setting aside to crystallise. From the mother wraters, an additional quantity of sulphate of quinia may be obtained by precipitating the quinia by solution of ammonia, and treating it with water, sulphuric acid, and animal charcoal. The above is the rationale of the process, recommended in the last edition of the Pharmacopoeia of the United States. Sulphate of quinia is in white, filiform, silky crystals, of a snow- white colour, without smell, and of a very bitter taste. It is soluble in 740 parts of cold, and in 30 of boiling water. It dissolves very readily in alcohol, and in water acidulated with sulphuric acid, but is insoluble in sulphuric ether. It gives a blue tinge to water. The quantity of sulphate of quinia prepared is very great. In the year 1826, in two laboratories of Paris, it amounted to 59,000 ounces. In this country, it was formerly imported altogether from France ; but the author is informed, that from 6,000 to 8,000 ounces are an- nually made by one firm in the city of Philadelphia. It is an ex- pensive article, and is, therefore, liable to adulteration. The chief articles, employed for this purpose, are sulphate of lime, mannite, and starch ; by digesting, however, the sulphate in alcohol, the salt is dissolved, whilst the sulphate of lime, the starch and the mannite, are left. Sulphate of quinia possesses almost all the medical virtues of cin- chona. It is an excellent tonic, and is the very best of the antiperi- odics. Hence, at the present day, no single article is so much em- ployed in the various diseases that are characterised by periodicity. In impressible individuals, and in others, when given in very large doses, it disorders the gastro-intestinal functions, and induces phe- nomena resembling those produced by narcotic agents,— as restless- ness, vertigo, confusion, depravation of vision, tinnitus aurium, and ANTIPERIODIC TONICS__SULPHATE OF QUINIA. 81 transient deafness. In certain cases, ptyalism would seem to have been induced, the saliva being inodorous, and the teeth firm; and, when calomel has been given along with it, it has been conceived, that ptyalism has ensued sooner than it might otherwise have done. Sulphate of quinia has now taken the place of cinchona in all pe- riodical diseases. In intermittents, it is largely employed. In re- mittents of the pernicious class, it is often necessary to administer it when the subsidence of symptoms is far from complete. It is one of the best remedies, too, in the engorgements of the spleen and the dropsical effusions, that are the consequences of intermittents; but in such cases, it must be given in very large doses. It has, likewise, been found very advantageous in very large doses in the yellow fever of the southern parts of this Union. Besides its antiperiodic virtues, sulphate of quinia possesses—as already remarked — those of a tonic. There are many, however, who esteem the cinchona to be preferable, as a tonic, to quinia, and who administer the latter to prevent the paroxysms of an intermittent, but prescribe cinchona, when they are desirous of strengthening the system and preventing a relapse. As an antiperiodic, sulphate of quinia may be given in the quantity of from four to ten grains in the twenty-four hours. The author is in the habit, in cases of regular intermittents, of prescribing five grains, dissolved in water, about an hour before the expected paroxysm, and repeating it in the course of half or three quarters of an hour; and, should there be evidences of the return of the paroxysm not- withstanding, he prescribes fifty drops of laudanum. Under the joint action of the tonic and the narcotic, the paroxysm will generally be prevented, or be so far broken as to yield to a repetition of the treat- ment before the next expected paroxysm. The sulphate has, how- ever, been given in much larger quantity than this, sometimes to the extent of thirty grains or more every hour, until upwards of ninety grains and more have been taken, but it is questionable whether such large doses can be necessary. In the cases of yellow fever, before referred to, from a scruple to a drachm was given for a dose with signal success. Sulphate of quinia, like cinchona, has been given largely in acute rheumatism—a disease, which is peculiar, — and, in the author's opinion, largely neuropathic. Some years ago, M. Briquet announced, that he had cured acute articular rheumatism, accompanied with violent pain, swelling, redness, fever, &c, in two or three days, with sulphate of quinia, in doses of about a drachm and a half daily. Such doses, however, cannot always be given with impunity; and whilst they were in vogue in Paris, they proved fatal— it is affirmed — in several cases. The author has often prescribed it in doses of from 20 to 30 grains in the 24 hours with decided advantage. Its febrifuge virtues are marked ; and instead of its acting as an excitant; the effects are rather those of sedation. Solution is a more disagreeable form of administration than pill; 82 SPECIAL TONICS. but as it is important that the new nervous impression should be as extensive as possible, it must obviously be advantageous, that the gustatory nerves should be impressed as well as those of the stomach. The taste, left by it, is said to be annihilated by chewing a piece of apple. Like cinchona, sulphate of quinia may be administered per anum, and it has the advantage, which cinchona has not, of being capable of being employed endermically, when the condition of the stomach forbids its use by the mouth. Three times the ordinary dose may be added to a common enema; and when it is to be exhibited endermically, from four to eight grains may be sprinkled on the sur- face denuded by a blister. An ointment, composed of 5J of sulphate of quinia, and 31J of lard, has been rubbed into the axilk, writh success, in cases of ague in children. PIL'IM! QUTNjje SULPHA'TIS, PILLS OF SULPHATE OF OJLYIA. (Quinia sulph. 5j; Acacia, in pulv. 3ij ; Syrup, q. s. to make 480 pills.) Each pill contains a grain of sulphate of quinia. Besides the sulphate, other salts of quinia have been prescribed. The Ac"etate of Qui'nia acts like the sulphate, but deserves no preference; and the same may be said of the Citrate of Qui'nia, the Mu'riate of Qui'nia, and the Nitrate of Qui'nia. The Ffr- rocy'anate of Qui'nia is considered by some to possess antiperiodic properties, superior even to those of the sulphate, yet it is but little used; and the Tannates of Qui'nia and Cincho'nia have been re- garded as the most active of the combinations of the alkaloids. None of them are used on this side of the Atlantic. For a farther description of these, — as well as of an impure sulphate of quinia, called, in the last edition but one of the Pharmacopoeia of the United States, Quinia Sulphas Impurus, formed by evaporating the liquor poured off the crystals of sulphate of quinia to the consistence of a pilular mass, and which has been known for years in Philadelphia under the name of Extract of Quinine, — the reader is referred to another work, (New Remedies, 4th edit. p. 512, Phlilad. 1843.) Cincho'nia, and the Sulphate of Cincho'nia, are obtained from pale bark, by a process similar to that by which quinia and the sulphate of quinia are obtained from yellow bark. It would appear that the sulphate of cinchonia is equally effective as an ordinary and antiperiodic tonic with the sulphate of quinia, — a fact which, as Dr. Pereira observes, acquires some importance from the apprehended failure of yellow bark, in which quinia abounds. Valerianate of Qui'nia has been lately introduced by M. Devay as superior to the sulphate of quinia. The following is his mode of preparing it. To a concentrated alcoholic solution of quinia, valeri- MINERAL TONICS--AR3ENI0US ACID. 83 anic acid in slight excess is added: the solution is diluted with twice its volume of distilled water, and the whole is well stirred, and then placed in a sand-bath, the heat of which does not exceed 145° xah. When the alcohol is evaporated, the valerianate of quinia presents itself in beautiful crystals, which increase from day to day. t As the salt is readily decomposable, M. Devay gives it in the most simple form, generally in a solution of gum Arabic. The dose is from 1^ to 6 grains during the apyrexia. The I'odides of Qui'nia and Cincho'nia, described under Eutro- phics, may be useful additions to the Materia Medica,—formed as they are by the combination of a valuable eutrophic and a tonic ; but their medicinal properties have not yet been fully tested. 61. ACIDUM ARSENIO'SUM. — ARSE'JNIOUS ACID. Arse'nious Acid, White Ars'enic, or White Oxide of Ars'enic, occurs in nature, either tolerably pure, or combined with other metals or metallic oxides. The white arsenic of the shops is understood, how- ever, to be obtained from the refuse found in the flues of furnaces where other metallic ores undergo the process of roasting; and more especially from the refuse of the roasting of the arseniuret of cobalt. The impure material from the flues is subjected to a second subli- mation, which renders it sufficiently pure for medicinal purposes. It is prepared in Silesia, Bohemia, Saxony and Cornwall, and the precise processes adopted in each of these places are depicted at some length by Dr. Pereira. From Penryn, in the last place, not less than 600 or 800 tons are shipped annually. That which is used in this country comes chiefly from Hamburg and Bremen. (Wood &Bache.) Recently sublimed arsenious acid is in masses, which are convex on one side, and concave on the other, taking the shape of the vessel used in the sublimation. The cakes are transparent, and of a vitre- ous appearance; but they soon become opaque and white externally, the opacity gradually extending from the circumference to the centre. It is entirely volatilised by heat; emits an alliaceous odour when thrown on ignited charcoal, and is completely dissolved by boiling water. It has little or no taste, and is devoid of smell; but if left for some time in contact with the lining membrane of the mouth or nostrils, it causes considerable irritation. \ Boiling water dissolves about one ninth of its weight, and on cooling to 60° retains l-35th. Temperate water takes up, scarcely l-400th of its weight. (Christison.) The presence of organic matters very much impairs the solvent powers of wTater in regard to it, which accounts for arsenious acid not having been found in the liquid contents of the stomachs of those who have been poisoned by it. (Pereira.) The adulterations of arsenic are unimportant. In large doses, arsenious acid is a virulent irritant poison, and is 84 SPECIAL TONICS. known as such in almost all parts of the world. In small doses, how- ever, and administered for a considerable period, it modifies the con- dition of the fluid of the circulation, and, through it, of the system of nutrition, so as to remove various morbid conditions of the same. Hence, it falls also under another head — that of Eutrophics. It is generally likewise regarded as a tonic, and all admit that it is an antiperiodic. Under continued use, a sensation of heat in the throat, oesophagus and stomach, is, at times, experienced, with nausea, pain of the stomach, and occasionally vomiting : great languor or depres- sion of spirits is likewise felt, with redness of the eyes, swelling of the eyelids, and oedema of the face: — to the last symptoms the name (Edema Arsenicalis has been given. The practitioner ought to be on the watch for their supervention, as they are the first evi- dences of poisoning ; and the remedy should be discontinued, until they have passed away. Arsenic was probably one of the agents employed in the cases of slow poisoning, that have been recorded in the annals of turpitude and crime. As an antiperiodic, arsenious acid has been employed in intermit- tents, and with much success. This property has been long known, and is still greatly prized. It succeeds, at times, when both sul- phate of quinia and cinchona have failed, although it is not per- haps so well adapted for the generality of cases as either ; and even were it so, the evils that occasionally result from its use would ren- der either of the others preferable. It has, however, its advantages; and a modern writer, Dr. Brown, who prescribed it in many hun- dred cases, considers it superior to cinchona, but inferior to sulphate of quinia. It is devoid of taste, which is an advantage ; and if any apprehension be entertained in regard to the exhibition of the bark, or its alkaloid, during the hot stage of an intermittent, it cannot apply to arsenious acid. At times, too, the acid, in combination with other antiperiodics, is successful, when neither singly has ar- rested the disease. Like sulphate of quinia, arsenious acid has exhibited its powers in other diseases characterised by regular periodicity, as in hemi- crania, and various other forms of neuralgia. In epilepsy, it has not been as efficacious as some of the metallic tonics already con- sidered ; but in chorea, in the practice of some, its beneficial agency has been marked. The dose of arsenious acid in substance is from one-sixteenth to one-eighth of a grain in the form of pill. Care must, of course, be taken that the arsenic is well divided. With this view, one grain may be rubbed with a little sugar, and then sufficient crumb of bread be added ; the whole being well beaten before the division into sixteen or eighteen pills. Most commonly, it is administered in the form of Fowler's solution, the preparation given below. Some, however, have believed, that they cannot be substituted for each other. As arsenious acid is apt to accumulate in the system, it may be well to intermit its use for a day or two every ANTIPERIODIC TONICS__SALIX. 85 fortnight, or three weeks at the farthest; and, to avoid unpleasant gastric symptoms, it has been advised that it should be taken when food is in the stomach; but it is questionable, whether there be much advantage in this. Dr. Christison thinks, that dilution is a more rational way of preventing any unpleasant immediate action. LIQUOR POTASSA ARSENI TIS, SOLU'TION OF ARS'ENITE OF POTASSA.— This is prepared by boiling arsenious acid and carbonate of potassa in distilled water, until the acid is wholly dissolved. To the solution, when cold, a little spirit of lavender is added to give it colour and flavour by which it may be distinguished from water. The prepara- tion was first proposed by Dr. Fowler, and hence was called after him Fowler's solution. It also long bore the name of the Tasteless Ague Drop. Each fluidrachm of the officinal preparation of the Pharmacopoeia of the United States contains half a grain of arse- nious acid. The usual dose is eight or ten drops two or three times a day. It has been prescribed, however, in larger quantities without any manifest inconvenience. 62. SAL1X. — WILLOW. The only species of willow, introduced into the Pharmacopoeia of the United States, is Salix alba or White willow; Sex. Svst. Dioecia Diandria ; Nat. Ord. Salicaceae. This species is received, also, by the London College ; whilst the Edinburgh acknowledges the Salix ca'prea, or round-leaved willow; and the Dublin the Salix frag"His, or crack willow. Dr. Pereira has suggested, that to judge of the therapeutieal value of different species of salix, the best prac- tical rule to follow would be—to select those whose barks possess great bitterness combined with astringency ; and the same rule is applicable to the species, that are native in this country, and are pro- bably of as much therapeutical value as Salix alba, which is in- digenous in Europe, but has been introduced here ; and is now very common : flowering in April and May. In the dried state, the bark is usually quilled, and devoid of odour. It has a bitter and astrin- gent taste, and yields its virtues to water and alcohol. It is in the secondary list of the Pharmacopoeia of the United States. Willow bark possesses similar virtues to Cornus Florida, and, like it, has been employed not only as an ordinary tonic but as an anti- periodic. It may be given in the same doses and cases as cin- chona. Of late it has acquired more attention in consequence of the separation of its active principle, which has been called Sal'icin. This is prepared by preference from Salix helix, but it is found, likewise, in the barks of other willows — as Salix alba, 8. vitellina, S. p>/r/>u'rea, S. Lambertia'na, S. pentan'dra, S. Pcly- an'dra, S.frag"i;'is, S. vimina'lis, &c, and in the leaves ..nd baiki vol. n.—8 86 SPECIAL TONICS. of several species of poplar — Pop'ulus trem'ulus, P. tremulo'ides, P. alba, and P. Graca. The various modes of preparing it are given by the author in another work, (New Remedies, 4th edit. p. 537, Philad. 1843.) It crystallises in very fine silky masses of white crystals, which have the appearance of mother of pearl. It is devoid of smell, but has a strong enduring bitter taste, with a balsamic flavour like that of the bark of the willow. One hundred parts of cold water dissolve six parts of it. It is more soluble in warm water, and, likewise, in alcohol, but is not soluble either in ether or the essential oils. It has no alkaline reaction. Salicin has been largely employed in intermittent fever, and with very successful results. Sentiments, however, in regard to its antiperiodic powers are discrepant; some placing it far beneath the sulphate of quinia, others above it. By general consent, however, it is regarded as inferior. The dose is four or five grains, repeated according to circumstances, as an antiperiodic : as a tonic, the dose is less. 63. PIPERI'NA.—PIP/ERIN. Black pepper, infused in whisky, has long been a popular remedy with sailors in intermittents ; and it is probable, that its virtues, in such cases, are dependent both upon the piperin, and the acrid oil, which the pepper contains. Piperin exists in black, wThite, and long pepper, and also in cubebs. At first it was regarded as a vege- table alkali; but M. Pelletier subsequently analysed it carefully, and showed that it was not such, but bore considerable analogy to resins, and was of a peculiar nature. He farther denied it all medi- cinal activity, but in this he was mistaken. He spoke as a pharma- cien, not as a therapeutist. When quite pure, piperin forms colourless rhombic prisms, wdiich are insoluble in water, but soluble in alcohol and ether. It is gene- rally described as bland, when quite pure; but Dr. Christison states, that the purest he has been able to obtain, was as acrid as that which was brownish, and emitted an intensely irritating vapour when thrown on a heated iron plate. Piperin has been given largely by the Italian physicians, espe- cially in intermittent fever ; and, they affirm, with very great success. Opinions, however, in regard to it, have been discrepant. It may be prescribed in the same cases as sulphate of quinia, in the dose of from gr. ij to vj and more, made into pill with extract of gentian, and repeated according to circumstances. ANTIPERIODIC TONICS__CORNUS FLORIDA. 87 64. CORNUS FLOR'IDA__DOGWOOD. coloured epidermis. Its smell is feeble, taste bitter and astringent. At one time, it was stated to contain a peculiar principle, to which the name Cornine was given ; but if such exist, it is not used. Like the other bitter barks, it yields its virtues to water and to alcohol. Cornus Florida was at one time much given as an antiperiodic, and doubtless still is in many parts of the country. Like most of these agents, however, it has fallen into comparative disuse since the introduction of the sulphate of quinia. It enjoys tonic virtues, and may be given in all cases in which cinchona is indicated, although far inferior to it in efficacy. In intermittent fever, the powder may be prescribed in the dose of a drachm, repeated so that an ounce or more may be taken during the apyrexia. As a tonic it may be given in infusion. (Cornus Florid. 5j ; Aqua bullient. Oj.) The decoction is the only officinal preparation. 88 SPECIAL TONICS. _ DECOC'TUM CORNUS FLORIDA, DECOCTION OF DOGWOOD. (Cornus Florid. 5J ; Aqua bullient. Oj.) The dose, as a tonic, is f. ^iss to f. ^ij and more. 65. Cornus Circina'ta, Round-leaved Dogwood; and — 66. Cornus Seric"ea, Swamp Dogwood, froth indigenous in the United States, yield barks, which are officinal in the secondary list of the Pharmacopoeia of the United States, and which possess the same vir- tues, and are inservient to the same uses as the bark of Cornus Florida. 67. LIRIODEN'DRON. —TULIP TREE BARK. Lirioden'dron tulipif'era, Tulip tree or Poplar; Sex. Syst. Poly- andria Polygynia; Nat. Ord. Magnoliaceae, is a well known boast of the American forest, — bearing, in May, numerous flowers, which have a resemblance to the tulip, and have hence ob- tained for it one of its popular names. The bark is officinal in the secondary list of the Pharma- copoeia of the United States. In the shops, it is in pieces of various sizes, of a yellowish white colour, and easily broken. That obtained from the root is generally preferred. Its taste is aro- matic, pungent and bitter — properties which are imparted to water and to alcohol. The aro- matic and pungent property, however, is injured by decoction. It was separated by the author's L.riodendmn tuiipifera. ]ate frjencl— Professor Emmet, of the University of Virginia — who called it Liriodendrine. It does not resemble quinia in its chemical characters, uniting wdth neither alkalies nor acids, and appears to hold a place between the resins and essential oils. It has not been used in medicine. Tulip tree bark has been prescribed under the same circumstances as that of the dogwood; its dose in the apyrexia of intermittents being, in powder, 3j- As an ordinary tonic, it may be prescribed in infusion. (Liriodendr. ^j ; Aqua bullient. Oj. Dose, f. 3iss to f. ^iij. The Pharmacopoeia of the United States contains no officinal preparation of it. 68. HIPPOCASTANUM.— HORSECHESTNUT. AUs'culus Hippocas'tanum, Horsechestnut or Buckeye; Sex. Syst. Heptandria Monogynia; Nat. Ord. Hippocastaneee, is indigenous in the mountainous regions of Asia Minor and Persia, and grows in this country as well as in Europe. The bark is the part employed in medicine : it has an astringent bitter taste, and contains a con- siderable quantity of tannic acid. A peculiar principle, Msculine, is said to have been discovered in it; but this has been contested. ANTIPERIODIC TONICS__NARCOTINA. 89 The bark has been long used as an astringent; and in modern times has been brought forward as a substitute for cinchona. It would seem to accord most in properties with willow bark, — the latter appearing, however, to be more effective, and to agree better with the digestive organs. It was much used during the wrars of Napoleon, when cinchona was scarce. It has, likewise, been ad- ministered as an astringent tonic when such an agent was indicated. Many of the European pharmacopoeias have an aqueous extract of the bark, which is said to agree better with the stomach than the powder or decoction. The following Factitious Powder of Bark is contained in the Prus- sian Pharmacopoeia: — &. Cort. Hippocast., Cort. Sulicis, Cort. Gentian, rubr., Calam. Aromat., Caryophyll. aa. 31J.— M. In this preparation, the willow—as already remarked — has medical vir- tues analogous to those of Horsechestnut Bark; the gentian is a simple bitter ; and the calamus and cloves are excitants. Hufeland affirms that this powder is an adequate substitute for cinchona in three cases in four. 69. NAR'OOTINA. —NAR'COTIN. Narcotin is obtained either from the aqueous extract of opium of the shops by means of ether, which dissolves only the narcotin, and consequently requires only to be evaporated to obtain it, or from crude opium, which has been exhausted by cold water. Narcotin crystallises in white needles, is devoid of taste and smell, neutral, and, of course, very soluble in ether. It is also soluble in hot al- cohol. Narcotin — as elsewhere remarked, (vol. i. p. 348)—was supposed to be the excitant property of opium ; morphia the sedative ; but subsequent researches have not established this. Although narcotin is insipid, its salts are intensely bitter. The sulphate and the muriate have been used as antiperiodics, ■—the latter with great success. The following is the mode of preparing the latter salt, which was employed by Dr. O'Shaughnessy in India as a substitute for quinia. Take of Bengal opium, two pounds ; alcohol, twenty pounds. Rub them in a large mortar, adding the alcohol gradually until the opium is robbed of its soluble portions. The so- lution is then decanted, and the insoluble part pressed. To the al- coholic solution as much ammonia is added as renders the liquid slightly turbid. Fifteen pounds of the alcohol are then distilled from a common alembic, and the fluid in the still is drawn off, and set aside to cool. On cooling, a mass of coloured crystals is deposited, which is composed of narcotin, meconate of ammonia, and resin. This is washed with water, which dissolves the meconate, and after- wards with a quart of water and a drachm of muriatic acid, which dissolves the narcotin and leaves the resin. The solution is then fil- tered and evaporated to dryness. 8* 90 SPECIAL TONICS. The muriate, thus formed, is a transparent, resinous mass, of a rosy colour, and brittle vitreous texture. It is very soluble in water, and alcohol, and intensely bitter. It has been prescribed largely in India in intermittents. Sixty cases were treated by Dr. O'Shaughnessy, of which all but two were successful; and the same gentleman refers to one hundred more, which had been treated by his pupils and acquaintances with perfect success by the same remedy. 70. PHLORIDZFNA. — PHLOR'IDZIN. The bitter principle, to which the name Phloridzin has been given, exists in the bark of both the trunk and the root of the apple, pear, cherry and plum tree. It is obtained by boiling the fresh bark of the root of the apple tree in sufficient water to cover the bark, decanting the decoction, and boiling again with a little more water. On uniting the decoctions, and permitting them to stand for twenty-four hours, the phloridzin is deposited in granular crystals. One thousand parts of water, at a temperature from 32° to 71°, only dissolve about one part; but at from 71° to 212°, water dissolves it in all pro- portions. It is also very soluble in alcohol at ordinary temperatures. It has no action on test papers. Ten to fourteen grains of phloridzin have occasionally arrested an intermittent after sulphate of quinia had failed. The testimony of many observers is, indeed, in favour of its antiperiodic virtues. It may be given, made into pill with the extract of* gentian as an exci- pient. It has also been administered in enema. 71. CETRARKNA. — CET'RARIN. Cetrarin is obtained from Cetraria Islandica, (i. 246,) by boiling coarsely powdered cetraria in four parts of alcohol, filtering the solution when tepid, acidulating with diluted muriatic acid, diluting with three times its volume of water, and allowing crystals to form slowly. The crystals may subsequently be purified. Pure cetrarin is of a white colour, and intensely bitter taste. Its best solvent is alcohol. It is very sparingly soluble in water, hot or cold. The acids do not unite with it. From a pound of cetraria, 135 grains of pure cetrarin were obtained. Cetrarin has been given as an antiperiodic in intermittents, in the dose of two grains every two hours during the apyrexia, but it has not been used in this country. It has been suggested that an al- coholic solution should be prescribed in place of the cetrarin itself; and it may act more speedily, for the same reason that a solution of the sulphate of quinia is more effective than the sulphate in substance in the form of pill. ASTRINGENTS. 91 72. BEBEERI'NA.— BEBEERINE. In the year 1843, Dr. Douglas Maclagan read a paper on the chemical history of the Bebeeru Tree, which grows in British Guiana. The bark and seeds yield two alkaline bodies, which he calls bebee- rine and sisseerine from the Indian and Dutch names of the tree. The sulphate of the former has been proposed as a substitute for the sul- phate of quinia, with which, indeed, it appears to possess analogous properties. Recently, in Edinburgh, a great improvement has been made in its manufacture, so that it is now made at less than half the price of the sulphate of quinia. From a scruple to a drachm between the paroxysms of a tertian is generally sufficient to arrest the inter- mittent. Much evidence in favour of its antiperiodic properties has been given in recent medical journals. Ill: ASTRIN'GENTS. Stnon. Constringentia, contrahentia, stegnotica, s-yncritiea, adstrictoria. Definition of astringents — Tannic acid the great vegetable astringent principle — Their modus operandi — Act best on parts with which they come in contact —bad effects of astringents — Indirect astringents — Therapeutical application — In fevers, inflammations, hemorrhages, &c. — Astringents often used by the snrgeon — Styp- tics — Special astringents. Astringents are defined, by Dr. A. T. Thomson, to be substances, which produce contraction and condensation of the muscular tissue; but in his table of classification, he ranges them amongst vital agents, which operate on the u muscular and sanguiferous systems." There is no reason, however, why their operation should be restricted to those systems. They affect also, as remarked by Schroff, the skin, mucous membranes, cellular tissue, and the glandular, and parenchy- matous organs, and a better definition would be, simply, " agents, that occasion contraction, and condensation of the tissue of organs." The inconsistency in the two definitions by Dr. A. T. Thomson, given above, is much less, however, than that developed in a sub- sequent part of his section on astringents, where he proceeds to give his theory on the nature of astringency. By a reference to his table of classification, (vol. i. p. 90,) it will be found, that he separates Excitants, Sedatives, Refrigerants, Narcotics, and Antispasmodics — which operate directly on the nervous system — from Tonics, and .Astringents, which operate on the muscular and sanguiferous sys- tems ; yet, the development of his theory, regarding the action of the last class, shows convincingly, that he ought to have referred it to the division, which comprises the various agents, that act directly on the nervous system. " I conceive it to be a power," he remarks, 92 ASTRINGENTS. " which through the medium of the motor nerves, acts on the insen- sible contractility of the muscular fibril, producing a closer approxi- mation of their component particles ; and, by thus augmenting their cohesion, causing a greater and more permanent density, and a corresponding vigour in the muscular tissue. This action differs from ordinary muscular contraction, in not being dependent on the nerves of sensation, and consequently in not being the result of any communication with the sensorium ; in not exhausting excitability; and in the permanency of its effects. The movements constituting muscular contraction are the consequence of impressions conveyed to the brain through the sensitive nerves, and thence to the motor nerves of the part: the contractions following the application of astringents are the result of direct impressions on the motor nerves themselves, altogether unconnected with those of sensation." It is doubtful, whether any such direct agency on the nerves, be exerted by astringents. It is more probable, that the primary effect is upon the intimate tissues of organs, as astringents are capable of producing condensation and contraction in parts that are deprived of the vital influence ; and, although much has been said against the idea, that anything like tanning can be effected upon the living tis- sues by the operation of this class of medicinal agents, the explana- tion does not appear to the author as wide of the mark as it has been conceived to be by many. The vital influence prevents the precise chemical changes from being effected — the requisite union of the gelatin of the skin, for example, with the tannic acid of oak bark— but it does not prevent the condensation and corrugation of tissue, something similar to which is produced in the dead fibre, as well as in vegetables, — organised bodies that are devoid of nerves. Astringents may be used internally, — either for the purpose of acting upon the parts with which they come in contact, or indirectly on distant parts—■ or externally, particularly with the view of arrest- ing hemorrhage, when they are called styptics; and a difference has been made amongst these, according as they act chemically or me- chanically ; — the chemical styptics coagulating the blood exuding from the part, and, at the same time, stimulating the tissues to con- traction ; whilst the mechanical— as felt, agaric, lint, &c. — detain the blood in their meshes, or absorb it, until it coagulates, and thus arrest the hemorrhage. Astringents can be readily detected by the taste. They convey a sense of roughness to the palate, which cannot be mistaken, but which is more marked in some substances than in others. It is thus, that the mineral acids, — alum, and the various metallic salts, and vegetables, — are readily detected as astringents. The vegetable kingdom furnishes largely to this division of thera- peutical agents; and the property, on which their virtues are mainly dependent, is tannic acid — the principium scytodephicum or Gerbe- stoffoi the Germans. This is associated with gallic acid in galls, krameria, tormentilla, uva ursi, &c MODUS OPERANDI. 93 The action of astringents, when taken internally, maybe altogether local on the tissues with which they come in contact; or the excitant effect, — for it is excitant, — may be communicated to other parts of the frame, as in the case of tonics; so that the action of organs at a distance may be modified, and immoderate discharges from them be, in this manner, arrested. When such is the case, the hemorrhage may be controlled, in consequence of a simple tonic influence exerted by the astringent; for it is not easy to see how the effect of the astringent itself can be extended beyond the-part which it immedi- ately touches; or, the astringent principle may pass into the mass of blood by absorption, and come in contact with the vessels whence the immoderate discharge is proceeding. This may be the case, but it is difficult to conceive, that a small dose of an astringent substance, received into the blood, can proceed to the seat of an undue flow— and there act in sufficient concentration to produce any manifest as- tringent agency ; yet this is the modus operandi presumed by many writers. Dr. Thomson, indeed, asserts, that, "without such a sup- position, we should not be able to explain the manner, in which they (astringents) act in stopping hemorrhage when internally administer- ed, especially when taken into the stomach ;" and he adds : — "Mr. Brodie gave a patient, who had a frightful hemorrhage from the prostate gland, and in whom all other remedies had failed, a dose of Ruspini's styptic, and repeated the dose twice in the course of twelve hours. About half an hour after the first dose was taken, the bleeding ceased, and it never recurred." This styptic is said to con- sist of gallic acid, a small quantity of sulphate of zinc, and of opium, dissolved in a mixture of alcohol and rose water; but, as the quan- tity of sulphate of zinc, and of opium, appears too small to influence the medicine, a simple solution of gallic acid in diluted alcohol, it has been conceived, will answer all the purposes of the expensive nostrum. Still, the above case is insufficient to establish the fact of absorption; and, without meaning to deny, that the styptic in it did exert some agency in arresting the hemorrhage, the author does not think, that one solitary instance of the post hoc is sufficient to establish the propter hoc. Dr. Thomson, indeed, himself admits, that he has not witnessed its influence, as an internal or general astringent, al- though he has frequently observed its power in checking the most obstinate bleedings from leech bites in children, after all other means had failed. Another mode in which astringents may act, in certain cases, is by passing into the mass of blood, and increasing the tendency to co- agulation of that fluid. It is manifest, that in all increased discharges, which occur from parts that ean only be reached through the medium of the circulation, no signal advantage can be expected from the administration of as- tringents; on the other hand, where they can come into immediate contact with the seat of the disease, they may be relied upon. Ac- cordingly, in haematemesis and epistaxis, and in chronic diarrhoea, 94 ASTRINGENTS. and dysentery, their action is more marked than in haemoptysis, in immoderate flow of the menses, or leucorrhcea; inasmuch as, when taken internally, they can only act on the lungs, uterus or vagina, either by the impression they make on the general system through the nerves of the stomach, or by being taken into the circulation. Under the view, everywhere embraced by Professor Chapman in his " Elements of Therapeutics," that the vital action of parts re- sists anything like chemical change ; — that " so long as vitality en- dures, every chemical action or combination is repelled by powers and resources peculiar to the animated condition," the modus ope- randi of astringents becomes a weighty stumbling block. " Never- theless," he remarks, " there would seem, at the first view, to be a class of articles endowed with the property of corrugating or con- tracting the living fibre. This is especially evinced by the sensa- tion, which they impress upon the tongue and fauces ; and, perhaps, still more conspicuously by their efficacy in restraining hemorrhages from wrounds. Yet how they operate has never been very intelli- gibly explained. Their effects are ascribed altogether by Darwin to the power of promoting absorption. Whether they have such a pro- perty is exceedingly doubtful. Conceding it to them, however, it will not, in the slightest degree, account for their suppression of hemorrhage." This is all that Professor Chapman says of the general modus operandi of astringents. He offers no view of his own ; and, in- deed, appears to doubt, whether there be any agents endowed with the property of corrugating or contracting the living fibre ; inas- much as he says, there would " seem, at the first view," to be a class of such articles: leaving the inference to be deduced, that far- ther examination would exhibit its non-existence. We can have no more doubts, however, of the astringent agency of such a class of substances, — modifying the condition of the living fibre, in the mode mentioned, —than we have of the reality of cathartics, eme- tics, or narcotics. In all cases where profuse discharges have to be checked, it is im- portant to inquire, whether they be accompanied by unusual activity of vessels, or, in other words, whether they be of the kind generally regarded and denominated active, — or whether they be passive. Some have denied, that there can be such a state as passive hemor- rhage, but it can be readily understood, that there may be a condi- tion of vessels in which their texture is so loosened as to permit the blood to transude with facility from within to without; and, accompanying, or not, this condition, there may be a degree of flu- idity and impoverishment of the blood, which may adapt it for a more ready transudation than when it contains more fibrin, and red corpuscles. The author attended a young female, who, in conse- quence of hyperaemia of the encephalon, had been bled every fort- night for several months, to the extent of a quart or more ; and in whom it was an object of moment to break in upon the habit thus MODUS OPERANDI. 95 induced. Her whole appearance was anaemic. She was pale, ap- parently almost exanguious ; the pulse small, and indicating the pre- sence of but little blood in the vessels ; yet at the usual interval of a fortnight, signs of augmented action in the vessels of the head supervened ; and it was for a time esteemed indispensable to repeat the blood-letting. The author's endeavour was to gradually break in upon this habit; — to cup her, when the encephalic symptoms made their appearance; and, by revellents, to direct the afflux of blood elsewhere. Occasionally, however, it wTas necessary, in con- sequence of the supervention of delirium, to take away a pint of blood, and this was largely composed of serum, — affording the strongest proof of that form of hyperaemia, which is characterised by impoverishment and deficiency of the circulating fluid. The original mischief was here probably in the great nervous centres, and blood-letting was doubtless, in the first instance, appropriate ; but the frequent repetition of it, was well adapted to lay the foundation for periodical irregularities of circulation like those under which she was suffering, and from which she ultimately recovered under the plan recommended by the author. The case is an elucidation of the fact—often referred to in these pages — that hyperaemia may be in- duced by agencies, which are regarded as best adapted for its re- moval, provided such agencies be pushed to an inordinate extent; and it is an additional evidence in favour of the importance of at- tending to the state of the nervous system, under whose influence hyperaemic affections are often developed, and where the indication of cure is less to withdraw the circulatory fluid than to allay the ner- vous irritability that gives occasion to the excited state of capillary vessels, which constitutes most of the varieties of hyperaemia. From what has been said, it obviously follows, that in acute in- uammations of mucous membranes, accompanied by increased dis- charges, powerful astringents may be — to say the least — of doubt- ful propriety ; whilst in chronic inflammations, where debility of capillaries exists, they may, like excitants, be the best class of agents that could be had recourse to. Care, however, has always to be taken with regard to their strength. Broussais has properly remarked, in one of his propositions, that " vegetables, which are astringent in small doses, produce gratro-enteritis when taken in large doses." But this does not apply to the gastro-enteric mucous membrane solely. The sudden application of a powerful astringent condenses and corrugates the mucous tissue, so that the calibre of the vessels is diminished below the natural; the circulation through them is consequently obstructed, and hence supervenes increased action of the vessels that are continuous with the constricted capil- laries. In another proposition, Broussais affirms, tint " the mineral astringents, the sulphates of alumina, of zinc, and of iron, act nearly in the same manner as the preparations of lead, except that the latter produce a truly deleterious effect on the nervous system :" "the primary action of all," he adds, "is stimulating; they all 96 ASTRINGENT.0, contract the fibres, and afterwards diminish the innervation." He asserts, too, that when astringents are applied so as to arrest the "serous elimination" of the skin, an internal exhalant action suc- ceeds ; and, as an instance of this, he adduces dropsies, that im- mediately follow the application of an astringent, which has repelled itch, tetters, and even acute inflammation — as erysipelas. " Similar dropsies have been sometimes induced by frictions with ointments containing sulphate of alumina, sulphuret of potassa, or baths im- pregnated with corrosive sublimate, employed for the cure of pru- rigo, or obstinate itch." Without meaning to deny, that where an accustomed irritation has been suddenly repressed, it may be transferred elsewhere, and that where a long established drain is arrested, exhalation may be pro- duced in other parts of the system, it is proper to observe, that the author has never witnessed dropsy induced in the manner referred to by Broussais, nor is he disposed to admit, that it could readily happen. The surface, in a case of tetter, is so small, and the elimi- nation, effected from the skin of the part, so trifling, that it appears improbable, that any augmentation of internal exhalation could be induced, to such an extent as to give rise to dropsy, by astringent or other agents employed for the removal of the cutaneous eruption. The astringent medication is considered, by many waiters, under the head of tonics ; and some of the substances in the catalogue of the Materia Medica eminently possess tonic or corroborant virtues. Such is the case with cinchona ; yet, its chief virtues are not de- pendent upon this astringency, as quinia possesses none of it. It is obvious, that the efficacy of astringents may vary according to the principles that are united with them, and this may give occasion to the exertion of some choice to adapt them to particular conditions of disease. The most potent of the vegetable astringents are indebted for their properties to the tannic acid they contain, but many others have a bitter or an aromatic principle associated with the astringency, and have, therefore, been termed respectively, by some of the Germans, amaro-adstringentia, and balsamico-adstringentia, — as salix, hippo- castanum, juglans regia, the caryophyllatae, and especially the cin- chonae, &c. Thus far the author has referred only to the action of direct astrin- gents: profuse evacuations may, however, be connected with differ- ent states of the living system ; so that agents, possessed of no astringent properties, may yet check them, or produce an astringent operation, indirectly. Hence we have direct and indirect astringent-, as we have direct and indirect tonics. Opium, for example, by allay- ing the. augmented peristole in diarrhoea, may exert an action of astringency, and diminish the number of discharges; and, accord- ingly, it is often had recourse to in such cases. Again, the increased discharges of dysentery are induced by an inflammatory condition of GENERAL EFFECTS. 97 the mucous coat of the intestines. Bleeding, therefore, by allaying this inflammation, and castor oil, given occasionally so as to gently remove the morbid secretions, by taking away the cause, may check the effects. A predominance of acidity in early infancy lays the foundation to many of the bowel complaints which are so common at that age, and keeps them up when once established. A proper antacid, by neutralising the acid, takes away the cause, and thus becomes an indirect astringent. In active hemorrhage, where a condition closely allied to inflammation exists, the flow of blood is arrested by antiphlogistic remedies, which thus become astringents; and, lastly, cold is one of the most valuable of the indirect astrin- gents which we possess, especially in hemorrhages of the active kind. Much of this effect is, doubtless, produced by its temperant, anti- phlogistic or refrigerant operation, which—it will be seen hereafter— is signal. Where, however, the cold — as in the form of ice or iced water — can be made to come in contact with the bleeding part, it produces condensation and corrugation of the tissues ; diminished calibre of the vessels; and coagulation of the exuding fluid, in the same manner as the substances, that belong to the class of direct astringents. When properly used, it is really one of the most valu- able astringents which we possess. Therapeutical application of Astringents. Fever. — With regard to the therapeutical application of an as- tringent medication, it need scarcely be remarked, that it is inad- missible in fevers, unless they should be complicated, in the latter stages, with symptoms specially indicating its employment. In in- termittents, they have been frequently used, and often with decided advantage. Generally, however, the astringents, that have been employed in such cases, have possessed other properties on which their efficacy wTas dependent. The author has already observed, that the different varieties of the cinchona contain a principle, which is not astringent, along with another that is ; yet the former exerts all, or almost all, the astringent power, which the bark in substance is capable of exerting. At times, however, we meet with cases, in which the bark in substance succeeds, when the quinia has failed ; and it is not improbable, that in such cases the astringent property may aid the tonic or febrifuge in arresting the disease. The dynamic influence of the tonic on the body is manifestly of a nervous character; and the author has attempted to show, that as- tringents are capable of exerting one of a similar kind ; so that even when the latter are administered in an uncombined state, they may succeed in putting a stop to intermittents. Astringents are, however, but rarely employed, inasmuch as we possess such valuable agents of another kind for effecting all that they can accomplish, and more too ; but there may be pathological conditions, during the existence of an intermittent, which may demand their use ; as when the ordinary VOL. n.—9 98 ASTRINGENTS, antiperiodic tonics run off by the bowels, or when discharges super- vene, which, if allowed to persist, might be attended with injurious consequences. Inflammations. — During the active stage of inflammations, the same rule applies to the administration of astringents as to that of excitants. Although occasionally employed with success during the violence of external inflammations, or those of the dermoid tissue, their efficacy is more decided after the violence of the inflammation has passed away, and when a state of over-distention of the extreme capillary is the chief pathological condition that keeps up the excited action of the vessel communicating with it. In some inflammations, however, their beneficial agency, like that of excitants, is marked from the first. Such are inflammations of the tunica conjunctiva, of the tonsils, velum pendulum, and of parts of the mucous membrane, which admit of being inspected — as of that which lines the mouth and fauces — or which can be reached by them in their undiluted state — as the inflammations that characterise blennorrhoea or gonor- rhoea, and leucorrhoea. In conjunctivitis, occasionally from the first, and almost always in what is called the catarrhal variety, after the violence of the action of vessels has been somewhat got under by the employment of ap- propriate antiphlogistics, the advantage of the astringent metallic compounds — especially of the nitrate of silver—is often signal. As soon as it is dropped in solution into the eye, decomposition oc- curs, in consequence of its meeting with the chloride of sodium con- tained in the tears. It becomes converted into the chloride of silver, which is recognisable by its white appearance; but the constringency, exerted by it on the vessels, tends to restore them to their wonted calibre. In that sluggish variety of sore throat in which the mucous mem- brane, covering the tonsils, is of a diffused dusky red, extending over the velum pendulum and the-uvula, and giving occasion to tumefaction and relaxation of those parts, excitant and astringent gargles are the best applications that can be used. The vessels are here loosely situate in the parts in which they creep ; remora of the fluid circulating within them is consequently facilitated ; tumes- cence results; and this state is not removed until the vessels resume their wonted calibre, — a result, which can be rendered more easy by the appropriate employment of astringents. In the malignant affections of the throat, which are concomitants of some of the forms of scarlatina, the same class of remedies is em- ployed as local applications; some vegetable infusion or decoction, wdiich contains tannic acid, being generally used, with or without the addition of one of the mineral acids. The decoction of cinchona, with the sulphuric or muriatic acid, is a common combination for this purpose. In those affections, too, of the mucous membranes, which are at- IN HEMORRHAGE. 99 tended with the formation of a pellicle or an exudation from the inflamed mucous surface, and which have been termed, by Breton- neau,Diphtherites, astringents are found to be extremely useful after the violence of action has been subdued, and the pellicle has formed, The most successful of these, again, is the nitrate of silver. When this salt is applied in solution to the mucous membrane of the mouth in a case of aphthae, or to the fauces in cases of diphtherites of the pharynx, larynx or trachea, the new action, induced in the part to which it is applied, is extended to the membrane lower down, and the most salutary agency is, at times, exerted. The exudation of coagulable lymph, — which the experiments of Schwilgue prove to correspond, in its properties, with coagulated albumen, and which constitutes the false membrane in cases of diphtherites, — frequently begins on the surface of the tonsils, and thence spreads along the arches of the palate, and ultimately descends over the internal sur- face of the pharynx and oesophagus, as well as of the larynx and trachea. The application of a solution of the nitrate of silver to the tonsils, velum palati, and uvula, frequently removes the albuminoid exudation; produces manifest relief of the symptoms, and ultimately dispels them. A modern writer, Dr. Eberle, asserts that he has seen one instance in which this application was made, and the result gave him a very favourable impression of the practice; but he says it must be confined to cases in which the fauces are found, on inspection, to present an irritated and inflamed condition. This is not, however, essential. The astringent effect upon the part of the mucous mem- brane, with which the solution is made to come in contact, may be propagated by continuous sympathy to the part of the trachea, lined by the false membrane; a new action may be induced; the albu- minoid substance be detached, and ultimately thrown off, although it is obvious, that when a complete adventitious tube is formed in the trachea, and of course, below the rima glottidis, the narrowness of the aperture into the larynx must, in by far the majority of cases, render the evacuation of the adventitious tube impracticable. With a similar object, Lae'nnec directed the inhalation or insufflation of very finely powdered alum—another astringent — and he asserts, that it generally afforded great and speedy relief, not only in trache- itis, but also in laryngitis, and amygdalitis. Hemorrhage. — The author has more than once referred to the importance of examining, in all cases of hemorrhage, whether they be active or passive, — characterised, that is, by polyaemia, or hyper- aemia, or by hypaemia or anaemia. In the former category, the use of astringents can in no wise be demanded. The fulness or the activity of vessels must be first reduced before the astringent medi- cation can be adopted. In but few of the cases of hemorrhage does the blood flow from a ruptured vessel. It generally passes out by diapedesis or transudation, and this may be of course favoured both by fulness of vessels, and by any causes that induce a remora of 100 ASTRINGENTS, blood in them. The bleeding that takes place in this way has been considered as an effort of nature to relieve this condition, inasmuch as it unloads the distended vessels; and, when this occurs, the ple- thora being reduced, the hemorrhage generally ceases spontaneously. Of these fancied efforts of nature the author has already spoken, and this has no more foundation. The fulness of vessels gives occasion to a physical transudation from within to without, and as this transu- dation removes the cause, the effect — the hemorrhage — neces- sarily ceases. In the passive state of hemorrhage, where wre have loosened cohe- sion of parts, often combined with anaemia, or with blood poor in fibrin and red particles, and rich in serum— as in sea-scurvy, and in some of those hemorrhages, that supervene, in the worst cases of typhus, and other diseases of prostration, — the use of tonics and astringents is absolutely needed ; and if the latter can be brought into contact with the vessels exhaling the fluid, they occasion a con- densation and corrugation of their parietes, so as to render transuda- tion less easy. They are, indeed, the chief resource of the physician. The mineral acids, when added to blood out of the body, coagulate its albumen, and it is probable, that they exert an analogous action, when taken as medicinal agents, in the cases under consideration. Their efficacy — as well as that of creasote — in scurvy, and in pas- sive hemorrhage of every kind, may be greatly owing to their in- creasing the tendency of the blood to coagulation. Epistaxis is one of the most common varieties of hemorrhage. Generally it occurs in youth, and is of no consequence. There are but few individuals, about the age of puberty, who are not more or less subject to it. In such cases, it is usually an active hemorrhage, and does not require the use of astringents. In the evolutions, that occur at puberty, and some time afterwards, irregular hyperaemic determinations are apt to supervene, and, as the vessels of the Schneiderian membrane are but loosely protected by the parts in which they creep, and therefore, yield more readily to any distend- ing force, diapedesis easily takes place through them. The system of medication is here sufficiently simple. If the hemorrhage should recur repeatedly, and not be excessive, the depletion and the revul- sion, excited by a dose of a saline cathartic — as the sulphate of magnesia — are often enough to rectify the evil; or if it should not yield to these, it frequently will to a repetition of the remedy, with the employment of a dry and spare diet. If much fluid be taken, either in cases of hemorrhage, or where abstraction of blood is re- commended for the removal of disease,—owing to the vessels being deprived of their usual quantity of circulating fluid, the activity of absorption is greatly augmented, and the drink passes rapidly through the coats of the vessels, to make up for the loss sustained by the accidental or artificial hemorrhage. In this way, the same quantity of fluid may soon be present in the vessels; but this fluid must ne- cessarily be more tenuous—less rich in fibrin and red corpuscles—and IN HEMORRHAGE. 101 the consequence is, that it soaks through the vessels, by transudation or diapedesis, more readily than it did in the first instance; and thus a foundation is laid for future recurrence of the hemorrhage. This abstinence from drinks is one of the most important practical pre- cepts that can be inculcated in the management of the different hemorrhages. If the hemorrhage from the nose should be so pro- fuse, at any one time — or if it should recur so frequently — as to bring on signs of hypaemia or inanition, it becomes the duty of the physician to have recourse to the class of remedial agents, whose properties w7e are considering. It is a common custom to apply cold water to the nape of the neck, or a piece of cold iron — as a key; and this simple agency often arrests the flow of blood from the Schneiderian membrane. This effect is probably induced by the impression, made on the nerves, occasioning a diversion of the blood from the vessels of the membrane; and a similar agency may perhaps be exerted, where mental impressions prove haemastatic ; — as in the case of charms, employed in such cases, in antiquity more especially, and not wholly abandoned at the present day. The impression on those vessels can, of course, be only of a sympathetic character. In cases of anaemic hemorrhages, however, more direct applications become necessary, and recourse is had to the metallic astringent salts, to alum, dilute sulphuric acid, and to plugging the anterior or poste- rior nares, — to the former, or to both, as the urgency of the case may require. In this way, both chemical and mechanical styptics are brought to bear; the former coming in contact with the vessels whence the flow of blood proceeds; and the latter preventing the escape of the blood by the anterior or posterior outlets of the nostrils, and thus favouring the formation of a coagulum around the bleeding vessel. Dr. Thomson recommends the use of internal astringents, " as the infusion of roses, (!), or of kino, or some other of the astrin- gent vegetable substances, acidulated with diluted sulphuric acid," but much benefit cannot be expected from the action of substances on parts at such a distance from the seat of the malady. This, too, is the reason, why astringents are of less efficacy in haemoptysis, which may take place from rupture or from diapedesis, but generally from the latter. Like all the other hemorrhages, too, it may be active or passive; but it is not very common to meet with the latter variety, un- less we regard as such the diapedesis, that occurs when the lungs are filled with tubercles, which is the most dangerous kind of hemor- rhage from the lungs, inasmuch as its prognosis merges in that of pulmonary consumption, of which it is a symptom. The existence of tubercles interferes with the due circulation of the blood in the pul- monary and bronchial arteries; and the consequence is, that on the application of a slight exciting cause — as any unusual bodily or pulmonary exertion — a vessel gives way, or the blood soaks through its coats. The active hemorrhage, which takes place from the lungs of a 9* 102 ASTRINGENTS, person of sound constitution, — in no wise predisposed to phthisis, — is by no means of the dangerous tendency usually conceived. An accidental circumstance may give occasion to the hemorrhage, which may be removed by appropriate measures, and may never recur. Whenever haemoptysis is attended with symptoms of vascular ful- ness or activity, indirect astringents are chiefly had recourse to — as blood-letting, and the agents belonging to the classes of sedatives and refrigerants. Little reliance is placed upon any of the articles of the materia medica, which are regarded as direct astringents; for the simple reason, that none of them can be made to come into direct contact, except in a very diluted state, with the vessels that are exhaling blood. There are obviously — as elsewhere stated generally — only two ways in which such articles can act; the one is by sympathetic influence on the affected vessels, through the astringent agency exerted on the stomach; and the other by the astringent getting into the blood-vessels, and proceeding, com- mingled with the circulatory fluid, through the pulmonary artery to the lungs, or through the ramifications of the bronchial artery, if the flow proceeds from the latter vessel. In neither of these ways could any energetic action be exerted, and hence it is, that the scientific physician trusts to general principles in the management of the case; combating it by the agents already referred to, and by a proper attention to the antiphlogistic regimen generally. Usually, when an individual is attacked with haemoptysis, the greatest alarm is felt, and, in all cases, it is expected that the practitioner should have re- course to blood-letting to arrest the flow. Such is the opinion of the vulgar, and occasionally it is that of the professional attendant also. This is not always, however, philosophical. Every one, who has had an opportunity of seeing many cases of haemoptysis, is aware, that the flow of blood may be arrested, at a less expense of fluid, when due attention is paid to ventilation and to posture, than when the lancet is used. A coagulum soon forms around the ruptured or transuding vessel, and the hemorrhage ceases. Whether blood-letting has to be practised must depend upon other grounds: — upon the results of an inquiry into the state of the circulation, general and capillary, connected with the hemorrhage : if there should be signs of polyaemia, or of hyperaemia, it ought to be unhesitatingly practised, otherwise the hemorrhage may recur, — care being taken — as has been remarked of all cases of hemorrhage — not to allow too much fluid to be drunk, but rather advising a small piece of ice to be put into the mouth occasionally, for the purpose of allaying thirst and excitement. The author is satisfied, too, that the repeated abstraction of blood, when there is no sthenic condition present, may lay the foundation for hyperaemia in the lungs, as it does in other organs; and this hyperaemia will be more apt, under such circumstances, to affect the lungs, from their being, owing to a previous attack, pre- disposed to the pathological condition. IN HEMORRHAGE. 103 Where haemoptysis is produced by the presence of tubercles in the lungs, it is, as already said, of unfavourable prognosis, because it is one of the precursors or concomitants of phthisis. Such cases can, of course, only be palliated by an attention to the general symptoms, and by the appropriate use of sedative and refrigerant remedies. Astringents cannot here be employed with well founded expectation of success. Occasionally, too, hemorrhage from the lungs supervenes in a more advanced stage of phthisis, owing to the giving way of a vessel in the parietes of cavities in the lungs. The author has at- tended cases in which the individual was choked by the quantity suddenly discharged in this manner. At other times, in this disease, as well as in some of the more active inflammations of the pulmonary organs, especially in children, a copious effusion of blood suddenly takes place into the lungs, so as to completely prevent the air from reaching the pulmonary vessels; and the individual dies, owing to the pulmonary apoplexy, thus induced, occasioning asphyxia, or, in other words, completely preventing the requisite aeration of the blood in those organs. Where the blood is exhaled from the vessels of the stomach, con- stituting haematemesis, astringents can be employed with more ad- vantage, because they come in contact with the vessels whence the hemorrhage proceeds. Here, however, it is of importance to in- quire, whether the exhalation of blood may not be dependent upon obstructed circulation — on mechanical hyperaemia — in some other organ ; and if so, attention must be paid to the idiopathic derange- ment. The author has seen many cases of haematemesis and dropsy of the lower belly, from hypertrophy of the spleen produced by resi- dence in a malarious locality. As a large quantity of blood is sent to the spleen, this state of the viscus prevents the free circulation of blood through it; the consequence is turgescence of vessels, giving occasion to transudation of the watery portion into the cavity of the abdomen so as to produce ascites, and an engorgement of the ves- sels of the neighbouring organ — the stomach — ending in hemor- rhage by diapedesis. It is not, however, the organs in the vicinity of any infarcted or indurated viscus, that are alone liable to be the seat of hemorrhage. If the circulation be impeded in any viscus, foundation is laid for irregularity of circulation, and under this irregularity, vessels may give way, or admit of transudation in parts that are at a considera- ble distance from the organ, whose diseased condition is the cause of the phenomena. Thus, epistaxis is often symptomatic of visceral infarction ; and the same hemorrhage, or haemoptysis, or haemate- mesis may be established where the uterine functions are not pro- perly accomplished. The same remarks are applicable to hemorrhagic discharges from the intestinal canal, constituting one of the forms of melaena. The lower the seat of the hemorrhage, the more mixed is the astringent before it reaches the diseased part, and, consequently, the less effi- 104 ASTRINGENTS, cacious. Generally, in ordinary cases, of both haematemesis and melaena, the author has found a combination of sulphuric acid with one of the alkaline or earthy sulphates, forming a supersulphate, to be well adapted for fulfilling-every object of the astringent medica- tion, where this is demanded; or metallic or other astringents may be used, under the general precautions previously inculcated. In cases of what are termed open hemorrhoids, or of hemorrhage from the rectum, astringent remedies may be made to come into im- mediate contact with the seat of the hemorrhage by injection. The use of gently astringent or stimulating lotions and of laxatives, to prevent irritation from indurated faeces, is, in such cases, more bene- ficial than any other mode of treatment. Occasionally it happens, that the hemorrhage is so alarmingly profuse as to require the em- ployment of the most powerful astringents, — of the mineral or vegetable kingdoms, and even the actual cautery. These, however, should never be used of such strength as to condense and corrugate the parts so much as to endanger the supervention of inflammation. Haematuria — or hemorrhage from the urinary organs — is a va- riety not directly under the control of astringents. No substance of this class can come in contact with the seat of the mischief, until it has passed into the mass of blood, and been separated at the kid- neys. How small, consequently, must be the quantity of the astrin- gent-taken into the stomach, which can act at any one time upon the surface affected with hemorrhage. The best mode of managing such cases is to treat them on general principles ; — by perfect quie- tude ; avoiding all irritation ; and, if there be excitement, reducing the quantity of the circulating fluid ; but if, on the other hand, there be want of tone, administering substances belonging to the class of tonics, or of excitants proper. The author does not know, that, in these cases, he has observed any very marked advantage from the use of astringents, except from their tonic agency. Improvement has occasionally followed the employment of some of the metallic and vegetable astringents, but it has been produced, apparently, by the general effect, not by any direct astringent action having been exerted on the vessels of the urinary organs; for, even in those cases in which a mineral astringent can be detected in the urine, its quantity at any one moment in the urine distilling from the kidneys must be too small to exert any sanative influence. Dr. Thomson, who has unbounded faith, and, perhaps, credulity on many points of therapeutics, as connected with the effect of particular medicaments, places great reliance on the use of certain astringents in hemorrhages from the urinary organs. " Haematuria, or bleeding from the blad- der," he says, " is generally depending upon some organic affection of the urinary organs ; but in attending to the primary disease, much immediate advantage is derived from the use of astringents. It was in a case of this kind that Mr. Brodie administered Ruspini's styp- tic with so much seeming advantage ; and I have seen great benefit, in similar cases, from the use of the uva ursi, which appears to pass IN UTERINE HEMORRHAGE. 105 unaltered through the kidneys. Since the discovery, which I have made of the composition of Ruspini's styptic, I am disposed to pro- pose a combination of gallic acid with an infusion of the leaves of uva ursi, obtained by rubbing them in cold wrater." It may be re- marked, on this passage, that, like many other articles of the ma- teria medica, uva ursi has been extolled for virtues which it by no means possesses, and already it has, in the opinion of many of its former supporters, sunk to the proper level above which it ought never to have been elevated. It was formerly proposed as a remedy for calculous complaints ; and for ulcerations of the urinary organs; and it is still prescribed in such cases. There are few, however, of the present day, who regard the agency it exerts to be any thing more than the tonic impression made by it on the stomach. When metrorrhagia or uterine hemorrhage occurs in the unimpreg- nated state, great reliance is placed on the use of sedatives, refrige- rants and astringents, — the former when the hemorrhage is active, and the latter when it is more atonic. Where astringents are indi- cated, the tonic medication is also required, and cases occasionally occur where the safety of the patient depends upon the effect exerted, through the general system on the vessels, that are pouring out the blood. In a former section, the author has referred to an instructive case of this kind. When astringents are demanded in metrorrhagia, they can be made to come in contact with the affected vessels by- means of the stomach pump. Cold water — ice cold — is, in this way, a valuable agent, as well as the solutions of sulphate of zinc or other saline astringents, and the infusions or decoctions of vegetable astringents, — as of red oak bark, catechu, &c. — which act as styptics. The tampon is also an excellent agent, after these means have failed, by detaining the blood in the vagina, and in contact wTith the exhaling vessels, until it has coagulated, and thus acting as a mechanical styptic. It is an efficacous remedy in cases of hemor- rhage occurring during utero-gestation. On the management neces- sary in these last cases, as well as in uterine hemorrhage, occurring during and after delivery, it is unnecessary to dwell, as it consists in manipulations appertaining to the science of obstetrics. Astringents are but rarely had recourse to, because, during utero-gestation, and prior to the delivery of the foetus, they cannot be easily thrown up as high as the seat of the hemorrhage ; and because other modes of management can be adopted, which strike more nearly at the root of the mischief. Hemorrhage, when the placenta is not attached over the os uteri, is owing to a partial separation of the placenta from the uterus; and the only effective mode of rectifying the evil is to cause the uterus to contract around the foetus, and thus to compress the uterine veins. This is done by discharging the liquor amnii. Where the placenta is seated over the os uteri, the hemorrhage is unavoidable — not acci- dental, as in the case just described — and there is no safety to the mother or child except in speedy delivery. 106 ASTINGENTS, Again, in hemorrhage after delivery, cold and astringent fluids might be thrown into the cavity of the uterus, but this plan is rarely had recourse to. The cause of the hemorrhage is here, also, the want of contraction of the uterus, and the means, found most effica- cious, are — if the case be urgent—to introduce the hand into the interior of the organ ; to irritate its inner surface with the fingers, and to press, at the same time, on the abdomen. The uterus will gene- rally contract, so as to force the hand out of it; and in ninety-nine cases in the hundred, when the organ can be felt in the hypogastric region, contracted to the size of the foetal head, the woman may, under ordinary precautions, be deemed free from all danger of recur- rence. At times, the hemorrhage has returned under these very cir- cumstances, but the instances are rare. When the case is not so urgent, simple pressure on the abdomen over the region of the uterus, until it is felt to be contracted, is generally sufficient. In most cases of hemorrhage after delivery, the flow of blood is so profuse that there is no opportunity for employing any astringent solution or in- fusion ; but in the more protracted and less alarming varieties, these agents may be employed with much prospect of advantage. They can only be regarded, however, as adjuvants. The means of primary importance are those obstetrical manoeuvres, to which allusion has been made. The use, then, of astringents in the different forms of hemorrhage, can be easily understood. In none of the active kinds can they be indicated ; and, in the passive varieties, great reliance can only be reposed on them, when they can be made to come into direct contact with the vessels that are discharging their blood, — whether by rup- ture or by transudation. Inflammations of the alimentary canal. — From the general prin- ciples, that have been laid down, it can never happen, that the em- ployment of astringents can be looked upon as advisable, in any of the more acute varieties of those inflammations of the alimentary tube, that are accompanied by discharges. Accordingly, in inflam- mation of the lining membrane of the small intestines, characterised by pain in the abdomen, on pressure, or without; redness of the tongue ; and repeated bloody or slimy discharges; as well as in the same inflammation, when seated in the large intestines, and consti- tuting dysentery, — astringents, during the first and active period of the disease, are to be avoided ; but when the complaint has persisted for a time, notwithstanding the general antiphlogistic medication and regimen, and the constant use of small doses of castor oil to remove all offensive secretions from the tube, gentle astringents may — as has been shown of excitants — be employed with much prospect of advantage. In very urgent cases, it may even be necessary to have recourse to the more powerful, administered both by the mouth and the rectum ; and their agency may be augmented by the addition of opium to allay the irritability of the canal, which the state of erethism IN DIARRHOEA. 107 of the mucous membrane so largely developes. Of the vegetable astringents employed for this purpose, catechu and kino are the most common. Of the mineral,— alum, dilute sulphuric acid, &c. ; and, if these fail, no plan can be adopted with better expectation of success than that of completely changing the whole of the physical circumstances surrounding the individual ; by travelling exercise, which, at times, removes these chronic affections of the mucous membranes, after the best directed efforts of the physician have been assiduously, but vainly, exerted. The same principles apply to the management of diarrhoea, which is caused by a degree of erethism of the mucous membrane, gene- rally produced by extraneous substances taken by the mouth, and irritating the lining membrane of the intestines. Astringents are here, in the first instance, improper. The cause of the mischief must be first removed by gentle evacuants, — as oleum ricini, — and it is not unless the discharges should be frequent, and colliqua- tive, that attempts should be made to check them by astringents. At different periods of medical history, diarrhoea has been viewTed in opposite aspects, — at times, as an effort of nature to get rid of morbific matter, and, therefore, not to be interfered with ; and, at others, as always injurious, tending to debility and death, and con- sequently to be arrested as speedily as possible. Both exclusive views are objectionable. The cause of ,the mischief must be in- quired into, and, if possible, removed ; and, let it be borne in mind, that an increased number of evacuations may take place in conse- quence of the retention of indurated fecal matter in some portion of the intestinal tube ; — the irritation, excited by its presence,inducing augmented exhalation from the lining membrane, and stimulating the muscular coat by contiguous sympathy, so as to increase the natural peristole of the intestines beyond the due bounds. Diar- rhoea may be, in this manner, a symptom of constipation, and it is not until this state of fecal retention has been removed, that a cure can be effected. In the cases of diarrhoea, which occur in phthisis pulmo- nalis towards its close, and which are occasioned by inflammation of the lining membrane of the ileum and colon more especially, we can employ only palliatives. The diarrhoea is but a symptom of the hectic, and whatever remedies are used, we cannot calculate on any important advantage from them. It is usual to exhibit an opiate, which has the effect of allaying the irritation in some degree ; and, occasionally, the Mistura Creta of the pharmacopoeias is made the constituent of the prescription, or the infusion of catechu or kino, or some other vegetable astringent; but, for the reasons just men- tioned, no calculation of positive, permanent benefit can be founded on their administration. Simplicity in the formation of prescrip- tions is highly important, in order that we may be able, in all in- stances, to trace the effects of particular remedial agents on parti- cular states of disease. The practitioner is often in the habit of combining remedies, taken from different classes of medicinal sub- 108 ASTRINGENTS, stances, and experience often leads him to ascribe virtues to the com- bination, which are perhaps referable to one ingredient of the pre- scription only. Dr. Thomson gives an instance of this kind. Dr. Fordyce thought he had improved the practice in diarrhoea by com- bining astringents with diaphoretics, and he recommended a combi- nation of ipecacuanha and tormentilla. " We now know, that no effect could be ascribed to the ipecacuanha in this combination, as an inert tannate of emetina is formed ; and, consequently, that the whole of the benefit must have resulted from the tormentil, which is indeed an excellent astringent in this disease." Blennorrhcea. — In that specific inflammation of mucous mem- branes, which constitutes gonorrhoea virulenta, much difference of opinion has existed regarding the employment of astringents. When they are used at all, it is in the wray of injection; and, whilst they are employed, from the first, by some practitioners, they are alto- gether discarded by others, —■ on the ground, that they are apt to induce stricture or orchitis. The author does not think there is much, if any, foundation for these fears. When such affections do supervene, it is generally owTing to the lesions produced by the pro- traction and extension of the inflammation ; and the practitioner ought not to hesitate to put an end to the specific inflammation at once, by an astringent or any other plan which is capable of accom- plishing the object. What has been said of the use of excitants and astringents in inflammations of the mucous membranes in ge- neral applies here ; and the same difficulty exists in knowing whether the over distended state of the extreme capillary, or the excited state of the vessel communicating with it, predominates. When, how- ever, the inflammatory signs are high ; the extremity of the urethra tumid and painful, and chordee is urgent, the general antiphlogistic treatment had best be confided in, and astringent injections be post- poned until these phenomena have been got under. When injec- tions are had recourse to in gonorrhoea, the metallic astringents, — as sulphate of zinc, acetate of zinc, acetate of lead, sulphate of cop- per, sulphate of alumina and potassa, and nitrate of silver, are usually selected. But whatever hesitancy may exist regarding the use of astringents in the early stages of gonorrhoea, none need be entertained when the inflammatory symptoms have almost wholly disappeared, and a state of gleet alone remains. Here, not only as- tringents, but excitants are needed ; and the bougie will often re- move the disease when every kind of injection has failed. This is partly owing to the instrument coming in contact with the seat of the discharge, however high up it may be in the urethra, which can- not easily be effected by injections ; —at least, cannot be effected in the ordinary mode of throwing them up by means of a syringe. They may, however, be directed to any part by a canula, — an orJi- nary silver or elastic-gum catheterfor example,-—which maybe passed up until it has nearly reached the seat of the disease, and the fluid of the injection may be propelled through it. IN EPHIDROSIS. 109 Leueorrhcea. — Similar remarks apply to the use of astringent in- jections in leucorrhoea. Little faith can be placed in the administra- tion of astringents by the mouth, for reasons applicable to hemorrhages from other parts than the alimentary tube,— namely, that the astrin- gent must enter the mass of blood, and can, of course, reach the mucous membrane of the vagina in a state of extreme dilution and admixture only. Leucorrhoea — like other inflammations of mucous membranes — is, in some cases, more highly inflammatory than in others. It may require the use of powerful antiphlogistics in one case ; whilst in another the astringent treatment may be advisable. At times, it is accompanied by considerable remora of fluids in the membrane, and by much relaxation of parts, and it is in these cases chiefly, that mineral astringents, and the astringent vegetable in- fusions and decoctions are employed. Where the inflammation and irritation are excessive, soothing topical remedies, — as warm milk and water; flax-seed tea, &c, — are rather indicated; or, if cold and astringent lotions afford more relief, care must be taken not to render the astringency too marked. In such cases, the solutions of the metallic salts, used in inflammation of the mucous membrane of the urethra, are generally chosen; but where the atony and relaxation above mentioned exist to any great extent, infusions or decoctions of catechu, or red oak bark, or of some other vegetable astringent are generally selected. In every case, care must be taken not to make the lotion too astringent; otherwise, as before seen, the inflammation may be augmented. Diabetes Mellitus. — In that singular disease of the function of nutrition — diabetes mellitus — characterised by an unusual discharge of sweet urine, — the vegetable and mineral astringents — in the ignorance that prevailed of its pathology—were at one time uni- versally prescribed, but without any benefit. The disease does not consist simply of a profuse secretion of urine. This is the smallest part of the evil. It is the formation of saccharine matter at the ex- pense of the system, which is the main source of mischief, and this can scarcely be touched by the use of astringents. _ Ephidrosis. — Immoderate sweating—technically termed ephidro- sis — is rather an unpleasant symptom of certain morbid conditions of the system, than a disease itself. One or two singular epidemics, of which this ephidrosis was a prominent symptom, have occurred from time to time in Europe. The Sudor Anglicus or 'sweating sickness' was a very severe epidemic disease, which appeared in England in 1486, and recurred at different times until about the middle of the 16th century. It was accompanied by coldness; ex- cessive prostration of strength; palpitation; frequency and irregularity of pulse ; and generally terminated favourably or unfavourably in the course of twenty-four hours. The Suette de Picardie is another epidemic malady, which has appeared several times in the province VOL. II.—10 110 ASTRINGENTS, of Picardy in France. The principal symptoms were profuse sweats, accompanied by a miliary eruption. The disease recurred in 1821, and has been described at length by M. Rayer, in a work, which he did the author the honour to transmit to him. M. Rayer considers the Suette miliaire of 1821 to consist of a simultaneous state of in- flammation of various tissues; and proposes to class it with variola, rubeola, and scarlatina. In these two epidemics, the state of the system appears to have been essentially different. Increased exhalation from the cutaneous surface may, indeed, take place in two opposite conditions of the vascular system. In the one, the vital forces may be exalted ; in the other, depressed; and hence the warm, genial perspiration of health, induced by exercise or by excitants of any kind; and the cold, clammy exudation, which is the precursor of dissolution. Phthisis. — In confirmed phthisis, colliquative sweating is one of the accompaniments of the hectic fever, and cannot of course be removed, unless the condition of the lungs, which gives rise to the hectic, can be rectified. As this is impossible, no signal advantage can be derived from the employment of astringents, although we are, at times, disposed to attempt to palliate an evil — which we cannot remove or prevent— in consequence of the complaints of the sufferer. There is nothing better adapted for this end, than a combination of tincture of opium, and diluted sulphuric acid, or the acidum sulphuri- cum aromaticum. Relaxations of parts. — In all relaxations of parts, with which astringent solutions can be made to come into immediate contact, they are the remedial agents, that are clearly indicated; hence, they are employed in procidentia ani, and procidentia vaginae, with the best effects ; —these pathological conditions being usually dependent upon a state of atony of the parts concerned. Topical diseases. — Lastly, the surgeon has recourse to astringents in many of the morbi externi, that fall under his province. Of their use in ophthalmia, aphthae, and in erysipelatous and phlegmonous inflammations, the author has already spoken, as well as of the particular morbid states, in which their employment seems to be indicated. In chronic ulcers of an indolent character, they are used like excitants to induce a new action in the ulcerated surface, and are often beneficial. As styptics — chemical as well as mechanical — they are likewise employed where the hemorrhage is insufficient to demand the use of the ligature, or where the ligature cannot be easily applied. Some years ago, a styptic was re-introduced into notice in Italy, which astonished the surgical world for a time, but whose operation — like that of many agents equally strongly recommended — has been found to far exceed its powers. This was the " new hamasta- IN TOPICAL DISEASES, 111 tic," as it was termed — the Acqua Binelli—so called after Dr. Fidele Binelli, the inventor. This liquid is perfectly transparent, almost tasteless, having a slightly empyreumatic odour, in which neither salt, earth, alkali, nor acid can be perceived by the senses- The first public trials, to test its efficacy in arresting hemorrhage, were instituted at Turin, in 1797, by order of the government, the results of which were regarded favourable. Soon after this Binelli died, and the secret for making this preparation is said to have died with him; but in the years 1829 and 1830, the successors of Binelli affirmed, that they had discovered the secret, and fresh experiments were instituted, and repeated in Germany. Various blood-vessels were divided on animals, — the femoral and carotid arteries, and the internal jugular veins; and the cuts were made in every direction, — some- longitudinally, some obliquely, others completely across, and in all cases the hemorrhage yielded as soon as charpie or lint, steeped in the Acqua Binelli, was applied and pressed gently against the wound for five or ten minutes. Encouraged by the results of the experiments on animals, its effects were tried on man. First. Be- fore the assembled class in Berlin, in the operating theatre, after am- putation of a finger, the arteries of which emitted blood very freely. Secondly, In the case of a wound of the hand, caused by a cutting instrument, which entered deeply between the metatarsal bones of the thumb and index finger, and in which the hemorrhage could not be arrested by compression or the tourniquet, without fear* of causing gangrene. Thirdly. After the removal of an indurated inguinal gland, accompanied by hemorrhage ; and, fourthly, after amputation of the thigh on account of a scrofulous knee joint, wThen the blood issued with great force — on the least relaxation of the tourniquet — from the crural, perforating, and other muscular arteries, as well as from the veins. In all these cases, the hemorrhage was speedily and permanently arrested by the application of the Acqua Binelli without any other aid. It did not cause the least pain on its application, nor did it produce any discoloration on the surface of the wound, or eschar, or any other local or general effect of a disagreeable cha- racter. Such effects would appear to be most strikingly ascribable to the causes assigned, notwithstanding the apparent inertness of the fluid, as tested by the senses ; but the experiments of Dr. John Davy have proved, that the boasted Acqua Binelli is only another example of the numerous remedial agents, which have given occasion to infer- ences not confirmed by farther investigations. They completely overthrow the fancied heemastatic powers ascribed to the liquid by the German and Italian experimenters. " I first examined," says Dr. Davy, " into its physical and chemical qualities. It proved of the same specific gravity nearly as distilled water. It was neither acid, alkaline, nor saline. Its odour was not unlike that of coal-gas, not purified, which is lost by boiling. Its taste was rather pungent, not in the slightest degree astringent; in brief, it appeared to be 112 ASTRINGENTS, merely water, containing a little volatile oil or naphtha, and was pro- bably prepared by the distillation of water from petroleum, or some kind of tar. I next made trial of it as a styptic. I scratched the back of the hand with a lancet till the blood flowed. The water applied to the scratch rather increased the bleeding than stopped it. The following morning, in shaving, the razor inflicted a slight cut: the Acqua Binelli was again applied, and the result was the same. These few and simple trials were made in January, 1831, just after I received the water ; and they of course convinced me that the thing was an imposition on the public, and deserving of no further inves- tigation. A short time since my attention was recalled to the sub- ject by a medical practitioner of this island, who had studied at Naples, inviting me with others to witness the effects of a preparation made in imitation of the Acqua Binelli, and which he maintained was identical with it in composition and virtues. The experiment he invited us to witness appeared an unobjectionable one, namely,—the partial division of the carotid artery of a goat, the bleeding of which he undertook to stop by means of his fluid. He allowed us to ex- pose the vessel and cut it across ; about one-half of the circumference of the artery was divided, and the bleeding was most profuse. He stood ready with compresses moistened with the fluid, which he in- stantly applied one over the other, and secured them by rolling a bandage about the neck, making moderate pressure on the wounded vessel. A.little oozing of blood followed w7hich soon ceased. He said that in three hours the bandage and compresses might be re- moved, without any renewal of the hemorrhage. Accordingly, at the end of three hours they were removed ; but when the last com- press was raised, the bleeding broke out as furiously as at first, and, to save the life of the animal, the artery was secured by ligature. On examining the last compress, a small coagulum of blood was found adhering to it, just the size proper to close the w^ound in the carotid ; thus accounting for the ceasing and renewal of the bleeding. Reflecting on this result, and considering the chemical nature of the fluid employed to moisten the compresses, which appeared analogous to that of Binelli, the conclusion I arrived at wras obvious — namely, that, had the compresses used been moistened merely with common water, the effect would have been the same, — the bleeding would have been stopped ; and it also appeared very probable, that, had the compresses been allowed to remain undisturbed, there would have been no renewal of the bleeding. " To ascertain the truth of these inferences, the following experi- ments were made. On the same day, February 8th, in the presence of several medical officers, I divided partially, transversely, the ca- rotid artery of two dogs; one small and feeble, the other of moderate size and strong. In each instance the bleeding was most profuse, till compresses dipped in common water had been applied and secured by a bandage, which, as in the case of the goat already given, com- pletely stopped the hemorrhage. The small dog, from the propor- AS HjEMASTATICS. 113 tionally large quantity of blood which it lost, was very feeble imme- diately, and appeared to be dying; but it presently rallied, and for several days seemed to be doing well. It unexpectedly died on the 15th, seven days after the infliction of the wound. The bandage during this time had not been touched, and no application had been made. Now, on exposing the neck, the wound was found covered with coagulable lymph discharging pus; and, on dissecting out the artery and eighth nerve contiguous to it, a mass of coagulable lymph appeared lying over the wound in the vessel, extending about half an inch above and below it. This mass of coagulable lymph having been carefully removed, and the artery slit open, the vessel was found quite pervious, not in the least contracted. The wound in the fibro-cellular tissue, or external coat, was closed by a minute portion of dense coagulable lymph. But not so in the middle and inner coats ; in these there was a gaping aperture, across which, on minute inspection, two fine threads, apparently of coagulable lymph, (as if the commencement of the healing process,) were observable. The cause of the dog's death was not discovered. The other dog did not appear to suffer from the wound. The bandage and compresses were removed on the 15th February without the occurrence of any bleeding. On the 20th of the same month, the wound in the neck was nearly closed by granulations. The artery was now exposed by incision ; and the portion that had been wounded taken out, between two ligatures previously applied. On careful examination of this excised part, it wras found free from coagulable lymph ; at least there was not the same thickening or tumour from lymph deposited, as in the former case : it was probably absorbed. When the external loose cellular tissue was dissected away, a very minute elevation, about the size of a pin's head, appeared on the site of the wound, the remains of the cicatrix externally. The artery was completely pervious, and not at all contracted where it had been wounded. Slit open for internal examination, the wound in the inner coat was marked by a red line interrupted by two white spots; there was no gaping; the edges adhered together, excepting at one point; else- where the union was complete. The white spots resembled the natural lining membrane ; and had the whole wound been similarly healed, I believe it would have been impossible to have traced it. " The general results of these experiments, (if I may be allowed to speak of so small a number,) are not without interest in application to surgery. They show how a hemorrhage from the wound of a large artery, which by itself would be speedily fatal, may be easily arrested by moderate compression through the means merely of several folds of linen or cotton moistened with water; and they further show how, under this moderate compression, the wound in the artery heals, the vessel remains pervious, and without the formation of an aneurism ; and how, after a time, only slight traces of the wound are discover^ able. Under this moderate pressure the healing of the wounded ar-. tery seems to be very analogous to that of a wounded vein, and ap* 10* 114 ASTRINGENTS. parently by means of the same natural process. Whether similar results could be obtained, were trial made of the same means in the wounds of arteries in the human subject, can only be ascertained positively by judicious experiments. The probability is, that the results would be the same. The analogy is very complete, and some facts wrell known in surgery accord with it, not to mention the expe- rience of the effects of the Acqua Binelli, as certified by men of high respectability. " It wras my intention to have given a selection of the certified cases in favour of the Acqua Binelli, brought forward in the pam- phlet which is furnrhed with the water. But on reconsidering them, it appeared a superfluous labour, as the results, (giving them credit for correctness,) however excellent in a curative point of view, are no more than the enlightened surgeon of the present time may readily admit to be owing to water dressings alone, without the aid of pres- sure,— the majority of instances adduced being examples of gun-shot wounds and contused wounds, from which there was no profuse bleeding, and no necessity, according to the ordinary mode of sur- gical treatment, for securing wounded vessels. I have laid stress on the effect of the pressure afforded by the wet compresses applied in the experiments related, believing that the virtue of the means consists in the pressure, — of course not in the water, excepting so far as it renders the compresses better fitted for adaptation to the wound to produce the degree of resistance requisite to counteract the heart's impulse in the vessel ; and also better fitted to exclude atmospheric air. I would also lay stress on the moderate degree of pressure that is produced in the maimer described, — allowing the blood to pass through the canal of the artery, and, as before observed, doing little more than resisting the momentum of the blood in its passage from the moving source. The importance of this moderate degree of pressure, which has the effect of reducing as much as pos- sible the wounded artery to the condition of a wounded vein, is, if I do not deceive myself, very considerable. WThen I have pressed with the fingers forcibly on the compresses applied to the wTound, expecting at the moment to arrest the bleeding, I have been disap- pointed. The hemorrhage has continued ; and it only ceased when the compresses have been secured, and not tightly, by a roller passed around the neck of the animal. And, further, in illustration, I may remark, that I have been equally disappointed in using graduated compresses, insuring considerable pressure on the wound. This means has failed, when general moderate pressure, effected by com- presses about two inches long and one wide, succeeded. On con- sidering the comparative circumstances of these twro modes of apply- ing compression, therefore, the difference of result is perhaps what might be expected. The severe pressure can hardly arrest the bleeding except by pressing the sides of the vessel together and closing the canal, the accomplishment of which requires a most nice adaptation, and a force which cannot easily be applied with steadi- ACIDUM TANN1CUM. 115 ness except by mechanical means, and in situations affording firm support beneath. Should the expectation which I have ventured to form of this method of stopping the bleeding of wounded arteries of a large size in man be realized on trial, I need not point out how very useful it may prove in military surgery, — how very available it will be in the field and in battle, especially in great actions, when, however numerous and well-appointed the medical staff of an army, the number of wounds requiring attention must always exceed the means of affording adequate surgical relief, according to the plan of treating them at present in use, of suppressing hemorrhage by liga- ture. I have said nothing of the boasted efficacy of the Acqua Binelli given internally. I trust it is as little necessary to make any comments on it now-a-days, as on the tar-water of Bishop Berkeley, so very analogous in nature and reputation. Both the one and the other in some cases may be serviceable ; but their principal recom- mendation appears to be, that in doubtful cases they are innocent." Dr. Davy's observations have been given at some length, because they contain interesting information, both as regards the physiology, pathology, and therapeutics of wounded vessels, and convey a useful lesson to the inquirer,—not to deduce inferences from inadequate data, without having investigated every collateral circumstance that bears upon the question. Were this course pursued, we should not have as many examples of the experientiafalsa as we are daily doomed to witness. It has been suggested that the Acqua Binelli may be in- debted for its fancied haemastatic property to creasote in some form : but Dr. Davy's explanation appears all sufficient to account for the phenomena. (For other testimony, in regard to the Acqua Binelli, see the author's New Remedies, 3d edit., p. 45, Philad. 1841.) Such is a general view of the modus operandi of astringents in the principal diseased conditions of the frame. When properly em- ployed, they are by no means the least useful of our medicinal agents. SPECIAL ASTRINGENTS. I. Vegetable Astringents. 1. ACIDUM TAN'NICUM.— TANNIC ACID, TANNIN. Tannic acid or tannin — as before remarked — is the great active principle of vegetable astringents. It became desirable, consequently, to separate it, in order that it might be administered in a state of purity. Different processes have been recommended for this pur- pose, but that of Pelouze appears to have superseded others, and has 116 SPECIAL ASTRINGENTS. been adopted in the last edition of the Pharmacopoeia of the United States, (1842.) It consists in extracting it from galls by ether, by the process of displacement. When thus prepared, tannic acid is of a yellowish white colour, of a strongly astringent taste ; and is soluble in wrater, alcohol and ether, reddening litmus paper, and forming salts with bases. Tannic acid is a very powerful astringent, and may be employed in all cases in which astringents are considered necessary. One ad- vantage is in the minuteness of the dose in which it can be given. It has been much employed by the Italian physicians especially, both in external and internal hemorrhages. When applied to the mucous membranes, it appeared to Cavarra to cause such a condensation and contraction of tissue, that the glands or follicles could no longer afford passage for the mucus which they secreted. It has been used in discharges from mucous membranes, and in the colliquative sweats of hectic fever. The dose of tannic acid is from a quarter of a grain to two or three grains, generally given in the form of pill. It may, also, be used as an enema in chronic diarrhoea and dysentery, or in prolapsus ani; and has been injected into the urethra by M. Ricord, in cases of blennor- rhea virulenta, in the quantity of 9ij of tannic acid, to |viij of aro- matic wine of the French Codex, or of red wine ; and in a less pro- portion in cases of chronic blennorrhoea or gleet. In the blennorrhoea of the female, he doubles the quantity of tannic acid; and even carries it still farther. Mr. Druitt is of opinion, that in any case in which a vegetable astrin- gent is indicated, tannic acid should have the preference. A simple solution of it in distilled water, he says, is much more easily and quickly prepared, as well as much more elegant than the ordinary de- coctions or infusions of oak bark, catechu, &c. Moreover, it may be pre- pared of uniform strength, and free from foreign inert matter, and is not liable to decompose quickly. It has, in fact, he considers, all the ad- vantages which the other simple vegetable principles have over crude preparations from the herbs or extracts in which they are contained. In sore nipples, Mr. Druitt has found it invaluable. He employs it in solution — five grains to the ounce of distilled water— on lint covered with oiled silk. He has also found it of great service in toothache. The gum around the tooth is first scarified with a fine lancet, and then a little cotton wool, embued with a solution of a scruple of tan- nic acid, and five grains of mastich in two drachms of ether, must be put into the cavity, " and if the ache is to be cured at all, this plan will put an end to it in nine cases out often." 2. AC'IDUM GAL'LICTJM.— GALLIC ACID. This acid is by no means so abundant as the tannic, and appears to be produced by an alteration of the latter. A solution of tannic VEGETABLE ASTRINGENTS__CATECHU. 117 acid in water exposed to the air gradually absorbs oxygen, and de- posits crystals of gallic acid, formed by the destruction of tannic acid. To prepare gallic acid, a strong extract of gallnuts in cold water may be precipitated in the cold by sulphuric acid; the thick mass be mixed with dilute sulphuric acid, be expressed whilst still humid, and introduced in this state into a mixture of sulphuric acid with two parts of water at the boiling temperature. The liquid is boiled for some minutes, and then allowed to cool: crystals of gallic acid are deposited, which may be purified by crystallising again from water, converting the new product — which is still coloured — by means of acetate of lead, into an insoluble gallate of lead, which is washed, then diffused through wrater, and decomposed by a stream of sul- phuretted hydrogen gas: the sulphuret of lead, thus formed, assists in carrying down the colouring matter. Gallic acid is in thin, silky needles; requires 100 parts of cold water to dissolve it, and three of boiling water. It is very soluble in alcohol, and, to a slight extent, in ether. The solution in water has an acid and astringent taste, and is gradually decomposed by keeping. Gallic acid has been recently much extolled as a valuable astrin- gent. It has already been remarked (p. 93) that the successful operation of Ruspini's styptic in haematuria has been ascribed to it. In some cases of menorrhagia, this acid has been employed by Pro- fessor Simpson, and by Dr. Stevenson of Edinburgh, with the most successful results. The former gave it during the intervals, as well as during the discharge, in doses of from 10 to 20 grains in the day, made into pills ; and it appeared to him to have the advantage over most other anti-hemorrhagic medicines, that it had no constipating action. He was first induced to prescribe it from finding a case of very obstinate menorrhagia get well under the use of Ruspini's styptic. Professor Simpson suggests, whether the anti-hemorrhagic properties of some others of the astringent drugs may not be dependent upon the gallic acid as much as, or even more than, upon the tannic acid which they contain,—• or upon the tannic acid becoming changed into gallic acid within the body. 3. CAT'ECHU. Catechu is an extract prepared from the wood of Aca'cia cat'echu, Mimosa cat'echu ; Sex. Syst. Polygamia Monoecia ; Nat. Ord. Leguminoste, which is indigenous in various parts of the East Indies, and is now common in Jamaica. (Pereira.) The Edinburgh Col- lege considers catechu to be not only the extract of the wood of Acacia catechu ; but of the kernels of Are'ca catechu or Betel nut tree, or Catechu palm; Sex. Syst. Monoecia Hexandria ; Nat. Ord. Palraae ; which inhabits most of the Indian continent and islands; 118 SPECIAL ASTRINGENTS. and of the leaves of U?ica'ria gambir or Nau'clea gambir ; Sex. Syst. Pentandria Monogynia; Nat. Ord. Rubiaceae, — Cinchonaceae, (Lindley,) which is a native of Malacca, Sumatra, Prince of Wales Island, Cochinchina, and other parts of Eastern Asia. It would ap- pear, however, that the extract obtained from the two last sources is rarely, or never, seen in European or American commerce. Catechu is supposed, also, to be obtained from Bu'tea frondo'sa or Dhak tree, of the East Indies ; Sex. Syst. Diadelphia Decandria ; Nat. Ord. Leguminosae. The number of catechus described by pharmacologists is consider- able. At least as many as thirteen varieties have been admitted ; but, although these may be of commercial and pharmaceutical inte- rest, they are of less moment to the therapeutist. They are described at length by some of the best modern pharmacologists. In this country, we are not troubled with varieties. The drug is procured either directly from Calcutta or from London. Catechu, formerly termed Terra Japon'ica — as met with in the shops— is in masses of different shapes and sizes ; of a rusty brown colour externally, and internally of a colour varying from a pale red- dish to a dark liver. It is devoid of smell, and has an astringent bitter taste. That which is preferred in this market is of a dark colour, and easily broken into small angular fragments, with a smooth, glossy surface, bearing some resemblance to kino. (Wood & Bache.) It is often mixed with various impurities ; and, with the exception of these, is soluble in water. Small, successive portions of cold water remove chiefly the astringent part, and a much larger proportion of water is required to dissolve the remainder, which is principally an extractive resinoid matter, with acid properties. (Christison.) Hot water dissolves both principles; but if the infu- sion be made very strong, a reddish extractive matter is deposited on cooling. Alcohol and diluted alcohol dissolve it more readily than water. When subjected to analysis, it is found to consist of about 50 per cent, of tannic acid, peculiar extractive mucilage, and insoluble matter. Catechu is one of the most powerful of the vegetable astringents, and is as well adapted for cases in which such agents are demanded, as any article belonging to the class. In atonic conditions of the mucous membrane of the mouth and fauces ; in the chronic forms of diarrhoea and dysentery ; in asthenic hemorrhages ; and in chronic mucous discharges from the genito-urinary organs, it has been pre- scribed with much success. It has also been used as a wash, in the form of infusion ; and in that of ointment to atonic ulcers, in which an astringent is indicated. A small piece of it, held in the mouth, and allowed to dissolve in the saliva, has been beneficial in relaxa- tion of the uvula; and it has been added to other substances, as to powdered cinchona, to form a dentrifice for spongy gums. The dose of catechu in powder is from gr. x to 3J, which may VEGETABLE ASTRINGENTS__KINO. 119 be given in bolus, or rubbed up with sugar, gum arabic and wrater. INFU'SUM CATJCIIU COMPOS 'HUM, COMPOUND INFUSION OF CAT'ECHU. (Cate- chu, m pulv. ^ss ; Cinnam. cont. 3j ; Aqua bullient. Oj.) The cin- namon adds aromatic virtues to the catechu ; and the infusion is much used in chronic discharges from the mucous membranes, espe- cially of the alimentary canal, — at times alone ; at others, associated with opium. It ought not to be given along with preparations of iron. The dose is f. ^j to f. |iij, repeated according to circumstances. TIXCTU'RA CAT'ECHU, TINCTURE OF CAT'ECHU. (Catechu,giij; Cinnam. cont. 3ij ; Alcohol, dilut. Oij.) The same remarks apply to the composition of this tincture as to that of the infusion. It is rarely given alone, the alcohol being so often an objection ; but is often added to chalk mixture, and occasionally to the infusion of catechu. Its dose is from f. 3J to f. 3iij, in sugared water, or in Port wine and water. 4. KINO. In the Pharmacopoeia of the United States, kino is said to be an extract obtained from an uncertain plant; whilst in the London Pharmacopoeia it is assigned to Pterocar'pus erina'ceus or Hedge- hog Pterocarpus: Sex. Syst. Diadelphia Decandria; Nat. Ord. Leguminosse, a tree which inhabits the woods on the Gambia and Senegal; and the Edinburgh College assigns it to the same, and to other undetermined genera and species. Different varieties of kino are described in pharmacological works. According to Dr. Pereira, two substances are met with in English commerce under the name,— the one called Botany Bay kino, which is the inspissated juice of Eucalyp'tus resinifera ; the other, apparently an extract, imported from Bombay and Tellicherry, and which he terms East India kino. The latter is presumed to be the substance referred to in the Pharmacopoeias, as it is always re- garded in commerce as genuine gum kino. As met with in the shops, kino is in small, angular, shining frag- ments, of a dark brown or reddish brown colour, affording a powder which is of a lighter hue. It is brittle, but softens in the mouth, and co- lours the saliva red. It is devoid of smell, and has a very astrin- gent taste. Cold water dissolves a portion of it, and hot water a larger quantity; whilst alcohol dissolves the greater part. When subjected to analysis, it is found to consist of tannic acid, and pecu- liar extractive, 75 per cent. ; red gum, and insoluble matter. Kino is closely allied, both in its chemical and medical virtues, to catechu, with which it has, indeed, been considered by some to be identical. It is given in the same affections. 120 SPECIAL ASTRINGENTS. The dose of the powder is from ten to thirty grains. An infusion made by pouring eight fluid ounces of boiling water on two drachms of the kino, may be given under the same circumstances as the In- fusum catechu compositum. The dose of this may be f. ^j to f. ijiij. A tincture (Kino, in pulv. ^iiiss ; Alcohol. Oij. imperial measure) is officinal in the London Pharmacopoeia. It becomes gela- tinous, however, when kept, unless — it is said — when prepared by displacement. It is used under the same circumstances, and in the same doses as the Tinctura catechu. 5. GALLA. —GALLS. Galls are morbid excrescences on Quercus Infecto'ria; Sex. Syst, Monoecia Polyandria; Nat. Ord. Cupuliferae; which abounds throughout Asia Minor, and especially along the coasts of the Medi- terranean. The young twigs of the plant are liable to be punctured by an insect of the Gallic'ola or Diplolepa'ria tribe, called Cynips galla tincto'ria, C. quercusfo'lii, or Diplolep'is galla tincto'ria, which deposits its eggs, and gives rise to so much irritation, that the nutii- tion of the part becomes modified, and a tumour or excrescence is formed which is termed a gall. In the interior of this, the young insect finds food during its transformation, and ultimately attains the state of fly, when it penetrates the gall, and escapes. This usually occurs about the end of July ; but, as the galls are of finest qua- lity just before the escape of the insect, they are generally gathered about the middle of July. The galls that are exported from Aleppo — hence called Aleppo galls — are the best. Those from Smyrna contain a larger admix- ture of white galls, and are, therefore, less prized. Others, brought from India, termed East India galls, closely resemble those from the Mediterranean. They are said to grow in Persia, and to be taken thence by the Arab merchants to Calcutta. (Ainslie.) Large quan- tities of these were introduced into the United States some years ago. The galls of Asia Minor and Syria are chiefly brought to this country from the ports of Smyrna and Trieste. (Wood & Bache.) In English commerce, three kinds of galls are distinguished —the black or blue, the green, and the white ; no essential difference, however, exists between the two first. They are the best, and are gathered before the insect has issued, whilst the white galls are col- lected for the most part after the insect has escaped, and hence they are found to be perforated with a circular hole. They are all de- void of odour, and have a styptic and powerfully astringent taste. The white kind, however, possesses these qualities in an inferior degree. Galls yield their astringent properties to water, alcohol and ether. Water seems to be the best menstruum, and, next to it, dilute alco- hol. When analysed by Sir Humphry Davy, they were found to consist of 26 per cent, of tannic acid ; 63 of lignin; 6.2 of gallic VEGETABLE ASTRINGENTS___KRAMT1RIA. 121 acid; 2.4 of gum, united with insoluble tannin ; and 2.4 of saline matters. It has been found, however, that the tannic acid is con- tained in larger quantity than was estimated by Sir Humphry— more recent and exact processes showing, that it amounts to 40 or even 60 per cent. (Christison.) Galls are an excellent and powerful astringent, possessing at least as much tannic acid as catechu ; but they are not by any means so often prescribed internally. They may be used, however, in the same affections. An infusion prepared of ^iv of the galls to f- §VJ or 5vi'J of boiling water may be given internally in the dose of f. Zss to f. ^ij ; but it is more frequently used as an astringent wash, and is occasionally prescribed as an injection in chronic diarrhoea and dysentery, and in leucorrhoea, or wherever a topical astringent is needed. The dose of the powder — which is rarely prescribed — is from ten to twenty grains. TINCTU'RA GAM, TINCTURE OF GALLS, (Gall. cont. |iv; Alcohol. dilut. Oij. Prepared either by maceration or by displacement.) This is a powerfully astringent preparation; and, when diluted with water, makes a good wash or gargle. It is rarely given internally ; its chief use, indeed, is as a chemical test. UNGUEN'TUM GALLE, OINTMENT OF GALLS, (Gall, in pulv. gj; Adipis, 3vij.) This has been a favourite application with many practitioners in hemorrhoids after the inflammatory stage has passed away. Some have employed it in the same cases much stronger, — the ointment being formed of equal parts of powdered galls and lard or butter. The London and Edinburgh Colleges have an Unguentum Gall.i: Compositum, formed of Galls, in very fine powder, 31J; Opium powdered, £j ; Lard, Jj. The author has often used this ointment in hemorrhoidal affections with marked advantage. 6. KRAME'RIA.—RHAT'ANY. The root of Krame'ria Trian'dra, or Rhatany ; Sex. Syst. Tetran- dria Monogynia ; Nat. Ord. Polygaleae, — Krameriaceae, (Lindley,) is officinal in all the Pharmacopoeias of Great Britain and in that of the United States. The plant inhabits the mountainous parts of Peru, especially in the district of Huanuco and other localities in which cinchona flourishes. As met with in the shops, it consists of a short root-stock, from half an inch to two inches in diameter, and of numerous roots pro- per, which are simple or branched, one or two feet in length, and varying in thickness from that of a writing quill to that of the thumb. The bark is of a dark brownish-red colour, wTrinkled and warty on the root-stock, but smoother on the branches. The central vol 11.—11 122 SPECIAL astringents. woody portion is of a yellowish or pale red colour. As the bark contains the largest amount of astringent matter, the smaller branches are preferred. It is devoid of smell, and of a very bitter astringent taste. The virtues of the root are readily yielded to water and to alcohol. When subjected to analysis, it has been found to contain about 40 per cent, of tannic acid ; and, according to Peschier, a peculiar acid, which he has called kramerin; the properties of which are but little known, and to which, as well as to the tannic acid, the astringency has been ascribed. Rhatany is an excellent astringent, and well adapted for all cases in which that class of remedies is needed. In chronic diar- rhoea and dysentery, it is frequently administered, both by the mouth and rectum. It is sometimes used as a tooth-powder, mixed with equal parts of orris root and charcoal; and a tincture is not unfrequently made by the dentists as an astringent tooth-wash in looseness of the gums. The dose of the powdered root is from gr. x to Jss; but it is not so often prescribed as the infusion or extract. A tincture may be formed by digesting three ounces of the bruised root in a pint of proof spirit; and a compound tincture is formed by adding to this one or two ounces of cinnamon, or half an ounce of Virginia snakeroot. Both these are astringent stomachics. A syrup of rhatany is sometimes prepared by making a saturated cold infu- sion, and adding sufficient sugar. A tea-spoonful of this is a dose in the chronic profluvia of children. INFU'SUM KRAMERS, INFU'SION OF RHAT'ANY. fKrameria, contus. |j; Aqua bullient. Oj.) The dose of this is f. 3j to f. 3ij. TINCTU'RA KRAME'RLE, TINCTURE OF RHAT'ANY. (Kramer, in pulv. gvj ; Alcohol, dilut. Oij ; made by maceration or by displacement.) This tincture may be added to astringent infusions or mixtures, or may be taken alone mixed with water. Dose f. 3j to f. 3iij. EXTRAC TUI KRAME'RIiE, EXTRACT OF RHAT'ANY. This is prepared by evaporating an infusion made by displacement. It is also occasion- ally imported, ready made, from South America. The dose is gr. x to 9j. SYR'UPUS KRAME'RIJl, SYRUP OF RHAT'ANY. (Extract, kramer. §ij ; Sacchar. Ifeiiss; Aqua, Oj.) This is a pleasant astringent syrup in the diseases of childhood, in which it may be given in the dose of a tea-spoonful. It may also be added to astringent mixtures. VEGETABLE ASTRINGENTS —HiEMATOXYLON. 123 7. QUERCUS ALBA. —WHITE OAK BARK; a>d 8. QUERCUS TINCTO'RIA. —BLACK OAK BARK. Of the numerous oaks, — Sex. Syst. Monoecia Polyandria; Nat. Ord. Cupuliferae, (Lindley,) — that flourish in our forests, these two are alone officinal; and the former is conceived to resemble most Quercus peduncula'ta, or Common British Oak. The White Oak is met with in every part of the United States, but is more common in the Middle states. Its bark is of a whitish colour, which distinguishes it from the other species. As we meet with the bark deprived of its epidermis, it is of a light brown colour, of a coarse texture, and not readily reduced to powder. Its taste is astringent and bitterish. It imparts its properties to water and to alcohol. These are mainly dependent upon tannic and gallic acids. The Black Oak has a furrowed bark of a dark colour, which is more bitter than the bark of the white oak: it is distinguished by its staining the saliva yellow, and is used, under the name of Quercitron, to dye silken and woollen fabrics yellow. It contains a considerable amount of tannic acid. Oak bark is a powerful astringent, and is adapted for all cases in which astringents are needed; yet it is rarely given internally. In decoction, it is often employed externally, both by the profession and the laity, in relaxation of parts — as in elongation of the uvula, relaxed sore throat, prolapsus ani, &c, and in chronic discharges from the bowels and vagina. It is said to have been used with ad- vantage in certain diseases of childhood, — as a bath, for example, in marasmus, scrofula, cholera infantum, &c, where the stomach would not receive kindly tonic and astringent remedies; but it is not easy to see how any considerable benefit could be derived from this plan. It has even been affirmed to cure intermittents in children, wdien administered in this manner. It has also been used benefici- ally, as a wash, in flabby ill-conditioned ulcers. Like alum, finely powdered bark has been inhaled in cases of phthisis pulmonalis, and especially in laryngeal phthisis. The dose of powdered bark is from jss to gj, but it is scarcely ever given in this form. The bark of the white oak is always pre- ferred as an internal remedy, in consequence of that of the black oak seeming to irritate the bowels. DECOC'TUM QUERCUS ALM, DECOCTION OF WHITE OAK BARK. (Querc. alb. contus. £j ; Aqua, Oiss; boiled to a pint.) The dose of this is f. 31J to f. 3iv; but it is rarely used except as an injection or lotion. 9. H.EMATOX'YLON.— LOGWOOD. Logioood, or Campeach'y Wood, is the wood of Hamatox'ylon 124 SPECIAL ASTRINGENTS. Campechia'num; Sex. Syst. Decandria Monogynia; Nat. Ord. Leguminosae; a tree, which is indigenous in Campeachy, in Yucatan ; and grows wild in Jamaica and other West India islands. Logwood, as an article employed by dyers, is wTell known in com- merce. It is imported in billets, the bark and white sap-wood being chipped off, and the inner wood or duramen being sent abroad. This is of a deep red colour, but it becomes dark by exposure to the air, and of a blackish brown colour. In the shops, it is kept in chips, or rasped into coarse powder. It has a peculiar, rather agreeable smell; and a sweetish, astringent, and subsequently bit- terish taste. When chewed, it colours the saliva violet. The colouring matter is extracted by both wrater and alcohol, so as to form deep purple solutions. WThen subjected to analysis, it has been found to contain volatile oil; a red crystalline substance of a slightly bitter, acrid and astringent taste, called ha'matin or hama- tox'ylin; a fatty or resinous matter; a brown substance containing tannin ; glutinous matter; acetic acid'; woody fibre, and various salts. Logwood is a gentle astringent and tonic; and is prescribed oc- casionally in chronic diarrhoea and dysentery, and other profluvia in which a mild astringent is indicated. It is often prescribed in cholera infantum after the active stage has passed away. It is always administered in one or other of the following officinal preparations. DECOCTUM ILEMATOX'YLI, DECOCTION OF LOGWOOD. (Hsematoxyl. gj; Aquas, OY]— boiled to a pint.) The London and Dublin Colleges add a drachm of Pulv. Cinnamom. towards the end of the boiling. The dose of this is f. jj to f. gij to adults; and f.3 ij to f. gss to children. EXTRAC'THM HIMATOX'YLI, EXTRACT OF LOGWOOD. (The decoction evaporated.) This extract appears to possess all the virtues of the wood. It is given in the dose of gr. x to ^ss in solution. WThen made into pills, and kept for any length of time, it becomes so hard as to pass, at times, through the bowels undissolved. 10. TORMENTIL'LA. — TOR'MENTIL. Tormentil is the root of Potentil'la Tormentil'la or Tormentil'la crec'ta, Common tor'mentil or Septfoil; Sex. Syst. Icosandria Poly- gyria; Nat. Ord. Rosaceae; — a small perennial plant common throughout Europe. The root — which is officinal in the secondary list of the Phar- macopoeia of the United States — as met wTith in the shops, is of very irregular shape ; generally of about the thickness of the first joint of the forefinger. Its colour is deep brownish-red externally, and flesh-red within. It has a slightly aromatic odour, and a very astrin- gent taste ; and yields its virtues to water and to alcohol. When VEGETABLE ASTRINGENTS___GERANIUM. 125 subjected to analysis, it has been found to contain a trace of volatile oil, 17.4 per cent, of tannin ; 20 of colouring matter; about 28 of gum, and 7.70 of extractive. Tormentil is a powerful astringent, one of the most so of the class; yet it is not much used, although applicable to all cases in which astringents are needed. Its dose, in powder, is from 3SS to |j ; but it is more frequently prescribed in decoction, (Tormentil. gij ; Aqua, Oiss. Boil to a pint. Dose, f. §j to f. §ij, repeated three or four times a day.) 11. UVA URSI. The general and medical properties of uva ursi have been de- scribed under Antilithics, (Vol. i. 300;) and it was there stated, that all its medicinal agency is probably as a tonic and astringent. It is unquestionably a good astringent, and is adapted for all the cases in which the other vegetable astringents appear to be requir- ed, but does not seem to possess any peculiar properties, or superior efficacy. It is in chronic cystirrhoea, that it has been most cele- brated ; and its use has been suggested in chronic bronchitis. The dose of the powder is from 9j to 3J ; but it is more generally given in the form of the DECOCTUM UVJ1 URSI, (Vol. i. p. 301,) the dose of which, is from f- 3J to 3U three or four times a day. 12. GERA'NIUM. — CRANESBILL. This is the root of Gera'nium macula'turn; Sex. Syst. Monadel- phia Decandria; Nat. Ord. Geraniaceae, a plant, which is indige- nous throughout the United States, flowering from May to July. The root is officinal, and is collected in autumn. This, when dried, is in pieces from one to three inches in length, and from a quarter to half an inch in thickness; somewhat flattened, twisted, wrinkled, tuberculated, and beset with slender fibres ; of an amber brown co- lour externally ; internally of a reddish gray. It is a pure astrin- gent ; its active constituent being tannic acid. It yields its virtues to water and to alcohol. Geranium is used in the same cases as other astringents; and, owing to its being devoid of bitterness, or other disagreeable fla- vour, it is adapted for infants, or for adults whose stomachs are deli- cate. It is sometimes used as an astringent injection in chronic diarrhoea and dysentery, leucorrhoea, &c, and as a wash to indolent ulcers. The dose of the powder is gr. xx to gss; but it is rarely given. It is most commonly prescribed in decoction, (Geran. 3J ; Aqua^ 11* 126 SPECIAL ASTRINGENTS. Oiss ; coque ad Oj. Dose, f. |j to f. §ij.) It is occasionally given boiled in milk to children. 13. GRANA'TI FRUCTUS CORTEX. —POME'GRANATE RIND. This is the rind of the fruit of Pu'nicagrana'turn, already referred to, (Vol. i. 213.) It is met with in the shops, in irregular, arched, dry, brittle pieces, which are devoid of odour, very astringent and slightly bitter; of a brown colour externally, and yellow within. It contains about 19 per cent, of tannic acid. Pomegranate rind has been used as an astringent, chiefly in the form of decoction,—(Granat. fruct. cort. §ij ; Aqua destillat. Oiss; boil to a pint; dose, f. §j ;) — in chronic diarrhoea and dysentery, and in the colliquative sweats of hectic fever. It has, likewise, been prescribed as an astringent injection in leucorrhoea ; as a gar- gle in relaxed sore throat, and as a wash in loose flabby ulcers,— in the very cases in which astringents in general are indicated,— but it is not much used on this side the Atlantic. The powdered rind has been given in the dose of gr. xx to ^ss and more. 14. ROSA GAL'LIOA. — RED ROSES. The petals of Rosa Gal'lica, — red, French or Provins rose, Sex. Syst. Icosandria Polygynia ; Nat. Ord. Rosaceae —a native of the south of Europe, but introduced into the gardens of the United States — is extensively cultivated for medicinal purposes. The pe- tals are gathered before the flower has blown, are separated from their white claws or heels, and dried: they have a velvety appear- ance, purplish red colour, and bitterish and astringent taste. Their chief constituents, for which they are valued in medicine, are tan- nic and gallic acids, and colouring matter. Red roses were, at one time, more employed in medicine than at present. They are more largely used, too, in Great Britain than in this country. Their astringent powers are certainly slight; but, owing to their colour, which they impart readily to water, they form elegant vehicles for the administration of other remedies. Hence, the infu- sion of roses, although astringent, is a common vehicle for the sul- phate of magnesia, which is a cathartic. INFU'SUM ROSiE COMPOSITUM, COMPOUND INFU'SION OF ROSES. (Rosa Gallic. §ss; Aqua bullient. Oiss; Acid, sulphuric, dilut. f. giij; Sacchar. iiss.) The astringency of the red rose is imparted to the water, but the main agency is that of the sulphuric acid, ^s above remarked, it is used, especially in Great Britain, as a vehicle for sulphate of mag- nesia, the taste of which it partly covers. Sulphate of quinia may, likewise, be given'in it, —the sulphuric acid dissolving the sulphate, and, at the same time, preventing the tannic acid of the roses from precipitating the quinia. Like sulphuric acid itself, it may be taken VEGETABLE ASTRINGENTS__M0NESIA. 127 in hemorrhages that require the use of astringents, and in the colli- quative sweats of hectic. It is also used occasionally as a gargle, associated_with alum, tincture of capsicum, &c. The dose is from f. 3j to f. ^iij and more. CONFEC'TIO ROSE, CONFECTION OF ROSES, Conserve of Roses. (Ros. Gal- lic, in pulv. ^iv; Sacchar. in pulv. 3xxx; Mel. despumat. ^vj ; Aqua rosa, f. Jviij.) This confection is slightly astringent; but it is now rarely employed excepting as an agent in the formation of pills of active remedies, as calomel, sulphate of quinia, &c. Rub- bed up with syrup, almond or olive oil, and dilute sulphuric acid, it forms a linctus which is an excellent demulcent expectorant, where such is needed. (See Oleum Amygdala, under Expectorants, Vol. i. 238.) It enters into the composition of the Pilula hydrar- gyri of the pharmacopoeias. MEL ROSiE, nONEY OF ROSES. (Rosa Gallic. §ij; Mel. despumat. Oij ; Aquce bullient. Oiss, reduced to specific gravity 1.32 by evaporation.) This is a very old remedy, employed in sore throat, and ulcerations of the lining membrane of the mouth. It is a mild astringent, and is occasionally used as a vehicle for more active applications. It is sometimes, also, added to astringent gargles. 15. MONE'SIA. It is only within the last few years, that this substance has been known in this country. It was introduced from France with high encomiums from several distinguished physicians and pharmaciens of Paris. It is imported into France from South America in cakes or loaves, weighing upwards of twenty pounds, wThich consist of an extract, prepared in South America from the bark of a tree, whose botanical name is unknown. The bark is said to be called, by some travellers, Goharem, and by others, Baranhem; and the botanists who have examined it in South America, think that it is derived from a Chrysophyl'lum. The bark is smooth and grayish, like that of the plane tree, except that it is much thicker : its sweet taste, too, contrasts greatly with the bitterness of the thin laminae of the plane tree. Monesia — the extract — is of a deep brown colour, very soluble in water; and of a taste at first like liquorice, but soon becoming astringent; and leaving behind a well marked and enduring acrid impression, which is experienced especially in the tonsils. When subjected to analysis by Persoz, it was found to contain tannic acid, rendering iron blue, 52 per cent. ; gum or mucilage, 10 per cent.; and sweet matter 36 per cent. The bark and extract of monesia re- semble those of the Quillaia Saponaria : but they are sensibly dif- ferent. The action of monesia on the economy is that of an excitant and 128 SPECIAL ASTRINGENTS. astringent, and as such it may be adapted for many pathological conditions in which such agencies are indicated. It has accordingly been prescribed in the various profluvia, which are of an atonic character, — in chronic bronchitis, and bronchorrhcea; chronic diar- rhoea and dysentery, leucorrhoea, blennorrhoea, and in asthenic he- morrhages— haemoptysis, metrorrhagia, &c. The powdered extract, or an ointment made of it, has been ap- plied to ulcers of a flabby and unhealthy character; and, like every new substance brought forward with lofty pretensions, it has been employed in affections of a heterogeneous character. It is unques- tionably entitled to attention as an astringent; but, already, it has almost passed into disuse. Monesia is generally given in pills, in the quantity of from 12 to 40 grains in the twenty-four hours — the medium dose being 15 or 20 grains, taken at twice or thrice. A Syrup of Monesia may be made of six grains to the ounce of simple syrup, which is adapted for children. A Tincture of Monesia, (Mones. gr. xxxij; Alcohol. dilut. f. ^j ;) may be given in the dose of f. ^j to f. ^ij in any bitter or astringent infusion. It may also be prescribed as an injection in the quantity of f. ^j to f. ^iss to six fluidounces of water. An Oint- ment of Monesia, to be applied to ulcers, may be composed of 3j of Monesia to 3vij of Lard or Simple ointment. 16. MATI'CO. At the meeting of the Provincial Medical and Surgical Associa- tion, held at York in August 1841, Dr. Jeffreys, of Liverpool, intro- duced to the profession an herb called Matico, used in South Ame- rica as a styptic, a short account of which appeared in the London Lancet for Jan. 1839. Since its introduction into England, it has been frequently used, but especially as a styptic, and often with de- cided success. In diseases of the mucous membranes and in hemor- rhages, it has been prescribed internally and with advantage. So long ago as 1834, the author's friend, Dr. Ruschenberger, of the Navy, brought a specimen from South America to the United States. It is there called Yerba del Soldada or Soldier's weed. In Peru, according to a statement kindly furnished the author by Dr. Rusch- enberger, it has a popular reputation of being a wonderfully powerful styptic, and it is said, that soldiers, on going to battle, carry with them a supply to stanch the blood should they receive a wound. The leaf is moistened in the mouth, and then applied. Matico is the Piper angustifo'Hum of Ruiz and Pavon. It evi- dently contains resin and volatile oil; but its exact chemical consti- tuents have not yet been determined. It is chiefly given in infusion of one ounce of the leaves to a pint of boiling water, of which a fluidounce and a half is a dose — and in Tincture — two ounces and a half of the leaves to a pint of dilute VEGETABLE ASTRINGENTS__MATIAS. 129 alcohol; of which the dose is from one to three fluidrachms, two or three times a day. Both solutions may be used as external astrin- gents ; or, to stop hemorrhage, the inner side of the leaf may be pressed upon the bleeding vessel. 17. MATIAS or MALAM'BO. Malambo bark, the source of which has not been positively de- termined, has been long known to, and examined by the French pharmaciens. Mr. Ure is of opinion, that the Matias bark received by him from South America is identical with it, and is described by him, as three or four lines thick, brittle, although somewhat fibrous; of a brown colour, and covered with an ash coloured tuberculated epidermis. It has an aromatic smell, and a bitter pungent taste, which it yields to water and alcohol — the former constituting an agreeable bitter infusion, and the latter a powerful bitter tincture. Malambo bark was analysed by Cadet, and subsequently by Vau- quelin, who found it to contain resin, a light volatile oil, and an ex- tract very soluble in water. No tannic acid was, however, found in it; scarcely any gallic acid; and none of the alkalies of the cinchonas; yetin New Granada, where the tree grows, it is held in high repute as an antipe- riodic and stomachic. Mr. Ure affirms that he has frequently admi- nistered Matias bark, with good effect, as a substitute for cinchona; and Dr. Mackay states, that he has witnessed good results from its em- ployment in cases in which an aromatic tonic was needed. An infu- sion may be made with two drachms of the bark to a pint of water; the dose of which is one or two fluidounces, repeat- ed two or three times a day in cases where a bit- ter stomachic is needed. Besides agents already Ufcwpyros Virginia™. described, the Pharmacopoeia of the United States has admitted into its secondary list the following astringents. 18. Dios'pyros, Persim'mon. This is the bark of Dios'pyros 130 SPECIAL ASTRINGENTS. Virginia'na; Sex. Syst. Dioecia Octandria; Nat. Ord. Ebenaceae; an indigenous tree, well known in the southern and middle States, flowering in May or June, and producing a berry,which, in the green state, is exceedingly astringent; but, when ripe, is sweet, mawkish, and cloying. The unripe fruit has very recently been re- commended in infusion, syrup, and in vinous and acetous tinctures, by Dr. Mettauer, of Virginia. The bark, wdiich is the officinal portion, is astringent and very bitter, and is adapted for cases in which a combination of astringent and bitter agents is needed. Fig. 18. 19. Geum, Water Avens — the root of Geum riva'le, de- scribed under Tonics, as in- digenous in the United States — is often used as an astringent in the cases so often mentioned already, as requiring astrin- gents. The dose of the pow- dered root is from £)j to jj ; but it is usually employed in decoction ; (Gei, 3jj; Aqua, Oj. Dose f. gj or f. gij.) 20. Heuche'ra, Alum root —the root of Heuche'ra cortu'sa, H. America'na, American San'icle; Sex. Syst. Pentandria Digynia; Nat. Ord. Saxi- frageae ; a plant found in the middle States, flowering in June or July. The root has a powerfully astringent taste, and — as well as the roots of other species of Heuchera — may be given in the same cases as vege- table astringents in general. 21. Rhus Glabrum, Sumach. This is the fruit or berries of Rhus glabrum, Smooth sumach, or Upland sumach; Sex. Syst. Pentandria Trigynia; Nat. Ord. Terebinthaceae; found every where in the United States. It is astringent, and is Heuchera acerifoiia. sometimes used in infusion as a gargle in sore throat. The inner bark of the root, which also possesses astringent virtues, may be used as a collutory in mercurial ptyalism, and various forms of stomatitis. VEGETABLE ASTRINGENTS__STATICE. 131 22. Rubus Trivia'lis, Dew'berry Root; and 23, Rubus Villo'sus, Black'berry Root; Sex. Syst. Icosandria Polygynia; Nat. Ord. Rosacere; are the roots of well known plants, whose berries are much used as food. The main bitterness and astringency appear to reside in the bark of the root. It is rarely given in substance, but if this be desired^ the dose may be twenty or thirty grains. It is com- monly, however, prescribed in decoction, (Ru0. trivial, vel R. villos. gj ; Aqua, Oiss. Boil to a pint. Dose, f. gj to f. |ij, repeated according to circumstances,) in chronic diarrhoea and dysentery, and wherever the vegetable astringents are indicated. Dr. Wood speaks favourably of it in the chronic diarrhoea Yla. 19. both of adults and children. 24. Rumex Britan'nica, Water Dock; and 25, Rumex Obtusifo'lius, Blunt- leaved Dock; Sex. Syst, Hexandria Tri- gynia; Nat. Ord. Polygonaceae. The root alone of these docks is officinal. The plants are common in the United States ; and the roots are possessed of astringent and tonic properties. They may be given in decoction, (Rumicis, ^j ; Aqua, Oj. Dose, f. ^j to f. ^ij) but are rarely em- ployed. Rumex crispus, a common species, is possessed of similar properties. 26. Spirje'a, Hardhack. The root of Spira'a tomento'sa; Sex. Syst. Icosandria Pentagynia ; Nat. Ord. Rosaceae. It is astringent and tonic, and employed in the same cases as the last. The best form perhaps of administration is the decoction, (Spiraa, ^j ; Aq. bullient. Oj. Dose, f. lj tof. 5ij.) 27. Stat'ice, Marsh Rosemary, The root of Stat ice Carolinia'na ; Marsh Rose- mary or Sea Lav'ender; Sex. Syst. Pentan- dria Pentagynia; Nat. Ord. Plumbagineae ; is a powerful astringent; and although not much used in Philadelphia, and scarcely to be found in the shops, is regularly kept by the druggists in Boston, and other parts of New England, where large Spir*a tomentbsa. quantities of it are sold annually. It is certainly, according to all testimony, a valuable astringent, and well adapted for cases in which the vegetable astringents are prescribed; It has been J 32 SPECIAL ASTRINGENTS. analysed by Mr. Edward Parrish, of Philadelphia, and found to Figj 20. contain, amongst other less im- portant matters, 12.4 per cent, of tannic acid — a much smaller quantity than exists in many other astringents ; with extractive matter, to which its bitterness is due. Decoction would appear to be the best form of preparation. 28. CREASO'TUM. — CRE'ASOTE. Creasote — whose main pro- perties have been described else- where, (Vol. i. 490,) owing to its powTer of coagulating albumen, as well as of exciting the vessels, with which it comes in contact, to contraction — has been employed as an indirect astringent in cases of hemorrhage; and is said to have been beneficial in haemop- tysis. In haematemesis, too, it has succeeded after the remedies, ordinarily prescribed, had been employed without effect. It has been prescribed, also, with ap- parent advantage as an internal remedy in leucorrhoea, and bron- chorrhoea; and Dr. Elliotson ac- complished a cure in two cases of chronic glanders, in the course of a few weeks, by the sedulous use of an injection of a dilute solution, (one drop to a fluidounce of water,) thrown up the affected nostril, combined with the internal use of the remedy. In vomiting, not arising from inflammation or other organic disease of the stomach, creasote has been very efficacious; and even in Asiatic cholera and sea-sickness, it appeared to allay the vomiting. In the vomiting of the pregnant female, and in that originating from nervous excitability, it was equally beneficial. The testimony in regard to it has, however, been discordant. Drs. Elliotson, Shortt, A. T. Thomson, and Christison, consider it to be a valuable means of arresting vomiting. Drs. McLeod and Pereira speak doubtfully of it, and with Dr. Paris it entirely failed. The author's success has been by no means striking. Frequently, it has been devoid of effi- cacy, and in many cases it developed irritability of the stomach, when it did not previously exist. To very impressible persons, in- stance Caroliniana. VEGETABLE ASTRINGENTS__TAR-WATER. 133 deed, its odour and taste are extremely repulsive, and apt to produce nausea and vomiting. Externally applied, creasote is a valuable styptic. It was discovered at a time when the Acqua Binelli enjoyed more confidence as a styptic than it does now; and the fancied pro- bability that the nostrum was indebted to creasote for its virtues gave rise to many experiments with the latter in cases of hemorrhage. For a detail of some of these the reader is referred to the author's New Remedies, 4th edit. p. 210, Philad. 1843. When placed in contact with a bleeding vessel, it coagulates the albumen of the blood, thus forms a clot, and at the same time causes contraction of the bleeding vessel. It has been used extensively as a haema- static, in epistaxis, bleeding from leech bites, and hemorrhage from large wounded surfaces; as an astringent in profuse suppu- ration, and in excoriations of children, as well as in those induced by lying; in gonorrhoea and leucorrhoea, in ophthalmia tarsi, or in prolapsus vaginae, besides the various morbi externi, mentioned under Excitants, (Vol. i. p. 491,) in which its remedial agency wras rather excitant than astringent. The dose of creasote, as an astringent, is one or two drops, seve- ral times a day, well diffused through mucilage of gum arabic It is proper to remark, that a fluidrachm contains one hundred and fifty drops of creasote. It is best given in the form of pill, with crumb of bread and mucilage as the excipients. As a topical application, it maybe mixed with water, with or without the addition of alcohol. Creasote water, as it is termed, is usually made with one part of creasote to eighty of water, and it is sufficiently strong for most pur- poses as a lotion or injection ; if not, the strength must be increased. A few articles, not in the Pharmacopoeia of the United States, have been supposed to owe a portion of their medicinal efficacy to crea- sote ; viz:— 29. Fuli'go or Wood Soot. — A decoction of this has been used as an astringent in the form of injection, in cases of cystirrhoea, and, it is said, with advantage. M. Andre Gibrin took from the chimney two ounces of compact soot, broke it up, washed it, and boiled it in a pint of water. After filtration, this was injected into the bladder twice a day. It has likewise been used as an injection in cases of chronic inflammation of the mucous membrane of the vagina. 30. Ac"idum Ace'ticum Empyreumat'icum, Pyrolig'neous Acid, is prepared in chemical laboratories by the dry distillation of wood. The chief constituent of this is vinegar. It has been occasionally used in affections of the mucous membranes accompanied by dis- charges ; but it is more employed as an antiseptic. 31. Aqua Picis Liq'uidas, Tar water; at one time so much ex- tolled by Bishop Berkeley, and of late recommended in phthisis, but vol. n.—12 134 SPECIAL ASTRINGENTS. more especially in chronic bronchitis; in the latter of which affec- tions it is found to act like the generality of excitant expectorants. (See Vol. i. p. 234.) It may be made by digesting an ounce of tar in a quart of water for eight days, and then filtering. It may be taken with milk, to the extent of from eight to twelve ounces in the day. It has likewise been used with advantage as an injection into the bladder, in cases of cystirrhoea, along with pills of turpentine. In this case, it was made by infusing for a night, in the cold, a pound of tar in ten pints of spring water, filtering and warming the solution before using it. Large quantities were injected through an elastic gum catheter, which was forthwith withdrawn,, and the patient directed to retain the injection as long as possible. This was re- peated daily. For further particulars in regard to the preparation and properties of these agents, see the author's New Remedies. II. Mineral Astringents. 32. ALU'MEN.—ALUM. Alum or Potash alum, Sulphate, or Super'sulphate of alu'mina, is a double salt, consisting of sulphate of alumina and sulphate of po- tassa. It is found native, as an efflorescence from certain rocks and soils principally in volcanic countries, and is termed Native alum; but is chiefly prepared artificially from Alum slate—a rock which contains, in considerable proportion, sulphur, iron and alumina. Either by spontaneous decomposition, or by roasting, the sulphur receives oxygen and is converted into sulphuric acid, whence result sulphate of iron and sulphate of alumina. These are obtained in solution by lixiviation; and, to the liquor, sulphate of potassa is added. The sulphate of iron is got rid of by repeated crystallisation. Alum is manufactured in this manner to a great extent in various parts of Europe ; whence it was, at one time, exported in conside- rable quantities to this country. Of late years, however, it has been made on an extensive scale by the chemists of the United States, and is sufficiently pure, as furnished by them, for medicinal pur- poses. It is consequently placed in the materia medica list, not only of the Pharmacopoeia of the United States, but of those of Great Britain. The method generally adopted in this country consists in the direct combination of sulphuric acid with clay. It is made, however, in Baltimore on an extensive scale by burning an ore, found at Cape Sable, on the Magothy river, Maryland, which con- sists of lignite, clay, sulphuret of iron and .sand. To the solution, obtained by lixivating the ashes, sulphate of potassa is added ; and crystals are obtained by evaporation. (Wood & Bache.) As met with in the shops, alum is generally in broken fragments of crystals; which are transparent, colourless, of a sweetish astrin- gent taste, and slightly efflorescent. It usually crystallises in regu- MINERAL ASTRINGENTS___ALUMEN. 135 lar octohedrons, frequently with truncated edges and angles, and sometimes in cubes. The size of the crystals is at times very large, and the author possesses magnificent specimens, made at the manu- factory of Tyson & Ellicott, in Baltimore. Dr. Christison states, that at Hurlet, near Paisley, which has been long celebrated for the manufacture of this salt, it has sometimes crystallised in columns two feet in length, weighing fifteen pounds, and consisting of a pile of octohedrons of great size. It dissolves in from fifteen to eigh- teen times its weight of cold water, and in less than its own weight of boiling water. Such are the main characters of the alum of the shops. A va- riety of alum from Italy, called Roman alum, is covered with a rose coloured efflorescence containing oxide of iron ; and another called Roche or Rock alum, from Roccha in Syria, is coloured with rose- pink. They are not used in medicine. The only impurity, which alum is apt to contain, is oxide of iron; the presence of this is detected by precipitating the solution with potassa, and redissolving the alumina by an excess of the alkali; — sesquioxide of iron is left. Alum is a powerful astringent, and as such is used both internally and externally. In haematemesis, and haemoptysis, it has been given in large doses, and, in the former affection especially, with great advantage, inasmuch as it can come in contact with the vessels ex- haling the blood, and act as a styptic. In all forms of internal he- morrhage, it has been given ; and in all increased discharges from mucous membranes, especially those from the stomach and bowels. In one disease of the bowels, — lead colic,— it has been recom- mended, but it is not easy to see on what principle. By some, it has been supposed to act on the lead presumed to be in the sto- mach, so as to form an inert sulphate of lead ; but this is a mere supposition. On the same principle, sulphuric lemonade has been recently advised. One observer, M. Gendrin, — affirms, that he has cured more than three hundred cases by administering daily from a drachm to a drachm and a half of sulphuric acid diluted in three or four pints of water ; and it is said to have been an effica- cious prophylactic against the disease in the laboratories of Paris. The experience of Gendrin has been corroborated by that of others; but the same agent has been found entirely useless by some. The truth would seem to be, that the disease, in many cases, terminates in health under very simple management. Of thirty-one cases, in which nothing but the ordinary tisane of the French hospitals was given for twelve days, three were cured by the fourth day ; two be- tween the fifth and eighth days ; ten between the eighth and twelfth days, and one on the thirteenth day. The remaining cases were subjected, after the twelfth day, to purgative treatment, under which they were speedily cured. It is said to have wonderful influence in allaying the tormina, and nausea and vomiting that attend upon the disease. 136 SPECIAL ASTRINGENTS. Alum has, likewise, been given freely in the colliquative sweats of phthisis, and in diabetes ; but in neither case can it be pre- sumed to act more than as a palliative. It appears to be adapted for all affections in which powerful astringents are deemed necessary. As a topical application, also, it is in extensive use. It enters into the composition of astringent gargles and collutories, injec- tions, and lotions for the treatment of relaxation of mucous mem- branes. It is an excellent styptic to constringe vessels that are allowing blood to escape from them, either by division or by trans- udation ; hence it is used as a styptic in hemorrhage from the nose, rectum or vagina, — a solution being injected; or lint, or rags, or sponge moistened with it being introduced into those out- lets. In the first and last affection, the author has found it neces- sary, more than once, to dip moistened lint in powdered alum and introduce it. A saturated solution forms a good application to leech bites; but where the bleeding is obstinate, it may be necessary to apply the powdered alum itself. As a collyrium, alum is often prescribed, and as a wash in inflam- mations in general. When the remedy is unsuccessful in the early stages, it may even augment the inflammation ; but after the inflam- mation has become- chronic, its agency is gradually beneficial, and is exerted in the manner elsewhere mentioned of excitant applications. Alum may likewise be used as an astringent wash to ulcers that are attended with too copious a secretion, or that are flabby and ill- conditioned. Of late, the insufflation of alum has been recommended in cases of diphtheritis. About a drachm of the fine powder is placed in a tube, and blown into the patient's throat. It is, also, occasionally applied to the throat, by means of the finger, when affected with other forms of inflammation and ulceration. The alum appears to possess the property of dissolving false membranes, whilst, at the same time, it induces a new action in the parts beneath. Alum lotions are fre- quently of service in various forms of stomatitis. The ordinary dose of alum, as an internal remedy, is from gr. x to 9ij ; but in lead colic, it is sometimes prescribed in the dose of 3SS to gij. It may be given in pill, with the extract of gentian as an excipient. It is sometimes prescribed in the form of Alum whey, which is made by boiling 31J of powdered alum in a pint of milk, and straining. The dose of this is a wine-glassful. As a collyrium, it may be used in the quantity of one to eight grains dissolved in an ounce of rose water ; and in injections and lotions the strength must vary according to the object which the practitioner has in view. It is occasionally applied in ophthalmia in the form of the Cataplasma Aluminis of the Dublin Pharmacopoeia, which is made by briskly agitating two whites of eggs with a drachm of alum. In cases of chronic and purulent ophthalmia it is placed between folds of linen and pplied to the eye. It has also been recommended as a good MINERAL ASTRINGENTS__PLUMBI ACETAS. 137 application to unbroken chilblains. A poultice, made of the curd resulting from coagulating milk by means of alum, is sometimes used. 33. PLUMBI ACE'TAS.—ACETATE OF LEAD. Ac"etate of lead, Sugar of lead, Ac"etated Cerusse, Superad'etate of lead, Sadcharum Satur'ni, is made on the large scale by the manufacturing chemist, and is, therefore, with much propriety, placed in the materia medica list of the Pharmacopoeia of the United States. The pharmacopoeias of London, Edinburgh and Dublin, however, contain formulae for its preparation, which consist in dis- solving litharge or protoxide of lead, or carbonate of lead, in diluted acetic acid, and crystallising. On the large scale, it is made by hanging lead plates in distilled vinegar or diluted pyroligneous acid. A saturated solution of protoxide of lead may be formed in this way, and the acetate is obtained by evaporation and crystallisation. Acetate of lead of the shops appears as a mass of needle-like crystals, which are transparent, colourless, and belong to the oblique prismatic system. (Pereira.) The taste is at first sweet, and after- wards astringent, and it has an acetous odour. In a dry and warm atmosphere, it slightly effloresces, and is apt to be decomposed by the carbonic acid of the air, and to become partially insoluble. Temperate wrater dissolves about four-fifths of its weight, according to one observer, (Turner;) two-fifths, according to another. It is soluble, likewise, in alcohol. When dissolved in water, owing to the fluid containing carbonic acid, a carbonate of lead is formed, which renders it turbid. This may be prevented, however, by the addition of a few drops of acetic acid. It is not often adulterated. Acetate of lead, in large doses, is a violent poison of the irritant class. In smaller doses, when continued for any length of time, it may give rise to the peculiar symptoms of lead poisoning. Yet it has been repeatedly prescribed by the author, and by a large num- ber of respectable observers, in considerable quantities, without the supervention of any such results. Its effect upon the system is pre- ceded by a narrow leaden blue line, which is seated at the edges of the gums, where they are attached to the neck of two or more of the teeth of either jaw. Dr. Burton has recently pointed out this symp- tom ; and Dr. Pereira states, that in every case of lead colic that has fallen under his care, he has observed this line, and in most of the cases it was accompanied by abdominal pain, The view of Dr. A. T. Thomson was, that acetate of lead becomes poisonous by being converted into carbonate in the stomach, and he affirmed, that if it be associated with vinegar, it may be administered freely, and with safety. Dr. C. G. Mitscherlich, however, has shown, that acetate of lead is a poisonous salt. And that when mixed with acetic acid it is more energetic than when given in the neutral state. It is now much employed as a sedative astringent in various forms of hemor- rhage ; and alone, or associated with opium, is highly esteemed by 12' 138 SPECIAL ASTRINGENTS. several practitioners, although in many cases the good effects are more ascribable to the general principles of treatment combined with it. It has, also, been freely prescribed in chronic diarrhoea and dysentery, as well as in cholera, cholera morbus, and cholera infan- tum. Some practitioners have extolled it highly in the first of these affections. In phthisis, it has been used, of course only as a pallia- tive, for checking colliquative sweats, and diarrhoea ; and both in that disease and in chronic bronchitis, it has seemed, according to some, to diminish profuse expectoration. In the irritability of stomach, that sometimes forms part of the phenomena of remittent and yellow fever, sugar of lead has succeeded when other remedies had failed. As a topical application it is much employed. It has been used as a wash to check profuse ptyalism induced by mercury, and in aphthous stomatitis, care being taken to wash the mouth well after- wards, to prevent the teeth from being blackened. It is, likewise, applied to inflamed parts — to phlegmonous and erysipelatous in- flammation, conjunctivitis, &c. ; and is used as an injection in gonor- rhoea, leucorrhoea and gleet. Cautions have been given against its use in the ulcerations of the cornea, that attend purulent and pus- tular conjunctivitis, as it forms a white compound, which is deposit- ed in the ulcer, to which it adheres tenaciously, and in the healing becomes permanently imbedded in the structure of the cornea. The dose of acetate of lead is from one or two grains to six or eight, repeated several times a day, in the form of pill, or, as sug- gested by Dr. A. T. Thomson, in diluted distilled vinegar, to pre- vent its conversion into carbonate. It is often associated with opium, both for internal and external exhibition; and Dr. Christison affirms, that for erythema and erysipelas, one of the best forms of applica- tion is a lotion composed of four grains each of acetate of lead and opium, to every ounce of water. A decomposition always takes place — meconate of lead being deposited, and acetate of morphia remaining in solution. The author has seen sulphuric acid pre- scribed as an astringent along with acetate of lead, — which must have been owing to gross ignorance or inadvertence, inasmuch as the sulphate of lead formed is wholly inert. When acetate of lead is used as a collyrium, the strength may be from one to five grains to an ounce of water or of rose water. This may be dropped be- tween the eyelids, or be applied by means of an appropriate eye- glass ; — or rags constantly wet with it, or a cataplasm of crumb of bread, to which it has been added, may be applied to the inflamed part. To inflammations of the cutaneous surface it may be ap- plied in the same way; but the lotion may be made much stronger, — for example, ten to twenty grains to the ounce ; and it may be used in the same proportion, as an injection, in cases of chronic diarrhoea and dysentery, and in leucorrhoea. In gonorrhoea, the strength may vary from gr. v to jss and more to the ounce. LIQUOR PLUMBI SUBACETA'TIS, SOLUTION OF SUBACETATE OF LEAD. (Plumb, acetat. ^xvi; Plumb, oxid. semivitr, in pulv. 5ixss; Aq. MINERAL ASTRINGENTS___ACIDUM SULPHURICUM. 139 destillat. Oiv. Boil for half an hour, adding distilled water so as to preserve the quantity. Filter.) The semivitreous oxide of lead, commonly called litharge, is a protoxide of lead ; so that when it is boiled with acetate of lead, a large quantity of it is dissolved, and the subacetate results. This has been long known under the name of Goulard's Extract. As directed by the Pharmacopoeia of the United States, it is a colourless liquid ; s. g. 1.267. Carbonic acid — even that which is contained in water — occasions a precipitate of carbonate of lead, and the same result ensues from exposing it to air; hence it is properly directed to be kept in closely stopped bottles. Solution of subacetate of lead is used externally only, and in the same cases as a solution of acetate of lead. It is rarely employed except in cases of external inflammation, such as that which charac- terises sprains, burns, or ordinary phlegmonous or erysipelatous in- flammation. It is always, howrever, diluted ; and is directed to be kept in the shops in the form, also, of LIQUOR PLUMBI SUBACETATIS DILU'TUS, DILUTED SOLUTION OF SUBACETATE OF LEAD, or LEAD WATER. (Liq. plumbi subacetat. f. 31J ; Aq. destillat. Oj.) This is Goulard's Vegeto-mineral water, or Goulard, and is used in the cases above mentioned ; cloths being kept constantly wetted, and applied to the inflamed parts. 34. ACIDUM SULPHU'RICUM.— SULPH'URIC ACID. Sulphuric acid — whose properties are detailed under the head of Tonics, (Vol. ii. 70,) — is possessed of astringent virtues ; and, as such, is frequently prescribed in atonic hemorrhages — especially in those that proceed from the lining membrane of the intestines — singly or combined with sulphate of magnesia, and under the viewTs elsewhere given, (Vol. i. 151.) It is also prescribed in the colliqua- tive sweats of phthisis as a palliative, often associated with opium, (Acid, sulphur, dil., Tinct. opii, aa partes aequales. Dose, ten drops every three or four hours.) In chronic diarrhoea and dysentery, it has been administered, but is not had recourse to frequently. It is prescribed in the form of ACIDl M SULPHU'RICUM DILU'TUM, DILUTED SULPH'URIC ACID. (Vol. ii. 70,) of which the dose is ten drops, three or four times a day, in water, or of AC IDUM SULPHU'RICUM AROMAT'ICUM, AROMATIC SULPH'URIC ACID, or ELIXIR OF VITRIOL, (Vol. ii. 70,) the dose of which is the same. Diluted sulphuric acid is sometimes applied externally to arrest ca- pillary hemorrhage, as in wounds, epistaxis, &c. It is likewise employed, when properly diluted, as an astringent gargle in relaxed sore throat, in ulcerations of the mouth and throat, and in ill-con- 140 SPECIAL ASTRINGENTS. ditioned ulcers in general, — as well as to check ptyalism, when profuse. 35. ARGEN'TI NITRAS. —NITRATE OF SILVER. Nitrate of silver, whose properties have been described under Tonics, (Vol. ii. 66,) is rarely given internally as as astringent. It is sometimes, however, prescribed in chronic diarrhoea and dysen- tery, and, it is said, with benefit. The author has used it, but has not been satisfied that it possessed any special advantage in such cases. It may be given either alone or associated with opium. It was elsewhere remarked, that whenever nitrate of silver comes in contact with chlorohydric acid, or a chloride, it is decomposed,— and that as the acid exists in health in the stomach, and chloride of sodium is present in most of the secretions, chloride of silver must be formed in the stomach, and perhaps the beneficial effects, ascribed to the nitrate as an internal remedy, may properly belong to the chloride. Under this idea, chloride of silver was given in the wards of the Philadelphia Hospital by one of the resident physicians, Dr. Perry, now of Philadelphia, and, in his opinion, with advantage. The author has also frequently prescribed it; and on the whole it has appeared to him" to be equal to the nitrate in chronic diar- rhoea and dysentery, and in other cases in which the nitrate of silver is indicated as an astringent. It is, however, as an external astringent that nitrate of silver is most employed. Independently of its action as a caustic and pow- erful topical excitant, to be described hereafter, it is used as a gen- tly excitant astringent in local inflammation, especially of the con- junctiva. It may be applied as a collyrium in the strength of a grain or two to the fluidounce of distilled water, and may be employed even in the acute stage of the inflammation, although it is most decidedly beneficial in the chronic stage. It is sometimes used in similar cases in the form of ointment, — from two to ten grains of the ni- trate to an ounce of lard, or of simple ointment, — and a piece, the size of a pin's head, and even larger, being introduced between the. eyelids by means of a camel's hair pencil. Warm fomentations are used at the same time, and the. application of the ointment is re- peated every third day. It is not often employed, however, in this mode, in ordinary ophthalmia. In the purulent variety it is pre- scribed both in the acute and chronic stage, but especially in the latter. In the variety of ophthalmia that affects the tarsi, this oint- ment is often highly beneficial, applied by means of a camel's hair pencil to the tarsal cartilages. A lotion, consisting of from five grains to twenty of the nitrate to the ounce of water, is often of great advantage in stomatitis and pharyngitis accompanied by ulcerations : the solid nitrate is even required at times ; and it has been passed over the tongue so as to reach the lining membrane of the larynx in chronic laryngitis and the pharynx in diphtheritic pharyngitis. In cases of chronic diar- rhoea or dysentery, that appear to be dependent upon ulceration of MINERAL ASTRINGENTS__CUPRI SULPHAS. 141 the rectum, the lotion may be thrown up in the way of injection. In gonorrhoea and leucorrhoea of the female, nitrate of silver has been used both in solution (gr. iij — xxto an ounce of water) and in the solid state ; but at times, serious inflammation results from the latter form of application. In the gonorrhoea of the male, the solu- tion may be used ; and occasionally an ointment proves effectual, applied around a bougie ; but inflammation of the urethra some- times results from it. (Pereira.) It can be readily understood, that in a variety of ulcers, and chro- nic cutaneous diseases, the excitant effects of this powerful agent may be advantageous. The dose of nitrate of silver, as an internal astringent, is from an eighth to half a grain, gradually increased to three or more, twice or thrice a day. Extract of gentian may be the vehicle. The oxide of silver has been given by Mr. Lane with success in uterine hemorrhage both in the impregnated and unimpregnated state ; and, recently, Sir James Eyre has strongly recommended it in the treatment of profuse menorrhagia. According to his expe- rience, it is superior to ergot, gallic acid, and, indeed, all other remedies. The dose is half a grain three times a day, gradually augmented to one or two grains. 36. CUPRI SULPHAS. _ SULPHATE OF COPPER. Sulphate of copper, whose general properties are described else- where, (Vol. i. 114,) has been advised as an astringent in chronic diarrhoea and dysentery, and it is said to have proved successful when the ordinary vegetable astringents had failed. Dr. Pereira states, that he has employed it with most excellent effects in the chronic diarrhoeas of infants, in doses of one-twelfth of a grain. It has likewise been given in increased discharges from other mucous membranes. Sulphate of copper, as an external agent, is used in the same cases as nitrate of silver, and especially in inflammation of the conjunctiva, of the mucous membrane of the mouth and fauces, and of the genito-urinary apparatus both of the male and female. In gangrenous stomatitis, commonly called cancrum oris, it has been highly recommended by Dr. B. H. Coates, of Philadelphia. Solid, or in solution, it is an excellent stimulant to ill-conditioned ulcers ; and superficial ulcerations often heal very readily by a single appli- cation, either of the sulphate of copper, or of the nitrate of silver in substance. This is strikingly the case in the superficial ulcera- tions often caused by stomatitis. A strong solution (gr. xx to xxx to the ounce of water) is em- ployed as a styptic in cases of capillary hemorrhage, as from leech bites ; and sometimes the powdered salt is required to repress the flow. The dose of sulphate of copper, as an internal astrin- gent, is an eighth or a quarter of a grain, made into pill with crumb 142 SPECIAL ASTRINGENTS. of bread or extract of gentian, and given two or three times a day. A grain or two to the ounce of distilled water forms a good excitant astringent collyrium ; and lotions may vary in strength from twTo to fifteen grains or more. The lotion, used by Dr. Coates in gangre- nous stomatitis, consists of sulphate of copper 31J ; powdered bark §ss ; water f. ^iv. 37. TINCTU'RA FERRI CHLO'RIDI.— TINCTURE OF CHLORIDE OF IRON. Tincture of chloride or muriate of iron, described elsewhere as a tonic, (Vol. ii. 54,) is likewise a powerful astringent, both when ad- ministered internally and externally. In cases of haematemesis, it comes in contact with the vessels that exhale the blood, and may therefore act as an external styptic ; but it has likewise been extolled in hemorrhage of the asthenic kind from other parts, as from the uterus and urinary organs. It has also proved beneficial in cystir- rhoea, and in gleet; and some have presumed, that it may have a specific influence over the whole of the urinary apparatus, " for on no other supposition can we explain the remarkable effects which it sometimes produces in affections of the kidneys, bladder, urethra, and even of the prostate gland;" yet Dr. Pereira, from whose excel- lent pharmacological work this quotation is made, shows, that such is not the verdict of the profession, and it would be strange if it were. It may be averred with confidence, that we have not in the lists of the Materia Medica any therapeutical agent, which possesses such influence on any organ. Dr. Pereira affirms, that he has found the tincture occasionally successful, when given in conjunction with tincture of cantharides, in the latter stage of gonorrhoea, after a variety of other remedies had failed. Tincture of chloride of iron is likewise used as an external styp- tic in capillary hemorrhage, and as a local astringent in bleeding ulcers, as well as in those that are accompanied by profuse secretion. The dose is from ten to thirty minims, which may be gradually augmented to f. 3j or f. 3ij twice or thrice a day, in some diluent. 38. FERRI NITRAS. —NITRATE OF IRON. A solution of nitrate of iron — the persesquinitrate — Liquor Ferri Persesquinitra'tis has been introduced, of late years, into notice chiefly as an astringent. It is made by dissolving small pieces of iron in nitric acid, and adding a little muriatic acid, to prevent the persesquinitrate formed from undergoing decomposition, according to the following formula. Take of small chips or pieces of iron wire, |iss; nitric acid, f. siij ; water, f. §xxvij ; muriatic, acid, f. 3J. Put the iron into an earthenware vessel, and pour on the nitric acid, previously diluted with fifteen fluidounces of the water. Set aside until the whole of the nitric acid has united wdth the iron ; decant the liquid MINERAL ASTRINGENTS__ZINCI SULPHAS. 143 from the undissolved iron ; strain, filter, and add the remainder of the water with the muriatic acid ; or as much of the water as will make the whole solution thirty fluidounces. The solution of persesquinitrate of iron resembles the tincture of chloride of iron in its medical properties. It has been used as an astringent in chronic diarrhoea, and in affections of the mucous mem- branes in general that are accompanied by discharges. It has been advised in cases of aphthous sores, and is said even to have relieved toothache. It is, unquestionably, a powerful astringent, but it is doubtful whether it possess any advantage over the tincture of chlo- ride of iron. The dose of the solution, prepared according to the form given above, is ten or fifteen drops, gradually increased to twenty or twenty-five drops, three or four times a day. It has been consi- dered to be especially adapted for diminishing irritability and tender- ness of the mucous membranes with which it comes in contact. 39. FERRI SULPHAS. —SULPHATE OF IRON. Sulphate of iron — whose chief properties are described under Tonics, (Vol. ii. 58,) is an astringent, and as such has been prescribed in the cases in which the tincture of chloride of iron is indicated. It is given internally in all the forms of asthenic discharges from mucous membranes ; and externally is employed in collyria, lotions to inflamed parts in general, and injections. The dose of the sulphate, as an astringent, is from one to five grains, in the form of pill. If administered in solution, the water should be recently boiled, to expel the air contained in it, the oxygen of which wTould convert the salt into a persulphate. As a collyrium, a grain or two may be dissolved in an ounce of water. Lotions may of course be made of various strengths to suit the particular case : as a general rule, however, from four to ten grains to the ounce of water will be sufficient. In leucorrhoea and prolapsus ani, the quantity of the sulphate may be doubled or trebled. It is not very much employed, either as an external or internal astringent. 40. ZINCI SULPHAS. —SULPHATE OF ZINC. Sulphate of zinc — whose general properties have been described under the head of Emetics, (Vol. i. 114,)—is occasionally given internally, as an astringent, in the same cases as acetate of lead; but it is not very frequently prescribed. It is more often, perhaps, used- in chronic mucous discharges, especially chronic catarrh, chronic gonorrhoea and leucorrhoea; and Dr. Christison affirms, that he has often prescribed it with the best effects in obstinate chronic gleet, in doses varying from three to six grains, twice or thrice a day. It is most frequently used as an external astringent, and as such forms a convenient collyrium, more especially in cases of chronic or of purulent ophthalmia. It is likewise prescribed, as an injection, in 144 SPECIAL ASTRINGENTS. gonorrhoea, leucorrhoea, and in gleet; and is applied as a lotion in aphthous affections of the mouth, and in relaxation of the uvula, and of the mucous membrane of the isthmus faucium ; but its disagreeable and enduring taste prevents it being much used in the last cases. A solution of sulphate of zinc is often applied to external inflamma- tions, and as a wash to ulcers attended with too copious a discharge. The dose of sulphate of zinc, as an internal astringent, is from gr. j to gr. vj in the form of pill. As a collyrium, the proportion may be gr. j to gr. x. to an ounce of water; — as an injection in gonor- rhoea, gr. v to gr. x; and in leucorrhoea from gr. x to gr. xx. As a wash to ulcers and to external inflammations, the proportion may be the same. 41. CRETA. — CHALK. Chalk or native friable carbonate of lime is met with in abundance in various parts of Europe, whence it is exported to this country. It is not found native, however, in a state fit for medical purposes, but requires washing to separate it from the gritty particles which it contains. It then forms the CRETA PRiEPARA'TA of the pharmacopoeias. When pure, it is wholly soluble in dilute chlorohydric acid with effervescence ; and the solution yields no precipitate with ammonia. It is devoid of taste and smell. It is almost insoluble in wrater, and much more soluble in carbonated water. When applied to the tongue, it adheres slightly to it. Chalk is used as an indirect astringent to the intestinal canal, probably on account of its absorbent properties. It certainly di- minishes the'number of alvine discharges, and, like argil, seems to form salts with the gastric acids that are binding. It is much used for checking diarrhoea, either alone or combined with opium, or with true astringents — as kino and catechu. As a local application, it is dusted on inflamed parts, whose surface it covers and protects from the desiccative and irritating action of the air. Dusted on excoriations, ulcers, burns, scalds, &c, it ap- pears to be beneficial by absorbing ichorous or other discharges. When given in powder, the dose is gr. x to ^ss or 3J, frequently repeated. MISTU'RA CRETJI, CHALK MIXTURE. (Creta prceparat. ps ; Sacchar., Acacia pulv. aa 31J; Aqua Cinnam., Aqua, aa f. |iv.) This pre- paration is very much used in diarrhoea, especially when accompanied with predominance of acid. The tincture of opium, or the infusion of kino or of catechu, is frequently associated with it. The dose is f. ^ss to f. ^ij. 42. TESTA PRIEPARA'TA. —PREPARED OYSTER SHELL. This is made by freeing oyster shells from extraneous matter, MINERAL ASTRINGENTS___LIQUOR CALCIS. 145 washing them with boiling water, and reducing them to powder by levigation. Prepared oyster shell is really only carbonate of lime, intimately associated with animal matter. It does not differ, consequently, in its medical properties, from chalk. The animal matter is supposed, by some, to render the carbonate of lime more acceptable to the stomach; but it is doubtful whether it possess any such agency. It is still retained in the Pharmacopoeia of the United States, but has been expunged from that of Edinburgh; and Dr. Christison states, that there is no other reason for any British College retaining it, than that in some places it is more easily obtained than other forms of carbonate of lime. 43. LIQUOR CALCIS. —LIME WATER. Lime water — which is prepared by pouring a gallon of water on four ounces of quicklime, and preserving the solution in stopped glass bottles — is a solution of lime in water; and the object of pro- tecting it from the air is to prevent the access of carbonic acid, which would unite with the lime, and form a carbonate of lime, that would be deposited. Like chalk, lime water possesses the power of diminishing the number of alvine evacuations, and is therefore employed in cases of diarrhoea, especially when accompanied by acidity. It has, likewise, been prescribed in diabetes, and in other cases in which an internal astringent is needed. It possesses the power of corrugating and indurating animal matters. In vomiting, induced by irritability of the stomach, and perhaps owing to too much secretion of acid, lime water mixed with an equal quantity of milk has been one of the best remedies ; and Dr. Wood states, that he has found a diet exclusively of lime water and milk more effectual than any other plan of treat- ment in dyspepsia, accompanied with vomiting of food. In this case, one part of lime water to two or three parts of milk is usually sufficient. Lime water is used as an injection in gonorrhoea after the active inflammation has passed away; and in ulcerations or increased dis- charges from the bladder. It is, likewise, employed occasionally as a wash to flabby ulcers, and to chronic eruptions, as scabies and porrigo. LINIMEN'TUM CALCIS, LIN'IMENT OF LIME. (Aqua Calcis, 01. Lin!, aa f. 5j.) Liniment of Lime water, — or Carron Oil, as it was called, in consequence of having been first used at the Carron works in Scotland, has long been a favourite application in cases of recent burns and scalds. The oil and lime form a soap, which, wThen smeared over the burnt surface, prevents the irritating influence of the air; or if it be applied by means of a rag, the areolae of the rag vol. n.—13 146 SEDATIVES. are filled up by it, and the same object is accomplished. Lime watef probably exerts none of its ordinary remedial agency in those cases, the effect being mainly mechanical. 44. ARGIL'LA PURA.—PURE ARGIL. Pure argil, or Alu'mina, was formerly known under the names Arme'nian Bole, Terra sigilla'ta, &c, and was much employed as an astringent in hemorrhages, diarrhoea, dysentery, &c.; but it had fallen into oblivion, when it was again brought forward as an effica- cious astringent. It is usually prepared by drying sulphate of alu- mina and ammonia, and exposing it for twenty or twenty-five mi- nutes to a red heat in a crucible. The sulphuric acid and ammonia are driven off, and the argil remains behind in the form of a white powder. Argil is devoid of smell or taste, but communicates to the tongue a feeling of astringency. When breathed upon, it exhales an earthy odour. It is insoluble in water, but attracts moisture greedily from the air, and forms with it a gelatiniform mass. Argil is an absorbent, and therefore, perhaps, an indirect astrin- gent, as regards the intestinal canal. It certainly diminishes the number of alvine evacuations. With the gastric acids, it seems to form salts that are binding, and hence it has been given in the vomiting and diarrhoea of children in which there is usually a pre- dominance of acidity. It has been associated in these cases with decoction of logwood, (Argil. x\y, Decoct. Hamatoxyl.f. ^iv* Dose, a tea-spoonful.) The dose of pure argil for a very young child, in the twenty-four hours, is from ^ss to 3J ; for older children, from £j to 3ij. It may be administered in an emulsion. IV. SED'ATIVES. Stnon. Sedantia. General observations—Subdivision of sedatives—Definition of sedatives—Modus ope* randi—Thomson's table of sedatives—Mental sedatives—Blood-letting—Its effects- Cautions respecting its use—Arteriotomy, phlebotomy, local bleeding—Other seda- tives—Contra-stimulants—Special sedatives. Under the head of Sedatives are included such agents as dimi- nish action directly or indirectly. The division comprises some of the most important classes of remedies which we possess, and such as are especially adapted for most of the numerous cases of acute disease that prove so fatal to mankind. On some of them, indeed, DIVISION OF SEDATIVES. 147 in violent inflammatory cases, entire confidence is reposed ; and, if they fail, farther efforts are not likely to be of much service. It may be said that many of the local excitants that have already been considered may be employed for the purpose of producing an in- directly sedative effect, and such is the case with many; hence they are used in febrile and inflammatory affections; but their sedative ope- ration is not as evident from the commencement as those that are ranked under the division of sedatives. In the case of narcotics, classed by the author as sedatives, a markedly excitant operation is observable when the agent is administered in a small dose ; and, perhaps, even when given to a larger amount, there is always some degree of ex- citation on careful examination, but this is succeeded so rapidly and predominantly by the depressing agency, that the excitant property is disregarded, and recourse is had to them in the same manner as if they were sedatives proper. These may be defined " agents that directly depress the vital forces." They are employed, consequently, whenever it is necessary to diminish preternaturally increased action. By many therapeutical writers, this class is not admitted, but there are certain remedial agents that cannot be brought under any other head ; —blood-letting, for example. Their main effect is, doubtless, exerted, directly or indirectly, on the nervous system, and, through this, on other parts of the body. The best evidence of their modus operandi is afforded by the most powerful pharmaceutical agentof the class with which we are acquaint- ed : — hydrocyanic acid, with the different compounds of cyanogen. If a drop of pure hydrocyanic acid be placed upon the tongue of an animal, its poisonous effects are so rapidly exerted, that the animal, at times, ceases to breathe before it can be removed from the lap of the experimenter. In this case, it is difficult to suggest any other mode of action than that induced through the contact of the poison with the nervous system. The instant this takes place, the lethifer- ous influence appears to be conveyed — with the rapidity of light- ning along conducting wires— by the nerves to the great nervous centres, which seem to be instantaneously paralysed, and all the functions carried on under their presidency are annihilated. Yet it would not appear, that the heart and intestines, or even the volun- tary muscles, have their contractility destroyed in poisoning by this fatal agent; and Professor A. T. Thomson thinks, that this is true also as regards other sedatives. We could, consequently, understand, that if the deleterious agency of any sedative were extremely fugitive or evanescent, provided we could maintain artificial respiration — effect, that is, the conversion of venous into arterial blood — and keep up the circulation, time might be allowed for the nervous sys- tem to recover from the deadly influence, and to resume its wonted action. There are other circumstances, which confirm — were any con- firmation wanting — the position, that sedatives exert their influence on the nervous system. When hydrocyanic acid is applied to one 148 SEDATIVES. limb only of a frog, the member becomes paralysed, whilst the other limbs remain unaffected. Robiquet, in executing experi- ments on the tension of the vapour of hydrocyanic acid, after having exposed his fingers to it for some time, felt a numbness in them, which lasted for several days, yet without experiencing any effect from the acid on his system. Of the precise nature of the impression made on the nerves by sedatives, we know nothing. The most careful examination ex- hibits no physical alteration of their tissue. It is manifestly not one of excitement, but the contrary : all the phenomena, as Dr. Thom- son has remarked, prove that there are powers which destroy excita- bility and life without previous excitemenl, or, at least, without any signs of it being discoverable. The author just mentioned divides sedatives, from the nature of their effects, into two distinct classes;—direct sedatives, or those which operate immediately on the nerves, — and indirect sedatives, or those which operate through the medium of the vascular system, — as in the following table: " a. direct sedatives. * Organic products. a. — Cyanogen — combined with hydrogen, in Hydrocyanic acid. Laurel water. Volatile oil of bitter almonds. combined with potassium, in Cyanide of potassium. b. — Empyreumatic volatile oil. Tobacco smoke. c. — Nicotina — contained in the leaves of Nicotiana Tabacum. ** Inorganic substances. d. Sulphur — combined with hydrogen, in Sulphuretted hydrogen gas. Hydrosulphuret of ammonia. e. — Carbon— combined with hydrogen, in Carburetted hydrogen gas. b. indirect sedatives. f. — Carbon—combined with oxygen, in Carbonic acid gas. g. — Blood-letting. To this table might be added the sedation produced by a resi- dence in certain localities, combined or not with the use of mineral waters — especially of the sulphureous kind — as at the Red Sul- BLOOD-LETTING. 149 phur Springs of Virginia,—the waters of which are reputed to have a wonderful effect in reducing the pulse, and hence the place is a common resort, during the summer season, for the phthisical valetudinarian. To the same agency might, perhaps, be referred — a residence in mountain gorges, and in other situations, where there is a paucity of light, and an absence of excitants of all kinds ; and certain emotions, which are of a depressing or sedative cast, and of which we have so marked an example in the nostalgic sadness, which, as before remarked, exerts so deleterious an agency on the Swiss, especially when absent from his native land. Although there may be doubt entertained as regards the aetion of certain sedatives, — whether the sedative influence be or be not pre- ceded by some excitation, —there can be none as respects blood- letting. Even hydrocyanic acid has been supposed, by Magendie and others, to produce a transient excitement in the first instance, followed, however, immediately afterwards, by an opposite state ; but closer examination, added to experiments on animals, seems to exhibit these views to be hypothetical. Indeed, there is not suffi- cient time, in most cases, to note any excitation, so rapid is the tran- sition from life to death, when the sedative is administered in a state of concentration ; and, when more diluted, the effects are clearly of a depressing character. In the modus operandi of blood-letting, however, there can be no- thing equivocal. There can be no presumption of excitation before the depressing effects are perceptible ; yet we can readily compre- hend, that there may be states of the system, in which the abstrac- tion of blood, instead of being followed by signs of sedation, may give occasion to greater activity of vessels, and to greater tone of the system than was apparent prior to the operation. Such is sig- nally the case in the fevers termed congestive, where the powers of life appear to be depressed, in consequence of the accumulation of blood in the internal organs; but if the oppressing or depressing cause be removed, by the abstraction of a due amount of blood, the powers of life develope new energy, the blood is regularly distri- buted through the different tissues and organs, and every sign of asthenia disappears. The immediate effects of blood-letting on the system are readily appreciable. The impression is, from the first, one of sedation ; and, accordingly, it is one of the sedative agents on which our main re- liance is placed in diseases of excitement. Carried too far, however, it is well calculated to develope capillary excitement, in the mode to be mentioned presently. At one time, this was an evil which was never apprehended, and if, after excessive loss of blood, hyperaemia occurred in any organ, or was augmented if it previously existed, the blood-letting was repeated, until the patient sank ; the practitioner, not suspecting the cause of death, but consoling himself with the re- flection, that the disease was irremediable, and that he had adopted the only judicious course for its removal, 13* 150 SEDATIVES. When an animal is bled to death, it is observed — as the blood flows — to become uncertain in its attitude; and, if it attempts to move, it staggers, and ultimately falls. This state is soon succeeded by convulsions, which, in death from hemorrhage, always precede dissolution. The same thing happens to the human subject, when death results from a rapidly fatal hemorrhage. The rationale of these phenomena would appear to be as follows. — As the blood flows from the vessels, the great nervous centres cease to receive that sup- ply, which is requisite for the due performance of their functions; hence, the proper amount of nervous energy is no longer transmitted to the muscles ; their contraction cannot be energetically maintained ; alternate contractions and relaxations become marked — in the form of tremors ; and, if the flow of blood continues, there is not enough of nervous influx transmitted to keep the extensors in a state of con- traction ; the animal consequently falls, and, unless the hemorrhage be now arrested, death is inevitable. The same inadequate supply of blood to the brain gives rise to irregularity of action in the cerebro- spinal axis, especially in those parts where the motor nerves arise ; and hence convulsions. Where hemorrhage takes place, naturally or artificially, to a less extent than this, and the individual recovers, a chain of analogous phenomena supervenes, with which it is important for the therapeu- tist to be acquainted. It would seem, indeed, that whenever the vital fluid is lost beyond a certain amount, — and in particular habits this amount need not necessarily be large, — a series of symptoms pre- sent themselves, or are apt to present themselves, which are of a nervous kind, or dependent upon the loss of balance between the nervous and sanguiferous systems. Uterine hemorrhage affords the best example of the effects of great loss of blood in the human sub- ject, although too many cases of mischief from the lancet of the prac- titioner are met with. When blood is discharged to an inordinate extent from the uterus, a feeling of faintness is sooner or later expe- rienced ; impaired vision and depraved audition,— in the form of tinnitus aurium, or other unusual noises, — supervene ; and, if the I.emorrhage be not arrested, fatal syncope ensues, generally preceded by more or less convulsive movement. If the patient recovers, it rarely happens that the restoration is effected without symptoms pre- senting themselves, which are referable to the effect produced by the loss of blood on the nervous system. In the course of a few hours, although the female may have been, to all appearance, exanguious, she may be found complaining of violent headache, suffused face, with throbbing of the temporal and carotid arteries ; yet these symp- toms, as elsewhere remarked, are certainly not referable to a condi- tion of thejblood or of the bloodvessels, which farther blood-letting is capable of remedying. The mischief has been induced by loss of blood, aud farther abstraction of that fluid could scarcely fail to add to the pathological condition. A striking case, exhibiting the difficulty of distinguishing, without BLOOD-LETTING. 151 extreme care, whether the state of reaction be one of sthenia or asthe- nia, was exhibited not many years ago in an institution of which the author was one of the physicians. A man, whose leg had been amputated, was found one morning almost exanguious from the giving way of an artery. In a few hours, however, he recovered, and was seen by an experienced colleague in the state of reaction, who was unacquainted with the history of the case, and who, as soon as he placed his hand upon the pulse, inquired why the surgeon did not bleed him! It may be laid down, perhaps, as a general law, that when blood is lost to a considerable amount, the great nervous centres receiving an adequate — and the rest of the nervous system an irregular — supply, their excitability becomes largely and irregularly developed, so that, under this impressible condition of the nerves, the blood- vessels, whose functions are carried on under their presidency, assume augmented action ; and if, owing to the previous existence of hyperaemia in any organ, the nerves, proceeding to that organ, are in a morbidly excitable condition, a fresh development of excitability may ensue after the bleeding, and the hyperaemic condition, instead of being relieved by the loss of blood, may be augmented by it. In individuals, whose nervous system is very impressible, the same effects may be induced by a full bleeding, as have been described to result from excessive discharges from the uterus, and, accordingly, where hyperaemic conditions occur in such individuals, the practi- tioner is cautious in the use of the. lancet, and if he employs it, he does not carry the depletion so far as to depress too much the powers of the system — aware, that if he should do so, under the nervous irritability or neuropathia, which he developes, reaction might succeed to such an extent as to reproduce the exaltation of organic actions in the part, and perhaps to a greater degree than before the operation. It is in such impressible habits, that advantage is found in the adoption of other sedative agents ; and that a combi- nation of blood-letting, short of inducing syncope, with a full sedative dose of opium, is often so serviceable;—-the bleeding diminishing the exaltation of the vital manifestations, by acting on the nerves through the blood-vessels ; and the opium preventing the subsequent development of nervous excitability. In strong individuals, the same plan, pushed to a still greater extent, is equally successful and not the less philosophical, when employed for the removal of internal inflammations. It is the plan which, as before observed, is adopted with so much success, in acute peritonitis; — the bleeding being carried so far as to make a decided impression on the system, and the opium administered in a full dose ; a sedative influence is thus exerted on the body generally, and on the inflamed tissue in particu- lar, under which the hyperaemia is effectually subdued. Along with his friend, Professor N. R. Smith, of the University of Maryland, the author attended a case, in which many of the ordinary signs of inflammation of the encephalon were present, and yet both 152 SEDATIVES. were satisfied, that great mischief would have resulted from copious abstraction of blood. The patient was a nervous female, who, soon after delivery, was attacked with excruciating cephalalgia, with the greatest intolerance of light and sound, so that every precaution was necessary to shut off those irritants. Along wTith this great impressi- bility, however, the tongue was moist, and the circulation, though hurried, not augmented in force. She was bled, but the symptoms were in no respect relieved. The operation was repeated to a trifling extent: so much palpitation and nervous turmoil were, how- ever, induced by it, that it was not practised a third time ; but leeches were subsequently applied to the epigastric region, for the removal of some accidental gastro-enteritic symptoms. This state of excitability of the encephalon continued for weeks, and at length yielded to time and quiet, rather than to any particular system of medication; and under the cautious reapplication of light and noise to the optic and auditory organs, they became gradually accustomed to the stimulus, and the recovery was ultimately complete. Had depletion been carried to a greater extent in this case — as it would most certainly have been, by those practitioners, who believe that general blood-letting is the only agent, that can be relied on as an antiphlogistic — great mischief would have, doubtless, resulted. Long, indeed, before Dr. Marshall Hall published his interesting " Researches on the effects of loss of blood," the author had been deeply impressed with what appeared to him to be the faulty views, entertained both as regards the pathology and the therapeutics of such cases as those mentioned; and had satisfied himself, that the maxim, inculcated by many practitioners as applicable to internal inflammations in general — "when you have bled in inflammation to such an extent, that you are doubtful, owing to the persistence of the symptoms, whether you should bleed again, — bleed," — was unphilosophical, and often, it was to be feared, attended with disas- trous consequences. As a general rule, the author would say, on such occasions of doubt and difficulty, — " do not bleed, but have recourse to some other appropriate sedative, or revulsive agent, until your doubt is removed." Every practitioner, much engaged with the diseases of women, must have met with cases of peritoneal in- flammation in the puerperal state, in which, after bleeding has been practised as far as he has esteemed it safe, the effects of a sedative dose of opium have been signally salutary. The irritability of the nervous system has been allayed, whilst there has been great reason to believe, that if the bleeding had been repeated, it might have been formidably developed. It is only in comparatively late years, that the attention of thera- peutists has been directed to a pathological condition giving rise to phenomena of ordinary occurrence, which, in one of the cases, ought to have been suspected earlier, from the effects, which we see deve- loped, by loss of blood, on animals, as well as on man. This occurs in certain encephalic affections, which were at one time — and are BLOOD-LETTING. 153 even now, by many therapeutists — considered to imperatively re- quire loss of blood, generally or locally, or both. Coma and con- vulsions were once looked upon as invariable evidences of congestion of the encephalic vessels, although what was precisely meant by the term, as employed by many writers, is not apparent; — whether, for example, they looked upon the congestion as an accumulation of blood in the vessels of the brain, produced by too great activity of the encephalic arteries ; or as a remora of blood in the veins, owing to some asthenic or mechanical cause, seated in the vessels them- selves, or in the parts in which they creep. Both conditions were, however, considered to indicate blood-letting— whether the tumes- cence, in other words, was active or passive, the abstraction of fluid was thought to be equally demanded. It is now known, that coma may exist independently of any ful- ness of the vessels of the encephalon; that it occasionally appears to be induced by a condition the opposite to those, and that the admi- nistration of excitants may be required for the removal of symptoms, closely resembling such as are cured by bleeding and by ordinary depletives. The precise condition of the brain during sleep has been an inter- esting topic of discussion with the physiologist, and is yet sub lite; but it may, perhaps, be unhesitatingly determined, that it is not di- rectly dependent upon modified circulation in the encephalon ; and that it is altogether a phenomenon of the neurine itself. Coma being morbid sleep cannot be wholly likened to that which occurs naturally. It is frequently the result of pressure made on the cere- bral substance by vascular turgescence, or effusion ; but it may, and doubtless, does, occur from conditions of the cerebral structure itself; and it by no means follows, that these must be conditions of turges- cence or excitement. Dr. Gooch has an excellent chapter on this subject in his work on Some Diseases Peculiar to Women. It is en- titled, " Of some symptoms in children erroneously attributed to con- gestion of the brain:" these he regards as dependent rather upon loss of nervous power. "I am anxious," says he, "to call the attention of medical men to a disorder of children, which I find invariably attri- buted to, and treated as, congestion or inflammation of the brain, but which I am convinced, often depends on, or is connected with, the opposite state of circulation. It is chiefly indicated by heaviness of head, and drowsiness ; the age of the little patients whom I have seen in this state, has been from a few months to two or three years ; they have*been rather small of their age, and of delicate health; or they have been exposed to debilitating causes. The physician finds the child lying on its nurse's lap, unable or unwilling to raise its head, half asleep, one moment opening its eyes, and the next closing them again, with a remarkable expression of languor. The tongue is slightly white ; the skin is not hot; at times the nurse remarks that it is colder than natural; in some cases there is at times a slight and transient flush ; the bowels I have always seen already disturbed 154 SEDATIVES. by purgatives, so that I can scarcely say what they are when left to themselves ; thus the state which I am describing is marked by heavi- ness of the head and drowsiness, without any signs of pain, great languor, and a total absence of all active febrile symptoms. The cases which I have seen have been invariably attributed to conges- tion of the brain, and the remedies employed have been leeches and cold lotions to the head, and purgatives, especially calomel. Under this treatment they have gradually become worse, the languor has increased, the deficiency of heat has become greater and more per- manent, the pulse quicker and weaker, and at the end of a few days, or a week, or sometimes longer, the little patients have died with symptoms apparently of exhaustion. The children, who were the subjects of this affection, and were thus treated," says Dr. Gooch, " died, not with symptoms of oppressed brain, but with those of ex- haustion ; and, on examining the head after death, the blood-vessels were unusually empty, and the fluid in the ventricles rather in ex- cess : in two instances death was preceded by symptoms of effusion, viz., blindness, a dilated pupil, coma and convulsions ; and after death the ventricles were found distended with fluid to the amount of several ounces, the sinuses and veins of the brain being remark- ably empty. I believe the prevalent notion of the profession is, that all sudden effusions of water into the brain are the result of inflam- matory action; but, putting aside for a moment this dogma of the schools, consider the circumstances of this case. For several days before death, all that part of the circulating system, which was cog- nisable to the senses, was at the lowest ebb consistent with life, and after death the blood-vessels of the brain wrere found remarkably empty of blood, and the ventricles unusually full of water. From such facts I can draw no other inference than this, that this sudden effusion was a passive exudation from the exhalants of the ventricles, occasioned by a state of the circulation the very opposite to conges- tion or inflammation. This is corroborated by the dissection of ani- mals which have been bled to death. Drs. Saunders and Seeds, of Edinburgh, found that in animals bled to death, whether from veins or arteries, there was found more or less of serous effusion within the head, and Dr. Kelly thus expresses himself: — " If instead of bleed- ing usque ad mortem, we were to bleed animals more sparingly and repeatedly, I have no doubt that we should succeed in draining the brain of a much larger quantity of its red blood ; but in such experi- ments we shall, I think, find a larger effusion of serum." " It is surely impossible " — he adds — "for the reader to mistake me so far as to suppose that I am denying the important practical truths, that heaviness of head and drowsiness of children commonly depend on congestion, and are to be relieved by depletion, and that acute hydrocephalus is a serous effusion, the result of inflam- mation, and capable of being cured only in the inflammatory stage by bleeding and purging. These vital truths I would state as strongly as any man, but there are opposite truths. All that I mean BLOOD-LETTING, 155 is, that these symptoms sometimes depend, not ori congestion, which is to be relieved by bleeding, but on deficient nervous power, which is to be relieved by sustaining remedies. All I advise is, that not only the heaviness of head and drowsiness should be noticed, but the accompanying symptoms also, and that a drowsy child, who is languid, feeble, cool, or even cold, with a quick, Weak pulse, should not be treated by bleeding, starving, and purging, like a drowsy child who is strong, plethoric, has a flushed face, perhaps swelled gums, and a heated skin. The cases which I have been describing * may not improperly be compared to certain species of plants, by no means uncommon, which are liable to be confounded with others by an inattentive observer.' " The above remarks are cited at some length, in consequence of their marked accordance with the views, which the author has been led to entertain in what have appeared to him to be similar patholo- gical conditions; and, he is satisfied, that both in children and adults, an analogous state of the brain is often met wTith, especially in Scarlatina. In the disturbed state of the encephalic functions, which so often attends that anomalous disease, there may be recog- nised —-> it has appeared to him —- a condition very different from that which is produced by active inflammation or congestion in the encephalon. Under the great expenditure of nervous energy, which takes place over the whole of the capillary surface, and which is indicated by the excessive activity of the agents of ca- lorification, and of the organic nerves distributed to the capil- lary blood-vessels, the encephalo-spinal nervous centre appears at times to be in a state very different from that of inflammation or active congestion. It is rather exhausted by the unwonted energy of the organic portion of the nervous system; and accordingly, in many such cases, the use of diffusible excitants has been found ser- viceable, -— the delirium or the coma gradually disappearing as the system begins to feel their compensating influence. This ^practice was adopted in scarlatina, when accompanied by such signs of en- cephalic disorder, with great success, by Dr. Baer, of Baltimore, and it has been followed by the most happy results in some cases, which fell under the authors own care. Under the vigorous use of depletives, the symptoms have not been mitigated; at times, indeed, they have seemed to be aggravated ; but on changing the system of treatment, and having recourse to tonics or excitants, a marked ame- lioration has speedily ensued. Convulsions wTere, at one time, universally referred to the same condition of the encephalon as was presumed to prevail in cases of coma ; blood-letting was, therefore, the remedy almost always deem- ed proper ; but some misgivings ought to have been produced by the well known fact already referred to, that death from hemorrhage is preceded by convulsions. Amongst the immediate effects of loss of blood, Dr. Marshall Hall enumerates, — syncope, convulsions, delirium, coma and sudden 156 SEDATIVES. dissolution ; and, amongst the more remote, — excessive reaction, sometimes with,—first, delirium, mania; secondly, coma, amauro- sis, or deafness, and the sinking state. Convulsion, he properly considers to be, after syncope, the most familiar effect of the loss of blood. " It constitutes," he adds, " one species of puerperal con- vulsion, and should be accurately distinguished from other forms of this affection, arising from intestinal or uterine irritation, and an im- mediate disease of the head." The fact of the copious effusion of blood, wTith the attendant signs of exhaustion, will enable the prac- titioner to discriminate these cases, and not to pretermit the use of those energetic agents, which are indispensable for the safety of the patient, when the convulsions are induced by the condition of the gravid uterus modifying the due circulation of blood in the brain. It is not in such cases, that the use of the lancet does harm ; on the contrary, it is the anchor of safety, and cannot be postponed. The mischief is here owing to the circulation in the brain being modi- fied, so that the nervous system is thrown into irregular excite- ment, and nothing will obviate this condition, except diminishing the circulatory current. Far different, however,—the author is satis- fied,— is the generality of cases of convulsions, which happen during early childhood. Prior to the period of the first dentition, ow7ing to certain evolutions of organs, the nervous system, as previously seen, is unusually impressible, so that intense irritation, existing any where, may be the occasion of irritative irradiations proceeding in all directions, until the parts of the cerebro-spinal axis have their functions deranged, and sensation, volition, and mental and moral manifestations become, for the time, suspended. In this manner, the irritation produced by the pressure of a tooth against the gum, or any source of excitation in the intestinal canal, may become the cause of convulsions ; and after the functions of the cerebro-spinal axis have been once so far deranged as they are during convulsions, they are extremely prone to reassume the morbid condition, until, ultimately, organic disease of the encephalon supervenes, or the little sufferer is worn out by continued irritation. In such a case, the predisposition to the disease is — the period of life ; and the ex- citing cause is— the irritation in the alimentary tube. Great im- pressibility of the nervous system is present even in health, and this impressibility only requires the application of a sufficient exciting cause to have convulsions developed. In addition to the general predisposition derived from time of life, there is doubtless an organisation, obtained from progenitors, which predisposes to convulsions. It is not very unusual for a whole fa- mily to be subject to them during childhood ; and, on inquiry, it may be found, that one of the parents was liable to the disease in his childhood. In such cases, a less energetic exciting cause is able to develope the mischief, possessing, as they do, a double source of predisposition. We cannot suspect in them the existence of polyae- mia, or hyperaemia of the encephalon. The phenomena are wholly BLOOD-LETTING. 157 neuropathic. The predisposition is unusual nervous impressibility ; the exciting cause is often situate in the digestive tube ; and very frequently the source of irritation is food of an improper character, or some inflammatory or other morbid condition of the mucous or lining membrane. The indication cannot, consequently, be to di- minish the quantity of blood in the system, with the view of remov- ing any supposititious congestion of the encephalon. Blood-letting, indeed, in such a state, could hardly fail to add to the impressi- bility of the nervous system, and it has appeared to the author, in many cases, to have been followed, too manifestly, by augmentation of the symptoms. The convulsions have recurred ; the surface has become cool, and pale, — almost exanguious ; the circulatory forces have exhibited, that their action was enfeebled ; the child has con- tinued in a state of coma between the fits, or has had but short in- tervals of consciousness ; and has gradually sunk with no signs of hyperaemia, — unless we consider the convulsions and the coma to indicate such a condition,—for, on dissection, no morbid appear- ances have been met with in the brain, or that effusion of serum has been discoverable, which, as before shown, is present, when an ani- mal— and a healthy animal— is bled to death. Proceeding on those pathological principles, the author has not often considered it proper to abstract blood in the convulsions of infancy: in almost all cases, he has found it but necessary to clear the alimentary tube by a gentle emetic, followed by a mild cathartic; to keep the child from every source of irritation, that might act in- juriously on its organs of sensation from without, or on the intestinal mucous membrane from within ; to equalise, as far as practicable, the excitability of the cutaneous surface by the use of frictions or of the warm bath ; and, under this plan of management, he has almost always found the affection eventuate favourably. At the same time, it is proper to remark, that there are cases of convulsions accompanied by every sign of vascular excitement, and where a true polyaemic or hyperaemic condition of the brain exists. In these, of course, blood-letting is the main agent to be relied on. If encephalitis be present, it must be treated as such ; but, in all cases, careful atten- tion must be paid to discriminate, whether the convulsions be accom- panied or produced by a redundancy, or by a deficiency of nervous and vascular energy. If blood-letting, then, be capable of exerting a sedative agency on the organism, and yet, if carried too far, or not appropriately prac- tised, it may give rise to all those mischiefs that follow excessive loss of blood, it becomes an interesting topic of inquiry, —how to regu- late the operation, where it is demanded, so as to have the sedative agency, without any of its unpleasant concomitants and sequelae. When blood is drawn in cases of internal inflammation, the great object is, by diminishing the amount of fluid circulating in the vessels, to depress the vital manifestations. But the effect of copious blood- letting, it has been seen, is mainly exerted upon the nervous system ; VOL. II.—14 158 SEDATIVES. and, as already remarked, when loss of blood takes place, either naturally or artificially, to too great an extent, irregular actions are apt to supervene ; and as, where hyperaemia exists, there is already a part of the nervous system disposed to be morbidly affected,— under the influence of excessive irritability of those nerves, the ves- sels of the inflamed part resume their inordinate action, and the hy- peraemia, after a full bleeding, is speedily reproduced, and, perhaps, to a like degree. We have obviously, therefore, to be careful not to carry the abstraction of blood, in these cases, to an extent that may develope irregularities in the nervous action. But this condition of excitability varies materially according to individual organisation, and to the character and intensity of the hyperaemia. There are some individuals, who faint at the sight of blood, and who are thrown into marked nervous excitement by an ordinary bleeding ; whilst others bear the loss of a very large amount without the supervention of syncope, and without seeming to suffer materially. In certain diseased conditions, again, the toleration is considerable; and a de- licate female will often bear a large loss of blood, when a few ounces, in health, or in a different affection, would have developed great nervous impressibility. The toleration, too, varies somewhat in the same individual. Dr. Thomson says he has witnessed cases of de- cided inflammation, in which syncope occurred after three or four ounces of blood were taken, yet, on repeating the operation in a few hours afterwards, from twenty to thirty ounces were abstracted with- out the least evidence of its approach. The author has more than once had occasion to confirm this ; and it is a therapeutical fact of importance, — because, if wTe were to be deterred from repeating the blood-letting, owing to the want of toleration at the first attempt, we might deprive ourselves of the use of one of the most valuable anti- phlogistics,— one, indeed, which is often indispensable; yet, it scarcely appears philosophical, that in a case of excited organic ac- tions in a part, — say, in the pleura, or the peritoneum, — we should take away blood from the arm ; or, in other words, from the whole system, in order to reduce the tumultuous action in a part. We have no mode, however, of getting at the affected vessels, — no mode of applying our remedies to the parts concerned, — and are, therefore, compelled to act on the diseased organ through the influence which we are capable of producing on the nervous system generally, as well as by the diminution in the supply of fluid to the inflamed part, which must necessarily result from the operation. From the great amelioration in the symptoms of inflammation, generally observed when syncope is induced from any cause, it has been deemed important, that blood-letting should always be pushed so far as to make this decided impression on the system ; and there are some who regard its supervention as an evidence that bleeding has exerted its full effect, even although a few ounces only may have been abstracted. The author recollects a case in which fainting Was altogether occasioned by the awkward attempts of a bungling BLOOD-LETTING. 159 provincial practitioner in France; yet it was regarded by him to be equally effectual for the removal of the hyperaemia, for which it was employed, as if twenty or thirty ounces had been taken before the occurrence of syncope. The state of fainting is one of suspended animation, — of suspension of the great vital actions, — and, there- fore, one in which there must be a truce to the various excited actions, that may be going on in any part of the organism; but the effect is only temporary ; and, as soon as the functions of respiration, circulation, and innervation are restored to the normal condition, the signs of hyperaemia may be as marked as before. By many, indeed, the state of syncope has been compared to the cold stage of an inter- mittent, and reaction, it is conceived, is as sure to follow as the hot stage succeeds to the cold stage of a paroxysm of that disease. " The morbid effects of large depletions," says an intelligent writer, Dr, Copland, " will necessarily vary with the nature of the disease in which they are employed. When carried too far, in case of excite- ment, where the nervous or vital power is not depressed, and the blood itself rich or healthy, reaction generally follows each large de- pletion, and thus often exacerbates or brings back the disease for which it was employed, and which had been relieved by the primary effects of the evacuation. This is more remarkably the case in acute inflammations of internal viscera, particularly of the brain or its mem- branes. Thus, every observing practitioner must often have noticed, that a large depletion, when carried to deliquium, will have entirely removed the symptoms of acute inflammation when the patient has recovered consciousness ; and that he expresses the utmost relief. But it generally happens that the inordinate depression — the very full syncope that is thought essential to the securing of advantage from the depletion — is followed by an equally excessive degree of vascular reaction, with wdiich all the symptoms of inflammation return; and the general reaction is ascribed entirely, but erroneously, to the return of the inflammation, instead of the latter being imputed to the former, which has rekindled or exasperated it, when beginning to subside. The consequence is, that another very large depletion is again prescribed for its removal; and the patient, recollecting the relief temporarily afforded him, readily consents. Blood is taken to full syncope, — again relief is felt, — again reaction returns, — and again the local symptoms are reproduced; and thus large depletion, full syncope, reaction, and the supervention on.the original malady of some or all of the phenomena described above as the consequence of excessive loss of blood, are brought before the practitioner, and he is astonished at the obstinacy, course, and termination of the disease; which, under such circumstances, generally ends in dropsical effusion in the cavity in which the affected organ is lodged ; or in convulsions, or in delirium running into coma; or in death, either from exhaustion or from one of the foregoing states; or, more fortunately, in partial subsidence of the original malady, and protracted convalescence. Such are the consequences which but too often result, — w*hich I have 160 SEDATIVES. seen on numerous occasions to result—when blood-letting has been looked upon as the only or chief means of cure — the ' sheet-anchor' of treatment, as it too frequently has been called and considered during the last twenty years." To prevent this reaction, Dr. Copland directs the following mode of practice, when large blood-lettings are required in the treatment of visceral inflammation. The patient should be either in bed or on a sofa, and in the sitting or semi-recumbent posture, supported by several pillows. The blood is to be abstracted in a good sized stream, and the quantity should have some relation to the intensity and seat of the disease, and the habit of body and age of the patient, but chiefly to its effects: it should flow until a marked impression is made upon the pulse, and the countenance begins to change. Farther depletion must not now be allowed; but the finger should be placed on the orifice of the vein, the pillows be removed from behind the patient, the recumbent posture assumed, and the arm secured. " Thus, a large quantity of blood may be abstracted, wThen it is re- quired, without producing full syncope, which should always be avoided : and when a large loss of this fluid is either unnecessary, or might be hurtful, the speedy effect produced upon the pulse and countenance by the abstraction of a small quantity will indicate the impropriety of carrying the practice farther. In this manner I have often removed about forty ounces of blood, where large depletion wras urgently required, before any effect wras produced upon the pulse, but always carefully guarding against syncope ; and by the subsequent means used to prevent reaction, no farther depletion has been required." The "means" alluded to, consisted of contra- stimulant doses of tartrate of antimony and potassa; of full doses of calomel, antimony, and opium; or opium singly, &c. &c. There can be but little doubt, that the course here recommended is judicious. The author has already remarked, that in many nervous individuals, syncope may be induced, even before the blood flows, or when a very small quantity has been discharged. In such case, every thing is favourable for the occurrence of violent reaction, and no good is to be expected from the temporary sedation effected during the syncope. The exaltation of the vital forces — to be permanently subdued ■— generally requires a copious abstraction of fluid from the vessels, and, by keeping the individual in the hori- zontal attitude, and waiting for a time, — pressing the finger on the vein when signs of syncope appear, and, after they have passed away, removing the finger from the bleeding orifice, — blood enough can generally be withdrawn to produce the necessary effect. At other times, the loss of very large quantities of blood is borne without the supervention of any evidences of syncope, and when there is great reason to believe the toleration would exist, until a slight additional abstraction of blood might throw the patient into a state of irretriev- able collapse, — or, into what Dr. Marshall Hall has called — " the sinking state." In the lectures of Mr. Lawrence, as given in the London " Lancet" is contained the case of a young female, of slender BLOOD-LETTING. 161 habit, from whom eight-and-forty ounces of blood were taken away without fainting being induced. The blood still continued running in a vigorous stream, without touching the surface of the arm, and it wTas stopped at that amount, only because the quantity seemed to Mr. Lawrence to be so very great. In a case like this, it would manifestly not do to continue to bleed until signs of syncope ensue. When the practitioner has bled to thirty, or at the farthest, to forty ounces, it would, perhaps, be wise to tie up the arm ; to follow up the sedative system by a full dose of opium, — and there is none so good in the vast majority of cases, where patients tolerate it, — or of some other sedative agent; and if, in the course of three or four hours, the mischief, for which the blood-letting was practised, be not subdued, to repeat it. The interesting fact was pointed out by Dr. Marshall Hall, that in inflammatory diseases, a much larger amount of blood may be drawn without inducing syncope than can be abstracted in health or in other diseases. The following table is the result of that observer's inves- tigations in regard to the tolerance of blood-letting in different diseases. The numbers represent the mean quantity of blood which flows be-. fore incipient syncope in the sitting or erect attitude, I. AUGMENTED TOLERANCE. Congestion of the brain . . . 5,xl.—1, Inflammation of serous membranes } Inflammation of synovial membranes > ^xxx—xl, Inflammation of fibrous membranes ) Inflammation of the parenchyma of or- gans (brain, lung, liver, mamma, &c.) Inflammation of skin and mucous mem- ) branes (erysipelas, bronchitis, dysen- > 5xvj, tery, &c.) , , , , ,) II. HEALTHY TOLERANCE, This depends on the age, sex, strength, ] &c, and on the degree of thickness ( % of the parietes of the heart, and is ( ' about , , , . „ . J III, DIMINISHED TOLERANCE, Fevers and eruptive fevers Delirium tremens and puerperal delirium Laceration or concussion of the brain ] Accidents before the establishment of f z ...__ inflammation.....f 3vnJ X" Intestinal irritation . . , . j Dyspepsia, chlorosis . . . . ^ viij. Cholera ,,,,.. 5yj. 14* ;xxx. 162 SEDATIVES. The explanation of the increased tolerance of blood in inflamma- tion, Dr. J. B. Williams apprehends, is to be found in the increased excitability of the heart, and tonicity of the arteries, which maintain a sufficient force and tension to preserve the circulation, especially through the brain, even when much blood is lost. " In asthenic or atonic diseases, on the other hand, the arteries being lax, and ill- fitted to transmit the blood, a smaller loss is felt, and syncope may result. The variations between inflammations occupying different seats must be referred to the arterial tone being less augmented in some than in others, and are therefore indications of the more or less sthenic character of the inflammation. The quantity of blood in the whole system will affect the heart's action, and arterial tension in a similar way ; and no doubt the more stimulating quality of the blood may contribute to the same results." The extent to which blood-letting should be carried, in cases of violent internal inflammation, is often a matter of great difficulty with the discriminating, but of none whatever with the reckless and unin- formed. In his state of blissful ignorance, the latter continues to bleed, and consoles himself, when the fatal result has been hastened — perhaps mainly induced—by his agency, that the sufferer has fallen a victim to an incurable malady. Many have laid down a rule, before referred to, that when blood-letting has been carried to such an extent, and so often, that we are in doubt, whether it should be repeated, the decision should be in the affirmative. But, with the disposition, which prevails so generally, — and which prevailed, a few years ago, to a much greater extent than it does even at pre- sent,— to bleed without due consideration, such a doubt will rarely be felt, without good ground at the same time existing for staying the hand ; and, therefore, the decision, according to the author's ex- perience, ought generally, as before said, to be in the negative. The argument, commonly urged for the further abstraction of blood, is, that the inflammation manifestly persists, and that it must inevit- ably destroy if it be not arrested ;—that blood-letting is more likely to subdue it than any other therapeutical agent; and that, if it should not, the physician will have the consolation of knowing that he has done every thing in his power to avert the melancholy termination. Were the abstraction of blood, in all cases and to any extent, de- void of danger, this mode of viewing the subject might be logical; but mischiefs result in these and similar cases, which are fairly re- ferable to it, and are equally serious in their results with the disease lor which it may have been employed. Often, too, whilst the prac- titioner is taking away blood, he allows the patient to drink freely of water or other fluid, and, under the augmented absorbent agency induced by the diminution of the quantity of blood in the vessels, a state of anaemia or oligaemia supervenes, and the blood is rendered so thin, that if the disease, for which repeated blood-letting has been adopted, be hemorrhagic, and the hemorrhage be owing to transuda- tion through the parietes of the vessels— as is almost universally the BLOOD-LETTING. 163 case—the recurrence of the hemorrhage is greatly facilitated. In an early part of this volume, the author has referred to an interesting case of anaemia, produced by excessive bleeding in what was sup- posed to be periodical encephalitis, and to the mischiefs so mani- festly referable to an inadequate quantity of blood circulating in the vessels, as well as to the impoverished condition of that fluid ; and, to a minor extent, similar evils are often found to result from the same causes, although they are too frequently not appreciated, or, if appreciated, regarded as inevitable. Whenever anaemia, of the kind referred to, exists, the excitability of the nervous system is irregu- larly developed, and hyperaemic affections are apt to arise in various parts, which seem formidable, and yet require a very different mode of management from such as are met with in those who are plethoric, or whose blood is rich in fibrin and red corpuscles. It must be borne in mind, too, that the researches of MM. Andral and Gavarret have established the fact, that the chief effect of loss of blood is to diminish the ratio of the corpuscles, — a statement which the researches of MM. Becquerel and Rodier have confirmed. As blood is abstracted, the fluid becomes impoverished, and more watery ; whence the density of defibrinated blood diminishes notably. The albumen also diminishes; but usually only slightly; hence the diminution in the density of the serum is small. The fibrin is unin- fluenced by venesection ; the extractive matters and free salts are unaltered ; the fatty matters are slightly lessened ; the serolin, always variable in quantity, is decidedly increased in some cases ; the cho- lesterin appears to be but slightly increased; the chloride of sodium and other salts remain unchanged; and the iron is diminished slightly, being in proportion to the corpuscles. It would, therefore, appear that blood-letting influences but little the main result of inflamma- tion on the blood, — the increase of fibrin in proportion to the red corpuscles. It was a remark of the distinguished Laennec, that the strength of the pulsation of the heart under the stethoscope is an excellent guide for the use of the lancet. " In all cases," he says, " in which the pulsations of the heart are, proportionately, more energetic than those of the arteries, wre may bleed fearlessly, and be certain of an im- provement in the state of the pulse. But if the heart and the pulse be alike feeble, blood-letting will almost always precipitate the pa- tient into a state of complete prostration,"—and he adds: — " the certainty and facility with which the stethoscope affords or excludes the indications for blood-letting appears one of the greatest advan- tages conferred by this instrument." As a general rule this is good; but account must be taken of exceptions in nervous and hysterical subjects in whom palpitations may exist, and a temporary increase of force be detected under the instrument; whilst in an excited state the force of the heart and arteries may be more feebly exerted than is usual. It must be recollected, too, that in some serious diseases, as in 164 SEDATIVES. enteritis, the pulse may be slow and feeble ; whilst in inflammatory diseases of infinitely less moment — as in amygdalitis, the action of the pulse may be strong and bounding; and again, as previously re- marked, in reaction from positive exhaustion, as after loss of blood, the excited state of the heart and arteries may readily deceive the experienced practitioner, who is not on the watch. Mere quickness of pulse, taken singly, can never be regarded as a positive indication for the use of the lancet, inasmuch as it occurs in diseases which are highly neuropathic, especially where they are ac- companied at the same time by debility; and is almost always pre- sent in approaching dissolution. The practitioner, consequently, who expects, under such circumstances, to diminish the velocity of the circulation by blood-letting, will find himself wofully mistaken. In scarlatina, quickness of pulse is one of the most marked functional phenomena, and in the most malignant cases this quickness is often most striking ; yet blood-letting can rarely be employed in such cases, and if it were, it would generally be found, that the quickness of pulse is increased rather than diminished by it. Formerly — not many years ago, indeed — it was laid down, by many, as a rule of guidance, that bleeding, in a case of internal in- flammation, ought to be repeated so long as the blood drawn exhibits the appearance of the buffy coat; but this is a rule which is now properly abandoned. It is clear, indeed, from the results of obser- vation, that, in some cases, it would exhibit this character immedi- ately before the occurrence of fatal syncope. But this buff is not perceptible in cases of high internal inflammation only ; it is met with in acute rheumatism, in the pregnant condition, in chlorosis, and, at times, in persons of great nervous excitability. In the first of these cases, there is no disorganising inflammation present,—none, that requires the same activity of treatment to preserve life, that pleurisy, for example, demands ; and, in the second, the buff appears, when the female is in perfect health. (Vol. i.'p. 41.) Perhaps, how- ever, the most important of the facts to be borne in remembrance is the third— that we observe it on the blood of persons of high ner- vous excitability, even when no inflammatory condition is present; and when, on the contrary, the blood is watery,—or, in other words, does not contain the healthy proportion of fibrin and red globules. They are cases that give rise to great hesitancy and difficulty in the mind of the practitioner, when signs of hyperaemia exist in any in- ternal organ. The author attended a case of this kind, in company with Dr. Gibson, of Baltimore. The subject was an amiable and gifted young lady, whose temperament might be regarded as emi- nently nervous or impressible. She had been labouring under pain on breathing, but without much cough: the skin was, at the same time hotter than natural, — markedly so at some periods of the twenty-four hours, and the mucous membrane of the tongue, though moist, was coated, and indicated the existence of internal hyperaemia. She had been judiciously treated : blood had been taken ; and coun- BLOOD-LETTING. 165 ter-irritation established, both on the region of the chest and in the secretory system in general; for, the mouth had been slightly affected by mercury. A day or two before the author saw her, she had ex- pectorated blood in the morning, which was florid, but not frothy, and it was not brought up by any effort of coughing. At his first visit with Dr. Gibson, it was proposed that blood should be drawn, not so much in consequence of the presence of urgent symptoms, but from the apprehension, that the affection, which appeared to ex- ist mainly in the pleura costalis, might extend ; whilst, at the same time, a knowledge of her temperament, and the character of her symptoms, suggested that the abstraction should not be carried to any great extent. The blood, previously drawn, was buffed, and this was regarded as one element in the decision, that a farther ab- straction should be made. She was accordingly bled, and the blood was again buffed ; but the crassamentum was small in quantity, and very thin ; so that it could be laid hold of, and separated from the large quantity of serum in which it was placed, and be held up like a piece of leather. Only a small quantity of blood was taken ; and yet the depression produced by it was urgent, and sufficiently demon- strated the propriety of the great caution that had been exercised in the employment of the lancet. The pain was, however, entirely re- moved by it; and, by keeping up a centre of irritation, by means of the ointment of tartrate of antimony and potassa, applied on the ex- terior of the chest, the symptoms were entirely removed. For this fortunate termination she wTas mainly indebted to the dis- crimination of her attending physician, for had he carried the blood- letting too far, prostration would have ensued to a much greater extent; a corresponding reaction would have been established, and any hyperaemia that might have existed would probably have been increased ; yet, if the buffy coat of the blood were to be regarded, in all cases, as unequivocal evidence, that a farther abstraction of that fluid should be made, it ought assuredly to have been prac- tised in this case, seeing that the appearance was marked; although, as before observed, the proportion of the crassamentum to the blood taken away was extremely small. In the case, too, of affection of the encephalon, which the author described as having attended with his friend Professor Smith, (p. 151,) the blood exhibited the buffy coat, and yet its abstraction, even in small quantity, induced violent palpitation and other nervous symptoms, which prevented its repe- tition. It maybe laid down, then, as a rule, that the appearance of the buffy coat cannot, when taken singly, be regarded as a sufficient rea- son for the farther abstraction of blood ; and that the propriety of a repetition must depend upon other symptoms taken along with the buffy coat; and farther, that such a coat may be present, wrhen there is no inflammatory condition in the system, or when it is by no means to a dangerous extent. The general views that have been laid down with regard to the 166 SEDATIVES. use of blood-letting, will have demonstrated the value of this thera- peutical agent in inflammatory affections, and the circumstances that must be taken into consideration in judging of the extent to which the abstraction of l)lood must be carried, and of the best mode of after management for reaping full advantage from it, where it may have been employed as far as the practitioner has deemed prudent, and yet where hyperaemia may still exist to some extent. The cases require the exercise of the nicest discrimination ; yet blood-letting has been so much the fashion in all diseases of an inflammatory cha- racter, and— it may be said—in all sudden diseases, that the pub- lic voice calls loudly for the use of the lancet in such cases; and the practitioner, led away by popular clamour, and not sufficiently fortified by the possession of proper pathological and therapeutical principles, is found to fall in too frequently with the wishes of by- standers, who are commonly totally ignorant of the proper course to be pursued. If, too, he be not possessed of right presence of mind, he may adopt measures which his better judgment might by no means approve. On a public occasion some years ago, in an address delivered to the Graduates in Medicine at the annual commencement of the University of Maryland, the author had an opportunity of adverting to some cases of this kind, which are of daily occur- rence. A man falls from a height, bruised — stunned perhaps — and the general call is for a surgeon to bleed him ; yet, at times, in such accidents, a shock is given to the great nervous centres — the brain and spinal marrow, the effects of which bleeding is well calculated to augment—and augment fatally — if it be em- ployed immediately after the receipt of the injury, and before reac- tion has taken place. In like manner, if a person, when vehemently addressing an auditory, falls down suddenly in a state of suspended animation, the impression immediately is, that he has had an apo- plectic seizure. A vein in the arm or neck, or the temporal artery, is immediately opened, and the state of suspended animation may, in this way, be converted into one of death. The heart, in such cases, has ceased to act, and the free abstraction of blood from the general circulation is not well adapted to restore it. When a person is attacked with apoplexy, it rarely happens that he dies instantaneously. A train of phenomena, characterised by loss of sensation, volition, and mental and moral manifestations, suc- ceeds for a time, and is the precursor of dissolution. Circulation and respiration, however, in the meanwhile, continue ; but, where the heart dies first, the circulation ceases; respiration is then no longer accomplished, and the state of suspended animation becomes con- verted, almost instantaneously, into positive death. This view has been confirmed by the cases of instantaneous death, which the author has had an opportunity of examining. In most of them, the state of the heart has indicated, that the cessation of its action was the first link in the chain of phenomena. BLOOD-LETTING. 167 The satisfaction, often felt at the exhibition of energy on the part of the practitioner, is well exemplified by an anecdote, which an illustrious native of this country—now no more — who had filled the highest office in the gift of a free people, and whom the author had the honour of ranking amongst his personal friends — was in the habit of recounting. Travelling from Virginia towards the north, he rested for a night at a tavern on the road ; soon after his arrival at which, the hostess came in from a neighbouring house, with the females of her family, — all exhibiting marks of deep distress. He was informed that they had been witnessing the parting scene of a young friend, who had died of some acute affection. "But, thank God !" observed the contented matron, "every thing was done for him, that was possible, for he was bled seven-and-twenty times." " It is not" — says the inimitable Moliere, who was unsparing in his ap- propriate philippics against the profession, and the public of his day — " it is not, that, after all, your daughter may not die ; but, at all events, you will have done something, and you will have the con- solation that she died according to form." After the lecture, to which allusion has been made, was delivered, the author's friend, Dr. Wright, of Baltimore, put into his hands a work, which he published twenty-seven years ago ; in an appendix to which are contained views so strikingly like those which the author promulgated on that occasion, that they might be regarded as the pro- totypes of his. Dr. Wright's excellent ' sketch' had not, however fallen under his observation : the coincidence of views is, therefore altogether accidental, and it afforded the author no little satisfaction to find, that his sentiments accorded so strikingly with those of so excellent an observer. The appendix contains a masterly critique on the views of the distinguished Rush, as contained in his ' Defence of Blood-letting.' " ' We must do something,' is the most unfortunate and pernicious maxim," says Dr. Wright, " which has ever been introduced into the policy of medicine. At the moment, when it received the sanc- tion of professional reputation, professional imposture was legalised, and ignorance and artifice acquired confidence from feeling security. I refer to no particular authority for the inculcation of this sentiment. It has unhappily been stamped with the approbation, and received the connivance of numbers, who could have wanted nothing but re- flection to have refused it their assent. Its adoption has never wanted advocates ; it has been eagerly received, and amply exer- cised ; and the profession is to this day disgraced by the admission, that ' mankind must be amused.' Had half the pains been taken to acquire professional understanding, which have been practised to impose on society, this maxim might long since have been commuted for the more honourable sentiment, that mankind must be instructed. It is under the covert of this professional mask, that the prejudices of the world have been pressed into the service of the practitioner, and its ignorance arrayed against its security. It is thus that a eonve- 168 SEDATIVES. nient resource has been provided against that false shame, which dreads a candid avowal; and the physician, armed with implements, for whose use or consequence he apprehends no responsibility. Among the weapons of this licensed warfare against decorum and integrity, the lancet holds a distinguished rank. Like the sword of Alexander, it is the universal solvent of every difficulty; and has often been made to sever the gordian knot, which defective ingenuity was incompetent to unravel. Justice would be violated were those remarks pointed solely at the worthless herd, whose business is im- posture ; who openly repose their claims upon the hopes and fears, the follies and the weakness of their fellow creatures. They reach even him to whom contingent circumstances have opened a more ample and elevated range in professional relation ; who, without an effort to improve that profession, is solicitous to enjoy, by other means, the benefits of its exercise." The whole of Dr. Wright's remarks on the subject of blood-letting as a therapeutical agent are most judicious ; and it is a matter of regret, that, owing to the exhaustion of the copies, the work is not available to the profession. It is to be hoped, however, that he will find leisure to lay before it the substance of the appendix to which the author has referred, with the modifications —if any — that have been suggested by his subsequent experience and reflection. Allusion has more than once been made to the induction of syn- cope, as marking the effect produced by blood-letting on the func- tions ; and this is the criterion established by many practitioners, as to the requisite quantity of blood to be abstracted in cases of inter- nal inflammation. In general, no harm may arise from the rule, but there are exceptions to this, as well as to all other general rules. Fortunately, the condition of inflammation impresses a degree of tolerance on Jhe system, which, in the vast majority of cases, ena- bles it to withstand the abstraction of blood, even when carried to an injudicious extent; but in the extreme ages —in early infancy, and in advanced life— the frame does not rally so readily from the sedation ; and the author is satisfied, from observation, that many persons at those ages have had their deaths hastened— if not mainly occasioned—r-by the too vigorous use of blood-letting. This is es- pecially apt to occur in diseases, in which the degree of inflamma- tory irritation is not so great as to communicate to the system the full tolerance ; and especially in those cases of coma or convulsions in early childhood, to which reference was previously made, as being presumed to depend on " congestion," and, therefore, to require blood-letting. In these unhappy cases, the fancied signs of conges- tion increase after the operation ; the farther abstraction of blood is, therefore, determined upon ; the powers of life fail; effusion takes place into the ventricles of the brain, and the child dies from ex- haustion,— that exhaustion having been partly induced by the means adopted for the removal of the malady. Such is not, however, in all probability, the opinion of the practitioner. He consoles him- BLOOD-LETTING. 169 self with the reflection, that the fatal event has been occasioned by the intensity of the disease : when a similar state of affairs occurs, he has recourse to the same management, with like results; and, at the end of a long life, he is perhaps ready,to exclaim, — that he has never had occasion to regret the employment of blood-letting, but has often reproached himself for not having pushed it farther. All this has arisen from the indiscriminate faith, placed in this valua- ble agent — valuable only when appropriately employed — by others besides the Sangrado of Le Sage. " With regard to age," says Professor A. T. Thomson, — "in infancy, the laxity of the solids, and the relative proportion of the serum or watery part of the blood to the crassamentum or clot, which consists of fibrin, and co- louring matter, are more considerable than in adult age : blood-let- ting, by increasing this greater proportion of serum," proves hurtful; and a state of syncope in infants is always one of great danger. The first effect of exhaustion in such young subjects is an increased de- gree of irritability, which leads to stupor, and generally terminates in convulsions ; the pulse is quickened, the pupil of the eye dilates, and symptoms closely resembling those which precede the effusion of water in the ventricles present themselves. I have seen this more than once occur in children in whom symptoms resembling those of inflammation of the brain, accompanying irritation of teeth- ing, have displayed themselves ; and leeching or cupping has been resorted to ; but, instead of affording relief, a state of evident de- fective stimulus supervened ; and, in one case, snoring, stertor, and other appearances of apoplexy having followed the bleeding, more leeches were applied, and the infant died. This state is detected readily by attention to the state of the breathing, which seems to be performed almost wholly by the diaphragm; and is always ac- , companied with the evolution of much flatus ; both circumstances denoting a very low state of the nervous energy. It is best obvi- ated by white wine whey, opium and ammonia, administered warm, in small quantities, and frequently repeated. In youth, and in the vigorous and robust, on the contrary, reaction takes place, and is % especially marked after repeated venesections: the most favourable age for bearing blood-letting is from eighteen to forty-five. In old people the reaction is extremely feeble ; and, during the flow of the blood, exhaustion often steals on so insidiously and imperceptibly, that when nothing injurious is anticipated, syncope appears ; no re- action can be induced, or it is defective, and gives way to a state of positive sinking. The risk in such a case is extreme." The dangers conceived to arise from general blood-letting, in early childhood, are considered by some to be so signal, that they never have recourse to it, preferring leeches or cupping; but, if carefully practised, it is safe, and the impression made upon the dis- eased condition— if one of active inflammation — is usually more decidedly salutary. The abstraction should not, however, be car- ried so far as to induce syncope. Owing to one or more fatal events VOL. II.—15 170 SEDATIVES. having succeeded to the operation in Edinburgh, the Professors, — during the author's attendance on the lectures there, — were in the habit of inculcating great caution in regard to its use at this early age. " The experience of fifteen years, and some of it of a sorrow- ful kind" — says a recent observer — Dr. Casper Morris, of Phila- delphia, " has convinced me fully, that children bear bleeding illy, and in asserting my convictions that as many children have sunk under the ill-judged use of depletion as from incurable disease, I would not cast censure upon others without taking to myself a full share of it." Of the propriety of the same caution in advanced life, the author had a striking instance soon after he commenced prac- tice. It was, indeed, of so alarming a nature, that it could not easily be forgotten. An elderly gentleman wTas directed to be bled for chronic bronchitis, and the author was requested to perform the operation. After the abstraction of a few ounces, syncope rapidly supervened, and it was so long before the vital functions were re- stored, that he became seriously apprehensive the patient would die under his hands. The patient ultimately recovered, but a consider- able period elapsed in this stage of examination or transition be- tween life and death. The same caution is requisite in taking away blood when there is much disease about the heart or great vessels. The author has known two cases, in which the syncope, induced by blood-letting practised for the removal of symptoms of internal hyperaemia, be- came the syncope of death : the irritability of the heart seemed to be suddenly destroyed, so that it never resumed its pulsations. In one of the cases, the existence of organic disease of the heart was known ; but the individual seemed as if he could tolerate a copious abstraction of blood ; before, however, a few ounces had been taken, he fell from his chair and expired. In such doubtful cases, the pa- tient should be placed in the horizontal posture, and the flow of blood be arrested, before any very marked effect appears to be ex- erted upon the functions of innervation or circulation. Such are some of the main points to be borne in view in the em- ployment of general blood-letting as a therapeutical agent, in inflam- matory affections especially. There are cases, however, in which our object is to bleed to positive syncope — to relaxation—and where we have no fears of the supervention of reaction ; as wThere we are desirous of overpowering forcible muscular contraction, or of reducing strangulated hernia. With this view, 1he patient is placed in a sitting posture, and the blood is made to flow from a free orifice in one or both arms. Again, there maybe cases, — as already remarked,— in which general bleeding may be unadvisable, and yet where topical bleeding may be advantageous. There was a time — and, indeed, the feeling still exists with a few — when it was maintained, that there can be no case in which topical blood-letting appears to be required, which could not be relieved, and more effectually, by blood drawn from LOCAL BLOOD-LETTING. 171 the general system ; and certain practitioners have gone so far as to express their regret, that such agents, as a leech, or a scarificator and cupping-glass wrere ever known. There is, in these cases, pro- bably defective observation — modified, perhaps, by the existence of ancient and preconceived opinions — which interferes with the correct observation and reflection of the practitioner. The author has repeatedly satisfied himself, that local abstraction of blood has produced the most beneficial results, when general blood-letting had been — or would, to all appearance, have been— entirely ineffectual. In many of these cases; however, the beneficial result was not per- haps owing so much to the blood drawn, as to the attendant revul- sion, — a modus operandi of blood-letting, general as well as topical, which is elsewhere considered. (See Revellents.) It has been a common remark, that local blood-letting — when not used as a revellent, but simply with the view of diminishing the quantity of circulating fluid, and of acting, in this way, on the pow- ers of the system — is extremely inefficient, and cannot therefore be relied on when internal inflammation exists ; but this is an erroneous position. By multiplying the number of cups, or leeches, we can as cer- tainly, although not always as effectually, reduce the organic actions, as by opening a vein; but the blood flows more gradually, and is, con- sequently, adapted for cases where venesection might not be appro- priate. Every practitioner, too, who has employed leeches freely, must have met with cases, in which the most decided effects have been produced by the depletion, which they occasioned. Each good American leech, if we reckon the quantity of blood, that may be en- couraged to flow from the leech bites, may be regarded as with- drawing a third of an ounce of blood ; and, consequently, if we apply as many leeches as some of the modern French practitioners were in the habit of prescribing in gastro-enteritic, and other inflam- matory diseases, we may take away a larger quantity of fluid from the vessels than we could do with impunity from the vein of the arm. Twenty or thirty ounces constitute a large bleeding, and it will rarely happen that the lesser quantity can be taken from a vein without the supervention of syncope, and the inconveniences, which, as has been seen, in particular habits, are apt to follow that state, whilst a much larger quantity can be abstracted under the gradual flow that takes place, either when leeches or cups are the agents. An experienced leecher of Baltimore informed the author, that there is not much difference in the quantity of blood, which the American, the Turkish, the German or the Spanish leeches can contain. This may be estimated at about a quarter of an ounce ; but they differ essentially as respects the flowr they occasion from their bites. By the Turkish and the German, an ounce maybe lost, including the quantity swallowed by the leech ; and by the Spanish, half an ounce ; whilst we can scarcely calculate on more than a third of an ounce from the American. It has fallen to the anthor's lot to witness some alarming cases of 172 SEDATIVES. exhaustion, especially in children, where leeches had been applied : in two, indeed, the result was fatal. In both, due attention had not been paid, and a large amount of blood was lost before the cause of the sinking was discovered ; and in one, every attempt to arrest the flow of blood failed. These cases are rare, but they constitute ob- jections to the use of leeches, which do not apply to cupping,— the flow from the wounds made by the scarificator being readily ar- rested. When practicable, the leeches should be placed over bone, in order that pressure may be conveniently made on the bleeding vessels, should such a course be requisite. " When leeches are applied to soft parts," — says an author to whom reference has often been made — Dr. A. T. Thomson — " for instance, to the abdomen, it is truly astonishing how much blood sometimes is detracted ; particularly when a poultice is applied over the bites, and the patient is kept warm in bed : to prevent, there- fore, injurious symptoms of exhaustion from such a circumstance, the poultice should be frequently examined. This is more likely to occur in children than in adults ; and in children it not unfrequently happens that the bleeding cannot be stopped without encircling the orifice of the ligature. On this account leeches should never be ap- plied late at night on children ; for, as the application of leeches in infancy must be regarded as a species of general blood-letting, the precise number which will regulate not only the quantity, but be equivalent to rapidity in the detraction of the blood should be de- termined ; but the bites should be instantly closed, on observing that the system is brought under the influence of loss of blood." In all cases of hyperaemia, occurring in the child, or in the adult, the therapeutist — it need scarcely be said — will have to exercise the best of his judgment as to the propriety of the adoption of general or local blood-letting, or both. It is not a true position, then, that general blood-letting can always be substituted for local blood-letting with equal advantage — nor does the converse of the proposition hold good. Both general and local blood-letting diminish the quantity of blood circulating in the system ; they are both, therefore, adapted to cases of polyaemia or plethora, although the former is more available than the latter where copious abstraction of the fluid is necessary; but general blood-letting is not adapted, as has been seen, to every case of hyperaemia. In some cases, a small quantity of blood, obtained from the inflamed part itself, affords instantaneous relief, when general bleeding has been used in vain ; and there are cases, again — as has been shown, when treating of Excitants — which are relieved by stimulating the vessels to contraction, after both local and general blood-letting have totally failed. It must be borne in recollection, that inflammation is not caused directly by the condition of the general circulation, but by a morbid state of the capillary vessels of a part. Inflammation may attack the arteries and veins themselves, and even this is not, or need not be, LOCAL blood-letting. 173 connected with the blood in the inflamed vessels, but may be de- pendent upon a pathological condition of the nerves and vessels that supply their coats. Blood-letting, consequently, even in this case, can be but an indirect agent. By diminishing the amount of circulating fluid, it may reduce the activity of the capillary vessels, and thus remove the hyperaemia, but it exerts no direct sedative agency on the vessels themselves. Such is the fact in every case of inflammation. The action of the capillaries is distinct from that of the heart; and — as before remarked — inasmuch as inflammation is produced by a morbid condition of the capillaries, the most philo- sophical plan of medication would be, to direct our remedial agents to those vessels; but as this cannot always be effected, we are com- pelled to have recourse to the only succedaneum we possess — the abstraction of blood from the general system, and the sedation, which this is capable of effecting. In affections of certain parts of the organism, we can have a choice of vessels so as to enable us at times to empty the affected capillaries, or to reduce the quantity of blood circulating in them — or, in other words, the amount of stimulus — more effectually; but our sphere of action, in these cases, is extremely limited, and we are not perhaps possessed of any in cases of internal inflammation. It can be understood, that if hyperaemia were present in the hand, — blood, taken from the bend of the corresponding arm, would empty the vessels concerned more freely than if it were taken from the other arm, or from the external jugular; but in hyperaemia of an internal organ, we have no mode of opening a vein between the inflamed part and the heart. It has, indeed, been recommended, that, with the views here laid down, blood should be taken, either from the temporal artery, or from the external jugular vein, in cases of inflammatory affections of the encephalon; yet very slight reflection will show, that no signal advantage is to be expected from this course ; and, indeed, plausible arguments might be advanced for the purpose of proving, that the disadvantages might overbalance the presumed benefits. For example, blood, in every case of the kind, where the artery is opened, must come from the external carotid — a vessel which does not supply the encephalon — and, consequently, it cannot be supposed, that any benefit could accrue from selecting this vessel, in a case of encephalitis: it may be argued, however, that if more blood be solicited into the temporal artery, less will pass along the internal carotid ; but this argument, again, might be com- bated—-and philosophically — under the view, that as both the in- ternal and external carotid arise from one trunk, any cause, which could solicit blood into the one, might attract a larger afflux along the common trunk; and, therefore, augment the flow along both branches —the internal as well as the external. The same reasoning applies to phlebotomy, practised upon the external jugular vein in head diseases. If we could open the in- ternal jugular vein, we might assuredly materially affect the state of the encephalic vessels, by emptying the sinuses, which, by their 15s 174 SEDATIVES. union, constitute that vessel; or rather, which supply it with blood ; but this is impracticable; and, as the external jugular conveys the blooct-back to the subclavian from the exterior of the head only, no advantage can accrue from selecting it, where the encephalon is in a pathological condition. It has been proposed by many, that a branch of the temporal ar- tery should be opened in cases of violent ophthalmia; but the pro- position has probably been hazarded without due examination. If we could always take blood from the ramifications, that proceed to- wards the eye, and, after the blood-letting, destroy them, by cut- ting them across, the plan might be advantageous, but unless we divide those very branches, the effect may be any thing but salu- tary. By obliterating some of the arterial ramifications, more blood might be distributed to the others, and, in this way, the ophthalmic branches might become developed, and more mischief than good accrue from the operation. Owing to these objections, arteriotomy is not often had recourse to, in such cases ; it is rarely, indeed, em- ployed, except in sudden seizures, as of apoplexy: and it is then employed, rather on account of the ease with which it can be ac- complished— in the absence of bandages, &c,—than in conse- quence of any therapeutical preference, which should be given to this mode of abstracting blood. It is an important fact, moreover, connected with this inquiry, that the experiments of M. Poiseuille with his haemadynamometer have shown conclusively, that the pres- sure of the blood in the different vessels is alike, and consequently, that the tension can be relieved as much by blood-letting from one vessel as from another. The essential difference, after all, between topical and general blood-letting, is, that by the one, we abstract blood from the capil- laries ; by the other, from the larger vessels. Now, in internal in- flammation, topical blood-]etting cannot be employed on the vessels of the part. It must be effected at a distance from the seat of the mischief; and, accordingly, its operation is of a mixed character — combining depletion and revulsion ; but, in cases of external inflam- mation, we can make our depleting agents affect the vessels them- selves, which are morbidly implicated. With this intent, cupping is rarely used. The operation cannot well be borne on an inflamed surface, owing to the pressure of the cups. Scarifying the part is, however,— in diffusive inflammation especially, — a most energetic agent, and half an ounce of blood, discharged from the over dis- tended vessels, is followed by more benefit than all other remedies together. Mr. Lawrence has well shown the marked utility of free scarifications through the integuments in the diffusive inflammation of the skin, which constitutes erysipelatous inflammation ; and in those varieties of erythematous inflammation of the fauces, —which are attended by deep dusky redness, and very painful deglutition, without any great degree of swelling of the mucous membrane of the fauces or of the subjacent parts, — the most signal relief is LOCAL BLOOD-LETTING. 175 afforded by scarification through the membrane. The pain on de- glutition'is often almost instantaneously removed, and the cure is rapid. In all such cases, the scarification should be free. The blood generally flows readily from the divided vessels ; retraction of their extremities takes place, and the new adhesive inflammation is substituted for the more slugglish and asthenic kind, which consti- tuted the original affection. Similar good effects supervene on scari- fication of the tunica conjunctiva, in inflammation of that mem- brane. Blood is sometimes abstracted from the capillaries of an inflamed part by means of leeches ; but it has been made a question with the reflecting, whether leeches be not likely to occasion more mischief than benefit, owing to the irritation excited by their bites, and the afflux of blood to the part caused by their sucking. Apprehensive that such may be the consequence, many therapeutists are in the habit of applying them on the sound parts, in the vicinity of the seat of inflammation ; but here, again, it may be a question whether there may not be evils attending this practice, which are weighty. When the leeches are applied over an inflamed surface, they ob- tain the blood immediately from the affected capillaries. This, of itself, ought to be salutary. But it is asserted, that their bites become centres of irritation, and that they may augment the phlogosis. This may be the case ; but in the generality of instances the new action, thus excited, has perhaps an opposite effect; — accompanying, as it does, the evacuation of the dilated capillaries, it may excite their tone, prevent subsequent distention, and thus remove the hyperae- mia. When, however, the leeches are applied near to the inflamed part, they cannot empty the affected capillaries, and by attracting blood into the neighbouring vessels, they may occasion a greater afflux towards those of the inflamed part. The author is not much in the habit of applying leeches immediately on the part in cases of external inflammation ; but where he has done so, they have not seemed to him to be followed by the aggravation of symptoms, which some have anticipated ; and in many cases marked relief has been experienced. Where applied at all, it appears to him, that they should be placed over the inflamed vessels rather than in their vicinity. The conflicting views, above mentioned, have been, and are, frequently entertained in cases of mastitis occurring after delivery. Whilst some recommend general blood-letting, and revulsion effected by powerful emetics and cathartics ; others advise the application of leeches ; and others, again, are of opinion, that their employment is not productive of any advantage. The author has used them in such cases more than once, and it has appeared to him with advan- tage ; but he has seen more benefit from the employment of agents of the excitant kind. The loose texture of the mammae allows the capillary vessels to be readily distended ; an asthenic condition is thus induced in them, which is the source of excitation in the arte- 176 SEDATIVES. rial ramifications continuous with the asthenic capillaries, and this asthenic condition is best removed by the application of excitants — as of heat considerably greater than that of the body—to the inflamed part. Where we are desirous of obtaining a larger quantity of blood than would flow spontaneously from leech bites, or when encouraged by the application of cloths wrung out of warm water, or by that of a warm cataplasm, cups are sometimes placed over the bites. A con- siderable quantity of blood may thus be abstracted, and we have the advantage of the revulsion, wThich the cupping glass is capable of accomplishing, should the propriety of such revulsion be indicated. It has long been the custom at the commencement of the cold stage of intermittents to apply ligatures to the extremities ; which, in many cases, have given occasion to a mild hot stage, and abridged the duration of the whole paroxysm. The modus operandi of this agency has been a matter of question. By some, it has been supposed, that the obstruction to the venous circulation in the extremities causes an accumulation of blood in the superficial veins, and a consequent increase in the action of the heart. The true 'modus operandi is probably the one suggested by Dr. Mack- intosh ; — the detention of blood in the superficial vessels cuts off, as it were, a certain quantity of fluid from the circulation, so long as the detention continues ; and in this manner exerts an analogous effect to the withdrawal of the same quantity of fluid from the vessels. This modus operandi is illustrated by the following case, cited by Sir George Lefevre from Dr. Wilson, in which the disposition to swooning in an erect attitude appeared to be owing to varicose veins of the lower extremities robbing the brain of its usual quantity of blood. A lady, past the middle age, was so subject to faint when in the erect posture, that, although otherwise in good health, she was confined to her bed and sofa. As soon as she attempted to rise, she felt faint or even swooned. The cause of this phenomenon for a long time baffled the skill of her medical attendant, until, by some acci- dent, he discovered that she had immense varicose veins in both legs ; and in the erect posture these became reservoirs for the blood, which accumulated too much in them to be propelled forward ; hence, the balance of the circulation was deranged, and the brain, robbed of its usual quantity, manifested symptoms of its weakness. By the appli- cation of proper bandages, which supported the vessels, when she was in the erect posture, the distressing affection was overcome. Hamostasis — as this mode of arresting the blood in the vessels has been termed — has been strongly recommended, of late, by Dr. Thomas Buckler of Baltimore, as a sedative agent, especially in in- ternal hyperaemia or inflammation, and there can be no doubt that it may be extensively available. "It is capable," he remarks, "of exerting, under given conditions, a more powerful control over the circulation than the lancet, antimony, or digitalis, and controls the CONTRA-STIMULANTS. 177 heart's action without exhausting the vital forces, or giving rise to the ill consequences, which the protracted use of most of the sedative agents is likely to do ; and, finally, haemostasis in the hands of judi- cious practitioners must prove the means of saving an incalculable amount of blood ; to say nothing of the incredible benefits, which would be derived from its adoption by those Sangrados of our art, who bleed empirically in all conditions, and who, in many cases, like the fabled vampire, suck the living current until the vital powers are spent." Under the head of sedatives may be included a set of therapeu- tical agents, now much used, in Italy more especially, but also adopted in France and in Great Britain, — rarely in this country; — agents, which, by removing excitation, might be termed sedatives, but wdiich, by their propounders, have been called contra-stimulants, and the theory which suggests them, the theory of contra-stimulus,— the new medical doctrine of Italy,—La nuova Dottrina, &c. Prior to the termination of the last century, the doctrines of Brown were universally embraced in Italy, and they continued in vogue, until Rasori, on the occasion of a petechial fever making its appear- ance in Genoa, subjected the prevalent views to considerable modi- fication ; and, as in most similar cases, ended by embracing views diametrically opposite. Rasori maintained, that most diseases, to which mankind are liable, are owing either to an augmentation of excitability, or to an excess of stimulus; and he conceived, that there are certain medicinal agents, which possess a peculiar debilitant power, and which act upon the excitability of the frame in a man- ner directly opposed to that in which stimulus acts upon it. To this power he gave the name contra-stimulus. The mode in which the different contra-stimulants have acquired their reputation appears to have been as simple as it must frequently have been fallacious. Every agent, which succeeded in removing a sthenic disease, could do so only, it was presumed, by diminishing the excitability, or removing the stimulus. Accordingly, it was a contra-stimulant. Substances were therefore classed together, which bore no relation to each other, either in their immediate properties, or in their secondary effects — as regarded the physiological pheno- mena they induced. We find, in the lists—emollients—as milk and gum ; astringents—as acetate of lead ; tonics—as gentian, simarouba, iron, and, according to some, even cinchona; excitants — as turpen- tine, squill, and arnica ; emetics — as tartrate of antimony and potas- sa, and ipecacuanha; narcotics — as stramonium and belladonna; acrid poisons — as arsenic, nux vomica, cantharides ; and a host of other animal, vegetable, and mineral substances, which had no kind of analogy to each other. It has been properly observed, that this manner of considering the effects of medicines tends essentially to bring together the most dissimilar substances, as well as to separate such as are closely allied, and, consequently, to confound all. In the case of this theory, however, as of every other, the prac- 178 SEDATIVES. tice, built upon it, has added valuable facts to therapeutics ; and not the least of these is the knowledge, that tartrate of antimony and potassa may be administered in large doses, in inflammatory affec- tions, not only with impunity, but with marked advantage. This. potent emetic may be given to the extent of ten or twenty grains or more, in divided doses, during the day, without either producing vomiting or purging; or, if the first doses prove emetic, a tolerance is soon acquired, and the subsequent doses may be followed by no marked effect, except the diminution of the febrile symptoms. At other times, the urinary and cutaneous depurations appear to be largely augmented, and rapid emaciation succeeds to its administra- tion. The contra-stimulant physicians maintain, that the exaltation of the vital manifestations, in febrile and inflammatory diseases, en- ables the system to bear the large doses of this and other contra- stimulants, and they say, that the tolerance vanishes with the disor- der that communicated it; but this assertion is not confirmed by experience. There is, certainly, a greater resistance to the action of these agents, as there is to blood-letting, when all is exaltation, but the power of resistance does not cease, although it is diminished, when the exhalation ceases. Some individuals, too, never possess the necessary tolerance ; so that, with them, the tartrate of anti- mony and potassa does not produce contra-stimulant effects ; and it would seem, that there are, also, what the French term medical con- stitutions or epidemic conditions, whieh forbid its employment. Thus, according to Bricheteau, although it was so successfully used in 1831, it could not be beneficially administered at the end of 1832, and the beginning of 1833. Not until the autumn of this last year, could it be resumed advantageously. On one occasion it was given in the hospital, by an Eleve de garde, during the choleric epidemy. The most violent symptoms supervened, and the patient died of cholera morbus, no sign of which existed before the tartrate was taken. Of the different phlegmasiae, acute rheumatism and pneumonia are those that are considered to have been most successfully combated by this agent in a large dose. "Emetic tartar," says M. Bricheteau, " should generally be preceded by blood-letting; and commonly it is advisable not to have recourse to the former, unless the latter is insufficient, except in cases in which blood-letting is contra-indi- cated, or impossible, owing to some special circumstances, — as hap- pened to me once in the case of a rickety individual, who had no veins proper for phlebotomy. The medical constitution of the sea- son is, also, occasionally opposed to the abstraction of blood : in such cases, the tartrate of antimony and potassa is a valuable agent. Re- course may, likewise, be had unhesitatingly to tartar emetic at the very first, when the patient is exhausted by age or other causes, and appears to be too weak to bear the abstraction of blood ; or, in cases where a positive refusal is given to the proposition for phlebotomy." " This agent," he adds, "must, also, be of great advantage, and of CONTRA-STIMULANTS. 179 convenient employment, in country situations, where the physician can rarely pay his visits at an early period. It may be practicable, by this method, and with the aid of an intelligent person, to regulate the treatment of a case of pneumonia or of rheumatism for several days after having premised a copious abstraction of blood, if it be considered desirable." The fact, however, referred to by Briche- teau—that it is not every one who presents the necessary tolerance— would render this agent by no means as easy of application by the laity as he presumes. Granting— and it would seem it must be granted— that the tar- trate of antimony and potassa is a sedative agent; it becomes interest- ing to inquire into the mode in which such agency is exerted. It is, as is well known, one of our best suppurants, when we are desirous of establishing a centre of fluxion on some part of the cutaneous sur- face, with the view of removing an internal disease. Experience, too, has sufficiently shown, that, when given in large doses, it pro- duces pustulation in the mouth and fauces, if not lower down in the alimentary tube. In a case, which occurred under the author's care in the Baltimore Infirmary, this effect of the antimonial was signally evidenced. M. Bricheteau—who has administered it largely, as a contra-stimulant—says its local action is exerted more particularly on the mouth, tongue, and pharynx, where false membranes and pus- tules are occasioned by it, but these lesions, he thinks, are by no means common. The oesophagus, he says, never participates in them ; and they are more frequent in the intestinal canal than in the stomach : and, in the former, the lower part of the small intestines, and the commencement of the large, exhibit themselves more sensible to the action of the antimony than other portions of the tube; but it cannot be said, that sufficient opportunities have occurred for testing the effects of the remedy, and for separating the morbid appearances which have presented themselves, and which may have proceeded from other causes. He is of opinion, that the lesions which maybe referred, with the greatest probability, to the use of the tartrate of antimony and potassa, — although he admits they are frequently owing to other inappreciable causes, — are, injection or infiltration of the submucous tissue of the intestines, and softening of the mucous membrane. In the mouth, considerable inflammation — either pustular or ulcerous—is sometimes observed, which speedily disappears after the discontinuance of the antimony. Many facts and arguments tend to the conclusion, that the contra- stimulant virtues of tartrate of antimony and potassa may be depend- ent upon its revulsive properties ; that this revulsion is produced in the lining membrane of the alimentary canal; and that when it is accom- plished, the excited actions, going on elsewhere, become diminished, and more or less nervous and vascular concentration takes place towards the seat of the artificial revulsion, whilst the general effect is one of sedation. Rasori thought that the remedy lessens stimulation, or augmented excitability, directly : Laennec first maintained, that 180 SPECIAL SEDATIVES. it acts as a revellent by irritating the stomach; but the followers of Broussais having made this a ground of opposition to the remedy, he latterly maintained, that it invigorates the activity of the absorb- ents ; whilst a recent writer, Dr. C.J. B. Williams, suggests, that the most reasonable view to take of its operation is, that it acts chiefly by diminishing the tonicity of the vascular system. He con- siders, in other words, that antimony — and some other remedies — "reduce directly the tone of the vascular fibre, acting as relaxants." "Small doses," he adds, "certainly relax the pulse and the skin, and when there is no fever produce perspiration without stimulating. They also seem to increase the biliary and intestinal secretion. In inflammation and fever, larger doses are required to produce the same result; and as soon as the excessive arterial tension is relaxed, the chief part of the fever is removed. By thus reducing the in- creased tonicity of the arteries, the circulation is equalised and quieted, and the determination to and distention of the inflamed part are diminished ; and the vessels generally are placed in the condition for their natural offices of secretion, wdiich their extreme tension had before interrupted." " This view," he properly remarks, " is, how- ever, at present, no more than hypothetical, and might with advan- tage be tested by experiments on the lower animals." SPECIAL SEDATIVES. 1. ACIDUM HYDROCYAN'ICUM. — BYDROCYAN'IC ACID. Diluted Hydrocyan'ic, Prussic, or Cy'anohy'dric Acid, has been long employed as a therapeutical agent when combined with essential oils in certain vegetables ; but it was not recommended in a separate state until about twenty-five years ago. It exists in the distilled water of Laurocerasus, and of "the bitter almond, as well as in the expressed juice of the leaves of Laurocerasus, the peach, &c. Its chief source, however, is in animal matters subjected to heat in con- tact with alkaline substances. The Pharmacopoeia of the United States, last edition, (1842,) adopts the London process for the formation of the acid, which con- sists in separating it by the reaction of dilute sulphuric acid on ferro- cyanuret of potassium. When wanted for immediate use it is di- rected to be prepared by the action of dilute muriatic acid on cyanuret of silver. By the double decomposition that ensues, hydrocyanic acid is formed, which dissolves in the water, and the chloride of silver subsides. The clear liquor is then poured off, and kept for use. Hydrocyanic acid, thus prepared, is colourless, of a peculiar odour, and wholly volatilisable by heat. One hundred grains produce with ACIDUM HYDROCYANICUM. 181 solution and nitrate of silver a white precipitate, which, when wTashed and dried, weighs 10 grains, and is readily dissolved by boiling nitric acid. It contains 2 per cent, of pure anhydrous acid, and has a cha- racteristic odour. This must not be confounded with that of the oil of bitter almonds, which is decidedly different, and is much more dependent upon a true essential oil than on the concomitant hydro- cyanic acid. (Christison.) Hydrocyanic acid should be kept in closely stopped bottles, from which the light is excluded. Some have supposed, that glass stop- pers are absolutely necessary for its preservation, but this has been denied. Hydrocyanic acid is usually classed amongst narcotic poisons; yet there is reason to believe, that its ordinary effects are purely seda- tive. Whilst agents belonging to the class of narcotics produce, first of all, excitation in the organic actions, followed, sooner or later, when the agent is in sufficient dose, by signs of sedation, this acid occasions the latter results only. Of the rapidity of its action, in highly poisonous doses, mention has already been made. When given in rather too strong a dose, or, if in proper doses, at too short intervals, it produces headache, and vertigo, which go off, however, in a few minutes. With regard to the parts of the economy that are primarily acted upon by it, there can be but little hesitation in designating the nervous system. In no other way can we readily explain the extreme rapidity of its operation in fatal cases ; yet when mixed with the blood out of the body, it altogether changes the cha- racter of that fluid, and opposes its coagulation. From what has been said of the action of hydrocyanic acid, it is easy to infer the morbid cases in which it may be indicated. It is decidedly sedative, allaying nervous irritability and vascular action ; and, therefore, adapted for all cases in which these are unusually excited. Yet its power, as a medicinal agent, is not as great as was at one time presumed, and is still presumed by many. The great objections that have been urged against it are — its dangers, even in a small dose, if not cautiously administered ; the difficulty of having it always of the same strength ; the impracticability of administering it undiluted, and the danger of giving too strong a dose, in conse- quence of its rising to the surface of water. More than once, too, the difference in the strength of the acid prepared by different me- thods, would seem to have given rise to unfortunate results. The case of a sick person is mentioned by Orfila, who had used it for a length of time, in increasing doses, with advantage ; when, being compelled to send her prescription to another apothecary, the acid he returned was so strong as to produce death with all the symptoms of poisoning by hydrocyanic acid. For these and other reasons, many of the German physicians prefer the cherrylaurel water and the water of bitter almonds, which, although in other respects not less objectionable, are far less dangerous. Sir George Lefevre, indeed, vol. n.—16 182 SPECIAL SEDATIVES. in a recent work, affirms, that the cherrylaurel water—Aqua Lauro- cerasi is a far more effective preparation than hydrocyanic acid. In many nervous affections, as palpitation, hysteria, &c, he generally prescribes the following draught: R. Aquae lauro-cerasi, ntxx. ------flor. aurantii, f. 3J. Syrup, tolut. f. 3j. M. ^ The draught to be taken pro re natd. The author has frequently employed hydrocyanic acid and its com- pounds, where a sedative agent has appeared to be needed, but the results have not satisfied him that they were owing to the remedy administered. It has been conceived to be especially appropriate in diseases that depend upon increased irritability of the nervous sys- tem, and in those connected with a state of excessive sensibility. In fevers — intermittent or continued — it is rarely used. It is affirmed by Dr. A. T. Thomson, that in no kind of iodiopathic fever — either intermittent or continued — has the acid been employed ; but in this Dr. Thomson is mistaken. There are practitioners, who have used, and continue to use it, in such affections. By many, it has been esteemed beneficial in hectic fever ; but here, again, its agency is doubtful. In all the phlegmasia?, and in every kind of hy- peraemia, simple or accompanied with hemorrhage, it has been tried, and numerous testimonials have been offered in its favour. Even in the formidable disease, phthisis, it has been extolled ; moderating the cough, it is affirmed, and lessening the hectic. It is, however, in diseases belonging to the class spasmi of Cullen, that its powers are looked upon as most conspicuous, —in diseases, in other wrords, in which it is difficult to appreciate therapeutical agencies. In asthma, even when the pulse was small, irregular, and often not easily dis- guishable, it is said to have acted almost like a charm, removing the oppressed breathing, and restoring the free play of the respiratory organs ; and in hooping cough it has been conceived by Dr. Roe to possess almost a specific power. " I do not think," says another ob- server, Dr. A. T. Thomson, " I am stretching my praise of it too far, in affirming, that few cases of this disease would prove fatal, were the hydrocyanic acid early resorted to, and judiciously administered. After emptying the stomach with an emetic, and purging briskly, the use of the acid should be begun, and the prescription never altered, except to increase the dose of the acid. When thus treated, the dis- ease seldom continues more than a month or five weeks." " It is necessary," he adds, "to confine the little patients to a graduated tem- perature, and to keep them altogether upon a milk and vegetable diet." The author has often used the hydrocyanic acid in hooping- cough, and endeavoured to observe its effects carefully; but the re- sults have not been such as to enable him to place much reliance upon it. It certainly has not answered, in his hands, in the very cases men- ACIDUM HYDROCYANICUM. 183 tioned by Dr. Thomson, half as well as narcotics employed so as to produce a sedative influence. In various neuropathic disorders of the stomach, especially in those in which pain at the epigastrium was the leading symptom ; in every form, indeed, of gastrodynia, and in painful affections of the bowels of a similar character, it has been found useful; as well as in chronic vomiting, connected or not with organic disease. It has, likewise, been given in different forms of neuralgia with great benefit. Externally, it has been employed in numerous cases;—as a soothing agent in severe pain, — for example, in toothache ; as a lotion, when diluted, in painful wounds ; as an injection in fistula ; and associated with belladonna, as a cataplasm, in neuralgia. In various forms of cutaneous disease, it has allayed the irritation that accompanies them ; associated with infusion of belladonna, it has been thrown into the vagina in cases of uterine pain from scirrhus; and been used as an injection in blennorrhoea. It is almost imprac- ticable, however, to enumerate the different morbid conditions in which it has been prescribed. If the practitioner will bear in mind the effects, which it is capable of inducing upon healthy man, when the dose is carried to the requisite extent, he will have no difficulty in deciding upon the cases in which its agency may be appropriate. If not a true sedative, it is the nearest approach to one in the lists of the materia medica ; and its employment is, therefore, clearly sug- gested in all diseases in which there is much erethism, — adminis- tered either alone, or along with other agents of the same class. The dose of hydrocyanic acid is one or two drops in a table-spoon- ful of any simple menstruum, increasing the dose gradually by one drop, until some effect is perceptible, either on the patient or on the disease. The most common effect on the patient is a peculiar im- pression on the back of the throat, with sluggishness in the move- ments of the tongue. " There is no distinct evidence of its being a cumulative poison, though this has been at times suspected. Its operation must be diligently watched at first, till the proper dose be ascertained. This is the only secret for using it with safety and confidence." (Christison.) The ordinary strength of a lotion for cutaneous affections and painful ulcers is one part of the acid to two hundred of water; but the strength may be increased to twice or thrice this amount: some- times rectified spirit is added to it. A lotion of f. ^i to f. ^iv of the acid to a pint of the decoction of common mallow has been used in acne and impetigo to diminish itching, and in ulcerated cancer to allay pain. It is important to bear in mind, that in these cases it affects the system, inducing giddiness and faintness ; so that great caution is needed. 184 SPECIAL SEDATIVES. 2. POTAS'SII FERROCYANURE'TUM. — FERRO-CYAN'URET OF POTAS'- SIUM. Ferroeyan'uret of potas'sium, Ferrocy'.anide of potas'sium, Prus'- siate of potas'sa, Ferroprus'siate of potas'sa, is prepared on the large scale, by calcining animal matters wTith pearlash, in a red hot iron crucible ; dissolving the cold calcined mass in water ; concentrating, and crystallising. It may, likewise, be prepared by boiling purified Prussian blue in solution of potassa, till the blue colour disappears, and then crystallising. The salt, thus formed, is a double cyanuret of potassium and iron. It is in crystals of a lemon colour, which are wholly soluble in four parts of temperate, and two parts of boiling water; but is insoluble in alcohol. It is in the materia medica list of the Pharmacopoeia of the United States. Ferrocyanuret of potassium is very rarely used in medicine. It wrould seem, indeed, to be inert or nearly so. Half a pound of a solution of it has been swallowed ; and a drachm and two drachms have been given without any inconvenience. (Christison.) On the other hand, one writer — Dr. Smart, of Maine, — regards it as a valu- able sedative in febrile and inflammatory cases. He ascribes, also, astringent powers to it in the colliquative sweats of phthisis ; and affirms, that it sometimes induces ptyalism, unattended wTith the fcetor which forms part of mercurial ptyalism. He, likewise, found it of service in neuralgia, and in hooping-cough. In an over-dose, it oc- casioned giddiness, coldness, and numbness, with sense of sinking in the epigastric region. Notwithstanding, however, the recommend- ation of Dr. Smart, it is scarcely ever prescribed. The author has watched its effects in the sweating of phthisis, but has never wit- nesssed the slightest benefit from it. The dose recommended by Dr. Smart is ten or fifteen grains dissolved in water, repeated every four or six hours. The salt is chiefly used for the preparation of the |3. POTAS'SII CYANURE'TUM.— CYAN'URET OF POTAS'SIUM. Cyanuret or Cyanide of potassium— received into the last edition of the Pharmacopoeia of the United States, (1842), as one of the preparations ■— is made by exposing Ferrocyanuret of potassium — the salt last mentioned — to a moderate heat until it becomes nearly white. It is then exposed to a red heat until gas ceases to be dis- engaged ; distilled water is now added to it when cold, and it is evaporated to dryness. In this process, the cyanuret of iron is de- composed, and that of the potassium remains. It is soiled, however, by the iron, and the charcoal belonging to the cyanuret of iron. When the mass is dissolved in water, the iron and charcoal are de- posited ; the cyanuret of potassium is dissolved, and is obtained by evaporating to dryness. DIGITALIS. 185 The dry salt, obtained, must be kept in a closely stopped bottle. It is a white powder, having a sharp, somewhat alkaline and bitter almond taste, and an alkaline reaction. It deliquesces in moist air ; is very soluble in water, but sparingly so in alcohol. Cyanuret of potassium has all the properties of hydrocyanic acid for which it has been recommended as a substitute. It has been advised, that it should be dissolved in eight times its weight of dis- tilled water ; and to this solution Magendie gives the name medicinal hydrocyanate of potassa, and advises, that it should be prescribed under the same circumstances, and in the same doses, as medicinal hydrocyanic acid. He farther suggests, that to render it wholly in- dependent of the action of the small portion of alkali contained in the cyanuret, a few drops of some vegetable acid may be added, or it may be prescribed with an acid syrup. The dose of cyanuret of potassium is a quarter of a grain, which may be gradually increased to a grain or more. It has been em- ployed advantageously as an external application in facial, sciatic and other forms of neuralgia ; in the form of lotion, (Potass. Cyanur. gr. i — iv ; Aqua, f. ^j ;) and of ointment, (Potass. Cyanur. gr. ij — iv ; Adipis, ^j.) Added to poultices, it is affirmed to have relieved the pain of white swelling. M. Andral employed it with complete success in a case of intense cephalalgia, which, for ten months, had resisted the most powerful remedies — as bleeding, a seton in the neck, blisters and sinapisms. It was used in solution in the pro- portion of six or eight grains to the fluidounce of distilled water ; and compresses, wet with it, were applied, for eight days, to the fore- head and temple. _______ Recently, the Sulpho-cyan'uret of potas'sium, Potas'sii Sulpho- cyanure'tum, has been proposed by Sommering as a substitute for hydrocyanic acid and cyanuret of potassium, on the ground, that it possesses the same therapeutical virtues without their inconveniences. 4. DIGITA'LIS. — FOXGLOVE. The leaves of Digita'lis purpu'rea—the pharmacological history of which has been given elsewhere, (vol. i. p. 282,) are unquestion- ably referable to the class of acro-narcotic poisons, when administered in a large dose. In ordinary doses, their effect on the circulation is sedative, diminishing its force and frequency, and acting as a diuretic. In larger doses it affects the alimentary canal, inducing nausea and vomiting; and also the cerebro-spinal system, causing stupor; and, in very large doses, coma, convulsions, and death. A slow, feeble, and irregular pulse likewise results, with cold sweats. Its operation on the nervous and circulatory organs has been observed by some to be preceded by manifest excitement; by others, however, this has not been witnessed. The author has watched attentively during its administration, but has not been able to satisfy himself of 16* 186 SPECIAL SEDATIVES. the existence of any precursory excitement. " The publications of Rush, Rasori, and Tommasini," says a recent writer, Dr. Billing, " would, I think, satisfy any person, that digitalis is a sedative, (' contra-stimulant,') though up to this time, not a year passes in which the pages of periodicals are not loaded with attempts to prove it a stimulant." At times, the pulse is reduced by it as low as 35 beats in the minute. Along with this reduction, when the remedy has been given for some days, there is generally a feeling of great languor, often with anxiety, nausea, vertigo, dimness of vision, head- ache and delirium; and if the doses be still continued, these symp- toms may be followed by those of true poisoning. Not only are the effects of the digitalis induced when the remedy is taken by the mouth, but they equally supervene when it is injected into the rectum or into the venous system. It has often been remarked, that after it has been given in ordi- nary doses for a time, without producing any constitutional effect, and certainly none of poisoning, it may suddenly explode, as it were, and produce alarming consequences: hence the great caution that is usually inculcated against administering it too vigorously, even when its effects are not apparent. Death, we are told, has resulted in numerous instances from its employment. Yet there are several authenticated instances in which it has been given to a great, extent with entire impunity. The author recollects being struck with the freedom writh which the tincture was directed by Professor James Hamilton, jun., of the University of Edinburgh, in the diseases both of women and children, that are attended with much vascular ex- citement ; and there are practitioners who give f. ^ss or f. ^j with much less effect than might be supposed. A recent writer, Dr. Pereira, cites the following communication from an old preceptor-of his own, as well as of the author — Dr. Clutterbuck—in illustration of this point. " My first information on this subject was derived from an intelligent pupil, who had been an assistant to Mr. King, a highly respectable practitioner at Saxmundham, in Suffolk, who, on a subsequent occasion, personally confirmed the statement. This gentleman assured me, that he had been for many years in the habit of administering the tincture of digitalis, to the extent of from half an ounce to an ounce at the time, not only with safety, but with the most decided advantage, as a remedy for acute inflammation, — not, however, to the exclusion of blood-letting, which, on the contrary, he previously uses with considerable freedom. To adults he gives an ounce of the tincture, (seldom less than half an ounce,) and awaits the result of twenty-four hours ; when, if he does not find the pulse subdued, or rendered irregular by it, he repeats the dose; and this, he says, seldom fails to lower the pulse in the degree wished for; and when this is the case, the disease rarely fails to give way, pro- vided it has not gone the length of producing disorganisation of the part. He has given as much as two drachms to a child of nine months. Sometimes vomiting quickly follows these large doses of DIGITALIS. 187 the digitalis, but never any dangerous symptom, as far as his ob- servation has gone, which has been very extensive. In less acute cases, he sometimes gives smaller doses, as thirty drops, several times in a day. ' Such,' adds Dr. Clutterbock, ' is the account I received from Mr. King himself, and which was confirmed by his assistant, who prepared his medicines. I do not see any ground for questioning the faithfulness of the report. I have myself exhibited the tincture to the extent of half an ounce (never more) in not more than two or three instances, (cases of fever and pneumonia.) To my surprise there was no striking effect produced by it, but I did not venture to repeat the dose. In numerous instances I have given two drachms, still more frequently one drachm; but not oftener than once in twenty-four hours, and not beyond a second or third time. Two or three exhibitions of this kind I have generally observed to be followed by slowness and irregularity of pulse, when I have im- mediately desisted.' " When the effects of the digitalis on the circulatory system were first observed, it was fancied, that a substitute had been found for the lancet in febrile and inflammatory diseases ; and some time even after that period, it was highly extolled as a contra-stimulant by Rasori and his followers. It is rarely, however, employed in sim- ple fevers, and neither in them nor in inflammation, can it be sub- stituted for the lancet. It may, however, be used with advantage after blood-letting has been premised, and especially where the in- flammation has gone on for some time, and has terminated in serous effusion. As a mere antiphlogistic, it is rarely trusted to in those cases. The circumstances that guide its administration in inflammation, apply equally to hemorrhages, in which it is very commonly direct- ed after antiphlogistics : yet but little faith is placed in its remedial agency, in these cases, by Dr. Christison. It certainly ought not to interfere wTith the employment of other remedies. It has been highly extolled in haemoptysis ; but in no disease is there more difficulty in deciding as to the precise effect of any particular remedy, as the hemorrhage generally ceases, after a time, of itself, and hence it is that so many internal astringents are recommended, which often cer- tainly can have but little influence, the curative effect being mainly, and perhaps altogether, induced by the general principles of treat- ment that are pursued along with them. In diseases of the heart, accompanied by augmented action, digi- talis would appear to be indicated, and it is, accordingly, much pre- scribed in hypertrophy of that organ, both when simple and accom- panied by dilatation, as well as in the various affections in which the heart's action is irregularly exerted, — as in angina pectoris, neuralgia, &c, or where there is an accompanying dropsical effu- sion, when its diuretic action becomes serviceable. At one time, in phthisis, it was considered to be capable of ar- resting the disease; and certainly, when its constitutional influence 188 SPECIAL SEDATIVES. is induced, the symptoms often appear to be suspended for the time; but in every case that has fallen under the author's notice, they have subsequently recurred. It has the power of diminishing the velocity of the circulation, but it must be borne in mind, that this velocity is a mere symptom of the pathological condition — the tuberculosis. In some of the neuroses, it has been prescribed freely, as in ma- nia, epilepsy, and even in delirium tremens, as well as in certain spasmodic diseases, as asthma and hooping-cough ; in some of which it has, undoubtedly, been given empirically. It is not easy, for ex- ample, to see on wdiat principle it has been prescribed in very large doses in delirium tremens. After all, the effects which it is known to exert, and which have been described above, will suggest the pathological states in which it is most likely to prove of service. The ordinary dose of powdered digitalis is a grain or a grain and a half, repeated three times a day, gradually increasing the dose — under the precautions already laid down—until some constitutional effect is perceptible. The ordinary dose of the INFUSUM DIGITALIS, (Vol. i. p. 285,) is f. §ss to f. §j; and of the TINCTURA DIGITALIS, (Ibid.) til* to njxx three times a day. From numerous experiments, Dr. Munk has re- cently recommended the tincture as acting with the greatest certainty and effect upon the heart. Digitalis has been applied locally in the form of a liniment made with the powdered leaves and honey to scrofulous ulcers, and es- pecially to ulcers that are attended with an excess of inflammatory action. In such cases the sedative action of the drug is exerted, and an improvement seems to be effected on the system of nutrition of the part, as manifested by the improvement in the discharge and appearance of the ulcer. Digitalin — the active principle of digitalis —described elsewhere (Vol. i. p. 288,) as having been separated by MM. Homolle and Que- venne, is a most energetic sedative. They found its action on the derma denuded by a blister to be so irritating as to forbid its ender- mic use. From experiments on their own persons, the action of digi- talin on the heart was always manifest, and was commonly exhi- bited by a progressive diminution in the number of its pulsations, which were lowered in some cases to 40, and generally to 50 or 55 in the minute. Its influence on the circulation appeared to continue for several days after its administration had been discontinued. Digitalin appears to possess all the active properties of digitalis. Its action, however, is most energetic; and, consequently, it requires to be given with the greatest circumspection. MM. Homolle and Quevenne have found, from comparative trials, that four milli- grammes (gr. .0616) of digitalin correspond in energy of action to about eight French grains (gr. 6.56) of digitalis. C0LCHICI RADIX ET SEMEN. 189 5. COL'CHICI RADIX. —COL'CHICUM ROOT. 6. COL'CHICI SEMEN. —COL'CHICUM SEED. Fig. 21. The cormus and seeds of Col'chicum autumna'lt—Meadow Saffron; Sex. Syst. Hexandria Trigynia; Nat. Ord. Colchicaceae, — Melanthaceae, (Lindley,) are both officinal in the Pharma- copoeia of the United States. The plant in- habits moist, rich meadows, in many parts, of England, and in various parts of Europe ; and is an autumnal ornament of the gardens, — the flowers appearing in September, and the fruit in the following spring or summer. Various attempts have been made to intro- duce its culture into this country, with no great succesfe, although small quantities of the bulb raised here, apparently of good quality, are said to have been brought to market. — (Wood & Bache.) The bulb is considered to be most active in June or July, when it is fully developed, and has not been exhausted by the produc- tion of the flower. The seeds must be gath- ered when ripe. The fresh cormus or root is about the size of a chestnut, and resembles in shape and size that of the tulip ; but differs from it, in the latter being in scales, whilst that of colchicum is solid. It is convex on one side, and flattened on the other, where the germ of a new cormus is perceptible, which, if it be allowed to grow, shoots into a stem; and bears the flower; — the old cormus, in the meantime, wastes away and becomes inert. This gerrn, in the opinion of Dr. J. R. Coxe, distinguishes the cormus of colchicum from all others ; but it is affirmed that it is not always present. Internally, the cor- mus is white and fleshy, contains a milky juice, and has an acrid, bitter taste. To dry the root, it has been recommended that the dry coats should be removed ; that it should be cut transversely in thin slices, and be quickly dried in a dark airy place, at a temperature not exceeding 150° or 170°. These slices — if the drug be in good preservation — are firm, dry, of a grayish white colour, and an amylaceous appearance. Colchicum seeds are about the size of white mustard seeds ; devoid of smell, and of a bitter, acrid taste. The flowers are not officinal. They are the mildest part of the plant, and have been successfully administered by several English physicians. Colchicum imparts its virtues to water and to alcohol; but even Colchicum autumnale. a. The flowering plant. b. Stipinas, with a portion of the styles. c. Leaves and fruit. 190 SPECIAL SEDATIVES. better to vinegar, and wine, or to diluted spirit of the same strength. Hence distilled vinegar and wine are used as menstrua for two offici- nal preparations that are much employed. The cormus has been analysed by different chemists. At one time, it was believed by MM. Pelletier and Caventou that it contained veratria, but from the examination of Messrs. Geiger and Hesse, it appeared, that the active principle was seated in an alkaloid closely analogous to veratria, but not identical with it, to which they gave the name Colchicine or Col- chicia. This is found in every part of the plant, crystallising in slender needles, inodorous, and of a very bitter, and afterwards biting taste. Introduced into the nose, it does not induce sneezing, like veratria. In excessive doses, colchicum is a poison of the acro-narcotic class. It is avoided by cattle, and its active poisonous properties have been long known: fatal cases, indeed, still occur, every now and then, from its use, not only in animals, but in consequence of its too free employment in the treatment of gout. Reynolds — the inventor of the wine of colchicum, commonly called Reynolds's Specific—is said to have killed himself by an overdose of it; and other fatal cases are recorded. It appears to be the hermodactyl of the ancients, and was exten- sively employed by them, but had fallen into almost entire neglect, when its use was revived in Great Britain, in the first quarter of the present century, as an efficacious agent in gouty and rheumatic affec- tions ; and it is now introduced into almost every pharmacopoeia. In its effects upon the system, it seems to resemble somewhat digi- talis;— rendering the pulse less frequent. In gouty and rheumatic cases, its action has been regarded by some as specific ; others have ascribed its efficacy in these cases to its action on the kidney. It is most probable, that its agency as an acro-nar- cotic is mainly exerted on the nervous system, although it certainly is not easy to explain its modus operandi. The Eau medicinale d'Husson, was long a celebrated gout remedy, and was extensively used by men of the first scientific eminence. Many trials were con- sequently made to discover its constituents. These are now consi- dered to be colchicum root, macerated in wine :—the Vinum col- chici, to be described presently; and it is singular, connected with this discovery by Mr. Want, that whilst he was directing attention to the colchicum, another investigator had satisfied himself that the vera- trum album was the basis: it has been since shown, that the active principles of the two substances are strikingly analogous. In acute rheumatism, and in various inflammatory diseases, colchi- cum was proposed and extensively used by the author's valued and able friend, the late Mr. C. T. Haden, of London, as an excellent sedative to reduce the excited organic actions, which he conceived it capable of effecting to such an extent, that blood-letting might generally be rendered unnecessary in febrile and inflammatory dis- orders, and the views of Mr. Haden have been confirmed by others. C0LCHICI RADIX ET SEMEN. 191 The author has often exhibited the different preparations of colchicum in gout, and, frequently, with decided advantage ; but very often it has altogether failed. In his own case, it has never exerted any power. In acute and chronic rheumatism, its advantages have not seemed to him so marked as they have to some others. Like ether acro-narcotics, as cimicifuga, when carried to the extent of slightly affecting the system — as shown by nausea, with some cerebral con- fusion, it has, at times, effected a revulsion, which has broken the chain in acute rheumatism. In chronic rheumatism, it has exhibited less marked results ; yet there is no agent, perhaps, which is so much employed in rheumatic affections in general. In none of these cases according to most observers, need any sensible evacuation be pro- duced by it, although some have affirmed — and such certainly is the result of the author's observation — that it is more efficient, when it evinces its influence upon the skin or alimentary canal. A recent writer, Dr. Wigan, asserts, that he gives it in rheumatic gout in the dose of eight grains every hour, until " active vomiting, profuse purging, or abundant perspiration takes place, or at least until the stomach can bear no more ;" and, when thus administered, he pro- nounces it to be " the most easily managed, the most universally ap- plicable, the safest, and the most certain specific [?] in the whole compass of our opulent pharmacopoeia." Colchicum has, likewise, been given in the tetanus of warm cli- mates ; in chronic bronchitis, leucorrhoea, scarlatina, ischuria, prurigo erysipelas ; and it is said to have been prescribed successfully in tape-worm. J m It is sometimes used externally, as a liniment, to rheumatic joints, in the form of the tincture of the seeds or bulb. The dose of the powdered root is from three grains to ten, several times a day. Dr. Holland affirms, that he knows no preparation more certain in effect or better capable of fulfilling the peculiar purposes of the medicine than the acetous extract. TINCTU'RA COLTfflCI SEMIMS, TINCTURE OF COL'CHICDI SEED. (Colchic semm. contus. 31V ; Alcohol, dilut. Oij — prepared either by macera- tion or displacement.) The dose of this preparation is from ott x to f. 3j. Dr. Pereira states, that he has often given f. Jij at aldose without any violent effect, and Dr. Barlow, who prefers this to the other preparations of colchicum, advises that in gout f *j f jdss or f. 51J of the tincture should be given at night, and repeated in the following morning. If this quantity fail to purge briskly, a third dose is administered on the following night. The tincture is sometimes used externally in gout. For this purpose, it has been recommended to mix two drachms of it with four fluid- ounces of a spirit lotion, but it is affirmed, that the local use of mor- phia had the same effect,—the part being bathed in hot water for a 192 SPECIAL SEDATIVES. minute, and then lint being applied spread with simple cerate, on which about three grains of acetate of morphia were distributed. More recently, the tincture of the root has been advised as an exter- nal application in rheumatism, — alone, or combined with tinctura camphora. It has been used at the author's Clinique in the Phila- delphia Hospital, and often wTith advantage ; but whether much or any benefit was produced by the colchicum, the author was unable to decide. VINUM COL'CHICI RADICIS, WINE OF COL'CHICUM ROOT, (Colchic. radic. contus. fbj ; Vini, Oij—prepared by maceration or displacement.) This is intended to be a saturated tincture. The dose is from ten minims to f. 3j ; repeated until some effect is induced. Sir Everard Home ascribed much of the griping and nausea that sometimes follows the use of this and other tinctures of colchicum, which have not been carefully filtered, to the sediment that forms in them, and wdiich may be removed without injury to the desired effect of the remedy. It would appear, however, that this sediment is inert. VINUM COL'CHICI SEMINIS, WINE OF COL'CHICUM SEED. (Colchic. Sem. contus. ^iv; Vini, Oij.) This is in none of the British Pharma- copoeias. It is the wine which was so much used by Dr. Williams in gout. The dose, in gout, is f. 3j to f. 3ij. ACE'TUM COL'CHICI, VINEGAR OF COL'CHICUM. (See Vol. i. p. 286.) This preparation is more frequently given as a diuretic; and in gouty and rheumatic cases. The acetic acid unites with the alkaloid and forms Acetate of colchicia, which is supposed by some to be equally active with the colchicia itself. Sir C. Scudamore, however, combines it with magnesia, in order that an acetate of magnesia may be formed, and the colchicia be left in the most favourable condition for admi- nistration. A mixture, proposed by him for gouty cases, which has received the name of Scudamore's mixture, is thus made — (Magnes. sulphat. |j—gij; solve in Aq. menth. crisp, f. 5x; adde Acet. colchic. f- S — 3iss; Syrup. Croci, f. |j; Magnes. Bviij.—M. Dose f. giss so that from four to six evacuations may be produced in twenty-four hours.) 7. VERATRIA. Veratria is the active principle of the seeds of Vera'trum Sabadil'la, V. officinale, Helo'nias officina'lis, and Asagra'a officinalis, which are known in commerce under the names Cebadil'la, Cevadil'la, or Sabadil'la, and are imported from Vera Cruz and Mexico. They usually occur in commerce mixed with the fruit of the plant, are two or three lines long, of a black colour, and are shining, flat, VERATRIA. 193 shrivelled, winged and elastic seeds. Vera'trum Sabadil'la belongs to Sex. Svst. Polygamia Monoecia; Nat. Ord. Colchicaceae, — Me- lanthaceae of Lindley ; the Asagrcea officinalis, to Sex. Syst. Hexan- dria Trigynia; Nat. Ord. Melanthaceae. Although cevadilla is applicable to all the cases in which veratria is used, it is still very rarely employed. A saturated tincture of the seeds is occasionally employed as a rubefacient liniment in chronic rheumatism and paralysis, and is rubbed over the heart in nervous palpitation. The rationale of the process for obtaining Vera'tria, Vera'trine, or Sabadillin, in the Pharmacopoeia of the United States, (1842,) is as follows. Bruised Cevadilla is boiled in fresh portions of alcohol for three times ; the cevadilla is then pressed, and the alcoholic solu- tions, containing veratria, united with a vegetable acid, are mixed. The alcohol is distilled off, and the residue is boiled three or four times in water, adulterated with sulphuric acid, by which means an impure solution of sulphate of veratria is obtained. The liquors are mixed, strained, and evaporated to the consistence of syrup. Mag- nesia is now added in slight excess, which decomposes the salts of veratria, and sets the veratria at liberty. The dried residuum is digested repeatedly in alcohol, which dissolves the veratria. The alcohol of the different digestions is mixed and distilled off. The residue is boiled in water with a little sulphuric acid and animal char- coal, the second of which unites with the veratria, whilst the third removes the colouring matter. The liquor is strained, and the residue thoroughly washed, the washings being mixed with the strained liquor. It is then evaporated to the consistence of syrup, and as much solu- tion of ammonia dropped in as may decompose the sulphate of vera- tria, and precipitate the veratria. The precipitate is lastly separated, and dried. Veratria is of a grayish white colour, pulverulent, devoid of odour, and of a bitter acrid taste, producing a feeling of numbness and ting- ling when applied to the tongue. It is sparingly soluble in water, but readily so in alcohol, ether, and especially in weak acids, which it neutralises. On account of its very high price, and the want of well defined external characters, the veratria of the shops is said to be very subject to adulteration ; and there would not seem to be any good criterion for ascertaining its degree of purity. (Christison.) Veratria is a most virulent acro-narcotic poison. Minute doses, injected into the venous system, have induced fatal tetanus. When taken internally, in medicinal doses, it causes heat in the mouth, nau- sea, and feeling of heat in the stomach and bowels, — at times, diar- rhoea and headache, with depression of the heart's action. Applied externally, it excites a singular sense of and pricking in the part, and occasionally the same cephalic heat and cardiac phenomena as vol n.—17 194 SPECIAL SEDATIVES. result from its internal administration. Only in a few cases has any eruption followed its application. The endermic use of the remedy has always excited so much irritation as to prevent its repetition. Owing to the presumed effects of veratria on the nervous system, and especially on the spinal marrow and the nerves connected with it, the use of veratria was suggested in nervous diseases, particularly in neuralgia, prosopalgia, and ischias. A single friction is said to have been sufficient to remove the disease without relapse. Some advantagehas likewisebeenfoundfromitsemployment in chorea,hypo- chondriasis, hysteria and paralysis, as wrell as in rheumatism and gout. Turnbull found it useful in glandular swellings, goitre, swellings of the mammary glands unaccompanied by pain, buboes, and scro- fulous tumours, even in cases wrhere iodine had failed. Farther experience is, perhaps, needed in regard to the virtues of veratria ; but the author must confess, that his own observation, thus far, has by no means confirmed the high-strained eulogies of Turnbull; and this is the general sentiment of the profession. It has often been used externally by the author, as well as by many other American physicians, but has always fallen short of the mark. Veratria may be given in pill, or in spirituous solution, — the dose being from one-twelfth to one-sixth of a grain several times a day. A Tincture may be made of four grains to the ounce of alcohol, and of this, ten to twenty drops may be given for a dose in a glass of water. Externally, it is best used in the form of Ointment. (Vera- tria, gr. v, x, xx ; Adipis, ^j.) The size of a hazel-nut to be care- fully rubbed in, morning and evening or Fig. 22. oftener, for from five to fifteen minutes. SULPHATE OF VF.RA TRIA, made by the com- bination of veratria with sulphuric acid, has the same virtues as veratria. Magendie has proposed the following solution as a substitute for the Eau medicinale d'Husson in gout. (Veratria sulphat. gr. i- Aqua destillat. f. gij. M. Dose f. 3j to f. 3iv.) 8. VERA'TRUM ALBUM. —WHITE HEL'LE- BORE. WThite hellebore is the rhizoma of Ve- ra'trum album; Sex. Syst. Polygamia Monoecia ; Nat. Ord. Colchicaceae, — ,7 . *.y^i- ' " Melanthaceae, (Lindley:) a plant which Veratrum Allium. Linn. . ' \ ***"v •>/ " l"""1^ var. Aibiflorum. grows in the mountainous regions of Europe, abounding in the Alps and Pyrenees, but is not a native of Britain. The root is brought to this country from Germany in the dried state ; and, as met with in the shops, is from two to four inches long, by an inch in diameter, having the shape of a cylinder, or more frequently of a truncated VERATRUM VIRIDE. 195 cone. It is rough, rugous, and of a grayish or blackish browm colour externally ; internally, whitish ; and usually has portions of the root fibres attached to it; at other times, the fibres remain attached. These are of a yellowish colour, and of the size of a crow's quill The odour of the fresh root is disagreeable ; that of the dried feeble. The taste is at first bitter, and afterwards acrid. On analysis, wdiite hellebore yields veratria, the properties of which have been considered, (ii. 192.) Another substance has, likewise, been announced in it, termed Jervin, from Jerva, the Spa- nish name for a poison obtained from the root of white hellebore, the properties of which have not been accurately investigated. White hellebore is a powerful acro-narcotic poison ; and an ac- tive irritant; hence it is one of the most potent errhines. (See Vol. i. p. 258.) In medicinal doses, unless very cautiously adminis- tered, it is apt to irritate excessively the gastro-enteric mucous mem- brane. It is said, indeed, to have produced these effects when the rhizoma has been placed in contact with the cutaneous surface, and especially when the cuticle has been removed. It appears to re- semble greatly, in its effects, sabadilla and colchicum. In consequence of the occasional severity and uncertainly of its operation, white hellebore is rarely given internally. Formerly, it was prescribed so as to induce its effects on the stomach and bowels in mania, melancholia, and other diseases of the nervous system, and, doubtless, at times acted beneficially as a revellent; but it is now never prescribed. When great efforts were made to discover the composition of the celebrated gout remedy — Eau medicinale d'Husson — it was announced by Mr. Moore, that white hellebore was the chief ingredient ; but, about the same time, Mr. Want es- tablished, that a kindred plant—colchicum — was entitled to the credit. At that period, it was often prescribed in gout and rheumatism; but, of late, has been almost wholly abandoned in favour of colchicum. Its chief use, at the present time, is as an external agent — an an- tiparasitic — in scabies, and to destroy pediculi. It is also used in porrigo, lepra, &c. The dose of it, at first, ought not to exceed one or two grains, but it may be gradually increased. VINUM VERA'TRI ALBI, WINE OF WHITE HEL'LEBORE. (Veratri albi, contus. 3iv ; Vini, Oj.) This is the form in which white hellebore has been generally given in gout and rheumatism ; but it is not much used. The dose is rr^x two or three times a day, gradually increas- ing the quantity, until it exhibits some effect upon the constitution. 9. VERA'TRUM VIR IDL—AMERICAN HEL'LEBORE. This is the rhizoma of Vera'trum Vir'ide, Indian poke, poke root, and swamp hellebore, an indigenous plant, which is found in swamps 196 SPECIAL SEDATIVES. and wet meadows, and on the banks of small streams, in almost all parts of the United States ; flowering from May to July. The root is collected in autumn, and ought not to be long kept. Its taste is bitter and acrid, and its properties are probably dependent upon veratria. The medical properties of this rhizoma resemble those of colchi- cum and veratrum album. It is acro-narcotic in large doses; and reduces the force and frequency of the circulation in medicinal doses. Professor Tully, of New Haven, who has paid much atten- tion to the virtues of indigenous plants, and especially to those of active powers, recommends it strongly as a substitute for colchicum. It has been chiefly given in gouty and rheumatic cases. The author has never prescribed it. It is said to prove emetic in the dose of from four to six grains of the powder ; but, as a sedative, the ob- ject is to give it short of inducing emesis, and yet to produce nausea or an approximation to it. The proper dose for this pur- pose will be two grains. It has been prescribed both in the form of tincture and extract. Like veratrum album, it is used externally as an antiparasitic. 10. CIMICIF'UGA.—BLACK SNAKEROOT. Black snakeroot — the root of Cimicifuga race- mo'sa, C. serpenta'- ria, Acta'a racemo'sa, Macro'trys racemo'sa, Black snakeroot, Cohosh, Cohort, Bugbane— has been elevated, in the last edition of the Pharmaco- poeia of the United States, cimicifuga raeemosa. from the secondary to the primary list. The plant is indigenous in the United States, growing in shady and rocky woods CIMICIFUGA. 197 from Canada to Florida. It belongs to Sex. Syst. Polyandria Di- Pentagynia; Nat. Ord. Ranunculaceae. It yields its virtues to boiling water and to alcohol, and was found by Mr. Tilghman, of Philadelphia, to contain gum, starch, sugar, resin, wax, fatty matter, tannic and gallic acids, a black and green colouring matter, Hgnin, and salts of potassa, lime, magnesia and iron. Cimicifuga, in large doses,unquestionably belongs to the division of acro-narcotic poisons; but the author has had difficulty in deciding as to what class of therapeutical agents it ought to be referred. It has appeared to him, however, to exert an action analogous to that of colchicum; ^and under this impression, he has placed it after that agent. The testimony of pharmacological writers, in regard to its action, is sufficiently imprecise, and this is shown by the following views of one of the most respectable of them, Dr. Wood, of Philadelphia. " Cimicifuga unites, with a tonic power, the property of stimulating the secretions, particularly those of the skin, kidneys, and pulmonary mucous membrane. It is thought, also, by some to have a particular affinity for the uterus, and probably exerts some influence over the nervous system, of a nature not exactly understood. Its common name was probably derived from its supposed power of curing the disease arising from the bite of the rattlesnake. Till recently, it has been employed chiefly in domestic practice, as a remedy in rheu- matism, dropsy, hysteria, and various affections of the lungs, particu- larly those resembling consumption." Some years ago, cimicifuga was largely employed in the author's wards in the Philadelphia Hospital, by two zealous resident phy- sicians— Drs. E.A.Anderson, of Wilmington, N. C, and Alexander Vedder, of Schenectady, New York — who published cases illus- trative of its powers in the treatment of rheumatism, in the American Medical Intelligencer, for January 1, 1838, of which the author was editor; and like other acro-narcotics, when pushed so as to produce catharsis, and even slight narcosis, it certainly appeared to be of service in the acute forms. In its action on that disease it strongly resembled colchicum. It is probably by virtue of similar powers, that it has been found beneficial in chorea. In some successful cases, published by Dr. Kirkbride, of Philadelphia, purging was premised ; and general frictions with salt or the flesh brush, and pustulation with croton oil over the spine, are considered by him of much value in the chronic cases. All these agents operate as revellents. A recent writer, E. J. Wheeler, affirms, that by some eminent physicians it has been thought a good substitute for the ergot in parturition. It is stated, however, to be dissimilar in its mode of action, relaxing the parts and thereby rendering labour short and easy; but evidence is required of its possessing any such powers; and still more of its being of any service in incipient phthisis, or in 17* 198 SPECIAL SEDATIVES. " acute phthisis, uncomplicated with much inflammation in the vesi- cular structure or pulmonary mucous or serous membranes ;" as has been affirmed by a recent writer. The dose of the powdered root may be half a drachm to a drachm, two or three times a day. It is most commonly, however, prescribed in decoction, (Cimicifug. contus. 3j ; Aqua, Oj. To be boiled for a short time. Dose, f. |j to f. 3ij several times a day.) The tincture is also given, (Cimicifug. contus. ^iv; Alcohol. Oj. Dose, gtt. xx three or four times a day.) 11. ER'GOTA. — ERGOT. The effects produced by ergot—whose general properties are described under Parturifacients, (Vol. i. 420,) when eaten as food, are extremely injurious, — the aggregate of the symptoms having been termed Ergotism. At times, these are limited to vertigo, spasms and convulsions, with a peculiar tingling or sense of formi- cation in the arms and legs, which has given the affection, among the Germans, the name Kriebelkrankheit, or " creeping disease." Most commonly, the limbs waste away, lose sensation and the power of motion, and separate from the body by dry gangrene, — consti- tuting gangrenous erethism or mildew mortification. Various experi- ments have been made by feeding animals on ergot, and, although the results have been discordant; and, in many cases, none have been perceptible, there can be little doubt, that ergot exerts a poison- ous influence on many animals, when mixed with their food. In another place, it is stated, that in his experiments on healthy individuals Jorg found, that symptoms of acro-narcosis were induced by ergot, when given in large doses; and that he explains the par- turient effects of the drug by the violence done to the system of the mother. A short time ago, the author caused various experiments to be instituted on healthy persons as to the effects of ergot, in doses of half a drachm, and a scruple, of the. powder, and in the form of an oily preparation pointed out by Professor Hooker, of New Haven. These experiments were made on both males and females; and the general effects were those described by Jorg. When the dose was too large, nausea or vomiting often resulted with signs of narcosis. A case of narcosis, produced by the drug, in the dose of thirty grains, administered with the view of restraining a real or supposed tendency to hemorrhage after the expulsion of the placenta, was also com- municated to the author by Dr. Beckwith, then of Raleigh, North Carolina. Elsewhere, (Vol. i. 420,) reference has been made to certain ex- periments by Professor Hooker, of New Haven, who digested ergot in ether, and evaporated the solution, until an oleaginous fluid was left, which consisted of a lighter supernatant oil, and a heavier. The lighter oil was found to be possessed of decidedly narcotic pro- perties; and in certain experiments, made by Dr. JVIcKee, at the ACIDUM HYDROSULPHURICUM. 199 author's suggestion, it was found, that in every case, when given in doses of from ten to forty drops, it at first produced slight exhilara- tion of spirits, with increase of the circulation ; but these symptoms were soon followed by sedation, and, in the larger doses, by nausea also. It is, perhaps, by reason of those narcotic properties, that ergot has seemed to be serviceable in leucorrhoea, gonorrhoea, dysentery, and other diseases of the mucous membranes, and in various hemor- rhages— epistaxis, haemoptysis, haematemesis, haematuria, &c. The author has often administered it in such cases, but has never had reason to believe that it exerted any efficacy; and such has been the case with other observers. It is proper, however, to remark, that Dr. Wright found it, in the form of powder, very serviceable in ar- resting hemorrhage, and not simply in a mechanical manner as was proved by experiment. Even in the form of infusion, it possessed the power in an extraordinary degree. Dr. Wright affirms, that he has several times divided the external jugular, and the saphena major veins, and has never failed to arrest the flow of blood by an infusion of ergot, although with arteries he was generally less successful. In the greater number of experiments, he used a dilute solution of ergot, in the place of warm water, to sponge the bruised parts, and always succeeded in preventing that continued flow, which is often a serious obstacle to the safe direction of the knife. He, consequently, recom- mends it as a valuable means of preventing the troublesome hemor- rhage from small vessels in the course of surgical operations ; and, upon the same principle, believes the injection of a similar solution into the uterus, in cases of flooding, w^ill be found to answer every practical end that can be desired. It is said to have been serviceable in hypertrophy of the uterus, and has been supposed to act as an excitant to the spinal marrow; accordingly, it has been administered in paraplegia, and in retention of urine, and, it was conceived, with benefit. It has even been given to effect the expulsion of fragments of calculi after the opera- tion of lithotrity! Farther observation is, however, needed before wre can regard all these statements to be accurate. The usual dose of the powder—the form generally chosen in these cases — is ten to fifteen grains three or four times a day. 12. Tobacco, (Vol. i. p. 126,) and 13, Lobelia, (Vol. i. p. 124,) are likewise sedatives; but their properties as nauseant sedatives are so fully described under Emetics, that it is unnecessary to add any thing here. 14. AC"IDUM HYDROSULPHU'RICUM—HYDROSULPH'URIC ACID. Hydrosutph'uric Acid, Sulphohy'dric Acid, Hydrothion'ic Acid, or Sulph'uretted Hy'drogen, is not officinal in the pharmacopoeias of Great Britain or of this country ; but it is admitted into many of 200 SPECIAL SEDATIVES. those of continental Europe as a sedative agent. It is an important ingredient, also, in sulphureous mineral waters. Sulphuretted hydrogen is an extremely deleterious gas, killing in. stantly when breathed pure, and so powerfully penetrant, that it [s sufficient to place an animal in a bag of it, without any of the gas entering the mouth, for it to act fatally. Even when mixed with a considerable portion of air, it may prove destructive. Birds perishe(j immediately in air containing one thousandth part of it; a dog died in air containing one hundredth part, and a horse in air containjno. one hundred and fiftieth part. When breathed in a more diluted state, it produces powerfully sedative effects — the pulse being ren- dered extremely small and weak, the contractility of the muscular organs greatly enfeebled, with stupor, and more or less suspension of the encephalic functions ; and if the person should recover he re- gains his strength very tardily. It is the gas which is so dangerous to nightmen, when they descend into the pits of privies# Sulphuretted hydrogen gas has been advised in the wav 0f inha- lation, to diminish excitement in pulmonary affections^ an(j especially in phthisis pulmonalis. It has been employed, also, successfully, in a case of obstinate cough that remained after an attack 0f pneumonia. It may be disengaged by pouring dilute sulphuric acid on sulphuret of potassa in a cup, and breathing the vapour cautiously through a funnel, always bearing in mind its extremely deleterious properties. Another form is to dissolve half an ounce of sulphuret of lime in a pint of water, and to add to this two drachms 0f weak chlorohydric or muriatic acid, — the bottle in which the mixture is made being allowed to remain open for a few hours in the patient's chamber. Liquid hydrosulphuric acid may be made by disengaging the sul- phuretted hydrogen from a mixture of one of the sulphurets with dilute sulphuric acid, and causing it to pass into water to saturation. This may be diluted with four times its weight of water. It has been prescribed occasionally as a sedative in pulmonary affections • but is now rarely or never used. The last edition of the Pharmacopoeia of the United States had a formula for the Liquor Ammo'nia Hydrosulpha'tis, Solution of Hy- drosulphate of Ammonia, Hydro sulphuret of Ammonia, which was formed by passing sulphuretted hydrogen through solution of ammonia. It is powerfully sedative, and has been given in diabetes mellitus for the purpose of lessening the morbid appetite, so common in that dis- ease ; but it is now scarcely ever prescribed, and has accordingly been omitted in the last edition of the pharmacopoeia. SEDATIVE gases. 201 15. SEDATIVE GASES. Certain of the gases have been much used in the way of inhalation as sedative agents, but they are not much employed at the present day. Of the effects of one of them — Sulphuretted Hydrogen — mention has just been made. a. gas hydrogen'ium.—hy'drogen gas. This gas is procured by the action of dilute sulphuric acid on iron or zinc ; but as a little acid vapour may possibly be diffused through it, it has been esteemed preferable to obtain it, when it is designed to be breathed, by passing water in vapour over iron at the tempe- rature of ignition. Hydrogen gas appears to act altogether negatively — proving sedative in consequence of the absence of oxygen, which is the ex- citing constituent of atmospheric air. It can be breathed with safety when diluted with an equal portion of atmospheric air ; but, for me- dicinal purposes, is usually mixed with four or five parts. It has been chiefly used in pulmonary catarrh, haemoptysis and phthisis. b. gas hydrogen'ium car'buretum. — car'buretted hy'drogen gas. The carburetted hydrogen that has been employed in medicine is made by passing the vapour of water over charcoal at the temperature of ignition in an iron tube. The oxygen of the water unites with one part of the charcoal, forming carbonic acid, and the hydrogen com- bining with another part of it forms carburetted hydrogen. The car- bonic acid is removed by agitating the gas with lime water. This gas in its undiluted state, can scarcely be breathed. Sir Humphry Davy found, that at the third respiration total insensibility ensued, and symptoms of great debility continued for a considerable time. It was, at one time, thought to be a useful sedative in phthisis, and to have arrested the disease in some cases ; but the results were by no means uniform : caution, too, was needed in its administration, and — what is applicable to the inhalation of all gases in pulmonary affections — its employment was inconvenient, and often distressing. It has been usually diluted with twenty parts of atmospheric air at first — the proportion of the gas being slowly increased, and care being taken not to induce much vertigo, or muscular debility. 202 SPECIAL SEDATIVES. C. GAS AC''IDUM CARBON'lCUM.--CARBONIC ACID GAS. Carbonic acid gas — wdiich is readily procured by the action of dilute sulphuric or chlorohydric acid on carbonate of lime ; or, what is preferable, by decomposing carbonate of lime by exposing it to a strong heat in an iron bottle, and collecting the gas over water — when undiluted, is altogether irrespirable, occasioning a spasmodic closure of the glottis and death; but, when diluted with atmospheric air, it appears to possess decidedly sedative properties. Formerly, it was much employed in phthisis, and great expectations were entertained that it might be at least a valuable palliative in that disease. It seemed, at times, to lessen expectoration, diminish hectic fever, and act as an anodyne. When employed, it was diluted with four or six parts of atmospheric air. In the irritable state of the bron- chial mucous membrane, in which cough and dyspnoea are induced by the application of cold, it has been found of advantage when breathed in a dilute state. The following has been advised as an easy mode of employing it with this view. Put a mixture of chalk or marble with diluted sulphuric acid and water into a large glass bottle, so that it shall occupy the depth of only a few inches. The carbonic acid gas is extricated, and forms an atmosphere mixed with atmospheric air in the upper part of the vessel, which may be breathed by introducing a glass tube to about the middle of the bottle, and in- haling from it. Carbonic acid has been employed externally as a local application to cancerous and painful ulcerations. A stream of it is directed on the part, taking care, that the gas is previously transmitted through water, if it have been procured by the action of a mineral acid on carbonate of lime, and confining it for some time over the sore by a funnel connected with the tube. The Yeast Cat'aplasm — Cataplas'ma Fermen'ti of the London and Dublin Pharmacopoeias — owes its virtues in part to carbonic acid. It is generally, however, esteemed as an excitant; and Dr. Pereira affirms, that he has often heard patients complain of the great pain it occasions. When applied to fetid ulcers, it corrects the foetor, and promotes the separation of sloughs. It is made of Flour, jf^j ; Yeast of Beer, Oss ; a gentle heat being applied until the mass begins to swell. Of late years, carbonic acid gas has been sent into the vagina in cases of amenorrhcea, and in uterine pains, which precede and ac- company the menstrual discharge ; and it is said with success. The fumigations are applied by receiving into the vagina the free ex- tremity of a gum elastic canula, surmounted by a nipple-like end, through which the gas is passed. The gas is disengaged by means of dilute sulphuric or chlorohydric acid poured on carbonate of lime. It does not appear, that any excitant effect is induced by the acid vapour that may pass over with the gas. Still, to avoid all risk, the REFRIGERANTS. 203 gas may be first passed through a Woulfe's apparatus, as suggested by an intelligent correspondent of the author, the late Prof. W. R. Fisher. V. REFRIG"ERANTS. St yon. Temperants, Psyctica. Definition of refrigerants — Modus operandi — External and internal refrigerants — Refrigerant baths—Therapeutical application of refrigerants — In fevers — In the phlegmasia, &c. — Special refrigerants. Refrigerants may be defined — agents that diminish the morbid heat of the body. The author, in another work, (Human Physiology, 5th edit., p. 203, Philad. 1844,) has entered at large into the interesting subject of the physiology of calorification, and has there attempted to show, that it is accomplished in every part of the system of nutrition — not ex- clusively in the lungs, as was at one time imagined. But, although not effected exclusively in those organs, the experiments of Le Gal- lois, as well as those since instituted by many others, have led to the inference, that there is always a general ratio between heat and respira- tion in both cold-blooded and warm-blooded animals; and in hibernat- ing animals, both in the periods of torpidity and of full vital activity. When the eighth pair of nerves is cut in the young of the mamma- lia, a considerable diminution is produced in the opening of the glottis, so that, in puppies recently born, or one or two days old, so little air enters the lungs, that when the experiment is made in ordi- nary circumstances, the animal perishes as quickly as if it was en- tirely deprived of air. It lives about half an hour. But, if the same operation be performed upon puppies of the same age, benumbed with cold, they live a whole day. In the first case, — M. Edwards thinks, and plausibly, — the small quantity of air is inadequate to counteract the effect of the heat; whilst, in the other, it is sufficient to prolong life considerably; and he deduces the following prac- tical inferences, applicable to the adult age, and particularly to man. " A person," — M. Edwards observes, — " is asphyxied by an ex- cessive quantity of carbonic acid in the air which he breathes; the beating of the pulse is no longer sensible, the respiratory move- ments are not seen ; his temperature is, however, still elevated. How should we act to recal life ? Although the action of the re- spiratory organs is no longer visible, all communication with the air is not cut off. The air is in contact with the skin, upon which it exerts a vivifying influence ; it is also in contact with the lungs, in which it is renewed by the agitation which is constantly taking place in the atmosphere, and by the heat of the body, which rare- fies it. The heart continues to beat, and maintains a certain degree of circulation, although not perceptible by the pulse. The tempera- 204 refrigerants. ture of the body is too high to allow the feeble respiration to pro- duce upon the system all the effect of which it is susceptible. The temperature must then be reduced ; the patient must be withdrawn from the deleterious atmosphere; stripped of his clothes, that the air may have a more extended action upon his skin; exposed to the cold, although it be winter, and cold water thrown upon his face, until the respiratory movements reappear. This is precisely the treatment adopted in practice to revive an individual in a state of asphyxia. If, instead of cold, continued warmth were to be applied, it would be one of the most effectual means of extinguishing life. This consequence, like the former, is confirmed by experience. In sudden faintings, when the pulse is weak or imperceptible, the ac- tion of the respiratory organs diminished, and sensation and volun- tary motion suspended, persons the most ignorant of medicine are aware, that means of refrigeration must be employed, such as expo- sure to air, ventilation, and sprinkling wTith cold water. The effi- cacy of this plan of treatment is explained on the principle before laid down. Likewise, in violent attacks of asthma, when the ex- tent of respiration is so reduced that the patient experiences suffo- cation, he courts the cold even in the most severe weather ; opens the windows ; breathes a frosty air, and finds himself relieved." Were the function of calorification wholly accomplished by the lungs, our refrigerants ought to be applied to these organs to exert their full effect; but, as the evolution of heat takes place in the capillary system of every part of the body, these agents are made to impress only a portion of that system, wdience the impression is conveyed to every part, by virtue of that intimate sympathy which is known to exist between every portion of the capillary system. To the extent of this sympathy, both in its therapeutical and patho- logical relations, the author has repeatedly had occasion to allude. In the healthy state of the frame, it is evinced by the morbific influ- ence of cold and moisture, when applied even to a small portion of the cutaneous surface, which has been previously shielded from their action. If a healthy person expose his feet to these agencies, the capillary function becomes modified, and there is not a part of the capillary system, which does not feel the effects ; but disease is not induced in the whole, unless the whole is, at the time, predisposed to assume the morbid condition. Generally, there is some portion of the capillaries more disposed at the time to take on a diseased state than another, and under the irradiations that occur, owing to the modified action of the capillaries of the feet, disease in such portion results. A similar action takes place, when we apply cold and moisture therapeutically, as is done in febrile affections, when- ever the skin is steadily hot and dry ; and we find it is not neces- sary, that these agents should be applied over the whole of the cuta- neous surface, but only over a comparatively small portion, — as of the hands and arms. The sedative influenqe of the cold is exerted upon the capillaries with which it is made to come into contact; the function of calorification has its activity diminished ; and, soon after- REFRIGERANTS. 205 wards, we discover that the heat of the whole system has been ma- nifestly lowered by the application. The temperature of the human body is rarely raised beyond 106° of Fahrenheit's scale. Professor James Gregory, of the University of Edinburgh, was wont to say, that he doubted the accuracy of any thermometer, when a higher temperature, under the tongue or in the axilla, was indicated. There can be no doubt, that the degree at which Fahrenheit has placed fever-heat on his scale, is too ele- vated. There may be cases in which it has reached that point, but the ordinary temperature of the blood in fever is far below this. In one of the hottest remittent fevers which the author has attended, it never rose higher than 102°, under the tongue. M. Edwards al- ludeSj in his work on ' Physical Agents,' to a case of tetanus, com- municated to him by M. Prevost, of Geneva, in which the tempera- ture rose to 110°.75 Fahrenheit. It was before remarked, that there is a general ratio between heat and respiration ; yet to this there are many exceptions. In the case of a man at St. George's Hospital, London, labouring under a lesion of the cervical vertebrae, Sir B. Brodie observed the temperature to rise to 111°, at a time when the respirations were not more than five or six in a minute ; and other cases of a like kind are on record. To reduce excessive heat, external agents, of a suitable tempera- ture, are most effectual. Damp cold — of all external means of re- frigeration— tends best to diminish the activity with which heat is developed. Hence its value as a refrigerant in fevers, — a point now universally acknowledged. But if damp cold cannot be suffi- ciently prolonged, sponging with water of any temperature below that of the body occasions abundant evaporation, and a salutary re- frigeration, the effect of which is extended to every part of the frame, in the manner already mentioned. Cool air, is, likewise, a valuable refrigerant; and its admission, in febrile affections, is generally grateful and salutary. There wras a time when it was altogether excluded ; when the temperature of the chamber was kept elevated, and hot fluids were administered, with the view of concocting or maturing some fancied peccant humour, and aiding its expulsion from the body. Since the time of Syden- ham more especially, these absurd notions have passed away, — although we can yet discover some relics of their existence, — and, fortunately for the patient, the instinctive desire for cold drinks is now no longer opposed. Indeed, the use of cold fluids internally, and the free admission of cool air into the apartment, when the wreather and the feelings of the patient will admit of it, may be looked upon as amongst the most important elements of our management of febrile cases. When the ventilation of an apartment is properly attended to, the quantity of febrile heat is diminished,—both by the contact of fresh portions of cool air, arid by the increased evaporationJthat necessa- rily ensues. vol. ii.—18 206 refrigerants. When cold fluids are taken into the stomach, they produce an effect there, analogous to what occurs when they are brought in con- tact with a portion of the cutaneous surface. They are, indeed, the best internal refrigerants ; and, of these, cold water — ice cold — and iced lemonade, are entitled to the preference. Every one must have observed how rapidly and copiously perspiration breaks out over the surface of the body, during the heats of summer, after a glass of cold water has been taken. This must be owTing to the refrigerant influ- ence of the low temperature reducing the erethism, which exists in the mucous membrane of the stomach, as it does in every part of the dermoid surface, whenever the temperature is extremely elevated. By depressing this erethism to the healthy standard, the sedative in- fluence is propagated at once to every portion of the capillary surface, and the cutaneous transpiration is augmented by the diminution of the exalted actions of the cutaneous exhalants. This is the only mode, in which the phenomenon can be rationally explained. It is impossible for us to admit, that the fluid can pass by imbibition so rapidly into the vessels as to account for it. The perspiration, in such cases, breaks out almost instantaneously after the fluid has reached the stomach, and impressed the lining membrane. Writers on the materia medica have admitted — besides those refrigerants to which allusion has been made — a number of agents, whose operation is much less unequivocal. " There are," says a modern writer — Dr. Paris— " certain saline substances, which, by undergoing a rapid solution, and acquiring an increased capacity for caloric, produce a diminution of temperature, and if this takes place in the stomach, the sensation of cold, which it produces, is equiva- lent to a partial abstraction of stimulus ; this being extended by sympathy to the heart occasions a transient reduction in the force of the circulation, and by this, or by a similar sympathetic affection, causes a sensation of cold over the whole body." It is obvious, however, that such substances, according to this theory, can be re- frigerant only whilst undergoing a rapid solution, and that, therefore, to produce their full effect, they should be given, either so as to un- dergo their solution wholly or partly in the stomach, or immediately after they are dissolved. Yet how trivial must be the operation of cold thus produced, compared with that which can be accomplished in fevers by a draught of iced water ; and, accordingly, as before remarked, iced drinks may be regarded as amongst the febrifuga magna — the most important refrigerants ; and they are now greatly employed to the exclusion of nitrate of potassa, borate of soda, &c, &c, on which reliance was at one time placed. There is a circumstance, by the way, connected with the use of these refrigerant salts, which is full of interest to the therapeutist, and exhibits that wandering from the true track, of which philosophy has to deplore the existence of so many examples in the history of medical science. The author has remarked, that internal refrige- rants have been made to comprise — in many definitions — saline substances, which, by undergoing a rapid solution, produce a dimi- MODUS OPERANDI. 207 nution of temperature in the stomach or elsewhere ; and the definitions have been so worded, and intended, as to include such substances only. Yet, strange to say, the attention of the therapeutist has strayed from the circumstances, that occasion such substances to be refrigerant, and we often observe a mixture, containing nitrate of potassa in solution, directed to be administered at intervals through- out the day. In this mode of administration, the whole refrigerant effect, according to the above explanation, must necessarily be lost. The mixture must attain the temperature of the chamber; and, if the nitrate of potassa produce any effect, it must be of an excitant cha- racter. The practitioner, notwithstanding, places great reliance, perhaps, on his febrifuge mixture ; and this at least is fortunate, for whilst he is administering it, he is not as likely to be officiously irri- tating the intestinal canal by repeated cathartics. In this way, the use of an inert compound may be followed by positive advantage. A recent writer, however, Dr. Spillan, after citing the above ob- servations of the author, adds, that " the refrigerant effects of nitrate of potassa, as a sedative, when given dissolved in even tepid drinks, such as whey, are known to every one." The whole object of the preceding remarks is to show, that they certainly are not known to the author ; yet he has wTatched most carefully for them; nor have others been more fortunate. Dr. A. T. Thomson states, that " the dose of the salt should not be dissolved until the instant in which it is to be swallowed ;" and Dr. Pereira accords with him ; whilst Dr. Christison, in his Dispensatory, recently published, expresses him- self in a manner that still more strongly corroborates the views of the author. " Its refrigerant action," he remarks, " generally admitted by systematic writers on materia medica, and by many practitioners, is of doubtful existence, — having probably been inferred rather from the coldness it occasions while dissolving in water, than from actual evidence of its effects in disease. The sedative action as- cribed by some to it has been probably inferred from its supposed refrigerant property, and not from observation." In another part of this work, (Vol. i. 498,) as well as elsewhere, (Human Health, p. 364,) the author has alluded to the marked differ- ence— which ought never to be lost sight of—between the effects of a bath some degrees lower than the temperature of the body, and those of one that approaches or exceeds it. Whilst the former is markedly refrigerant, the other is powerfully excitant. The two are adapted, consequently, for very opposite affections. A difference, again, exists, between immersion or affusion, and ablution, — the former being attended with a shock or powerful im- pression on the nervous system. When, therefore, the object is to diminish febrile heat, ablution or sponging a part of the capillary surface, as of the upper or lower extremities, is preferred to general baths, affusion, — as the shower-bath, or any variety of the douche; but if the object be to excite a revulsive effect, — to brea'k in upon a morbid chain — as to cut short a fever, — then the form of appli- cation is chosen which produces the greatest shock, or, in other 208 REFRIGERANTS. words, the most marked impression upon the nervous system. The shower-bath is well adapted for such cases; it acts, in the main, like the ordinary bath, as regards temperature, producing sedative effects, when cold, stimulating when hot. Owing, however, to the shock produced by it, it is not suitable for those of great nervous susceptibility. For such as are predisposed to certain head affections, the shock and refrigeration of the cold shower-bath applied directly to the head, whilst derivatives are applied to the lower extremities often proves most salutary. The effects of the douche or dash are dependent mainly on the shock, but partly, also, on the temperature of the fluid. They are, however, modified by the size of the stream, and the force with which it is made to impinge on the part. It is a most valuable tamer of the furious maniac. The most violent paroxysm can generally be speedily brought to a close by it, and the im- pression made upon the nervous system is so overwhelming, that tran- quillity succeeds rapidly to the state of cerebral excitement and turmoil. In an ordinary case of hysteria or in cerebral affections when a small stream of water is sufficient, the douche may be formed from the spout of an ordinary tea-pot held at such a distance above the head as to regulate the force with which the water is made to impinge upon it. An excellent shower-bath for children, which may be used also for the adult, has been recently invented, and is described by Dr. A. T. Thom- son. It consists of a hollow vessel made of tin with a perforated bottom, as in Fig. 24. The body of the vessel is of a bell-shape ay with a hollow tube b, Fig. 25, rising from the top, and terminating in a broad perforated rim c. When the bath is to be used, it must be sunk in a bucket of water, until it is completely submersed ; the air is thus driven out of the bath, through the tube b c, and the bath filled with water. The thumb of an attendant is then to be placed on the opening in the centre of the rime, and the bath is raised from the bucket of water. The pressure of the air on the holes in the bottom retains the water in the bath ; and on raising the thumb from the upper orifice, the whole is rapidly discharged. In using it, the child must be placed in an empty tub, and the bath, being held ,i i1, ' . , over his head, is then to be dis- ':"'i:i!!l:!";J!ii^'!'""' charged. Immediately afterwards he must be dried with friction. Almost the only form of the bath, which is now employed m Fig. 25. THERAPEUTICAL APPLICATION OF REFRIGERANTS. 209 febrile cases, is simple ablution, and the warm pediluvium or foot- bath. It might seem, that, in these very cases, a more powerful refrigerant influence would be exerted by the cold pediluvium, and, as regards the mere abstraction of caloric, this would, doubtless, be the case; but the impression made upon the nervous system is so considerable, when we first immerse our feet in a cold fluid, that the cold pediluvium becomes liable to the same objections as the cold affusion or the cold douche, when employed with simple refrigerant views. On the other hand, the warm pediluvium is devoid of those objections, whilst the ultimate refrigerant effects are scarcely perhaps less. In addition to the internal refrigerants, which come under the definition of Dr. Paris, certain others have been enumerated, which are presumed to exert a temperant effect, — independently of the simple abstraction of heat. Thus, acetic acid, it is said, when pro- perly diluted, renders the pulse, in a febrile state of the habit, slower; the animal temperature less, and improves the secretions. The same has been observed of all the vegetable acids, as wTell as of the borate of soda, and the boracic acid; but there does not appear to be any strong evidence in favour of their possessing this property. Acids and subacids are always grateful in febrile affections, and by proving agreeable to the palate they may tend to allay irritation, but this applies equally to the mineral acids; and, accordingly, mine- ral lemonades are often beneficially prescribed in continental Europe. A modern writer, A. T. Thomson, however, excludes them, although he classes among the refrigerants — the acetic, oxalic, citric, tartaric, and malic acids. As for the borate of soda, and the boracic acid — although the latter was at one time termed sal sedativus Hombergi — it is unnecessary to say much. Common consent has led to their total exclusion from the catalogue of internal refrigerants, in this country and in Great Britain, although they are still prescribed in some parts of Germany, whose pharmacopoeias exhibit too many relics of prejudices, and irrational practices, prevalent in times which have long passed away. Therapeutical application of Refrigerants. With respect to the therapeutical application of refrigerants, much need not be said. They are obviously proper, whenever the vital manifestations are exalted beyond the healthy standard: yet they may not all be equally appropriate ; and the practitioner has to consider, whether there may not be other influences exerted by them, indepen- dently of mere abstraction of heat; — whether, in other words, their refrigerant operation be simple, or combined with some other, that may modify their influence on the economy. This is wrell exem- plified, in the cases of the cold ajffusion and cold ablution, when em- ployed at the commencement of ^ IS* 210 REFRIGERANTS, Fevers, with a view of arresting their course. Whilst the former may be successful, the latter may totally fail. The object is here, to excite a new impression on the totality of the nervous system, as well as to diminish febrile action ; and, accordingly, that form of applying the cold medium ought to be selected, which communicates a powerful shock, and thus breaks in upon the morbid chain, which constitutes the disease. Now, as simple sponging of the hands and arms with cold water communicates no such shock, it is manifestly not calculated to cut short fever ; whilst on the other hand, the cold affusion be- comes inappropriate, whenever the morbid phenomena, constituting continued fever, have persisted so long, that all hope of cutting the disease short has vanished, and when any powerful impression is likely to give rise to irregular action, and, therefore, to hyperaemia in some internal organ. In these cases it is, that cold, tepid, or even warm ablution is employed so advantageously, tempering the organic actions of the part to which it is directed, and thence extending its benign influence to every part of the organism. A great rule for the use of external and internal refrigerants in fever is — to observe, whether the skin be steadily hot and dry. If so, cold ablution may be practised ; cool air be admitted ; the quantity of bed-clothes be diminished, and cold fluids be freely indulged in ; but wThether all, or any of these, may be applicable to particu- lar cases, has to be left altogether to the discrimination of the prac- titioner. In the different stages of the paroxysm of an intermittent, condi- tions are present, which modify materially the employment of agents belonging to the class under consideration. In the cold stage, the hot stage, and the sweating stage, we are guided by rules, which are applicable to similar conditions occurring in other morbid states. In the cold stage, the functions are oppressed and depressed, and there is more or less congestion internally : this is dependent upon modified innervation,—suchmodificationconsistingin diminished action: fluids, therefore, which are of a temperature equal to, and above, that of the body, are needed to excite the nervous and vascular symptoms to a proper play of the functions : as soon as this has been accomplished, and reaction has taken place, general excitement is substituted for the previous state of diminished action, and all the phenomena of synochal or inflammatory fever are present. Cold drinks now be- come grateful and appropriate ; they reduce the exalted actions and hasten the supervention of the sweating stage, during which the heat is undergoing resolution, and in which cpld drinks are, consequently, not advisable : tepid drinks are accordingly substituted. That, which applies to cold drinks, during the paroxysm of an in- termittent, applies equally to the admission of cool air, and the regu- lation of the coverings of the patient. In the cold stage, warmth is advisable; in the hot, the whole system of refrigeration has to be adopted ; whilst, in the sweating ^tage, care must be taken in the application of cold, lest the cutaneous capillaries be morbidly im- IN INFLAMMATION. 211 pressed, so as to excite irregular action in some important part of the organism, and consequent hyperaemic, or other mischief. Allusion has already been made to the prejudice, at one time uni- versally prevalent, against the use of cold drinks in fever. This ex- isted as long as, and even longer than, the doctrine of concoction, which taught, that a certain amount of febrile heat was necessary to maturate the peccant matter. Fortunately for the patient, the preju- dice is now daily yielding, and we rarely meet with it except amongst those whose minds have not been enlightened by the more modern, and more correct views of therapeutists. The author has likewise referred to a similar prejudice, as regards the use of iced drinks, when calomel has been given. The prejudice is unfortunate, as it often causes the denial of the very best febrifuge we possess, and suggests an opposite plan of treatment, which can scarcely fail to aggravate the disease. Were the idea, indeed, well founded, it ought to sug- gest an interesting and important question, whether the calomel or the iced water should give place ? and no doubt, in the author's opinion, ought to exist in the mind of the reflecting practitioner, that the former, in most cases, should yield. To this decision he may be led universally, where calomel is given as a simple cathartic. The lists of the materia medica contain such a variety of those agents, that sufficient room is left for selection. Where, also, the mercury is ad- ministered as a revellent in fever — to produce a new action in the system — cold water, in moderation, may be permitted with impunity, and even with advantage. The author has been, for years, in the habit of administering mercurial cathartics, and mercurial revellents in fever, and has never wholly restricted the patient from the use of ice ; yet, in no case, has he seen the slightest inconvenience from the association. The notion of detriment from this course is now mainly abandoned by the physician ; but it still clings with perti- nacity to the extra-professional. In fevers, that are accompanied with eruptions, the cooling regi- men is not less important than in the simple continued, or remittent varieties. There was a time, when the eruption of small pox and of scarlatina was supposed to be injuriously checked by the free admis- sion of cool air; but it is now acknowledged, that the use of refrige- rants is attended with better effects than that of any other class of medicinal agents; and, in the generality of cases, the efforts of the intelligent physician are confined to the admission of cool air; sponging the body with cold or tepid -water —especially during the eruptive fever — and the use of cold water internally ; keeping the alimentary canal clear, at the same time, by the employment of jrentle cathartics. Allusion has already been made to the peculiar character of scarlatina, and to the fact, that, although the organs concerned in calorification are inordinately excited — yet, that it is an excitement originally more nervous than vascular — and, that copious blood-letting, instead of mitigating, too often adds to, its vio- lence. In all cases, however—except, perhaps, in the most malignant 212 REFRIGERANTS. typhous forms, the application of cold to the surface, either by means of cold water or cool air, or both, may be had recourse to advan- tageously. Where such agency is improper, the fact will be indicated by the feelings of the patient. He will be rendered chilly, and the powers of the system will be manifestly depressed by it; but there are few cases in which the admission of fresh air will not be grateful and salutary. Inflammation and hemorrhage. — It has been conceived that cold sponging, and other forms of external refrigerants are not as service- able, wdiere hyperaemia exists in an internal organ, as where the case is uncomplicated. This is true; but it by no means follows, that they should do harm. In certain internal inflammations, indeed, we are in the habit of employing them freely as remedial agents, and the au- thor thinks—-and it is generally thought—with advantage. In in- flammation of the encephalon — primary, or occurring in the course of fever — the practitioner does not hesitate to have the head shaved, and to apply ice freely to it. " In no disease," says Dr. A. T. Thomson, " does the powerful sedative influence it possesses display itself so conspicuously as in phrenitis. The most furious delirium is quickly subdued by allowing cold water to drop on the vertex, whilst the rest of the scalp is covered with cloths moistened with vinegar and water." Much, however, of the effect, in this case is revellent rather than refrigerant. The author has before attempted to show, that every form of the cold douche produces its chief in- fluence by the nervous abstraction it occasions; and not only is this the case in the ordinary hyperaemiae concerned in constituting inflam- mations, but in those of an analogous nature, that constitute hemor- rhages. The cold key, applied to the nape of the neck in epistaxis, produces its effect in arresting the hemorrhage, less by refrigeration than by revulsion. In active hemorrhages, however, the refrigerant effect of cold is a most valuable agency; and, where ice can be pro- cured, it may be used internally, without the inconvenience that might result from the too free use of cold water. It has been else- where remarked, that where hemorrhage of this kind takes place, absorption is more active; and, if fluid be largely allowed, it soaks readily through the coats of the blood-vessels, so that in a short space of time there may be the same quantity of blood circulating in the vessels as before the hemorrhagic attack; and as the blood is ren- dered more watery, a recurrence of the flow happens more easily. But, by taking a small piece of ice into the mouth, the full refrige- rant influence is exerted, whilst there is no danger whatever of much imbibition, and consequent repletion of vessels. The utility of cold applications in hemorrhages was referred to under Astringents. Whenever, indeed, it is necessary to produce a diminution in the amount of fluid in the capillary vessels of a part, their employment is indicated ; and hence, in topical inflammations, strangulated hernia, &c, they are greatly employed. In the first of these affections, they act much in the same manner as hot applica- WATER-CURE. 213 tions. Both cold and heat, indeed, occasion diminished calibre of the capillary vessels. Pulmonary diseases. — In diseases of the respiratory organs, which interfere with the due aeration of the blood in the lungs, the exposure of the body to cool air — under precautions to be sug- gested by the individual case — is a useful agent; and its propriety is indicated by the instinctive desire which is felt for the free ad- mission of air under such circumstances. The function of haema- tosis is not confined to the lungs, although chiefly accomplished there. It takes place, but to a slight extent only, over the whole cutaneous surface ; and thp author has before alluded to the marked connexion, that exists between the functions of calorification and respiration ; so that if the latter be impeded, it is requisite that the former should be reduced likewise. It is unnecessary to dwell on all the cases in which refrigerants may be beneficial. The reflecting practitioner will easily under- stand those, in which they may be demanded ; and, in this, he is fortunately guided, in most instances, by the sensations of the pa- tient. Where the abstraction of heat is attended wTith disagreeable sensations, it can rarely, if ever, be proper: even in fevers, where the employment of refrigerants is most clearly indicated, we are greatly guided by the feelings of the patient ; and if the free ad- mission of cool air, cold ablution, and cold drinks excite chilliness, or any uncomfortable feeling, their application is regulated ac- cordingly. Of late years, an Austrian peasant, of the name of Priessnitz, at Grafenberg, in the mountains of Silesia, has proposed to cure all diseases that are curable, without any medicine except cold water, employed externally as well as internally, together with a close at- tention to regimen ; mountain air; regular exercise ; entire absti- nence from all fermented or distilled liquors ; and the plainest and coarsest food ; and, although the way in which he is followed indi- cates the height of credulity in his patients, there is no question that the entire change produced in their mode of life, and the new im- pressions made by his novel mode of employing the pure element, are highly beneficial; in the same manner as a trip to the mountain springs of this country, when proper attention is paid to the em- ployment of the waters internally and externally, and to regimen — without taking much into consideration the feeble medicinal action which some of them are capable of exerting— is annually observed to restore many valetudinarians who have employed the various agents of the Materia Medica in vain. Priessnitz treats diseases on the principle of revulsion ; or rather, it would seem, his cures are effected in that manner. He himself believes in the existence of peccant humours, which must be eva- cuated. Under this view, he endeavours to induce perspiration or 214 SPECIAL REFRIGERANTS. eruptions, boils or abscesses ; and he wisely refuses to treat diseases — such as phthisis — which are incurable, and those in which the powers of life are evidently exhausted. He appears, however, to employ but one plan of management; — somewhat modified, accord- ing to the individual and the particular seat of the disease. To this new system of medication the terms Hydrop'athy, Hydrosudop'athy, Hydrosudotherapei'a, Hydrotherapei'a, and Hydriatri'a; and by the Germans, Wassercur — have been applied. (See the section on Mineral Waters.) SPECIAL REFRIGERANTS. In the preceding remarks, enough has been said of the acidulous and other refrigerants that are usually employed in febrile and in- flammatory affections. It may be proper to add, however, that in these diseases, no single refrigerant is more agreeable than the soda water of the shops, kept in ounce vials in ice, and given from time to time when the thirst is urgent. In the absence of this, the arti- ficial soda powders may be used, which are made by dissolving twenty-five grains of tartaric acid in water, and thirty grains of bicarbonate of soda, adding the two together, and drinking the mix- ture m a state of effervescence : — or, what is better, dissolving each of the powders in half a tumblerful of water, which must be kept cold, and a wine-glassful of each solution be taken whilst effervesc- ing, every two or three hours, or oftener. In this manner, the sto- mach is not loaded, nor is the tartrate of soda formed in sufficient amount to affect the bowels ; for it must be recollected, that in the artificial soda water the patient takes a solution of that salt in place of the carbonated water, which constitutes the soda water of the shops. Effervescing draughts are likewise made with lemon juice. (Succ. hmon.f. Jss; Soda carb. 5SS ; vel Potassa curb. gr. xxv.) The neutral or saline mixture, already referred to, (Vol. i. p. 316,) is a composition of this kind, given either in effervescence, or after this has passed away. When it is desirable to unite a refrigerant and ca- thartic, the Seidhtz powders, described elsewhere, (Vol. i. p 186 ) may be given. '; 1. Saline Refrigerants. < Almost all the neutral salts are refrigerant when properly admi- nistered ; but the saline substances that have been regarded as emi- nently so are the following, which will not, however, require much consideration after the remarks that have already been made in re- gard to them. sod;e boras. 215 1. POTAS'SA NITRAS. —NITRATE OF POTAS'SA. The general characters of this salt have been given under the head of Diuretics, (Vol. i. p. 275,) and its title to be esteemed a refrigerant has been canvassed in the general observations on the present class of medicines. In protracted fevers, it is not unfrequently given in this country, associated with tartrate of antimony and potassa, and mild chloride of mercury, (See Vol. i. p. 309,) but it is obvious that in such a com- bination it is impracticable to infer any thing positive in regard to the action of the nitrate. The dose, in which nitrate of potassa is usually prescribed, is from five to fifteen grains, every three or four hours; and it is well to bear in mind the remark before made, that it ought to be dissolved in water immediately before being taken. It is sometimes used as a gargle in inflammatory sore throat, (Potass, nitrat. 3iss ; Mellis, 3iij ; Aqua, f. gvj ;) and it occasionally forms part of frigorific mixtures — which are applied as topical refri- gerants. Of late, the nitrate of potassa has been given in large doses in acute rheumatism, as had been done in the last century by Dr. Brocklesby— a distinguished physician of the British army, and medical writer. The testimonies in its favour are not few ; but it must be borne in mind that the disease is self-limited in many instances, or in other words, appears to run a definite course greatly uninfluenced by me- dicine. From six drachms to two ounces have been given in the twenty-four hours dissolved in sweetened barley water, in the pro- portion of half an ounce of the nitrate to a pint and a half or two pints of the barley wTater. It is said, under such circumstances, to act as a sedative, decreasing the force and frequency of the pulse — perhaps indirectly by its revulsive action on the stomach ; but farther obser- vations are needed to establish its efficacy, before we attempt to ex- plain its modus operandi. The last Edinburgh Pharmacopoeia contained a formula for Troches of Nitrate of Potassa, composed of one part of the nitrate to three parts of sugar; which were used in inflammatory sore throat, and in excessive ptyalism ; but they do not exist in the present pharma- copoeia. The Germans, according to Sir George Lefevre, consider the nitrate of soda more antiphlogistic than the nitrate of potassa. 2. SODiE BORAS.— BORATE OF SODA. Borax, — Biborate, Borate, or Subborate of Soda, is probably no more entitled to the reputation of a refrigerant than nitrate of potassa. It is an abundant natural production in Persia, and especially in SPECIAL REFRIGERANTS. Thibet, being contained in the waters of various lakes, on the borders of which it is left during the dry season, in impure crystals. In this state it is called in commerce Tincal or Crude Borax, and is usually imported from Calcutta. It is in flattened, six-sided prisms, coloured writh a greasy substance which has been considered by Vauquelin to be a fatty matter saponified by soda. Different methods have been recommended for purifying it. At one time, the purification of it was altogether in the hands of the Dutch, and was kept a profound secret; but in 1818, MM. Robiquet and Marchand made known the process, which is now generally followed by manufacturers. It con- sists in rinsing tincal in lime water, so as to decompose the alka- line soap on its surface, and convert it into an insoluble calcareous soap, — dissolving the salt in water, and decomposing any remains of the alkaline soap, in the solution, by a little muriate of lime, — finally evaporating and crystallising by very slow cooling. (Chris- tison.) This is refined borax. A great part of the refined borax of commerce is now made by the direct combination of boracic acid with soda. The boracic acid is an abundant natural production of certain lagoons and hot springs in Tuscany ; and the mode of separating it is described at length by Dr. Pereira. The manufacture is now so extensive, that one single indi- vidual is said to fabricate the enormous quantity of 2,400,000 pounds annually, for the supply of most parts of Europe and America. (Buch- ner, cited by Christison.) The borate of soda, of the shops, is in large crystals, wdiich are oblique rhombic prisms. It occurs, also, in octohedrons, but is gene- rally seen in irregular shaped masses, of a saline, cooling, and some- what alkaline taste. It effloresces slowly in the air, and is wholly soluble in water, the solution having an alkaline reaction. It re- quires twelve parts of cold wrater, and two of hot w7ater to dissolve it. When added to bitartrate of potassa, it renders the latter soluble — forming soluble cream of tartar. This may be effected by boiling six parts of cream of tartar and two of borax in sixteen of w-ater for five minutes. Borax has generally been considered refrigerant, yet this has been probably owing to the cooling taste of the salt rather than to correct observation : when used locally it is admitted to be a mild excitant, causing smarting when applied to sores. It is never given internally in this country as a refrigerant, but is often employed in cases of sto- matitis, — particularly in the follicular form ; and has been occasion- ally used as an injection in gonorrhoea and leucorrhoea. In these cases it probably acts as a gentle excitant. As a gargle, it is often used in association with honey. (Soda borat. 3i; Aqua, f. Svj ; Mel- lis, 3iij,) in sore throat, and in ptyalism. HONEY OF BORAX, MEL BORA CIS, is officinal in the British pharma- copoeias, (Soda borat. 3i; Mellis, oi.) It is used in aphthous affec- TOPICAL REFRIGERANTS. 217 tions of children, and, dissolved in water, in stomatitis and cy- nanche. Boracic Acid — formerly termed Sal Sedati'vus Homber'gi — is never used, at the present day, as a sedative. It is nearly, if not wholly, inert. It has been given in very large doses, without pro- ducing any sensible effect on the functions. 2. Topical Refrigerants. After the general remarks that have already been made, it is un- necessary to dwell on the topical use of cold, applied to the surface of the body in any of the modes then mentioned. It is the abstrac- tion of caloric, which is the main agency ; and the degree to which this shall be carried must be dependent upon the particular case. It may be proper to add here, that where the local abstraction of heat is demanded, and ice is the appropriate agent, it cannot always be had, and it becomes important to apply substances — as to the head in cases of encephalitis — which by their evaporation may induce cold : hence, ether and alcohol are employed, and, in ordinary prac- tice, cloths steeped in whisky, which are changed as they become warm. A common mixture for the same purpose consists of equal parts of Whisky, Liquor Ammonia Acetatis, and Water ; but it pos- sesses no virtues over simple whisky. In the application of topical refrigerants, the part should be co- vered with a single layer of thin linen or cotton or muslin, which should be frequently wetted with the cold fluid ; or a sponge, holding some of it, should be squeezed over the rag, without removing it from the head. Dr. James Arnott has recently recommended what he esteems to be a perfect mode of applying cold. He covers the part with a very thin bladder of the requisite dimensions, containing a small quantity of water of the desired temperature, which is con- stantly renewed by establishing a current through the bladder, by means of two pewter tubes, — one connected with a reservoir, and having a stopcock at its end to regulate the stream, — the other leading to a waste vessel. The elevation of the waste-pipe regulates the quantity of water in the bladder; and as, from the'change-of position of the patient, this elevation must be frequently altered, it is convenient to rest the extremity of the pipe on a sliding ring of a common retort stand. By this apparatus, he says, the temperature can be regulated wTith the greatest precision, and when such a test should guide, water can be chosen of such temperature as may be most agreeable to the feelings of the patient. If sudden and severe cold be desirable, very cold water running rapidly through the blad- der will reduce the temperature much more rapidly than the appli- cation of ice. Where a great degree of cold is required, in the absence of ice, or where the temperature of 32° is not sufficiently depressed, frigo- vol. n.—19 218 revellents. rific mixtures may be substituted, of which the following are amongst the most available : 1. Ammon. muriat.; Potassa nitrat. aa p. v.; Aqua, part. xvj. This depresses the temperature from 50° to 10°. 2. Ammon. muriat. ; Potassa nitrat. aap. v.; Soda sulphat., p. viij.; Aqua, p. xvj. Depresses from 50° to 4C. 3. Ammon. nitrat. ; Aqua, aa. p. j. Depresses from 50° to 4°. 4. Ammon. nitrat. ; Soda carbon. ; Aqua, aa, p. j. Depresses from 50° to 7°. 5. Soda sulphat., p. iij. ; Acid, nitric, dilut., p. ij. Depresses from 50° to 3°. 6. Soda phosphat., p. ix. ; Acid, nitric, dilut., p. iv. Depresses from 50° to 12°. 7. Soda sulphat., p. viij. ; Acid, chlorohydric., p. v. Depresses from 50° to 0°. 8. Soda sulphat., p. v. ; Acid, sulphur. ; Aquce, aa, p. ij. Depresses from 50° to 3°. VI. REVEL'LENTS. Synon. Antispastics, Derivatives, Counter-irritants, Revulsives. Definition of Revellents — Epispastics— Definition of Epispastics—Rubefacients — Vesicants — Suppurants — Actual and Potential Cauterants—Modus Operandi — Permanent and Intermittent Revulsions — Intensity of the Revulsion — Blisters, as Revellents in Fever— Revulsion in the Changeable Phlegmasia? — Choice of Situa- tion for the Revulsion — Therapeutical Application of Revellents — In Fevers—in the Phlegmasia — In Hemorrhage — In Mental Alienation, Hysteria, Tetanus, &c. — Special Revellents. Revellents are agents, which, by producing a modified action in some organ or texture, derive from the morbid condition of some other organ or texture. The effect, thus induced, is termed revul- sion, antispasis, or derivation, and it is said, by Conradi, to be ex- erted, " when a topical congestion, or stimulation, or other affection of a part leaves that part, and is drawn towards another, and usually less important part." The author has more than once referred to the value of this agency in the treatment of disease, and has remarked, that much of the good effects produced by local stimulants, of every kind, is ascribable to this principle of action. The effect, indeed, of almost every variety of revellent, is ascribable to the exaltation of vital manifestation it produces in the parts with which it is made to come in contact. " Next to direct debilitation," says a modern therapeutical writer — M. Begin — "there is no medicinal agency more certain, and that ought to be more frequently resorted to, than revulsion. It is in- duced by stimulating substances, which elevate the organic actions EPISPASTICS. 219 in the parts to which they are applied, or towards which their action is directed, and that are more or less remote from the inflamed or- gans. The remedies, employed in this medication, have been called, by some, ' indirect debilitants ;' but such a denomination is inexact, for all revulsives exert a stimulating impression ; and if their object be to allay irritations existing at a distance, their inopportune use, or their too great activity is followed, in many cases, by contrary re- sults :"— and he adds in a subsequent page— " The phenomenon of revulsion has hitherto been viewTed in too limited a manner. Physicians have not properly attended to the fact, that every medi- cinal operation by means of which the vital actions are excited in others than the parts affected, also belongs to the class. It would seem, that the rubefacient, suppurative, or escharotic, cutaneous revellents have alone occupied the attention of practitioners, and that frictions, baths, cataplasms, — in a word, all agents, calculated to solicit the organic activity, concentrated internally, to the external parts of the body, are not esteemed revulsives ; and reciprocally, the effects of a multitude of stimulants on the digestive organs, heaped in during the most serious acute diseases, and whose impression is not always mortal, are inexplicable to a great number of physicians, because they do not recognise in them the revulsive effect, which such agents occasionally produce. This medication, when properly investigated, ought to become the object of more extensive and use- ful considerations in practice, until the whole extent of its influence, and the astonishing variety of which it is susceptible in its applica- tions, shall be better understood." Under the history of the separate divisions of remedial agents, already considered, the author has adverted to their revulsive ope- ration, and it has been seen, that all local stimulants are possessed of more or less of it. It will, therefore, be only necessary, under this head, to make some general observations on their application in disease, and to regard especially those agents which are usually em- ployed as cutaneous revellents; or, in other words, such as are generally classed by therapeutical writers, under the head of epis- pastics, and of escharotics, whenever the latter are employed to do more than act chemically on the parts with which they come in con- tact, and to affect organs or tissues, that are at a greater or less dis- tance from the seat of their impression. Epispastics are agents, that occasion inflammation, vesication, suppuration, or sloughing when applied to the cutaneous surface. Dr. A. T. Thomson has subdivided them into rubefacients, vesicants, suppurants, and actual cauterants. To these, his division of escha- rotics may be appropriately added, for although the articles belong- ing to this division are generally employed for mere local agencies on the part with which they are placed in contact, they, like the rest of the class of epispastics, are often used for acting revulsively on other parts of the system. 220 REVELLENTS. Rubefacients—as the name imports—are substances that red- den the surface, by exciting the action of the capillaries, and giving occasion to an afflux of vascular and nervous power to the part on which they are applied ; hence pain is a usual consequence of their employment. The most common rubefacient, in acute affections more especially, is the sinapism or mustard cataplasm; but every stimulating application — every liniment, of which capsicum, tur- pentine, ammonia, &c, form the basis — is rubefacient. The same may be said of friction with the dry hand, and of the application of heat. Every thing, in short, which, by irritating the cutaneous sur- face, attracts the nervous and vascular influxes to the irritated part, and reddens it, is a rubefacient. If the rubefacient be sufficiently powerful, it may, besides indu- cing redness, be followed by an effusion of serum beneath the cuti- cle of the part, so as to form a blister. The rubefacient then be- comes a Vesicant. The first effect of ordinary vesicants is to pro- duce rubefaction, and the action maybe arrested at this point, if the practitioner be desirous that it should not extend farther. It may be laid down as a general rule, that blisters do not act by the dis- charge they excite : their depleting effect, in this way, can obviously be but trifling, unless in very debilitated states of the system, — and in such case, the loss of fluid, thus incurred, might be disadvan- tageous. Counter-irritation is the great sanative agency, and this can be obtained without vesication, although the production of the latter condition may be an evidence, that the former has been carried to the necessary extent. In the case of many of the vesicants, too, it is difficult to obtain the necessary extent of counter-irritation without A'esication resulting at the same time, and therefore the practitioner rarely attempts to arrest their action at simple rubefaction. Of the various agents, used for exciting vesication, cantharides are the chief; but where it is desired to excite sudden vesication, the application of boiling water, or of the red hot iron, is, at times, had recourse to. Vesication or counter-irritation, thus induced, is rarely, however, as efficacious in changing certain morbid condi- tions as where it is more generally induced. Hence, time has been regarded as a useful element, in many cases, in the action of revel- lents. The inflammation of the skin, caused by vesicants, is occa- sionally attended with fatal consequences. It is of the erysipela- tous kind, and, under particular circumstances—as regards age, condition of the system, &c.—the inflammation eventuates in gan- grene and death. In very young children, great irritation is apt to be induced by blisters, and, if they be labouring under any morbid condition of the dermoid tissue,— such, for example, as is present in measles or scarlatina, —the inflammation may terminate in slough- ing or gangrene. To obviate this, when vesicants are esteemed ne- cessary in the diseases of infants, they should not be permitted to SUPPURANTS. 221 remain too long on the part. From two to six hours will generally be sufficient, and a piece of fine gauze or tissue paper maybe placed between the plaster and the skin — if cantharides be used—in order that no particle of the flies may adhere to the vesicated sur- face. An occurrence more disagreeable to the philanthropist can hardly be imagined, than that of a patient dying in consequence of the application of an agent from which he expects a cure, or at least a mitigation of the symptoms ; great caution is therefore necessary in the use of these agents in very early life, especially in the diseases referred to. The author has known several cases of death mani- festly caused by the use of blisters under such circumstances, al- though it is probable, that in most of them a fatal event might have ultimately resulted from the disorganisation produced by the mischief for which the blister was recommended. The result has produced, at times, so powerful an impression on the practitioner, as to prevent him from ever afterwards applying blisters in the diseases of child- hood. There is another great inconvenience attendant upon the employ- ment of vesicants composed of cantharides. This is — the absorption of the cantharidin, which enters the circulation, and proceeds to the urinary organs, giving rise to strangury, and, at times, to intense vesical irritation. That this is the mode in which the effect is pro- duced is demonstrated by the fact, that the intervention of tissue paper, or of gauze, although it may not prevent vesication, effectu- ally obviates strangury ; — the tissue paper preventing the absorption of the cantharides, which would otherwise have been effected. Some have referred the strangury from blisters to sympathy. Were this explanation correct, the tissue paper or gauze ought not to prevent it, as vesication is accomplished through them. At times, it be- comes necessary to apply the blistering plaster over a surface, which has been scarified in the operation of cupping, or over leech-bites. The only precaution, here requisite, is to cover the wounds, made by the scarificator, with tissue paper. Suppuraxts produce a deeper degree of inflammation than the epispastics thus far mentioned. Their effect extends to the cellular membrane ; involving the whole of the common integuments. Issues and setons belong to this class, as well as the pustulation induced by friction with the ointment of tartrate of antimony and potassa rubbed upon a part — a remedy which has been much employed of late years. It is a somewhat singular circumstance, that, when this oint- ment is rubbed upon the skin, instead of producing simple inflamma- mation of a diffusive or erysipelatous character, it should excite inflammatory irritation, more especially in the cellular membrane be- neath, and that this irritation should exhibit itself in the form of a crop of pustules, not very much unlike those of variola. In this country, issues and setons are still greatly used, but they are by no means as much so in Europe as they were formerly. They 19* 222 REVELLENTS. are uncleanly, by means of the discharge which they excite, and great attention to them is necessary; whilst it is extremely doubtful, whether any of the benefit, derived from them, is ascribable to the discharge that accompanies them. The author rarely has recourse to them on these accounts, preferring repeated blisters, and a suc- cession of revulsions, to their more permanent irritation: to this lat- ter the system soon accommodates itself, so that, after an issue or seton has been long established, it becomes, as it were, a part of the healthy condition, and cannot even be healed without clanger of evil consequences. At one time, it was the universal belief— much en- couraged by the arguments of Mr. Pott — that the discharge is an important adjuvant to the counter-irritation caused by issues or setons, but, since his time, the belief has gradually faded away, and there have been many surgeons — amongst whom may be mentioned Lar- rey—who think it better to produce counter-irritation, where practi- cable, without any discharge; hence, when they use the moxa, for ex- ample, they endeavour to restrict its effects to rubefaction. Still, there are cases ■— as in spinal disease — where it is easier to insert a seton, or to establish an issue, than to apply a succession of other counter- irritants ; and, consequently, issues and setons are no where banished from practice, although they are more sparingly used by the most distinguished practitioners in many countries. In the perpetual blister—as it is called — we have an example of a suppurant agency. Some irritating salve is applied to the surface denuded by a blister, which excites suppurative inflammation, and this may be kept up, as in the ordinary issue, of which the perpetual blister is of course a variety, — but it is liable to the same objections as the issue, and may be advantageously replaced by repeated blis- ters, which establish a succession of centres of fluxion or of revulsion, so that the system never becomes habituated to them ; and more in- fluence is, therefore, exerted upon the morbid conaition, for the removal of which they may have been adopted. It is to substances, that are capable of producing an eschar or slough, that the term Escharotics has been given. They are, con- sequently, most commonly had recourse to for the formation of issues, — caustic potassa, for example, being applied to the skin, so as to chemically disorganise it, or destroy its vitality, after which a new action is set up in the vessels beneath the slough, so as to cause it to be thrown off; the excavation is then kept open by inserting some irritant— as an issue pea— which maintains a copious secretion of pus from the ulcerated surface. In the ordinary division of eschar- otics— as adopted in the books — we have a separation made into those that operate more powerfully, destroying the life of the part under all circumstances, and which are arranged under the head of cauterants, and those that act with Jess energy, and are chiefly em- ployed to destroy diseased and fungous growths, and which are classed as erodents. ACTUAL CAUTERANTS. 223 Cauterants maybe either actual or potential; that is, they may either produce their effect by the agency of caloric, or by virtue of chemical powers, wdiich are capable of destroying, or disorganising, the living solid. The effect of the actual cauterant differs according to the form in which the caloric is applied; — whether by means of heated metal, or the moxa, or by heated vapour, water, or other fluid. It differs, also, when the metal is used, according to the de- gree of heat: —at the white heat producing immediate disorganisa- tion of the parts with which it comes in contact; at the red heat. rather a state which may admit of the parts being restored, without much, if any loss of substance. The less degree of heat is, there- fore, attended with more pain and inflammation, because the vitality of the part is not extinguished. Whenever actual cauterants are employed as counter-irritants, the excitement they produce is rapidly effected;— at once, by the appli- cation of heated metal or water, — more gradually by the moxa ; but still, even in the latter case, almost instantaneously, compared with the action of many of the class of potential cauterants, which require a long time before the eschar is formed. This is the case with caustic potassa — the potential cauterant most frequently employed. It is not until after the lapse of several days, that the eschar, made by rubbing potassa over the skin, separates, or gives unequivocal evidence of disorganisation. As the effects of actual cauterants are rapid and severe, — accompanied with intense pain, heat and redness, — they are adapted for cases, in which it is necessary to make, at once, a powerful impression upon the nervous system. Accordingly, the use of the moxa has occasioned a salutary ab- straction of the nervous influence ; and many deep-seated pains have yielded to it, which had resisted the action of the ordinary counter- irritants, although repeatedly applied. In long continued neuralgic pains — whether seated in the cerebro-spinal centres, or in the nerves emanating from them — the morbid catenation is often suddenly and effectually broker^ in upon by these severe and rapid revulsions. Of the value of the moxa, as a therapeutical agent, in these and similar cases, — numerous examples are recorded on the authority of Larrey, and many other practitioners of France and the continent of Europe more especially. The remedy was introduced to the notice of British practitioners by the author, in the first English monograph on the subject, and, since then, it has been treated by Wallace, Boyle, and others. (uOn the use of the moxa as a thera- peutical agent; from the French of Baron Larrey, with notes, and an introduction, containing the history of the substance," by Robley Dunglison, etc., etc. London, 1822.) All the forms, then, of epispastics are indebted, for their efficacy as remedial agents, mainly to the counter-irritation or revulsion which they effect, and the choice of such as are adapted to particular cir- cumstances of disease must greatly depend upon convenience, &c. 224 REVELLENTS. of application, which certain articles of the class may possess more than others; and as there are generally fewer objections to vesicants and rubefacients than to the others, they are more frequently employed, wdienever the revulsion, which epispastics in general are capable of effecting, is deemed necessary or expedient. In the employment of revulsives in general, it is an interesting inquiry to determine the extent of surface, which it is desirable to affect by their direct application. This is a difficult matter to decide. It is obvious, however, that if we have the vital manifestations modified over a very limited compass, but little beneficial agency may be exerted on the morbid catenation, which it is designed to break up: whilst, on the other hand, if a very large surface be irritated, the disease may be aggravated by the irritative irradiations proceeding from it. Moreover, it is probable, that if a very exten- sive surface were inflamed in this manner, the same disastrous con- sequences might ensue as in cases of extensive burns. In these, it has been considered, that death wTill almost surely occur, if they implicate one-eighth part of the cutaneous surface. M. Begin affirms, that the extent of the surfaces, receiving the impression destined to become revulsive, exerts great influence. Thus, the same pediluvium, which, wrhen applied to the feet, proves ineffi- cacious, may often produce the desired effect if the whole leg be immersed; and he adds, that an extensive though moderate rube- faction may produce greater effects than a violent inflammation limited to a small portion of integuments. This is true, howTever, only within certain limits. In many affections — as the author has remarked in reference to the moxa especially — a violent degree of irritation, excited over a very trifling extent of surface, may effect what other varieties of epispastics, although repeatedly employed, have totally failed to accomplish. Custom has established a magni- tude for the ordinary blister, as well as for the extent of surface to be implicated in the formation of an issue, and although it is possible and probable, that their size might often be varied with advantage, it is a point, as already observed, on which it is extremely difficult to decide. A similar remark applies to the length of time, during which counter-irritation should be maintained, in order to produce the greatest amount of benefit. Whether, for example, a mere mo- mentary irritation, however violent, can occasion as salutary results as one that is more prolonged; and again, whether a permanent or an intermittent revulsion is, as a general rule, more effective for the removal of disease, especially of disease of some continuance. In the case of moxa, the revulsion is but temporary, yet, we have seen, it has been often useful, short as may have been the duration of the irritation produced by it. Moxa is not, however, in general, as well adapted for the removal of inflammatory and many other conditions, as the revulsion, which can be effected by vesicants, and by certain PERMANENT AND INTERMITTENT REVULSIONS. 225 of the rubefacients. It is chiefly when the diseased action has been prolonged for a considerable period, and in affections, which belong to the neuralgic class, that sudden and violent revulsions are pro- ductive of the most marked advantage. When the disease is of an acute character — as the different phlegmasia? — revellents, which implicate a greater extent of surface, and are more prolonged in their action, are decidedly preferable. With regard to the question — whether a permanent or an inter- mittent revulsion be more efficacious — the author does not think, that much difference now exists amongst therapeutists. The majority are unequivocally in favour of the latter plan, although circumstances may often induce them in practice to have recourse to the former. The reasons, in favour of this preference, are cogent. When an arti- ficial irritation, accompanied or not with increased secretion from the part, has been established for some time, it ceases, in a great mea- sure, to be a morbid condition, and becomes, as it were, a part of the healthy function, so that it cannot be arrested, without inconvenience being apt to result, and without danger of a centre of fluxion being established in. some internal organ, more disposed than others to assume the morbid condition. In this way, many discharges, the result of morbid action, become, in process of time, healthy, and cannot be officiously interfered with. On the other hand, if a suc- cession of irritations be produced, the system never becomes habi- tuated to them, and the repetition of the irritation, after the lapse of a short period, occasions the same beneficial impression, as on its first employment. Hence it is, that a succession of vesicants, and, in- deed, of every variety of epispastic, is to be preferred to a more permanent application, and that issues and setons lose much of their beneficial influence in the latter periods of their employment, — their good effects, as revulsives, being in an inverse ratio with the short- ness of the period, during which they have been in action. The intensity of the artificial irritation, induced by a revellent, is wrorthy of consideration, in a therapeutical point of view. If it be but trifling, it may be insufficient to break in upon the internal mor- bid catenation ; and, on the other hand, if too violent, irritative irradiations may pass in various directions, and may even add to the internal mischief. Every practitioner must have occasionally wit- nessed an aggravation of symptoms from this cause, especially in those whose nerves are unusually impressible. In such, no variety of epispastic can, at times, be used. There are some who are thrown into the most violent nervous agitation by the application of the smallest blister ; and blisters have occasionally been known to induce convulsions. Certain individuals, too, suffer excessively from the vesication caused by cantharides, and yet, they may not be — what would be called — extremely nervous. Their cutaneous nerves are, however, unusually impressible. In such persons, vesicants would necessarily fail in their effects — by the general disorder, which 226 REVELLENTS. would follow the high degree of erethism of the dermoid structure. In such individuals, blisters are never found to exert their ordinary salutiferous agency; on the contrary, the irritation they produce is reflected to every part of the economy, and too often the diseased action, for the removal of which they were applied, is, in this way, augmented. In like manner, where the powrers of the system have been greatly reduced, and much nervous irritability has been deve- loped, blisters are apt to cause mischief. Broussais has made this fact the foundation of one of his propositions, — restricting it, how- ever, to cases of gastro-enteritis. The character and period of the disease have much to do with the action of revellents. Every practitioner must have observed, that in phlegmasiae, when the disordered actions run high, but little effect is usually produced by revellents. The author had an opportunity of witnessing, for a long time, the practice of an individual, much engaged with the duties of his profession, who always had recourse to blisters, from the first onset of inflammatory affections, often not only with impunity but with manifest advantage. Such is the prac- tice pursued by M. Gendrin of Paris, — the greater part of his treat- ment in pneumonia and other acute inflammations consisting in the application of very large blisters ; and it is affirmed by two followers of his service at La Pitie, that their repeated application, with a very moderate use of blood-letting, was attended with very successful re- sults. It is an interesting question, however, to solve, — whether the inflammation induced by large and repeated blisters may not augment the ratio of fibrin in the blood. Experiment can alone de- termine this. " A large blister," says M. Andral, " takes from the blood a certain quantity of its serum ; but some fibrin is deposited at the same time at the surface of the sore caused by the action of the cantharides. Where there exists in the blood a superabundant pro- portion of fibrin, would this be the means of diminishing the excess of that principle in the blood. Or rather, if the action of the can- tharides be exerted over a pretty large surface, or the inflammation resulting from it be intense, — if, especially, it augment the febrile movement already existing, may there not thus arise a new cause for a superabundant formation of fibrin ; and may not this cutaneous phlegmasia, artificially induced to diminish the intensity of another phlegmasia, by the kind of influence which it may exercise upon the blood, have the effect of augmenting the morbid condition, which represents in the blood the inflammatory state, and marks the, inten- sity of it?" Theoretically, it would seem, that if the organic actions are already largely exalted, any source of irritation ought to add to such exalta- tion ; the principle, however, that two irritations do not easily exist, at the same time, in the body, in the like intensity, applies even here ; and the author can say, from extensive observation, that although the beneficial agency of revellents is not as marked as where reme- dies have been premised to allay the tumult in some measure, they IN FEVERS. 227 have not always appeared to him to aggravate the disease, and have often been followed by a mitigation of the morbid action. He can- not, therefore, subscribe to the opinion of M. Begin, that " in very strong subjects affected with intense irritations accompanied with considerable febrile excitement, and having their seat in viscera im- portant to life, or propagated to larger surfaces, revulsion is next to impossible, and cannot even be attempted without danger." The danger does not appear to the author to rest so much on the employ- ment of revellents, as on the neglect of more effective measures, which such cases imperiously demand. It has been maintained by M. Broussais, that revulsive irritations must always be stronger than those they are intended to replace, otherwise they turn to the benefit of the latter; but this appears to be a mere gratis dictum, and it has, accordingly, been dissented from by many of his followers. Upon the principle of action, which the author has endeavoured to lay down, it would seem, that good must always be derived from a revulsive irritation in appro- priate cases, even should such irritation fall somewhat short of the precise degree necessary for completely putting an end to the morbid action for the removal of which it was adopted. He cannot see how the morbid action must necessarily be augmented by it. There was a time, when blisters were much employed at a par- ticular period of adynamic fevers, — in those very cases, indeed, in which, according to Broussais, they do not render the services ex- pected of them. The practice has gone out of vogue in Europe, but it is followed in this country. It consists in applying blisters to the arms and legs, in protracted fever, when the powers of life have become so far reduced, that stimulants appear to be clearly indi- cated. It has been before remarked, that epispastics are not ad- visable stimulants in fever, but as revellents they may be had re- course to, occasionally, with marked advantage. When, for ex- ample, the disordered actions, constituting fever, have gone on for weeks, without the existence of any considerable local mischief, the revulsive irritation, induced by epispastics, becomes a centre of flux- ion, so that the mischief is, as it were, localised, and the morbid chain broken in upon. Accordingly, in this way, epispastics may be used advantageously in febrile complaints; but care must be taken, that the irritation induced by them is not too intense, so as to be reflected to every part of the system, and thus add to, rather than detract from the disorder of functions. In like manner, in chronic irritations of different organs and tissues, epispastics fre- quently break in upon the habitual derangement of action, and suc- ceed in inducing a salutary revulsion, after every other medication has failed. It would be a matter of moment were we enabled to point out the parts of the system, which sympathise with each other, in such sort, that if revellents were applied to the one, they might certainly detract from the morbid actions going on in the other; but this is a 228 REVELLENTS. difficult subject of investigation, and we are not sufficiently mas- ters of the physiology of the animal economy to pronounce with much satisfaction on the subject. Often, too,»we find, that although sympathetic movements may be established between different organs, they are by no means of the antithetic or revulsive kind ; and hence the rule — difficult of execution — has been laid down, that artifi- cial irritants should be made to operate upon such parts as perform functions contrary to those of the irritated organ, and always at a distance from those that may sympathise with that organ. In eluci- dation of this, it has been remarked, that the skin may be irritated with advantage in pulmonary catarrhs, owing to the balance of ac- tion existing between it and the mucous coat of the bronchia, but this does not apply to gastritis, as its over-excitations are too readily communicated to the stomach. These rules are, however, too ex- clusive ; and every therapeutist must have discovered their inaccu- racy in the good effects which he has found to be produced by revel- lents, wdiere the lining membrane of the stomach has been more or less inflamed. The severe vomiting, w7hich accompanies such affec- tions, often resists every other remedy, and is ultimately arrested by epispastics. The true explanation of the action of revellents appears to be that already offered, — that two irritants do not readily exist, at the same time, in the system ; so that, if, under proper conditions, during the existence of any morbid irritation in some internal organ, an ar- tificial irritation be excited at a due distance from it, the morbid process may subside in the internal organ, and the vital energies be concentrated towards the part artificially irritated. Farther than this we cannot go with much satisfaction, and if we attempt to desig- nate the parts, which perform functions that are antagonistic to those of the irritated organ, in order that wTe may apply our revellents to them, we are likely to be led to the most erroneous conclusions. On the deeply interesting subject of the sympathies of organs, we are but little instructed. We observe the physiological relations be- tween the stomach and the uterus, in the changes induced by preg- nancy ; and the intimate consent between the latter organ and the mammae, as evinced in the same changes, as well as in the evolu- tion of organs that takes place at puberty ; but who could have di- vined the sympathetic effect between those organs, referred to by a modern observer, Dr. Rigby, from which it would seem, that prac- tical advantage may be derived in the suppression of uterine hemor- rhage. We allude to the sudden and powerful contraction, which, he affirms, is excited in the uterus, when in a state of inertia, by applying the child to the breast. A common saying, amongst nurses — that " the child brings after pains" — shows, that this sympathy has been a matter of observation amongst the vulgar; but Dr. Rigby's attention was first directed to it by Carus, who in his Gy- nilkologie recommends the application of the child to the breast, to promote the expulsion of the placenta. " In cases," he remarks, IN THE CHANGEABLE PHLEGMASIA. 229 cc where there has been considerable disposition to hemorrhage after labour, from non-contracted uterus, and where I have been afraid to leave the patient, lest flooding should come on in my absence, I have been for the last two years in the habit of ordering the child to be put to the breast, as soon as the clothes, &c, were changed, and herself comfortably settled in bed, feeling that I thus diminished the chances there might be of any hemorrhage occurring. It was not, however, till last year that I began to see the practical importance of this sympathetic connexion between the breast and uterus in its full extent. Having had two or three cases of severe hemorrhage after labour, from uterine inertia, which had to a degree resisted all the common modes of treatment, and where permanent contraction could not be induced even by repeated injections of cold water and vinegar into the vagina, I determined to see what effect the applica- tion of the child to the breast would have upon the relaxed uterus, and was agreeably surprised to find the observation of Professor Carus confirmed in its fullest extent, — firm and permanent contrac- tion having been immediately produced in every case." Admitting, then, that such a sympathy exists, how important it may be, in a therapeutical point of view, to*be acquainted with it! It is not, however, always easy to apply the child successfully to the breast soon after delivery. The young being is awkward, and can- not seize hold of the nipple. In such cases, the application of the breast-pump would probably be an efficacious substitute. It is certainly worthy of trial, and may be found useful in hemor- rhage, which is dependent upon a wTant of due contraction in the parietes of the uterus. The importance of discovering the precise play of sympathies between different organs is strikingly exemplified by this case ; and observation may, hereafter, point out many, which may aid us materially, in the therapeutical use of our remedial agents. At present, we are greatly in the dark, and most of the suggestions on the subject have been hazarded rather from particular theoretical considerations than from observation. In diseases that are metastatic, constituting—what have been termed, by some — the i changeable phlegmasia,' we might seem to have an index to the proper organ on which to apply our revellents. In parotitis, or ' mumps,' after the inflammation has existed for some time in the parotid gland, it is apt to quit its seat, and to pass to the testicle of the corresponding side in the male, and to the mamma in the female. In the same way, rheumatism or gout appears to leave the joints, and attach itself to some internal structure. In all these diseases, there is a tendency, in particular structures, to be morbidly implicated ; and they, who believe in metastasis, consider that there is a true translation of the disease from one part to the other, or at least a decided predominance of irritation in the organ sympatheti- cally irritated. " Organs," says Broussais, " sympathetically irri- tated, may contract a degree of irritation greater than that of the organ from which they derive their irritation : in these cases, the vol. ii.—20 230 REVELLENTS. disease changes its seat and name ; these are metastases." Others consider that metastasis is a mere extension of the disease to structures liable to be affected by it; — such extension occa- sioning a diminution of diseased action in the part primarily af- fected. For example, the tissue composing the heart and the parts about the joints is liable to be attacked by rheumatic in- flammation, and, when the inflammation has been seated in the joints for some time, and symptoms of pericarditis or endocarditis supervene, it is conceived, by one party, to be owing to the retro- cession of the articular inflammation, or to metastasis, whilst the other maintains, that the affection of the heart is simply owing to an exten- sion of the articular inflammation, which is necessarily more or less diminished in the part first attacked, owing to its diffusion over a larger surface. But, in whatever light it may be regarded, whenever an affection, esteemed metastatic, has diminished in, or left, any part, and be- come prominent in a more important organ, the indication to be ful- filled is, in the minds of most practitioners, to call back the irritation to the part primarily affected, by the application of revellents ; —to the parotid region, for instance, where the testicle or mamma has become inflamed in parotitis ; and to the joints, in cases of gouty or rheumatic inflammation translated or extended to internal organs. The remedy, however, is not as clearly indicated as might at first appear. The organs concerned seem to possess this sympathy only under special morbid conditions, between which, and the irritation excited by revellents, there may not be the slightest similitude ; and this accounts for the want of success we are doomed to experience, whenever w7e attempt to recall a changeable phlegmasia back to its former seat. In accordance with the views generally inculcated, the author has, over and over again, attempted, by revellents, to bring back inflammation to the parotid, in cases of retrocedent parotitis, and to the joints, in cases of gout and rheumatism, but he does not recollect, either in his own practice, or in what he has witnessed of that of others—in public or in private— a solitary instance where such an appeal has been responded to ; and, accordingly, he now attends exclusively to the superinduced affection, and never, for a moment, suffers his attention to be diverted from it; for, in the cases of pericarditis especially, which are so often observed as concomi- tants of acute rheumatism, any loss of time might be fatal. It is, indeed, by no means clear, that the artificial irritation, which we excite by revellents, can be practised, in such cases, with perfect impunity. We must bear in mind, that the inflammation, which has changed its seat, was Originally situate in the part we desire to irri- tate artificially ; and it might be asked, with much propriety, whether the revulsive irritation we induce may not equally pass to the organ secondarily implicatedi and add to the mischief already existing ; so that, in truth, revellents might be less safe and efficacious there than when applied to other parts of the economy. WHERE TO BE APPLIED. 231 Contrariety of sentiment exists among therapeutists as to the part to which epispastics ought to be applied ; some maintaining, that they should be placed as near as possible to the seat of the disease; others, at a distance from it. A good deal of this discrepancy of sentiment has been owing to the varying views entertained of the precise modus operandi of epispastics, — and especially of vesicants, — by different practitioners. By some, who believe that inflammation is dependent upon debility of the extreme vessels, and that this is always the pro- minent lesion, the epispastic is applied as near as possible to the seat of the disease, with the view of stimulating the debilitated vessels to a more healthy condition. The same practice, though on less intelli- gible grounds, has resulted from the revulsive theory ; — it being imagined, that the nearer the artificial irritation is established to the seat of the disease, the more powerful and satisfactory will be the revulsion. This appears to have been the view7 entertained by most of the modern writers on therapeutics, but it seems to be neither con- sistent with true theory, nor with observation of facts. The recom- mendation, indeed, appears to have been handed down from one writer to another, without sufficient reflection, and hence we disco- ver no clear ideas regarding the mode of action of revellents, or their therapeutical application. Whilst Dr. A. T. Thomson affirms — without offering any reason for the affirmation — that " blisters, by whatever means they are raised, should be applied, as near as pos- sible, to the affected part;" he observes, elsewhere, when treating of the employment of epispastics in apoplexy, that " in applying blisters, or employing other epispastics with this view, I found them more beneficial when applied to the nape of the neck than upon the head." Similar diversity is perceptible in the observations of Professor Chapman on this subject. "It will be right," he says, " in local affections, and in the whole of the phlegmasiae, to apply the blister as nearly as possible over the immediate seat of the complaint, its efficacy thereby being much increased: but washing to interrupt trains of morbid association, as in most of the diseases of periodical recurrence, to the extremities alternately will answer better. Equally does this precept apply in the cases where revulsion is the object." Since this paragraph, however, was written, the Professor's views, regarding the action of epispastics, appear to have undergone some change. In an article on tic douloureux, published in the American Journal of the Medical Sciences, for August, 1834, he observes : " the common practice of establishing issues immediately on each side of the affected vertebra is bad. They should be placed some inches from it, and the same remark applies to leeching; being near to, or in contact with it, instead of operating as divellents or counter- irritants, they may have a contrary effect, exacerbating the irritation of the spinal marrow; but especially the'intensity of inflammation, whi^h is so apt to follow caustic issues, should be avoided. By this circumstance alone, I have, in more than one instance, seen neuralgic 232 REVELLENTS. pain, and the paralytic state, conspicuously increased, and each again relieved, on the reduction of the inflammation, by emollient poultices, &c. Moxa issues are greatly to be preferred to those produced by other means. They are less painful, more manageable, and decidedly of superior efficacy." This last opinion appears to be more philosophical, and the most in accordance writh true experience. If we are desirous of irritating the vessels of any organ, we apply the blister, if possible, so near to it, that we may implicate branches of the same vessels and nerves as proceed to the affected part. If, on the other hand, we wish to produce revulsion or counter-irritation — as is almost invariably the case, when we have recourse to epispastics—we carefully avoid applying them to branches of the same vessels and nerves, and seek out a surface where no such identity of nervous and vascular supply can exist. We can thus understand, that a blister to the shaved scalp may be improper or proper, according to the precise character of the disease of the en- cephalon, for the removal of which it is applied. In encephalitis, for example — affecting the encephalon or its membranes — a vesi- catory, applied to the head, is too near the seat of the disease, and can scarcely fail to add to the internal mischief, inasmuch as it occa- sions an augmentation of vital manifestations towTards the part irri- tated, which can only be accomplished by increasing those of the whole head, and consequently of the part diseased. Besides irritative irradiations cannot fail to proceed through the media of communi- cation between the exterior and interior of the head ; and hence it is, that a coup de soleilproduces encephalitis ;— the erethism, occasioned by the solar rays, being speedily propagated to the organs within the cranium. In like manner, the irritation of a vesicatory, and of exciting ointments applied to the head, in cases of porrigo, has pro- duced serious mischief of the brain by the same mode of extension; and, in inflammatory affections of the joints, strong revellents applied over the joint may add to-, rather than detract from, the mischief. In the generality of cases, however, in which cutaneous revulsives appear to be indicated, there need not be much apprehension enter- tained from placing them as near the affected organ as practicable. Thus, in inflammation of the abdominal or thoracic viscera, the nervous and vascular distribution is so different in the parietes from what it is in the viscera, that we need not hesitate to apply our epispastics to the former, whenever the state of internal mischief suggests the propriety of their employment. But, although blisters may be improper in cases of violent encephalitis, before the disease has terminated in effusion, they may be clearly indicated after such termination, or whenever there is reason to believe, that advantage may be derived from exciting the organic actions of the encephalon or its meninges. In the last stages of the form of meningitis, to which the name hydrocephalus acutus has been given by many noso- logists, epispastics may be properly prescribed ; but, unfortunately, in too many cases, without any well founded prospect of benefit. In WHERE TO BE APPLIED. 233 like manner, whenever the functions of an organ have to be excited to greater activity, the application of a blister so near the organ, that the stimulation may be felt by it, may be had recourse to with ad- vantage ; but this plan of management would obviously be improper, when the organ is in a state of superexcitement. The author has elsewhere remarked, that in external inflammations, in which the dilated state of extreme capillary appears to predomi- nate over the excited condition of the vessel communicating with it, we often find the direct employment of excitants followed by the most happy results. In this way, blisters produce their good effects in superficial paronychia, and in erysipelatous inflammation. In these cases of tegumentary inflammation, such a dilated and atonic condi- tion of the extreme vessels generally, if not always, exists, which the stimulation of the vesicatory is often successful in removing. There are, doubtless, many cases of inflammation of internal organs, which would, likewise, be relieved by the application of excitants, but the organs concerned are generally so important to the economy, and so intimately associated by sympathetic relations with the organs of the vital functions, that we dare not venture on their administration. Occasionally, however, we observe the reckless empiric exhibit them boldly in such affections, and we are surprised, that the extensive mischief, which we had anticipated, has not supervened on their use. We could understand, that gastritis might possibly be relieved by them, in the same manner as cutaneous inflammation, but we are astonished to discover, that their secondary effect, — that of hurry- ing the general circulation and augmenting the inflammatory ten- dency, — has not taken place to the degree we had anticipated. The efforts of a class of empirics, not uncommon in every section of the United States, has taught us one useful lesson, — namely, that there are some diseases, usually and correctly esteemed inflammatory, and especially certain stages of such diseases, that are not aggravated by the exhibition of powerful excitants, which seem, at times, to act more as revellents, by exciting the lining membrane of the stomach, and thus detracting from the intensity of mischief existing elsewhere. From what has been said of the modus operandi of revellents, it will appear, that when we have recourse to them in inflammatory affections of internal organs, we avoid applying them so near the seat of the disease that it can be increased by their direct action ; much farther than this the author's information does not extend ; his expe- rience, however, has induced him to infer, that the same amount of irritation, artificially excited, has had pretty nearly the same thera- peutical agency, whatever may have been the part chosen for such irritation. The selection of a seat for the artificial irritation is often, indeed, sufficiently whimsical. It is an old remedy to apply a garlic poultice to the thumb in cases of toothache ; the vesicatory is put behind the ear in ophthalmia ; but, many cases of ophthalmia which have resisted the artificial irritation, induced in this situation, have yielded to a vesicatory on the nape of the neck ; and others, which 20* 234 REVELLENTS. have resisted both, have yet been removed by the same agent applied to the interior of the arm: perhaps, however, in these cases, the benefit has accrued from the aggregate of irritations rather than from any one of them. The origin of the choice of the interior of the arm was probably owing to the same idea, that gave occasion to the epithet cephalic to one of its vessels, — to some fancied connex- ion between it and the head ; but the good results are probably owing to the thinness of the skin, and to the greater sensibility of the arm, which render it a favourable situation for the induction of revulsion. Again, by common consent, we apply our revellents to the feet and legs in apoplexy and other cephalic affections ; whilst, in the same diseases, — where abstraction of blood by means of leeches, and some degree of counter-irritation are demanded, — the French prefer, that the blood should be drawn from the region of the anus. With them, greater attention is paid than with us to revulsive bleedings, and although their notions on the subject may be carried to a somewhat chimerical extent, there can be no doubt, that a re- vulsive influence may be exerted, in many cases, by a proper choice of vessels;—the afflux to the vessels, which are discharging the blood, deriving somewhat from organs to which it is already directed in too great quantity or force. In the case before offered — of encephalitis liable to be augmented by epispastics applied to the shaved scalp, — we rarely observe, in American or British practice, the revellent ap- plied at a greater distance than the nape of the neck. There is no reason, however, why this part should be preferred to the top of the sternum, — where the author is in the constant habit of applying it in such cases, and, as he conceives, with full advantage ; whilst there is a cogent objection to the former situation, — in the circumstance of its rendering the position on the back uncomfortable, and, at times, impracticable, owing to the abraded surface being subjected to attri- tion on every change of position of the head. Practitioners have been so little in the habit of reflecting on the mode in which epispas- tics produce their salutary agency in these cases, that they rarely select a more convenient, and yet equally effective, centre of irrita- tion, at a greater distance from the seat of the mischief. Many of the French writers recommend blisters to be placed upon the arm, or between the shoulders, in encephalitis ; but it has always appeared to the author, that the top of the sternum is perhaps the least objec- tionable situation, where counter-irritants are demanded in head affections, accompanied by exaltation of the organic actions. After all, in the general rules for the use of revellents, and their adaptation to special morbid conditions, the physician must be alto- gether guided by sound physiological principles. It is clear, that any agent belonging to the class of excitants, when properly administered, is capable of exerting a derivative effect, and may be beneficially used, whenever, owing to the concentration of vital manifestations on any important organ, it is considered proper to divert them else- where. THERAPEUTICAL APPLICATION OF REVELLENTS. 235 Therapeutical application of Revellents. After what has been said of the great principles of action of revel- lents, and of epispastics generally, their adaptation to particular dis- eases will be intelligible. Yet doubt in several instances exists as to the propriety of their application in certain diseased conditions. Such doubt, however, ought scarcely to be indulged, and it will be generally found to yield, if we bear in mind the great facts and considerations already expatiated upon. Intermittents. — During the paroxysms of an intermittent, revel- lents can rarely be demanded. When the cold stage, however, is unusually protracted, and no signs of reaction make their appearance about the time when they might be expected, — and especially ia the pernicious forms of intermittent, which occasionally prove fatal in the congestive condition of the cold stage, — substances, belonging to this class of medicinal agents, may be had recourse to with advan- tage, for the purpose of concentrating the vital manifestations towards some point of the cutaneous surface, and thus detracting from the accumulation, that may be present in internal organs. With thes« views, epispastics may be applied over the epigastric region ; — this part of the cutaneous envelope being chosen, in consequence of its vicinity to the epigastric nervous centre, in which, rather, perhaps, than in the stomach, we ought to place the ' centre of sympathies.' The epispastic, which we choose in the congestive stage of an inter- mittent, is usually the flour of mustard, applied in the form of the sinapism or mustard poultice; and we select it, because its operation is more speedy than the plaster of cantharides. The irritation, pro- duced by it in the nerves and vessels of the skin, is soon extended in all directions ; the ganglionic, cerebro-spinal, and spinal systems of nerves feel the influence, and, in this way, new force is communicated to the vital movements ; reaction becomes established, especially if recourse be had, at the same time, to appropriate adjuvants, and all apprehension of death, during the stage of congestion, vanishes. The same remarks are applicable to similar conditions occurring in diseases of a different character : and, accordingly, whenever a state of depression, or of collapse, occurs, which is dependent upon mischief existing in some of the great systems, or in some particular organ or part of such systems, we endeavour to derive from the organ or part morbidly implicated, and to attract the vital manifestations to some unimportant part of the organism by means of the artificial irritation, which epispastics are capable of producing. Hence it is, that the practitioner employs them in cholera, both during the state of inflammatory irritation in the mucous membrane, — as indicated by the copious exhalation and secretion from the mucous membrane of the alimentary canal, with the pulse still exhibiting sufficient en- ergy of circulation, — and during the oppression and depression of 236 REVELLENTS. the vital forces, which characterise the state of collapse : — in the former case, to have the benefit of the revulsive medication ; and in the latter, of both the revulsion and stimulation, which epispastics are capable of effecting. In all cases, where time is valuable, and the revulsion important, the practitioner has recourse to rubefacients whose action is speedy ; but, where the case is not so urgent, vesi- cation, by means of cantharides, is at times preferred. It has been already remarked, that the latter operation or agency on the frame is essentially that of the former ; and that, wdiere great prostration ex- ists, the separation of the serum, which is occasioned by blisters, is rather an objection than an advantage. It would be well, therefore, perhaps, that the practitioner should, in all such cases, place his con- fidence altogether in the former ; and this appears to be the feeling of most therapeutists of the present day. Rubefacients are, indeed, now employed in states of disease, in which, a century ago, they would have been looked upon as wholly inoperative. At thaj: time, the idea, almost universally prevalent, was, that the good effects of blisters — and the same applies to issues, setons, &c. — were de- pendent upon the discharge ; and, as rubefacients produced no dis- charge, they were necessarily discarded. Here, again, therapeutics reconducted the speculatist to the true path : and taught him prac- tically, that rubefacients are valuable revellents; and, accordingly, as in too many cases, the opposite exclusive view was embraced by many, and it is now asserted by several, that no good whatever is occasioned by the discharge, — the whole benefit being ascribable to the counter-irritation, or revulsion. Certain it is that the main, if not the sole remedial effect exerted by cutaneous revellents, in the cases under consideration, would seem to be independently of, and notwithstanding, the effect produced on the system by the separation of the fluid of the vesication from the mass of blood. During the state of exalted action, which succeeds the cold stage of an intermittent, recourse to this class of remedial agents is seldom necessary, and the same remark applies to the sweating stage. Com- plications rarely exist, wdrich can demand the administration of revel- lents ; and, if any such should arise, the practitioner has to be guided by the great general principles and rules which inculcate their adop- tion. The last remark applies, also, to the accidental complications, that may exist during the stage of apyrexia. Where an individual has been long resident in a malarious region, or has been subjected to repeated attacks of intermittent fever, visceral infarctions and in- durations are apt to be induced, which may act as foyers of irritation, and prevent the tonics, that are administered, from exerting their proper agency on the nervous system, so as to break in upon the morbid association, which keeps up the periodical exacerbations. In these cases, it may be necessary — should the disease be of the usual indolent character, which we witness in the indurations of the spleen and liver, to which the vulgar have usually given the name ague- cake—to attempt their removal by revulsive remedies; and, with IN INTERMITTENTS. 237 this view, epispastics are occasionally applied over the abdomen; or revellents of a more general nature are prescribed, — as the pre- parations of mercury or iodine, — which, by inducing a new artificial condition of the system, derive from the one already existing, and occasion its removal. Such are the remedies usually employed in these cases, as well as in all those that indicate the presence of local mischief; and for which such a system of medication seems to be more appropriate than the vigorous employment of antiphlogistics. If we inquire into the exact etiology of these visceral engorgements, we may often find that they are really only the results of a morbid condition elsewhere, as in the lining membrane of the alimentary canal, — the irritation extending from it to the parenchymatous viscera, and occasioning inflammation and its results in those organs; but, in whatever man- ner induced, and even if complicated with some degree of gastro- enteritis, the plan of treatment recommended is best adapted for their removal. It is not alone, however, in such accidental complications, super- vening in intermittent fever, that revellents have been regarded as appropriate. They have been advised in the apyrexia, with the view of preventing the subsequent paroxysm. The mode, in which they probably act, in such cases, is by attracting the nervous and vascular afflux to the part, and concentrating the attention of the patient to the new point of irritation. Their operation is exerted in the same manner as mental tonics produce their effect, and as the animal magnetiser, Perkiniser, &c, successfully operate on their patients. In cases like these, the remedy ought obviously to be applied as near to the anticipated paroxysm as possible; and, there- fore, epispastics, which produce their effects at once, are indicated; those, which, like ordinary blisters, require a length of time for the accomplishment of the necessary degree of irritation, and which have that irritation diffused through a period of hours, are by no means as well calculated for destroying the continuity of the chain, as those that make a rapid and powerful impression upon the nerves. A few drops of hot water let fall upon the naked surface, or the actual cau- tery applied a little before the expected paroxysm, would, accord- ingly, be the most appropriate agents ; but the acquired dread of fire — although one of the essentials to their due efficacy — occasions so much repugnance to their employment, that they are scarcely ever used ; and, indeed, we possess in agents belonging to other classes —especially the class of tonics—such efficient means for breaking the morbid chain, that we very rarely have recourse to those of the class now under consideration, — mental revellents or mental tonics being almost wholly handed over to the practisers of animal magnetism, and its kindred arts for operating on the minds of the feeble, and for the encouragement of mystery, credulity, and delusion. Remittent and continued Fevers. — In remittent and continued 238 REVELLENTS. fevers, epispastics are not indicated during the violence of action, which usually attends the first periods; unless, indeed, in those fevers which are adynamic from the commencement, and are com- plicated with local mischief, when they may be required, especially if blood-letting—general or local—has been premised. It is chiefly in the latter periods of continued fever, when the violence of febrile irritation has, in some measure, passed away, that revellents, applied to the cutaneous surface, may exert a salutary effect, by localising that which has been general, and concentrating the disordered ac- tions towards one point — and that an unimportant one—of the economy. The practice, pursued by some individuals, — of at- tempting to drive from every organ that is incommoded by the ir- regular afflux of blood, which occurs in the course of every remit- tent fever, by the application of an epispastic, whenever symptoms of such partial afflux present themselves, — is not, we think, judi- cious. It is apt to keep up the irritation, and to add to the disor- dered movements, by those irradiations, which have been mentioned as capable of being induced by epispastics, and which, in the opinion of Broussais, add to the intensity of inflammation in the gastroen- teric mucous membrane. There is a tendency, in all these fevers, to run a definite course, and, unless disorganising inflammation occurs in some part, to terminate in health. The true method of treatment is, therefore, to allay all irritations, wherever existent, as effectively as possible, and not to adopt any course, during the period of superexcitation of the organic actions, which can augment them. But when, as already said, those disordered movements have per- sisted until the period at which the disease ordinarily yields, and appear to be likely to be farther prolonged, the application of revel- lents, which excite a new action in the system generally, or in some part of it, will frequently destroy the chain, and restore all to har- mony. It is thus, that a blister acts beneficially in such cases,—not as an excitant proper, as elsewhere shown ; and that we have the valuable effects of mercury, when pushed so as to affect the system in these protracted cases. If we can once succeed so far as to in- duce a new action by means of this agent on the system generally; if we can cause the gums to fall away from the teeth, the mouth to be slightly sore, and mercurial fever to be established, we may, generally speaking, look forward, with confidence, to a favourable ter- mination ; owing to the incompatibility of the original and the arti- ficial irritation in the system at the same time. The very fact of our being able to induce a mercurial disorder is, of itself, an element of favourable prognosis; for, in the worst cases of continued fever, we may in vain attempt to arouse the action of the absorbent vessels. The gastro-enteric mucous membrane — and indeed the whole sys- tem— is so excited, that no absorption can be effected, whatever may be the amount of mercurials exhibited. These circumstances have led to the belief, strenuously advocated by some, that, so long as high febrile action continues, we cannot affect the system by mer- IN EXANTHEMATOUS FEVERS. 239 cury, and that when we do so, it is an evidence, that the fever has abated, or is about to terminate — not that the mercury has broken in upon the morbid catenation. Exanthematous Fevers. — In the exanthematous fevers, revellents are chiefly employed for the removal of local mischief when occur- ring in the course of the disease. In all these complaints, the mu- cous membranes are more or less inflamed, and, at times, this is to such an extent as to require the ordinary treatment adapted for in- ternal inflammation. It must be borne in mind, however, that in these diseases, when occurring in young children, the dermoid sys- tem is very liable to assume gangrenous inflammation, under the irritation of an epispastic. It behooves us, therefore, to be cautious; to be satisfied, that it is imperatively demanded; to place some sub- stance between it and the skin — as before inculcated— and not to let the plaster remain on too long. Those precautions are proper, in- deed, whenever it is deemed requisite to apply blisters in the dis- eases of early childhood; for, although such disastrous results are more likely to occur, where the cutaneous system is morbidly affect- ed, they may supervene in diseases in no respect exanthematous. Inflammation. — It is in the different phlegmasia*, that revellents are most frequently, and advantageously had recourse to ; and there is not an agent of the class, which has not been employed in par- ticular cases. Whilst the inflammation is very active, our attention must be directed to the employment of those great sedative agents, on which our main reliance is habitually and properly placed ; but, when the violence of the phlegmasia has been got under, and ex- altation of the vital forces still continues in the diseased part, revel- lents may be employed with the best prospect of success. It has been before observed, that many of the practitioners of continental Europe are of opinion, that blood, drawn from particular parts of the body, in diseases of certain organs, is more efficacious than when the same quantity of fluid is taken from other vessels. This system of revulsive blood-letting is a relic of antiquity. Of old, the vein from which the blood was to be taken was specified; and, at one period, great discussion was carried on, respecting the propriety of bleeding from the vein of the arm of the affected side in pleuritic inflammation, or from the vein of the opposite arm. Strangely enough, an appeal was made to the Emperor Charles IX. ; but, be- fore he delivered his judgment, he was bled for pleurisy, and died; and his death was of course ascribed to the blood having been drawn from the wrong side. These injudicious controversies are no longer carried on ; and practitioners have settled down into the opinion, that the effect upon the system is the main thing to be regarded ; yet a modern writer, Conradi, maintains, that in thoracic inflammation blood should be drawn from the arm of the affected side. This is a topic, however, to which allusion will be made hereafter. It will 240 REVELLENTS. be then seen, that there may be cases in which greater advantage may be derived from emptying the vessels of the inflamed organ, than where the blood is taken from a more distant vessel. Revulsive bleeding—as it has been termed,— alone concerns us at present. American and British practitioners attach, perhaps, too little impor- tance to this matter, although too much weight is, doubtless, given to it elsewhere. If we are in the habit of exciting a revulsion in the feet, or in the rectum, in encephalic affections, there is some show of reason in our drawing blood from the feet or from the neigh- bourhood of the anus; and when the author has seen it practised in France, by opening a vein in the foot, and immersing it in warm water; or by applying leeches around the verge of the anus, a greater effect, it appeared to him, was produced on the system by a smaller loss of blood, than where the abstraction of the fluid was made from the exterior of the head, for example. Many of the European practitioners are firmly of this opinion, and they, conse- quently, have recourse to these revulsive bleedings in all such affec- tions. Revulsive bleedings from the neighbourhood of the anus were so common at one time in Great Britain, as to be alluded to in the popular songs. Thus, a wit of the time of the "Rump Par- liament," — alluding to Cromwell's hunting the members out of the house by military force — observes : — " Our politic doctors do us teach, That a blood-sucking red coat's as good as a leech To relieve the head, if applied to the breech." Although doubts may be entertained regarding the propriety of placing any stress upon the revulsive effect of general bleeding, there can be none as respects the action of topical bleeding. Often, in- deed, wdien we are in doubt regarding the propriety of general bleeding ; and w7hen still the degree of phlegmasia seems to require the farther abstraction of blood, we can derive the most striking ad- vantage from the combination of revulsion and evacuation, which cupping or leeching affords. It is, in truth, in such cases, that we avail ourselves of the use of these mixed agents, rather than of the more powerful simple revellents, which we usually postpone, until the inflammatory action is more decidedly reduced. When, there- fore, we wish still farther to reduce the quantity of circulating fluid, or the activity of the circulating forces, and, at the same time, are somewhat afraid of general blood-letting ; and when we do not con- sider the condition such as to admit of the application of the more active counter-irritants — as blisters — we have valuable agents in those means, that remove a small quantity of blood from the vessels, and are, at the same time, decidedly revellent in their action; and it has always seemed to the author, that the good effects of cupping and leeching, in many cases of internal inflammation, have been as much dependent upon the latter operation as upon the former. Even the simple application of the cups, without the scarificator, constituting IN THE PHLEGMASIA. 241 the operation of dry cupping, is often signally salutary ; and where there is, in addition, the irritation, or series of irritations, produced by the wounds of that instrument, the revulsion is still more marked. In the same manner, the punctures made by leeches are the source of salutary derivation. It has been the opinion of many therapeutists, that local blood- letting is of but little service, compared with that operated on the larger vessels ; and that the effects of both are proportionate only to the quantity of blood taken. Were this the sole effect, which local blood-letting is capable of producing, the objection would be valid ; but such is not the fact. It has been already remarked that the re- vulsion is a most important agency ; — not less so, perhaps, than the depletion ; and hence cupping and leeching may be employed suc- cessfully in cases, in which the same, and even a larger amount of blood, taken from the arm, would be far less efficacious. When, therefore, we are desirous of evacuating the vessels, and of diminish- ing the vital actions generally, and, through them, those of any part affected with hyperaemia, we can employ no substitute for general bleeding ; but where the inflammatory or subinflammatory irritation is not to such an extent as to demand the use of the lancet, or to re- quire much loss of blood, topical blood-letting may still be employed without hesitation. In all fevers, consequently, where there is a complication of local hyperaemia, but not perhaps to a great extent, we adopt topical revulsive bleeding, unhesitatingly and freely ; and, in the practice of the Broussaist, — if any such there be at the present day, — it is used in most cases of fever to the exclusion of the lancet; leeches or cups being generally applied over the epigastric region, in accordance with the views of that pathologist, who, as often observed, places the local origin of all fevers, or of most fevers, in the gastro- enteric mucous membrane. A like treatment is suggested by the views which regard dothinenteritis or follicular gastro-enteritis, as the cause, essence, or consequence of ataxic and adynamic, or other fevers. There is no variety of revulsion that has not been embraced in the management of the phlegmasiae. The author has already remarked that every local stimulant — whatever may be the organ or tissue on which it acts by preference — is a revellent; and, accordingly, all local stimulants are used in the treatment of inflammation. Epispas- tics, too — our great counter-irritants — are employed under the same circumstances; and the operation of all, in the removal of dis- ease, is alike. As regards local stimulants, we rarely have recourse to them as re- vellents, until the time has come when we can adopt advantageously the whole revulsive system of medication. There are cases of in- flammation, however, in which the inflammatory chain may be at times severed, at an early period, by revellents. The author's friend, — Dr. R. H. Thomas, of Baltimore, — informed him, that in cases of mastitis or mastodynia apostematosa occurring after delivery, when vol. n.—21 242 REVELLENTS. the symptoms have strongly threatened suppuration, he had corn" pletely and suddenly removed the hyperaemia by a combination of the sulphate of magnesia and the tartrate of antimony and potassa, given so as to produce full vomiting and purging. In this way, an afflux of vital activity was provoked towards the abdominal organs, and a corresponding derivation took place from the inflamed mamma. A similar course of treatment is said to have been found useful even in cases of peritonitis, but notwithstanding the salutary revulsion that might be operated by the vomiting, apprehension may be entertained that irritation, excited in the intestinal canal by the cathartic, might be propagated, by contiguous sympathy, to the part labouring under inflammation, and that more harm might accrue from the excitation, thus occasioned, than good from the revulsion. Under the different classes of remedies that act as local excitants, allusion has been made to the revulsion they are capable of operating, and to the cases of disease in which they have been employed by reason of this operation. It will not, consequently, be requisite to dwell upon them here. It may be merely observed, that whenever we consider internal revellents to be indicated in cases of hyperaemia of any organ, we generally choose the lining membrane of the in- testinal canal, on which to effect such revulsion ; and, accordingly, emetics and cathartics are our most valuable internal revellents. In all the varieties of internal inflammation, wdien the exaltation of organic actions has been reduced by an appropriate medication, epispastics are employed; and the blister of cantharides is usually selected for this purpose. Sometimes, however, nitrate of silver, red iodide of mercury, ammoniated lotions, &c. are chosen, where cantharides are known to irritate unusually, or where the object is to excite vesication more speedily. Of the best mode of applying those agents, and the great general principles to be attended to, mention has been made already. When wTe are desirous of maintaining a succession of revulsions', or a constant revulsion, we employ either repeated blisters, or keep the blistered surface discharging, by the application of some blistering salve; or we have recourse to some of the other epispastics, as moxa, the seton, the issue, the ointment of tartrate of antimony and potassa, &c, &c. The last agent is well adapted for cases of chronic in- flammation and for phthisis, because, whilst the pustules, induced in any one part of the exterior of the thorax, or elsewhere, are going through the stages of increment and maturation, a fresh crop can be elicited on some other part of the chest; and thus a succession of irritations can be developed, which, as before said, is more beneficial than one that is more permanent. In these, and similar cases, there- fore, pustulation, effected by this ointment, is preferable to the issue or the seton, wdiich, when once intioduced, are permanent, so long as they are permitted to exist; and as their good effects are mainly owing to the irritation and consequent revulsion, which they operate, and as the system soon becomes accustomed to the discharge, whilst IN THE PHLEGMASIA. 243 advantage can scarcely be derived from it, it is better to select more cleanly and less Objectionable counter-irritants. It is at times, how- ever, difficult to induce the patient to submit to any kind of epis- pastic, or to persevere in the use of those, which, like the ordinary blister, or the ointment of the tartrate of antimony and potassa, may require a repetition of the application. It may, therefore, be ad*- visable to fix upon a method of revulsion, which, when once estab- lished, can be maintained without difficulty; and, with this view, the issue, or the seton is often selected, especially in hospital practice. There are situations, too, in which there may be some difficulty in our having the remedy properly applied, unless it is established at once ; when the patient, for instance, is compelled to subject himself to the inconvenience of a constrained posture, — as where the ver- tebral column is affected with chronic inflammation, and the bones themselves with caries. In such cases, we insert a seton, or establish an issue, on each side of the affected vertebra, and keep this open as long as we think the diseased condition requires it. Still, even in these cases, a succession of revulsions would, probably, be more effective than this continued irritation. The moxa is rarely employed in the more active inflammations. It is more commonly used in those cases, in which the seton or the issue is demanded ; and where it is desirable to break in upon a morbid catenation, which has been long existent. A centre of fluxion is formed in all these cases; the vital manifestations are directed towards the part artificially irritated ; and, at times, the derivation is so complete, that the disease is removed, as it were, by a charm. In this way, the moxa occasionally produces a good effect in mania. The author has applied it in some cases with the effect of so com- pletely directing the attention of the maniac to the cauterised part, and towards the artificial irritation there established, that it has broken in upon his abstractions, aroused him to consciousness, and been followed by markedly beneficial results. What has been already said of the general rules for guidance in the application of revellents, near to, or at a distance from, the diseased organ, wrill render it unnecessary to say more here, than to remind the reader, that where revulsion has to be operated, the counter-irritant must not be applied over the same vessels and nerves, that are concerned in the lesion. A part of the body must be chosen, whose vessels and nerves are not so connected with the seat of the disease, that when the nervous and vascular afflux is solicited into them, the exaltation of action may be participated in by those of the part affected. In chronic ophthalmia, it is very common for the unprofessional to select the interior of the arm as the best locality for a seton or issue, but, although this situation may have been chosen originally for the reasons before mentioned, connected with the idea that some more particular relation exists between the vessels of the arm and those of the head, the custom is kept up, perhaps, in consequence 244 REVELLENTS. of as little inconvenience accruing from the presence of the issue there, as in any part of the economy, that could be selected for the purpose. As in cases of long sustained febrile irritation, so in those of an inflammatory character, when they have become chronic, mercury is a valuable revellent. By the new action which it establishes, it breaks in upon the morbid condition more effectually than any other agent. It is in such cases, too, that we frequently see the most marked results from the revulsion effected by change of air, and of all the physical influences surrounding the individual; but this course can be adopted only when all active disorder has subsided. Arthritic Fevers. —From the great leading rules laid down with regard to the employment of external revellents in the phlegmasiae in general, it is unnecessary to occupy time and space with the spe- cial consideration of individual diseases. Allusion may be made, however, to one of those singular discrepancies in medical opinion, of w7hich we have, unfortunately, too many examples, but which generally, perhaps, owe their origin to defective observation or re- flection, or to both. It respects the propriety of employing epispas- tics in rheumatism and gout. " Of the utility of blisters in rheuma- tism," says Professor Chapman, " no one doubts. Yet even here they are productive of harm, if prematurely applied, and, where it can be conveniently done, should be preceded by general evacua- tions and local detractions of blood. My conviction is, that they are much better adapted to chronic than acute rheumatism, almost always proving serviceable in the former instance, and especially when they induce the suppurative process. By some waiters it is recommended to vesicate the affected part in regular gout, and, as it proves so beneficial in some analogous cases, we might imagine, that? it wrould be attended with the same results ; on trial, however, I have been disappointed, and no longer employ applications of this nature. It has, indeed, been alleged, that they have the effect of repelling the disease on some internal part of more value to life, and hence are hazardous measures. But such applications are the very best means to invite and fasten down, if I may use the expression, gout on the extremities, and I can have no idea of a remedy blowing hot and cold in this way." It is proper to remark, however, that these views of Professor Chapman were published many years ago. In his recent work on Eruptive Fevers, &c, (Philadelphia, 1844,) he says his own experience with blisters in gout " is too limited to decide confidently on the matter." "But," he adds, "from analogy, as wTell as on account of what I have seen of their operation, I pre- sume that after a partial reduction of the phlogosis, they would be serviceable — which opinion is strengthened by the consideration, that counter-irritation by some means seems always to have been a favourite practice in such cases." On the other hand, Dr. A. T. Thomson thus expresses himself on the same subject. IN THE PHLEGMASIA. 345 { In gout and rheumatism, the application of epispastics, whether vesicants or rubefacients is more problematical. < Blistering,' Dr. Cullen remarks,' is a very effectual means of relieving and discussing a paroxysm of the gout, but has also frequently had the effect of rendering it retrocedent.' I have little experience of the truth of this observation in gout, having scarcely ever ordered the application of epispastics ; but, in acute rheumatism, I have so frequently seen the most alarming translation of the inflammation to the vital organs, that I cannot too strongly denounce their employment in this dis- ease." The reader is referred to a preceding page for the analysis, which the author has endeavoured to make of the action of revellents in the changeable phlegmasia?. They are signally applicable to the present inquiry,—both rheumatism and gout belonging to these very phlegmasia?. It was there remarked, that it is by no means clear, that the artificial irritation, excited by revellents, can be used in such cases with perfect impunity. The irritation excited by the epispastic may, indeed, be added to that which appertains to the disease, and if there be a disposition in the phlegmasia to change its seat, or to extend to analogous structures, —the gouty, or rheumatic irritation in such structures may be augmented by it; but it is not easy to see that it can have the effect, either of "fastening down" the gout on the extremities, according to the view of Professor Chapman ; or give occasion to metastasis, according to that of Professor Thomson. The disease itself— as well as rheumatism — is metastatic or changeable, and this, whatever may be the plan of treatment pursued, although the author is not prepared to say, that such change of seat may not be promoted by certain agencies rather than by others. He has had the misfortune to witness several cases of serious pericarditis and endocarditis occurring in the course of acute rheumatism, although neither blisters nor any other applications were made to the affected joints ; yet he has little doubt, that had they been employed, the metastasis, or the extension of the disease, would have been ascribed by Professor Thomson, and by those who think with him, to the epispastics. But, although difference of sentiment exists regarding the effects of epispastics in acute gout, and rheumatism, practitioners are agreed as to the benefits to be derived from them, where the gout is atonic, and the rheumatism chronic. They are then used by all, and in the latter disease especially, revellents of almost all kinds are more or less prescribed ; — all the varieties of epispastics are applied in some condition or other, and by some practitioner or other ; the urinary organs are irritated by the turpentines, whose action in such cases is altogether revellent ; and, in those cases of rheumatism, or of neu- ralgia, to which the terms lumbago and sciatica have been appro- priated, the excitation, produced in the urinary organs, exerts a salu- tary agency — the new impression, made there, deriving, or detract- ing from the neuralgic condition in the lumbar or coxal region. In 246 REVELLENTS. some of these cases, the use of phosphorus, or of moxa, or of the actual cautery in its ordinary form of application, has destroyed the morbid action when other external revellents had failed. It is in such cases, too, that the new nervous impression made by acu- puncturation is so advantageous. In consequence of the easy absorption of the cantharidin when the flies come in contact with an abraded surface, blisters have been considered improper in inflammatory conditions of the urinary or- gans ; but the plan, to which the author has already adverted, of placing some material between the plaster and the skin, obviates this objection, and permits counter-irritation by those agents to the same extent as if the inflammation were seated in any other organ. Hemorrhage. — The remarks, that have been made on the em- ployment of revellents in inflammation, are equally applicable to hemorrhages. When hyperaemia exists in any tissue, the action of a revellent detracts from that hyperaemia, whether its presence be indicated by the ordinary signs of inflammation, or by the occur- rence of hemorrhage. Accordingly, the various forms of revellents are had recourse to, in these cases, with marked advantage. Eme- tics and cathartics exert their efficacy in hemorrhage rather by their revulsive than by their depleting or evacuant properties, and the great general principles that guide the practitioner in the administra- tion of revellents in the phlegmasia? must aid him here. It has been before remarked, that substances or agencies, belonging to this class, often act in the most salutary manner as indirect astringents, by causing a diversion of the blood from the seat of the hemorrhage, and, that it is in this way that the application of cold to the nape of the neck, and charms are haemastatics. Led by the great principles referred to, we excite the feet, or the rectum, in apoplexy; apply vesicants, suppurants, or rubefacients to the exterior of the thorax in haemoptysis, endeavouring, in this manner, to establish a centre of fluxion in some part of the organism, which does not receive its blood from the same arterial trunks as are concerned in the hemor- rhage. Even in cases of the less active and passive kinds of he- morrhage, marked advantage is derived from the employment of revellents; and they are, consequently, amongst the remedies most frequently used, whenever a discharge of blood from any set of ves- sels is kept up for a length of time ; precisely, indeed, for the same reason, that we have recourse to them, in prolonged morbid condi- tions of any internal organ. In the haemoptysis, which is symptomatic of phthisis, and in phthi- sis in general, revellents are more relied upon than any other class of remedies; and, if they fail, as almost every agency does when the disease is once fixed in the pulmonary tissue, we cannot look, with any weil founded expectations of benefit, to any other division of therapeutical agents. The revulsion is here variously effected ;— sometimes by cantharides ; at others, by tartar emetic ointment; at IN MENTAL AFFECTIONS. 247 others, by moxa, issues, the seton, &c, &c. The object being to establish and maintain a centre of fluxion on the exterior of the chest, a succession of blisters is well adapted to the case, or the tartar emetic ointment; but the issue or the seton, when once inserted, being easily kept up, is preferred by some physicians and patients. Diseases of the nervous system. —With regard to the employment of revellents in affections of the nervous system, much need not be said. The author has already spoken of their utility in apoplexy, when considering their use in hemorrhage. In paralysis, epispas- tics are often had recourse to, but never, perhaps, with the view of producing revulsion. They are employed altogether as excitants proper, and have, accordingly, been considered under that division of medicinal agents. In mania, every variety of revellent has been used. Whether the disordered intellect have arisen in the ordinary course of life, or in the puerperal state ; whether it may have been hereditary or acquired, the mischief has too often been regarded as requiring exclusively physical management; and most of the agents, that have been ad- vised, have been of a kind adapted for repressing inordinate organic actions. That the disease is of a physical nature, or dependent upon an altered condition of the organ, through which the mental and moral manifestations are elicited, is, perhaps, unquestionable ; but it is not of such a character, in the majority of cases, as to be re- moved by those agents, that are adapted for removing a hyperaemic condition of the encephalon ; and, whether these, or, indeed, any physical agents have to be employed, must depend upon the parti- cular circumstances that occasioned, or are present during the dis- ease. As a general rule, we are constrained to confine our treat- ment to the influence which we can exert on the encephalon, through the moral; and, by a proper application of mental revel- lents— if they may be so termed — to break in upon the insane hallucinations. A modern writer, Dr. Gooch — in a lucid and phi- losophic essay on the " Disorders of the Mind in Lying-in Women" <— has the following remarks, which are applicable to mental aliena- tion in general. " Whatever may be the causes which excite these diseases, the most important question still remains to be considered — what is that morbid state of organisation on which the disorder oi the mind depends? This is the proper object of medical art. We have no power by medicinal agents of relieving a disordered mind, excepting indirectly through the disorder of the body with which it is connected. It is impossible, therefore, to stir one step in the treatment of the disease without first ascertaining what this disorder is ; or if different in different cases, what they are, how to discri- minate them, and whether experience shows that one is more com- mon than the other. There is a strong disposition, not only popular but professional, to attribute raving of the mind to inflammation of the brain. Perhaps it originates in this — that the disorder of the 248 REVELLENTS. mind with which we are most familiar is drunkenness, which is known to be caused by spirits, and to be cured by temperance. Mania is called brain-fever, and the sight of a raving patient in- stantly suggests the thought of cupping-glasses, iced-caps, low diet, and purgatives. This view of mania is, w7hen it occurs in child- bed, still farther corroborated by the popular notions about lying-in women. If a woman becomes deranged in childbed, it is said not only that she has a brain fever, but that the milk has flown to her brain, hence the term ' mania lactea.'. Dr. Denman says, that in his time it was a prevalent notion among the people, but an obsolete one in our profession; and formerly it was usual to attempt reliev- ing the disease by restoring the milk and the lochia. It would be as good pathology to attribute puerperal fever to a suppression of the milk, and as good practice to attempt to cure it by drawing the breasts, fomenting the pelvis, or using any other local means for restoring these secretions. „ But experience and reflection lead to very different conclusions : they teach us that the disorder of the mind may be connected with very opposite states of the circula- tion, sometimes writh inflammation or active congestion, for which depletion is the shortest and surest remedy ; sometimes with an op- posite condition of the circulation, which depletion will only ag- gravate. Cerebral excitement does not necessarily depend on in- flammation or congestion, nor is depletion, however moderate, ne- cessarily the proper remedy. Cerebral excitement is often aggra- vated by depletion; and in some cases, as I shall have occasion to relate, absolutely brought on by it. Now the question, what is the morbid state of organisation on which puerperal insanity depends, must be determined in the usual way. There is only one safe mode of working the problem, by observing the causes which brought on the disease, the bodily symptoms, which accompany it, the way in which it is affected by remedies, and the morbid appearances dis- covered after death. These points can be learned only by an atten- tive and thoughtful observation of cases, and w7ill be best communi- cated by the relation of them." For the removal of most of those bodily symptoms, that are usually observed in mental alienation, much use is made of agents of the revellent kind. If there be headache ; suffused eyes ; flushed face, &c, general blood-letting may be demanded ; but usually the com- bination of depletion and revulsion, afforded by cupping, is sufficient for the evil, and more beneficial, in its operation, than general blood- letting. In furious mania, epispastics to the head, nape of the neck, or to the lower extremities, have been strongly advised by some ; but although, as has been seen, they may occasionally break in effectually upon the abstractions, they frequently add to the excite- ment, by the irritation they produce ; and cannot often be indicated. As a general rule, indeed, the soothing or abirritating system of management is required, and if the patient be indomitable by other agents, recourse may be had to the douche, which rarely fails. In IN MENTAL AFFECTIONS. 249 all insane establishments an apparatus of the kind exists. It consists of a reservoir above the ceiling of the apartment, from the bottom of wdiich a plug can be withdrawn, so that a column of water may be made to impinge on the naked head. The powerful revulsive impression made on the nervous system, by the "shock" from the fluid, rarely fails in taming the most furious. Even the cold dash or douche, or spout bath, is often sufficient for the purpose ; and the means are always at hand. The head of the patient may be placed over a pail of water and over the edge of the bed, and water may be poured from a watering pot, or from any vessel — the operator stand- ing on a chair, and in this manner allowing the water to fall from a height. A professional friend informed the author of a distressing case, in which he employed this variety of the douche with signal advantage, and several such cases have occurred to the author him- self. A lady, in consequence of the abrupt announcement that her son — a fine boy—was burnt to death, became frantic, and was completely unmanageable, until the douche was employed, in the mode just described ; under the operation of which she was gradu- ally overpowered and sank to sleep. Since the introduction of this agent, more violent means of restraint, in mania, have been almost abandoned ; and, by analogy, the cold dash or douche has been em- ployed with signal advantage in various other morbid encephalic conditions, — as convulsions, poisoning by opium, delirium ^tre- mens, &c. Where mental alienation has persisted for some time, and ade- quate attention has been paid to appropriate seclusion, and to pre- venting, as far as possible, the intrusion of any insane idea, the most salutary revulsion is occasionally effected by that thorough change in all the physical influences surrounding the individual, which travel- ling affords. The new objects, which perpetually present themselves to the eye, keep the mind actively engaged, and prevent it from brooding upon any topic, which may have constituted the insane hallucination. Exercise and amusement out of doors are, indeed, amongst the most important of the agencies, adopted in the treat- ment of insanity, and every well constituted private or public insti- tution for the insane is provided with means for keeping the mind engaged, and amused. Some of the private establishments, in France and elsewhere, are admirably supplied in this respect. If the patient choose the more active games, of which there is an extensive selection ; or if he prefer riding, or sailing,—for there is usually a considerable basin of water, in some part of the Ferme ornee, — or if he select the exercises of horticulture or agriculture, he is always indulged, care being taken to discriminate, whether he be in a state to be permitted the recreation, with or without his keeper. The whole moral system of management is, indeed, one of revulsion. It consists in keeping the mind engaged on every topic, except the one which is predominant; or, as the phrenologists would say, in haying every cerebral organ of the mental and moral manifestations occupied, except the one which is prominently, if not solely, diseased. 250 REVELLENTS. Hysteria, the seat of which is the cerebro-spinal nervous system especially, is mainly treated by revellents, as by cupping over the sides of the vertebral column, or elsewdiere; by stimulating injections; the cold douche; and by nauseous antispasmodics, as they are termed ; — all of which exert their beneficial effects through the new impres- sion they excite on the nerves with which they come in contact, thus detracting from the nervous concentration directed towards some other point of the nervous system, and generally, perhaps, of the cerebro-spinal axis. In tetanus, and in hydrophobia, revellents are rarely used, if we except the cold affusion, w7hich, in one case of tetanus algidus, or tetanus arising from cold, that fell under the author's observation, removed all the spasmodic symptoms by the shock it occasioned. In convulsions, epilepsy, and chorea, epispastics are rarely em- ployed, and never without some accidental symptom is present, which appears to indicate their use. In the two last diseases, how- ever, the most salutary operation is occasionally exerted by a thorough change of all the physical influences surrounding the individual. The disease appears, at times, to be kept up altogether by habit, and change of air and scene frequently break up the morbid associations better than any other agency. In neuralgic affections of various kinds, the practitioner trusts mainly to the effect of new impressions made upon the nerves. In this way tonics act, and the same may be said of narcotics. It is in such cases that the use of galvanism — in its various forms of appli- cation — as well as of the mineral magnet, has been found efficacious, breaking in upon the morbid condition, by exciting impressions on nerves not implicated in the disease, and, at the same time, attracting the nervous influx and the attention of the patient to the nerves artificially excited. In like manner, cupping — both with the scari- ficator and dry — is often beneficially employed as a revulsive agency. Dropsy and hypertrophy. — From what has been said regarding the action of revellents — mental as well as physical — it can be understood, that in dropsies, as w7ell as in hypertrophy of various kinds in the solid structures of the body, the different forms of re- vulsion may be advantageously employed. The reader is referred to the section on Eutrophics, and to those on the various local stimulants, for elucidations on this point. In hydropic affections in general, blisters appear to be more indicated, where there is much local irritation, as in hydrothorax especially — which is usually a sthenic dropsy. Still, in all, they establish a new action in the nervous and sanguiferous systems ; and cases are on record, in which the discharge from the blistered surface has been so profuse as to constitute an outlet, as it were, for the fluid of the dropsy. It is obviously impossible to point out every variety of morbid con- SPECIAL REVELLENTS. 251 dition, in which revellents may be useful. They can easily be in- ferred by one, who has attended to the great general principles which the author has endeavoured to lay* down. In other works he has pointed out the advantage to be derived from the revulsion, which change of air, society, and scene, are capable of effecting in health : and an attentive consideration of both its hygienic and therapeutical relations and applications cannot fail to exhibit it as one of the most important of the agencies which we employ both in prophylactic and curative medicine. SPECIAL REVELLENTS. From the general remarks that have been made, it is clear, that every physical and moral agent capable of modifying the functions of innervation, and, through itj those of circulation and secretion, must be capable of acting as a revellent; and, therefore, that all the classes of therapeutical agents hitherto considered, and most — if not all — those that have to come, must be esteemed capable of a re- vulsive operation in particular cases. Enough has, howTever, been said in regard to them, and, therefore, under special revellents those only will be considered which act as Cutaneous Revellents, com- prising what have usually been classed together under the head of Epispastics. The class willj however, admit of certain subdivisions, which may tend to facilitate the study of the modus operandi of the individual agents; most of which have been described under the head of Excitants, and will, therefore, require but a brief consider- ation here. a. Rubefacient Revellentsi I. SINA'PIS.^- MUSTARD. The excitant properties of mustard have been described elsewhere" j (Vol. i. p. 470,) and the fact that vinegar and other acids interfere with the formation of the acrid principle, especially in black mustard, has been particularly noticed, (Vol i. p. 126.) On this account it is advisable, that the sin'apism or mustard poultice, or mustard cat'a- plasm, or mustard plaster, should not be made with boiling vinegar, as directed by the London and Dublin Colleges, but that water of a temperature not exceeding 100° should be used, as heat likewise ap- pears to be injurious. It is always made extemporaneously, and, therefore, the framers of the Pharmacopoeia of the United States have properly omitted it. As a local stimulant, its use has been pointed out elsewhere, (Vol. i. p. 470.) It is likewise used as a revellent in various neuralgic and other painful disorders of internal parts, where 252 SPECIAL REVELLENTS. it is necessary to establish an action of revulsion speedily. Care has, however, to be taken where the sensibility is diminished, as in apo- plectic and paralytic cases, lest it should be kept on so long, that vesication, and even sloughing may occur. Usually, where the sen- sibility is not much impaired, a stinging pain indicates, that the ex- citant is taking effect; and, if rubefaction be induced, it ought to be removed, the mustard being carefully washed off, should any adhere. The best plan, indeed, is to put the cataplasm between gauze, which prevents any adherence to hairs, &c, which ought, however, when they are numerous, to be shaved off, where the cataplasm is placed in immediate contact with the skin. The strength of ordinary mustard varies materially. Usually, for simple rubefaction, equal parts of flour and mustard, mixed with warm water, will form a sinapism of the proper strength. In violent neuralgic and other deep-seated pains, the sinapism is occasionally applied to excite vesication. For this purpose, it may be made altogether of flour of mustard. It is, however, a very pain- ful application, and, unless carefully watched, may implicate the in- tegument so seriously, as to give rise to alarming sloughing. Hence, it is not often used as a vesicant. Oil of turpentine is occasionally added to the sinapism to increase its excitant effect. The volatile oil of mustard — Oleum Sinapis — is a powerful acrid, exhaling so strong a smell of mustard that the attempt to test its odour excites a violent pungent sensation in the nose, and tears in the eye. Its acridity is so great, that its application to the sound skin immediately occasions a sense of burning, and intense redness and vesication in the parts with which it is made to come in contact. It is applied in two modes, according to the sensibility of the skin, and the effect it may be desirable to induce. These consist either in rubbing the liquid on a part of the surface, or in applying strips of linen wetted with it. The first method is advisable where the skin is delicate—as in the cases of women and children, and in those whose sensibility has not been diminished, as by paralysis. When rubbed on the skin it speedily evaporates, exciting a sense of burn- ing and redness, which disappears in a few hours. The application of the oil by means of strips of linen, is adapted for skins which are thicker and less sensible, as well as for morbid cases, in which the sensibility is diminished. A strip or strips of linen dipped in it are placed upon the skin and suffered to dry, which generally takes six or eight minutes. The pain is often most violent, and sometimes.insup- portable, and is followed by redness and vesication. It has been ex- tensively used in Germany, especially in cases, in which a sudden counter-irritation is needed. RUBEFACIENT REVELLENTS___AMMONIA PRAPARATA. 253 2. CAP'SICUM. — CAYEN'NE PEPPER. Of the employment of powdered capsicum and the Tinctura Capsici as rubefacient revellents, enough has been said when treating of capsicum as an excitant. (See Vol. i. 466.) 3. AL'LIUM.—GARLIC. Garlic, by virtue of its acrid volatile oil— Oil of Garlic — is rubefacient; and the bruised cloves are sometimes applied to the feet in place of sinapisms, and writh the same objects. A garlic poultice, apphedtothe thumb, is a popular revellent in toothache. It is rarely used, however, by reason of its very strong, and — to most persons—disagreeable odour. The same may be said of 4. Allium Cepa, the Onion; and 5. Allium Porrum, the Leek; the bulbs of which, by virtue of their acrid principle are rubefacient also. 6. AMMO'NLE PR^EPARA'TA.— PREPARATIONS OF AMMO'NIA. All the preparations of ammonia are rubefacient; but the Liquor Ammonia is the one most frequently had recourse to. Under the head of Excitants it was stated, that ammoniated lotions had been highly extolled as revellents in recent times; and the mode of forming those of Granville, as well as the Pommade Ammoniacale, of Gondret, was given. (Vol. i. p. 493.) All these are powerful agents ; in their strongest form, giving rise, in a short time, to rubefaction and vesication over the whole surface to which they are applied ; almost as rapidly, indeed, as if boiling water were applied to the part. Their strength may, however, be regulated so as to produce either full vesication or simple rubefaction, by varying the proportion of liquor ammoniae. The mode of applying the ammoniated lotions is to impregnate a piece of cotton or linen, folded six or seven times with them, or a piece of thick and coarse flannel, and then place either of these on the spot to be acted upon, pressing the hand, at the same time, very steadily and firmly on the compress, over which there should be placed a thick towel, doubled several times, so that not only the evaporation of the lotion may be impeded, but the hand employed in pressing the application on the part may not suffer from direct or indirect contact with the liquid. Care must be taken, that the ammonia does not reach the eyes or nose. As a general rule, the application ought not to be kept on longer than from one to six or eight minutes; and, sometimes, the good effects supervene in less than a minute ; but to excite the higher de- grees of counter-irritation — as vesication and cauterisation — as many as ten or twelve minutes may be necessary. vol ii.—22 254 SPECIAL REVELLENTS. It is chiefly in neuralgic diseases, that the benefit of these rapid counter-irritants is most marked. The author has often employed them both in public and in private practice ; and in nervous and spas- modic diseases, and in neuralgic and deep-seated rheumatic affec- tions, the benefit has often been most signal. Severe pains have yielded rapidly ; hyperaemiae of particular organs have been diverted elsewhere, especially after blood-letting, and other sedatives had been premised ; and in short, whenever revellents, sudden and rapid in their action, have been demanded, the ammoniated counter-irri- tants have effected every thing that similar powerful revellents were capable of accomplishing, but no more. There is an objection, how- ever, that applies to these potent lotions —that they are apt to occa- sion sloughs and sores, which are often considerable, and remarka- bly difficult to heal. This, it is true, may be partly prevented, by being careful, that the application is not too long continued ; but, with the greatest caution, these results will supervene at times. When such is the case, simple dressings with emollient poultices will be found the best applications. LIMMENTUM AMMON'LE,LINIMENT OF AMMONIA. (Liq. ammon. f. Jj; 01. oliv. f. Jij.) This saponaceous liniment, of which hartshorn and oil is a variety, is often employed as a revellent in sore throat, as well as in lumbago, sciatica, and every form of rheumatic and neuralgic pain. It may either be rubbed on the part, — or a flan- nel, soaked with it, may be retained on the part of the cutaneous surface, which it is desired to irritate. 7. CAN'THARIS. —SPANISH FLIES. Cantharides — whose properties as an internal remedy have been been described elsewhere, (Vol. i. p. 278,) are chiefly used to induce vesication ; but they are employed, likewise, as rubefacients. The author has, indeed, remarked, that when they induce vesication, the fluid, abstracted from the cutaneous vessels, can scarcely be regarded as exerting much, if any, agency; and that the whole therapeutical influence would seem to consist in the rubefaction. Accordingly, the object of the practitioner in the application of blisters often is to induce redness of the surface, and, as soon as this is accomplished, to remove the blistering plaster ; but even then vesication frequently results, in consequence of the impression which has already been made on the secretory vessels of the skin. Wh-m the blistering plaster is applied to excite rubefaction only, it ought not to be kept on more than an hour or two. It is impossi- ble to fix upon the exact time, as this may depend upon difference in the thickness of the skin ; varying strength of the plaster, &c, and, therefore, the best plan is to raise the plaster gently, and re- move it on the first appearance of redness. A common rubefacient RUBEFACIENT REVELLENTS__PIX ABIETES. 255 liniment is made of the tincture of cantharides mixed with soap or camphor liniment, (Tinct. cantharid. f. ^ss ; Linim. camphora, seu Tinctura saponis camphorat. f. ^iss.) LMMEN'TUM CANTIIAR'IDIS, LINIMENT OF SPANISH FLIES. (Cantharid. pulv. £j ; 01. terebinth. Oss.) Oil of turpentine dissolves the can- tharidin, and becomes a powerful irritant. It will generally excite rapid vesication ; and requires to be reduced by the addition of olive or linseed oil, when the object is merely to excite rube- faction. 8. OL'EUM TEREBIN'THIN,E. — OIL OF TUR'PENTINE. Oil of turpentine —whose general properties have been described already, (Vol. i. p. 475,) — is a powerful local excitant, and is used as a rubefacient in many diseases. In long protracted fevers of an adynamic kind, it is rubbed hot or cold on the extremities, partly with a view of arousing the organic actions, and partly of localising that which is general. As a local rubefacient, it is employed in cases of deep-seated neuralgic and rheumatic affections of a chronic kind, and in sore throat and other internal inflammations. Applied hot, it has been used as a rubefacient to the abdomen in malignant puerperal peritonitis. It is considered to be the chief ingredient in Whitehead's essence of mustard, (Paris,) and the celebrated Lini- ment of St. John Long is said to have consisted of oil of turpen- tine and acetic acid suspended by yolk of egg. LIN1MENTUM TEREBINTIi™, LINIMENT OF TUR'PENTINE. (Vol.i.p.477.) This may be employed in rheumatic and other affections, in which ii is desirable to produce a rubefacient effect. Oil of turpentine enters into the composition of the Linimentum cantharidis, of the Pharmacopoeia of the United States. 9. OL'EUM OAJUPU'TL —CAJ'EPUT OIL. Cajeput or Kyapootie oil, (Vol. i. p. 481,) has been used — mixed with an equal quantity of olive oil — as a rubefacient liniment, in chronic rheumatic and neuralgic affections. It does not appear, how- ever, to possess any virtues that do not equally belong to other essential oils ; all of which, by the way, are rubefacient revellents ; yet but few of them are used as such, in consequence of their high price, 10. PIX ABIE'TIS. — BUR'GUNDY PITCH. Burgundy pitch is the prepared concrete juice of A'bies excel'sa, 256 SPECIAL REVELLENTS. Pinus A'bies, or Norway Spruce Fir ; Sex. Syst. Monoecia Monadel- phia ; Nat. Ord. Coniferae; Fig. 26. which is a native of Germa- ny, Russia, Norway, and other parts of Europe ; and also of the northern parts of Asia. It is cultivated in England, flowering in May and June. It yields, by spontaneous exudation, Common Frank'incense — the Abie'tis Resi'na of the London Pharmacopoeia, Thus, of the Dublin. From this, Burgundy pitch is pre- pared by melting in hot water, and straining through a coarse cloth, by which the volatile oil and the im- purities are separated. Ac- cording to Dr. Pereira, the substance sold in the shops as Burgundy pitch is rarely prepared in this w7ay, but is fictitious, the principal constituent being rosin, rendered opaque by incor- poration with water, and coloured by palm oil. One fabricator of it in- formed him that he prepared it from old and concrete American turpentine. Burgundy pitch is hard, brittle, opaque, of a yellowish white co- lour, and of a weak taste and smell of turpentine. When applied to the skin it adheres strongly, and therefore forms an excellent material for a rubefacient plaster. Its chief constituent is resin, which is as- sociated with a small quantity of volatile oil. Spread upon leather, Burgundy pitch is used as a plaster, —under the names Burgundy Pitch Plaster, or Pitch Plaster. A margin should be left on the leather free from the pitch, otherwise it will adhere to the clothes, and subject the patient to much inconvenience. It is used in various chronic affections of the chest and abdomen' and in cases of chronic rheumatic or neuralgic affections, where a plaster is applicable. It almost always excites more or less' irritation of the surface, which may be limited to simple rubefaction, but at times extends to vesication, and even to ulceration. Abies excelsa. RUBEFACIENT REVELLENTS__FRICTIONS. 257 EMPLAS'TRUM PICIS CUM CANTHAR'IDE, PLASTER OF PITCH WITH SPANISH FLIES Emplas'trum calefa'ciens, Warming Plaster or Warm Plaster. (Picis abiet. tbiiiss ; Cerat. cantharid. tbss.) This is an excellent rubefa- cient plaster, but cannot be borne by many individuals. For such, the proportion of flies may have to be diminished, or they may not be tolerated in any proportion. It is adapted for all cases for which a rubefacient plaster is indicated. Burgundy pitch enters into the composition of the Emplastrum Galbani Compositum of the Pharmacopoeia of the United States. 11. PIX CANADENSIS.—CAN'ADA PITCH, HEMLOCK PITCH. Hemlock Pitch is the prepared concrete juice of Abies Canaden'sis, Pinus Canaden'sis, or Hemlock Spruce, a tree, which flourishes in the British northern provinces, and in the more northern parts of New England, as well as in mountainous regions in the Middle states. The pitch exudes spontaneously from the full grown trees, and con- cretes on the bark. This is removed from the tree, broken into pieces, and boiled in water. The pitch rises to the surface, whence it may be removed, and be purified by a second boiling. It may be freed from its impurities by melting, and straining through a coarse lineh'jor canvass. Canada pitch, hemlock pitch, or hemlock gum, as met with in the shops, is hard, brittle and opaque, like Burgundy pitch, of a dark yellowish-brown colour, and peculiar smell. When made into a plaster, it is a mild rubefacient, resembling, in its properties, Bur* gundy pitch, for which it may be substituted, 12. CALOR'IO, Heat, when applied to any part of the cutaneous surface, may be regulated so as to act as a rubefacient revellent. Thus, hot water, between 120° and 150° Fahr., operates in this manner; and hence, pediluvia and cataplasms exert an unquestioned revellent agency in many cases of internal inflammation. Occasionally, other rubefa- cients are added, as when wTe stir flour of mustard in the water of a common foot-bath, or add it to a cataplasm. Hot fomentations act upon the same principle in the relief of internal and deep-seated pains, of a neuropathic character especially. 13. FRICTIONS. Frictions, when properly employed, are excellent revellents, pro- ducing, if employed for a sufficient length of time, redness of the surface. It is mainly by virtue of the friction that several of the liniments exert their beneficial agency in many morbid conditions, 22* 258 SPECIAL REVELLENTS. This is proved by the fact, that astonishing relief is afforded by dry rubbing. The use of the curry-comb, it is universally admitted, has an excellent effect On the nutrition of the horse ; and the flesh-brush, or rubbing the Whole of the surface of the body with a coarse tow7el, has a no less beneficial agency in many morbid cases, — of torpor of the digestive function especially. Friction with the dry hand, exe- cuted for at least half an hour by the clock, is an excellent agent in many rheumatic and neuralgic affections ; but it must be faithfully employed, and for a fixed period, to reap much benefit from it. When thus used, it has afforded marked relief in deep-seated pains, after liniments, rubbed in for a short time, had been used in vain. The only precaution necessary is for the rubber to dip his hand every now and then into wdieaten flour or rye meal, which prevents abra- sion either of the rubber or the rubbed. 14. DRY CUPPING. Under the general observations on revellents, the derivative effect of local blood-letting by cupping was examined. This effect was considered to be induced by the compound action of the loss of blood from the divided capillaries, and of the wounds made by the scari- ficator ; and, it may be added, from the diminished atmospheric pressure on the part to which the cupping glass is applied. When dry cupping is employed, the last is the main revulsive influence exerted. Yet it is a very valuable one in many cases, and well adapted for the relief of local pains, especially in those persons who, from protracted indisposition, or other causes, are unable to bear cup- ping with the scarificator, or what are commonly called cut cups. An air-pump bath has been employed, in which the atmospheric pressure is diminished over a greater or less surface of the body ; and the application of vapour has been associated with this, constituting the air-pump vapour bath, which has been used in gout, rheumatism, and paralysis. Hamospa'sia — as this mode of revulsion has been termed — was first urged some years ago by M. Junod, who twice received the Monthyon prize for his essays on the subject. It has been properly described as a means of producing a powerful revulsion of the blood from one part, and an equally powerful direction of it to another part of the body, by removing the atmospheric pressure from a large extent of surface, —as from one or both extremities at the same time. It is, in other words, dry cupping on a large scale. In 1835, M. Magendie highly extolled it in cases in which it is im- portant to attract the blood from the internal parts towards the sur- face of the body, without causing any loss of the vital fluid ; and its effects certainly entitle it to great attention. They resemble those produced by haemostasis, which—as elsewhere remarked — detains the blood in the vessels of the surface, and thus acts, for the time, in the same manner as the withdrawal of a certain quantity of blood from the circulation. The face, under the haemo- RUBEFACIENT REVELLENTS__ACIDUM NITRICUM. 259 spastic treatment, is rendered pale ; the pulse slower ; at times, there is a tendency to syncope; and often a good deal of disturbance of the gastric and intestinal functions. In inflammatory diseases it may be employed under the same circumstances as haemostasis ; and in addition, in affections of internal organs, which require the use of an efficacious and powerfully revellent influence. At a recent meeting of the British Provincial Medical Association at Plymouth, Dr. Marsden exhibited M. Junod's apparatus. It is made of copper in the shape of a boot, and is applied as one, having an Indian rubber top to tie round the thigh, and render it air-tight. The air is then exhausted by means of a syringe. By the application of this apparatus, the leg may be distended to double its ordinary size ; the pulse is at first quickened, but is gradually reduced both in frequency and strength, and even syncope may supervene. Very little pain attends the operation. After the removal of the apparatus, the blood gradually returns to its course, and in a couple of hours the swelling of the. leg subsides. Experience has shown, that sixty ope- rations on the same leg, w7ith one or two days interval, may be at- tended with no injurious effects to the nervous system. It need scarcely be said, that the diminished pressure induced over a con- siderable surface must necessarily have the effect of modifying the circulation of the blood, and inducing a new effect on the nervous system, and hence it may be an energetic revellent. 15. AC'DUM ACE'TICUM. — ACE'TIO ACID. Strong acetic acid — described under Escharotic Revellents — is employed as a rubefacient. It may be diluted with an equal quantity of water; and a piece of cotton, or blotting paper, dipped in it, may be left on the skin, until the effect is induced. In its concentrated state it may be applied in the same manner to cause vesication, and if kept on for a long time may disorganise the integument so as to induce sloughing. In cases of cramp, and in other affections, in which it is esteemed advisable to induce a sudden revulsion, it has been used ; but it is rarely had recourse to. 16. ACIDUM NI'TRICUM. —NITRIC ACID. Nitric acid, (Vol. ii. p. 71,) is capable of exciting rubefaction, when rubbed on the skin, where it is desirable to induce a speedy action on the cutaneous surface, as in malignant cholera. For this purpose it may be diluted with six or eight parts of water. In its concentrated state, it acts of course more violently ; but it is not pre- ferable, as a counter-irritant, to boiling water ; whilst its destructive action on every organic substance with which it comes in contact makes it objectionable. It is rarely used as a rubefacient. The Dublin College has an Unguentum Acidi Nitrici, which is 260 SPECIAL REVELLENTS. composed of Olive oil, ffcj ; Lard, giv; Nitric acid, f.3vss; which may be rubbed on the skin to excite rubefaction. 17. ACIDUM SULPHU'RICUM.—SULPH'URIC ACID. Sulphuric acid may be used like the nitric to produce a rubefa- cient action. The Dublin College has a formula for an Unguentum Acidi Sulphurici, which is composed of Sulphuric acid, ^j; Lard, |i. It is used in the same cases as the Unguentum Acidi Nitrici. Acupuncture, Electropuncture, Electricity, Galvanism, &c, considered under Excitants, (Vol. i. p. 502, et seq.) act as revellents in a similar manner as the agents just considered. b. Vesicant Revellents. 18. CAN'THARIS.—SPANISH FLIES. . The employment of cantharides as a rubefacient rellevent has al- ready been described, (ii. 256.) They are most commonly used, how- ever, as vesicants : indeed, they are the only agents employed with this view by the mass of practitioners, and with the exception of cases in which the irritation produced by them is excessive, they are the best of the vesicants that require time for their operation. The general properties of cantharides have been described else- where, (Vol. i. p. 276.) It was there mentioned, that their active property resides in a peculiar principle, canthar'idin. This has been found, likewise, in the cantharis vittata and other vesicating insects. It is obtained by concentrating an alcoholic tincture of the flies, made by displacement, and setting it aside. The cantharidin crys- tallises slowly. It is considered to be a solid volatile oil. It is not, of itself, soluble in water, but becomes so by combination with other constituents of cantharides. It is easily dissolved in ether, and in oils — fixed and volatile—aS well as in hot alcohol. One hundredth part of a grain, placed on a slip of paper, and applied, by M. Robi- quet, to the edge of the lower lip, caused small blisters in a quarter of an hour. Its action as a vesicant is exceedingly energetic. Powdered cantharides yield their vesicating properties to boiling water, and more readily to acetic acid, alcohol, dilute alcohol, ether, and to the fixed and volatile oils ; all of which have, therefore, been used pharmaceutical^, and most of them are employed at the pre- sent day in different officinal formulae. When applied to the cutaneous surface in a proper form, cantha- rides first induce rubefaction, as already shown, and then vesica- tion. The length of time required to produce the latter effect varies in different individuals. The usual routine direction is to put on a! blister at bed-time, and to remove it the following morning. Where VESICANT revellents___CANTHARIS. 261 the skin, however, is thin, vesication will be induced in a much shorter time — in six or eight hours. The blister should then be re- moved, as a longer continuance may induce so much irritation in the true skin, as to give occasion to sloughing; or the cuticle may break, the effused fluid be discharged, and, owing to the vesicating substance coming in contact with the exposed derma, absorption of the cantharidin may occur endermically, and cause great nephritic and vesical distress. In children, it is extremely important to bear this in mind, as gangrene has supervened on the application of blis- ters, especially where erethism has existed in the dermoid tissue,— as in cases of measles, scarlatina, &c. A few hours — three or four at the farthest — are commonly enough to excite rubefaction, if not vesication ; and if the former be fully developed when the blister is removed, the latter is pretty sure to succeed under the use of simple cerate. When the blistering plaster is taken off, the blisters should be opened by snipping them with a pair of scissors, and applying a dressing of simple cerate ; or of oil and wax melted together. In the Southern states—the leaves of the common cabbage are used as a dressing. Generally, the blistered part heals in the course of a few days, but, at times, suppuration follows. Occasionally, the skin is so little sensible, that blisters do not affect it, unless the surface has been first irritated by rubbing it with oil of turpentine, or by the ap- plication of a sinapism. To prevent the absorption of cantharidin, and its irritating effects on the urinary organs, a piece of gauze or tissue paper may be placed over the blistering plaster, through which the vesicating property is sufficiently exerted. It is said, that by boiling the flies in water, their power of causing strangury is destroyed, whilst their vesicating property is unimpaired. When those effects have been induced, the best remedies are diluents and opiates. Owing to the liability of these painful accidents, especial caution should be used in the em- ployment of blisters of cantharides in inflammatory affections of the urinary apparatus. CERA'TUM CANTHAR"IMS, CERATE OF SPANISH FLIES. (Cantharid. in pulv. subtiliss. tfej ; Cerce flava, Resin., Adipis, aa, ^viij.) This is the Emplastrum epispasticum or Blistering Plaster of the shops. When used, it is generally spread upon leather, a margin being left to pre- vent the plaster coming in contact with the clothes of the patient, or the margin is spread with Emplastrum plumbi or Emplastrum resina, to cause it to adhere. In eleemosynary institutions, it is gene- rally spread upon coarse paper. The use of sheepskin has been objected to, by Mr. Wm. Procter, junr., of Philadelphia, and with propriety, as, owing to its porous character, it absorbs much of the vehicle, and sometimes leaves the surface of the plaster so dry, that its adherence and activity are prevented. The material should be soft and yielding, at the same time that it ought not to absorb the 262 SPECIAL REVELLENTS. oil from the cerate; and, accordingly, oiled silk, which possesses all these requisites, has been proposed as a substitute for sheep- skin. When it is desired that the blister should heal speedily, it maybe dressed with simple cerate, in the manner before mentioned. At times, however, it becomes exceedingly red and inflamed, and the margins are covered with an ecthymatous eruption ; at others, a kind of diphtheritic exudation accompanies the vivid inflammation. In such cases, an emollient poultice may be demanded, wTith the ordi- nary treatment that is required in inflammation of the skin. When the surface remains red without any disposition to heal, dusting it with hair powder, or with chalk, has sometimes a salutary effect; and if the granulations be too luxuriant, it may be necessary to touch the surface with the sulphate of copper and dress it with dry lint. Occasionally, it is considered desirable to keep the blister open, or to form what is called a "perpetual blister." This may be effected by dressing it with the Ceratum resina, the Ceratum sabina, or the Unguentum cantharidis. The Edinburgh College has an Emplastrum cantharidis compositum, (Tereb. Venet. givss ; P-icis Burgund., Cantharid. aa, Jiij ; Cera, 5J; Cupri subacetat. ^ss; Sinap. alb., Piperis, aa, 31J) which is said to be an infallible vesicant. It is an unnecessary polypharmacal addition to the list. The London and Edinburgh Pharmacopoeias have an Acetum can- tharidis or Vinegar of cantharides, (Cantharid. in pulv. §ij ; Acid. acetic. Oj. — Pharm. Lond.) which resembles the chemical blistering fluid, recommended by Messrs. Pugh & Plews, of Edinburgh, several years ago. A piece of lint, wetted with this preparation, may be placed upon the part, and be covered by adhesive plaster. It is said to vesicate in the course of three hours, and not to induce strangury. It would appear, however, to be somewhat uncertain in its operation. An ethereal extract of cantharides, melted with twice its weight of wax and spread upon cloth or paper prepared with waxed plaster, has been employed as a blistering cloth, and substituted for the ordinary blistering plaster. A blistering paper has likewise been made by spreading upon paper an ointment, composed of white wax, 8 parts; spermaceti, 5 parts ; olive oil, 4 parts; turpentine, 1 part; cantharides, in powder, 1 part; water, 10 parts. This is boiled slowly and strained. (Henry & Guibourt.) A solution of cantharadin in olive oil has been proposed as a sub- stitute for the ordinary blistering plaster — paper being saturated with it; but it is not much used. The Can'tharis Vitta'ta, Pota'to flies, may be used as a substi- tute for the Cantharis. VESICANT REVELLENTS.— RANUNCULUS. 263 19. AMMO'NL*! PR^SPARA'Ta, — PREPARATIONS OF AMMONIA. Enough has already been said of the use of these as vesicants, Under the head of Rubefacient Revellents j (Vol. ii. p. 255.) 20. ARGEN'TI NITRAS. —NITRATE OF SILVER. Nitrate of silver is most frequently employed as an escharotic, but it is likewise used occasionally as a vesicant. With this view7, the part is moistened, and the solid nitrate is passed lightly over it in a crucial direction, so that the w7hole of the moistened surface may be affected, and yet not to the extent of inducing ulceration. In three or four hours, the epidermis rises, the subjacent fluid being rather purulent than serous ; this may be discharged, and if any dressing be needed, it may be the Ceratum simplex. Dr. A. T. Thomson affirms, that he has found this mode of exciting vesication admirably adapted for pulmonary affections, attended with much morbid excitement. Twenty of these blisters may be made over the surface of the thorax, in as many days, with the best effects. It is equally useful, he adds, in diseases of the joints, and deep-seated pains. " The only caution required is moderation in the application ; when too much of the nitrate is rubbed on the part, the pain is excruciating, and its in- fluence on the vascular system is sufficient to counteract any benefit which might result from its contra-stimulant property." Nitrate of silver has been strongly recommended as an application in external inflammation ; applied, at times, so as merely to blacken the surface ; at others, so as to excite vesication ; and the new ac- tion thus induced, in the vessels of the part — as elsewhere remarked of blisters, (Vol. i. p. 433,) — is sufficient at times to arrest erysipelas, and occasionally phlegmonous inflammation also. It is not uncom- mon to trace a line around the inflamed parts with the stick nitrate of silver, with the view of circumscribing the inflammation ; and the artificial excitement of the capillaries, thus induced, is at times effectual in limiting the disease; but it has often failed in the author's practice, as it has in that of others. 31. RANUN/CULUS. « CROWFOOT. Ranunculus—in the secondary list of the Pharmacopoeia of the United States — is the cormus and herb of Ranun''cuius bulbo'sus, Crowfoot, Buttercup, or Yellow weed; Sex. Syst. Polyandria Poly- gynia; Nat. Ord. Ranunculaceae; which is common in the pastures of the United States, flowering in May and June. All the ranun- culi are possessed of an acrid principle, wdiich passes over in distil- lation with water, and is lost by the process of drying. The ranunculus, when bruised and applied to any part of the cutane- 264 SPECIAL REVELLENTS. Fig. 27. ous surface, excites redness, and if kept on for any length of time, gene- rally induces vesication; but it appears to be exceedingly uncertain in its ope- ration; sometimes producing scarcely any effect, but at others causing ulcer- ation and sloughing of the integument. It is, consequently, but little used. 22. SINA'PIS. — MUSTARD. Enough has been said of the vesi- cating action of mustard, and its es- sential oil, under Rubefacient Revel- lents, (Vol. ii., p. 251,) to which the reader is referred. 23. CALOR'IC. Ranunculus acris. Vesication can be effected by the application of steam, or boiling water, or heated metal. Steam is very rarely used therapeutically, in conse- quence of the difficulty of restricting its action to any part of the cutaneous surface ; and the same applies, to a great extent, to the application of boil- ing water. By the use of heated me- tal, this inconvenience can be avoid- ed. The mode of applying it is by means of a piece of polished metal, dipped in boiling water, and applied to the part to be vesicated. These agents induce sudden revulsion, and are adapted for violent affections, such as spasm of the stomach, or severe neuralgic affections of any kind. A plan, lately proposed, for raising vesications on the surface, is very effective, and has been regarded as a form of moxa. It is, however, attended with intense pain ; yet in severe cases this may be far from objectionable. A piece of linen or paper, being cut of the requisite size, is immersed in spirit of wine or brandy. It is then laid on the part to be blistered, care being taken that the moisture from the paper or linen does not wet the surrounding surface. The flame of a lighted taper is then applied quickly over the surface, so as to produce a general ignition, which is exceedingly rapid. At the conclusion of this operation, the cuticle is found detached from the true skin beneath. SUPPURANT REVELLENTS__UNGUENTUM ANTIMONII. 265 c. Suppurant Revellents. 24. ANTIMO'NII ET POTAS'SA TARTRAS.—TARTRATE OF ANT'IMONY AND POTAS'SA. Tartrate of antimony and potassa — when associated with lard and rubbed on the skin night and morning — inflames the true skin, and gives occasion to a crop of large pustules with inflamed bases. It is sometimes used, also, in the form of solution, which is rubbed on the part; and in other cases, from ten grains to a drachm of it in fine powder are sprinkled over a Burgundy pitch plaster. The effect is the same from these different forms of application. When the pus- tules have once appeared, the application should be discontinued, for fear that troublesome ulcerations should ensue. Tartrate of anti- mony and potassa has been used, likewise, in the form of ointment to keep issues open, but caution is here again required, lest exten- sive ulceration or sloughing should be induced. In the last case, too, danger is incurred of the absorption of the salt, which sometimes follows the other modes of employing it, but such absorption is rare. The pustules produced by the ointment of tartrate of antimony and potassa are generally exceedingly painful ; but they are well adapted for establishing effective counter-irritation, in chronic, pulmonary, and other internal diseases. It is well to bear in mind that the large pustules are often succeeded by white scars, so that the salt should not be applied to parts that are apt to be exposed. UNGUENTUM ANTIMO'NII, ANTIMO NIAL OINTMENT. (Antim. et Potass. lartrat. in pulv. subtiliss. ^ij ; Adipis, ^j.) A portion of this oint- ment, of the size of a hazlenut, may be rubbed on the skin night and morning: in the course of a day or two, the part generally becomes painful, and a crop of pustules appears : the rubbing may then be discontinued, and a fresh portion of skin be selected ; so that, in this way, a succession of irritations may be maintained. The facility with which the eruption can be produced depends upon the thick- ness and impressibility of the skin ; at times, the author has found the advent of the pustules hastened by the previous application of a sinapism. The ointment should not be applied over an abraded or cut surface. Instances have been related in which severe and even fatal constitutional disorder has appeared to have resulted from the use of antimonial ointment, but the author has never met with a serious case. In two or three persons, it has excited vomiting. Tartrate of antimony and potassa may likewise — as remarked above — be used in the form of lotion, in the proportion of one drachm of the tartrate to an ounce of boiling water, rubbed together in a mor- tar. It is often employed in pulmonary affections, rubbed on the vol. ii.—23 266 SPECIAL REVELLENTS. chest night and morning. Dr. Hannay adds five grains of the corro- sive chloride of mercury, by which, he says, the power and efficacy of the lotion are quickened. 25. IPECACUAN'HA. A new counter-irritant of powdered Ipecacuanha has been recently recommended by Dr. Hannay, which, he says, was first suggested to him by his colleague, Dr. Easton, Professor of Materia Medica in Anderson's University, Glasgow. It is composed of Ipecacuanha powder and olive oil, of each two drachms ; lard, half an ounce. The part is to be rubbed freely with this liniment for fifteen or twenty minutes, three or four times daily, and to be enveloped in flannel. In about 36 hours, or sometimes sooner, very numerous small papulae and vesicles appear, seated on a deep red base of ir- regular extent. These soon become flattened and assume the pus- tular character. They never ulcerate like the pustules produced by the tartrate of antimony and potassa, than which ipecachuana is much less severe, but not less efficacious. The author has never employed this counter-irritant, and not- withstanding the encomiums of Dr. Hannay, the experience of others does not encourage him. Dr. Cormack recently detailed to the Medico-Chirurgical Society of Edinburgh, the result of his hospital observations with it, in the form advised by Dr. Hannay. In 10 out of 12 cases, it failed to produce any eruption, even when the powder was in the proportion of half an ounce to an ounce of lard. In a few persons only, M7ho had delicate skins, or had had recent blisters on the surface experimented on, he succeeded in bringing out an eruption, which was vesicular in three carefully observed instances. In the persons on whose skin the ointment of ipecacuanha produced no effect, a good crop of pustules was, in every case, brought out by one, two or three frictions with a liniment of equal parts of olive and croton oil. Dr. Cormack expressed the belief, that there are many vegetable powders, which would be found more active coun- ter-irritants than ipecacuanha. The experience of Dr. Cormack was corroborated by that of other physicians, who were present at the meeting of the society. 26. O'LEUM TIG'LII. -, CROTON OIL. Croton oil — whose general properties have been described under Cathartics Vol. i. p. 198,) - when rubbed upon the skin, excites redness, followed by an eruption of pustules, provided the friction be long continued, or often repeated. These pustules, when nu- merous, become confluent, and around the place where the confluent eruption is seated, pimples appear over a wider extent which be- come transformed into pustules, and are surrounded by a red base or areola. When the pustules are discrete, they dry up more ra- SUPPURANT REVELLENTS___ISSUES AND SETONS, 267 pidly ; and when confluent, they usually form scabs. As in the case of antimonial ointment, the pustulation is sooner induced where the skin is thin. Commonly, the eruption is perceptible within twelve hours after the first friction, if it have been continued for some minutes, and it usually disappears in the course of from three to six days. It is never so painful as that caused by the antimonial ointment. Frictions with croton oil are adapted for cases in which counter irritants, that require time to induce their action, are indicated. It has been much used in chronic internal inflammations, in gouty and rheumatic affections, aphonia, chronic hoarseness, phthisis, asthma, and hooping-cough ; and has been regarded as especially effective in rheumatic odontalgia and otalgia. When applied with the view of exciting an eruption, — from four to six drops, or even more, may be rubbed in twice a day. If the skin be thick, it may be well to rub it first with a coarse towel, or to apply a sinapism. Where the skin is excitable, it may be mixed with from one to five parts of olive oil, oil of turpentine, soap lini- ment, or lard. An ointment of a still feebler kind is sometimes used for the same purpose. (01. Tiglii, r^x — xxx ; Adipis, ^ss.) This is adapted for the delicate skins of children. Recently, M. Bouchardat (Annuaire de Therapeutique, 1844,) has recommended the following plaster of croton oil. Melt eighty parts of diachylon plaster at a very gentle fire, and when it is semiliquid, mix with twenty parts of croton oil. The resulting plaster is to be spread thickly on muslin. It is capable of producing considerable irritation of the skin, and may be employed in all cases where revel- lents are required. It does not occasion such severe pain as many other counter-irri- tants ; and, according to M. Bouchardat, will be found available in the treatment of many chronic diseases of the thoracic and abdominal viscera. 27. AC'IDA MINERA'LIA — MIN'ERAL ACIDS. The mineral acids — especially the Sulphuric and Nitric — when combined w7ith a greater quantity of lard than that mentioned under the head of Rubefacient Revellents, (Vol. ii. p. 261,) and rub- bed for some time on any part of the cutaneous surface, give occa- sion to the formation of pustules, which may be the means of de- riving from inflammatory and other irritation existing in internal organs. They are not, however, much employed with this object. 28. ISSUES AND SETONS. Issues — Fontic'uli—may be made with any actual cauterant, or with any of the potential cauterants described hereafter. The most common agent, however, is potassa ; and, when the slough has 268 SPECIAL REVELLENTS. separated, either the Curagoa orange — Auran'tium Curassaven'tium — or a common dried pea, is introduced, and kept in its place by diachylon or some form of adhesive issue plaster. Occasionally it becomes necessary to apply one of the suppurant ointments already described, to keep them discharging. The seton — Seta'ceum — is established by pinching up the com- mon integument of the part with the finger and thumb of the left hand, and then passing through it a seton needle, armed with a skein of silk ; or an ordinary tape, or a caoutchouc tape, or a strip of sheet lead may be used for the same purpose. The position of these must be changed daily, and it may be necessary to smear them with some excitant ointment from time to time. Issues and setons are valuable counter-irritants; but, as already remarked, their good effects are not dependent upon the discharge, but upon revulsion. At the same time they are uncleanly and dis- agreeable, and require great care. Consequently, they are by no means as often employed as they were formerly. It is difficult to induce patients to repeat the application of other counter-irritants as often as may be desirable ; and, therefore, the practitioner has re- course to permanent revellents of this kind. The system, however, gradually becomes accustomed to them, so that they, in some mea- sure, lose their effect; and by long continuance, become so much a part of the natural actions, that they cannot be suddenly arrested with impunity. When old ulcers heal, a source of irritation is apt to occur elsewhere; and it becomes advisable to insert a seton, or to establish an issue in the vicinity. For head affections, the seton is usually placed in the nape of the neck; for phthisical cases in the side. It is a popular preference to establish an issue in the arm for ophthalmia. In spinal affections it is generally made on each side of the vertebral column. 29. CAN'THARIS.— SPANISH FLIES. Cantharides are employed in the form of ointment to keep blisters open, and to excite suppuration. UNGUENTUM CANTHARIDIS, OINTMENT OF SPANISH FLIES. (Cantharid. in pulv. ^ij ; Aqua destillat. Oss; Cerat. resin, ^viij.) The Spanish flies are boiled in the w7ater and strained ; the cerate is then mixed, and the whole is properly evaporated. Boiling the flies in water does not destroy their peculiar powers, but it has been considered by some that it renders their active principle less liable to be ab- sorbed. Spread on lint, this ointment is a very common and good application to blistered surfaces to excite suppuration, and to issues to keep them open ; and it may be used in cases of atonic ulcers to excite them to a new action. SUPPURANT REVELLENTS__.MEZEREUM. 269 30. SABI'NA.—SAVINE. Savine — whose irritant qualities have been referred to elsewhere, (Vol. i. p. 412,)— is frequently employed as a suppurant to establish perpetual blisters. With this view, it is formed into a cerate, which is made in Europe of the fresh leaves, and is, therefore, more active ; but even then is complained of on account of its uncertainty;—perhaps, as suggested by Dr. Christison, owing to the volatile oil—the active constituent — being driven off in part by the high heat directed in preparing it. As the drug is usually brought to this country, the savine cerate is prepared from it, as imported, according to the fol- lowing proportions. CERATUM SABINE, SAVINE CERATE. (Sabin. in pulv. §ij ; Cerat. resin, ^j.) This cerate is to be preferred to the Unguentum Cantha- ridis, for one reason—-that there is no risk of strangury from ab- sorption of acrid matter. It is occasionally applied to the threads or tapes of setons, and to issues to increase the discharge. An ointment is sometimes prepared from Juniperus sabina or American savin, which is used for the same purpose, 31. MEZE'REUM. —MEZE'REON. Mezereon—wdiose general properties are described in the first volume, (p. 319,) — is a local irritant and vesicant. The recent bark is more active, but the dried possesses the virtues. Both that of Daphne meze'reum and of Daphne gnid'ium or garou is employed. It may be soaked in hot vinegar and water, and then be applied to the part by a compress and bandage. The application must be re- newed night and morning, until it vesicates ; which generally re- quires from 24 to 48 hours. UNGUENTUM MEZE REL OINTMENT OF MEZE'REON. (Mezerei, concis, §iv ; Adipis, ^xiv; Cera albce., ^ij. The mezereon is digested with the lard in a salt-water bath, according to the directions in the Pharma- copoeia. To the strained lard, the wax is added, and an ointment formed.) This ointment may be used to keep blisters and issues open. It has been introduced into the last edition of the Pharma- copoeia of the United States. An ointment has likewise been formed of the alcoholic extract of mezereon, which is employed for the same purposes. 23* 270 SPECIAL REVELLENTS. d. Eschar otic Revellents. I. Brodents. 32. ARGENTI NITRAS. — NITRATE OF SILVER. An an erodent, nitrate of silver is applied, in the solid state, to fungous growths, warts, corns, &c, which possess feeble vitality, and are, therefore, readily destroyed. When first brought in con- tact with luxuriant growths or an ulcer, it produces a white film, which is owing to the combination of the nitrate with the albumen of the surface of the ulcer, and probably also with the chloride of sodium of the secretions. This constitutes a slough, which gradually becomes dark, and is ultimately thrown off— a new action having often been induced in the sound parts beneath the slough, so that, on its separating, the ulcer is sometimes found to be healed. With the view of changing the condition of the diseased surface, and de- stroying the morbid state, it is not unfrequently applied to chancres. It is likewise found to be very beneficial in fissured or excoriated nipples ; and in certain chronic cutaneous affections. Dissolved in distilled wrater, in the proportion of from gr. 40 to gr. 60 of the nitrate to one ounce of water, it is applied, by means of a camel's hair pencil, in the same cases. 33. CUPRI SULPHAS. —SULPHATE OF COPPER. Sulphate of copper— elsewhere described (Vol. i. p. 114,) —com- monly known under the name blue stone — is frequently used as an erodent to destroy fungous growths on ulcers. It is applied either by touching the surface of the proud flesh w7ith the solid sulphate ; or the powder is sprinkled upon them ; or they are washed with a strong solution of it. It appears to enter into combination with some of the constituents of the tissues with which it is placed in contact. It w7ould seem, however, to occasion but little decomposition of the part, and can scarcely — it has been considered by Dr. Christison — be regarded as a corrosive. It is, doubtless, a powerful excitant, and induces a new action in ulcerated parts so as to give occasion, in many cases, to their cicatrisation. When applied in solution, the proportion may be gr. ij to viij of the salt to the ounce of water. The pow7der is sometimes rubbed on warts—simple or syphilitic; and a strong solution may be used for the same purpose. 34. CUPRI SUBACETAS.—SUBACETATE OF COPPER. Subacetate of copper, Alru'go or Verdigris, wdiose general proper- ties have been described elsewhere, (Vol. ii. p. 68,) is not unfre- quently employed as an erodent in cases of warts and fungous ER0DENTS--SABINA. 271 growths, and as a detergent to foul ulcers. It may be sprinkled, in powder, over the surface of the ulcer; and when mixed with savine powder it is occasionally rubbed over venereal and other warts. It is occasionally used, likewise, in certain chronic cutaneous affections, and has proved highly serviceable in ringworm of the scalp. UNGUENTUM CUPRI SUBACETA'TIS, OINTMENT OF SUBACETATE OF COPPER. (Cupri subacetat. in pulv. subtiliss. 3J ; Unguent, simpl. 3XV.) This may be employed in the cases above described. When reduced with lard, it is, also, used in ophthalmia tarsi, — being applied at bedtime especially, with the aid of a camel's hair pencil. 35. ALU'MEN EXSICCA'TUM.—DRIED ALUM. Dried alum is alum melted in an earthen or iron vessel over the fire, the heat being continued until it becomes dry. The alum is then rubbed into powrder. Dried alum is chiefly used as an erodent, to destroy exuberant granulations on ulcers ; for which purpose, it may be sprinkled over the surface. It acts, also, as an excitant to indolent ulcers. 36. AC'IDA MINERA'LIA.—MIN'ERAL ACIDS. The Sulphuric, Nitric and Muriatic acids, pure, or diluted with water, are used as erodents, chiefly in cases of warts and corns; and the same may be said of the 37. ACIDUM ACE'TICUM—ACE'TIC ACID. This is formed, according to the process introduced into the last edition of the Pharmacopoeia of the United States, by decomposing acetate of soda by means of sulphuric acid, and distilling until the residuum becomes dry. The resulting acetic acid is mixed with red oxide of lead and again distilled to dryness to remove the sulphurous acid, which has passed over in the first distillation. This acid has a specific gravity of 1.06, and 100 grains of it saturate 83.5 grains of crystallised bicarbonate of potassa. The acetic acid or radical vinegar, thus obtained, is a colourless volatile liquid, having a pun- gent smell, and a strongly acid and corrosive taste. 38. SABl'NA.—SAVINE. It has been just remarked, (p. 271,) that savine powder is added to powdered subacetate of copper, to form an efficacious agent for the removal of syphilitic warts ; and that the cerate is used as an ir- ritant to maintain a discharge from ulcerated surfaces. A strong in- fusion is likewise employed in cases of warts, indolent ulcers; and, 272 SPECIAL REVELLENTS. also, in certain chronic cutaneous diseases — as scabies, and porrigo favosa. The expressed juice of the plant, diluted writh water, is said to be applied in the same cases. 39. SAC'CHARUM.—SUGAR. Refined sugar (Vol. i. p. 241,) in powder, is sometimes sprinkled over the surface of ulcers on which the granulations are exuberant; is blown into the eye, in specks of the cornea; and into the throat in diphtheritis. It is probable, however, that it acts in these cases merely as an excitant, thus modifying the condition of nutrition of the parts beneath, and removing the morbid state. It is in this way, doubtless, that specks of the cornea are removed; not by any corrosive action possessed by the sugar. 2. Actual Cauterants. 40. CALOR'IC. The application of free caloric to the surface of the body, in a certain degree of intensity, is a valuable revellent. As an actual cauterant, it is employed to produce disorganisation of the part with which it is made to come in contact; and thus either to excite a new action in the morbid structures seated beneath the slough formed ; or to constitute centres of irritation, which may act as revellents in dis- eased actions going on elsewhere. Actual cauterants are much more powerful disturbing agents, than the potential, which induce disor- ganisation by a slow combination with the elements of the tissues. The natural dread of fire, however, prevents their use in this country to the extent that might be advisable ; and, therefore, the potential, — the apparently less formidable, and certainly less efficacious,— are made to take their place. There are two forms of actual cauterants which are used in prac- tice — the hot iron and the moxa. 1. the hot iron. A difference exists in the degree to which the heat of the metal is carried. When the cautery is at a red heat, unless it be applied for a longer period, it does not so rapidly and completely destroy the tissues as when heated to whiteness. The latter is, therefore, chosen. Nor is it as painful an application as might be imagined. If the sur- rounding parts be well protected so that they are not burnt by radiant heat, the death of the part takes place instantaneously, and but very little feeling is experienced — certainly far less than is caused by any form of the potential cautery, which destroys by slow degrees. In applying the white hot iron, therefore, it is advisable to protect the surrounding parts by having pieces of thick paper wetted and applied ACTUAL CAUTERANTS--MOXA. 273 layer upon layer, with a hole in the centre, of the size that is desired, so that the cautery can be brought in contact with a restricted sur- face. This should be done quickly, inasmuch as the chief pain is occasioned by the approach of the heated metal to the skin. The application of the hot iron is a powerful counter-irritant, and of great value in many internal diseases. It is rarely, however, em- ployed in such cases, but is in use, especially in France, for destroying malignant growths. It was considered, in antiquity, as the last re- source,— that which fire could not cure being deemed incurable. 2. MOXA. The term moxa is applied by the Chinese and Japanese to a cot- tony substance, prepared by beating the dried leaves of Artemis'ia Chinen'sis, or, according to Lindley, of A. Moxa. With the down they form a cone, which is placed upon the part to be cauterised, and set fire to at the top. This mode of cauterisation has been long practised by those people, and by the ruder nations of the old world ; but it was not much employed in Great Britain and France, until about the commencement of the seventeenth century, when Ten Rhyne — a Dutch practitioner— introduced it from India. It fell, however, into disuse, until it was revived during the last century, since which time it has been much used, especially by some of the French army surgeons. In other works, the author has referred to the various combustible substances employed by different nations in " moxibustion." In modern times various substances have been used for the fabri- cation of moxas. In Germany, they employ the tinder — amadou— which is an agaric prepared for the purpose ; and it is not uncom- monly employed in our hospitals — a small disc or cylinder being placed on the part and set fire to. It is now generally adopted in the French hospitals. The match, used by artillerists, was recom- mended by Percy, after Bontius. It is composed of hemp, steeped in a solution of nitrate of potassa. He likewise proposed the pith of helianthus annuus, recommending that the stalk should be cut into cylinders of the desired length, the bark being left on, so that, when ignited, they may burn in the centre, whilst held in the hand. Percy's moxas, prepared by Robinet, are said to be found in the London shops. They consist of pith, rolled in cotton, and enveloped in muslin. (Pereira.) That used by Larrey, and very generally employed by many practitioners, is made by taking a quantity of cotton wool, pressing it somewhat closely together, and rolling it over a piece of fine linen which is fastened at the side by a few stitches. Larrey advises, that it should have the shape of a trun- cated cone — the form usually adopted — and be about an inch long. It is generally, however, made shorter and smaller than this. The moxa may be held in its place by means of two long hair pins or 274 SPECIAL REVELLENTS. wires, which are slightly bent, so as to accommodate them to the shape of the moxa, by which it is retained in its proper position. For the same purpose, Larrey employed a porte-moxa, consisting of a ring to receive the moxa, with a handle attached to it, and three small knobs or supports of ebony, placed beneath the ring, to pre- vent the heated metal from acting on the skin. Professor Grafe, of Berlin, employed wafers, dipped in a mixture of three parts of oil of turpentine and one part of sulphuric ether. Before applying this inflammable matter to the skin, it is necessary to remove carefully from the wafer the superfluous liquid. These moxas are said to ignite readily, burn promptly and uniformly, and do not crepitate. Phosphorus has been recommended in the place of moxa, as more convenient and safe. Of late the following moxa has been recommended. Mace- rate strips of coarse cotton or muslin in a saturated solution of ' bichromate of potassa, and when nearly dry roll them tightly on a piece of wire of the twentieth of an inch in thickness, until the cylinder shall be about three-fourths of an inch in diameter, or as thick as may be thought desirable. The roll must then be wrap- ped round very tightly with strong thread and covered with a piece of fine muslin stitched over it. The wire may then be withdrawn, and the cylinder completely dried. When wanted for use, a small piece of the requisite length may be cut off by a sharp knife and be fixed on the part by a piece of adhesive plaster having a cross cut in the centre. This moxa burns with a more uniform and steady ig- nition than those prepared with nitre. To prevent the surrounding parts from being burnt, a wet rag may be placed on the skin, having a hole in it large enough to re- ceive the moxa. In the application of most of the moxas, their effects can be so graduated as to produce simple rubefaction, or vesication, or the formation of an eschar. Where a rubefacient action is alone desired, the cylinder may be removed, when the pain becomes somewhat severe; or the material in ignition may be held close to the sur- face, and be moved gradually along it. In this way, a counter- irritant effect may be exerted along the spine or any extensive sur- face. Any burning substance — a lighted coal, for example — will answer for this purpose. When it is desired to induce vesica- tion, the moxa must be kept on longer; and if it be required to produce an eschar, it may have to remain on until it is wholly consumed. Larrey, indeed, advises that the blowpipe should be occasionally employed to hasten its combustion. When the in- tegument has once become disorganised, the slough will be thrown off in due time, leaving an ulcer. Larrey says, that the sloughing can be prevented by the application of liquid ammonia to the burnt surface, after the moxa has been removed. This will do, when the disorganisation is partial; but the author knows from experience that when such is not the case, it will often fail. POTENTIAL CAUTERANTS__POTASSA. 275 3. Potential Cauterants. 41. POTAS'SA; Potas'sa, Caustic potas'sa, Hydrate of potas'sa, Pure kali, Lapis inferna'lis, or strongest common caustic, is prepared by evaporating liquor potassae till ebullition ceases and the potassa melts. It is then run into moulds, and, when cold, is kept in well-stopped bot- tles. As met with in the shops, it is either in fragments of plates, or in pencils of a gray or green colour. It is very deliquescent, and greedily attracts carbonic acid from the air. It is very soluble in water, dissolving in less than its weight; and, unlike the carbonate and bicarbonate of potassa, is soluble, also, in alcohol. It always contains various impurities, but they do not interfere with its medi- cinal action. Caustic potassa is a most powerful destroyer of organised tissues, combining rapidly with fibrin and albumen, and corroding and de- stroying the cuticle so as to give occasion to a soapy feeling, when it is rubbed between the fingers. It is the most common caustic ap- plication for forming issues, although its extreme deliquescence is an objection to it. To obviate this, layers of adhesive plaster should be placed on the skin, with a hole of the proper size cut in their cen- tre ; and on the exposed skin, the extremity of a piece of potassa must be rubbed until the skin is discoloured. The part may then be washed with water or with vinegar, and a bread and milk or flax- seed poultice be applied. In a few days, the eschar will be detach- ed, after which the ulcer may be kept open by the issue pea and plaster, or by any of the suppurant ointments already referred to. Like the nitrate of silver, it has also been applied" to poisoned wounds ; and to strictures of the urethra, being inserted at the ex- tremity of an appropriate bougie. Mr. Whately affirmed, that this application might be employed with entire impunity, but the ap- prehensions of practitioners, owing to its great deliquescence; have prevented them from adopting it extensively, and it is now rarely used. A solution ofpotassa ^iss, in distilled water f. |ij, has been recom- mended by Dr. Hartshorne, of Philadelphia, to be drawn quickly along the spine by means of a sponge, attached to the end of a stick, in tetanus. It acts as a powerful rubefacient. The Potas'sa cum Calce, Potas'sa with Lime, is in the London and Edinburgh Pharmacopoeias. It is formed by the union of equal parts of Potassa and Quicklime, which are rubbed together, and kept in a well-stopped vessel. This is the milder common caustic ; yet although so called, it is a powerful potential cauterant. It is not wholly soluble in water, unless the water be in very large proportion ; and is only partly soluble in alcohol. It is employed for the same 276 SPECIAL REVELLENTS. purposes as the potassa. It is usually made into a paste with alco- hol, and applied to the part to be cauterised. It is slower in its ope- ration, and less deliquescent than potassa, and therefore less liable to spread beyond the part to which it is applied. 42. ZINCI CHLO'RIDUM. — CHLORIDE OF ZINC. Chloride or Butter of Zinc, whose general properties are de- scribed under Tonics, (Vol. ii. p. 65,) has been recommended as a caustic, that does not exert any disagreeable influence on the organism. It has been used by Hancke and others to form issues, which it does in from six to eight hours, and has been considered only superior to many other caustics, where the destruction of a con- siderable thickness of structure is required, or where the removal of an excrescence in this manner is preferred by the patient to the knife. The nitrate of silver has been considered superior in pro- moting a sound action, w7hen the unhealthy surface or stratum of the ulcer is superficial. Chloride of zinc has been used successfully for the destruction of naevi materni, and lupus, and in cancerous and malignant growths and ulcerations ; and has been largely employed in this country. It is, indeed, an excellent cauterant. Chloride of zinc may be applied as a caustic, by means of a camel's hair pencil, either alone, or mixed with an equal portion of oxide of zinc, sulphate of lime, or wheaten flour. To give it the proper consistence, from twenty-four to thirty drops of water may be added to each ounce of the chloride. It seems to act not only chemically, by destroying the part with which it comes in contact, but dynamically on the neighbouring living tissues, — as the appear- ance of the parts beneath is generally greatly improved after the separation of the eschar. In the strength of two grains to the ounce of distilled water, it has been applied two or three times a day on lint to atonic ulcers ; and when reduced by solution in water or wine, or mixed with oil or lard, has been used in paralysis as a rubefacient. 43. ARGEN'TI NITRAS. — NITRATE OF SILVER. Of the uses of nitrate of silver as an erodent, mention has already been made. As a cauterant, it has been employed to cut short the progress of variolous pustules, and to prevent pitting; with which view, it is applied on the first or second day of the eruption ; the solid nitrate being applied to each pustule, after their tops have been removed. It has occasionally been used in the same manner in cases of herpes zoster. In strictures of the urethra and oesophagus, the nitrate is put into the extremity of a bougie, and passed down to the seat of the ob- struction; and in the former affection, it has often entirely succeeded, POTENTIAL CAUTERANTS___ARGENTI NITRAS. 277 not apparently by destroying the stricture, but by inducing some change in the vital actions of the part, which is followed by relax- ation of the narrowed portion of the canal, " but which change is as difficult to explain as is the subduction of external inflammatory action by the application of this salt." (Pereira.) By rubbing the solid nitrate, moistened, over a portion of the cu- taneous surface for some time, the vitality of the integument may become so much impaired, that an eschar may be induced, which, when it sloughs off, may form an issue ; but it is rarely used for this purpose. It is an excellent application, however, in phagedenic ulcerations of all kinds, gangrenous stomatitis, &c, in which it is necessary to destroy the surfaces, and induce a new action in the parts beneath. 44. ANTIMO'NII MU'RIAS. — MURIATE OF ANTIMONY. Mu'riate or Sesquichlo'ride, Hydrochlo'rate or Chlorohy'drate of An'timony; Oil or Butter of An'timony, as met with in the shops, is usually prepared by dissolving roasted sesquisulphuret of antimony in chlorohydric acid. It may also be made by dissolving crude anti- mony in the same acid. It is a transparent liquid, the colour of which—dependent on the iron it contains — varies from yellow to deep red. When applied to a wounded surface, it acts as a power- ful caustic, forming an eschar without any excessive pain; hence, it is sometimes used in cases of poisoned wounds, and as a caustic to sloughing ulcers. It is not much employed, however, and is not admitted into the Pharmacopoeias of Great Britain or into that of this country. 45. AC'IDA MINERA'LIA. —MIN'ERAL ACIDS. The mineral acids are sometimes employed as caustics, especially the Ac"idum Ni'tricum, or Nitric Acid. This is not used, however, to form issues; but is applied not only to destroy warts, but to dis- organise the surface of foul phagedenic ulcers, and as a caustic to the bites of rabid animals or venomous serpents. With this view, it is applied undiluted, and is kept in situ, by smearing the surrounding parts with some resinous ointment. An eschar is in this manner formed, which falls off, and the base of the ulcer is often found to have assumed a new action. It may be applied by means of apiece of sponge or linen rag tied around a small piece of stick. Sometimes it may be necessary to cut through the slough so as to make the acid reach the living tissues beneath. In the strength of about f. £j of acid to Oj of water, it is a good application to foul ulcers ; and when still farther diluted — nixU to water Oj it is an excellent stimulant to atonic ulcers. The Unguen'tum Ac"idi Ni'trici of the Dublin Pharmacopoeia, vol. ii.—24 278 SPECIAL REVELLENTS. (01. Oliv. fbj ; Adipis, §iv ; Acid Nitric, f. 3VSS ;) is used in various skin diseases — for example, in scabies, porrigo, &c, and occasion- ally as a dressing to syphilitic and other obstinate ulcers, in which it is advisable to induce a new action. The Sulphuric and Muriatic Acids are employed in the same manner, and for similar purposes. 46. ACIDUM ARSENIO'SUM.—ARSE'NIOUS ACID. Arsenious acid — wdiose properties have been described elsewdiere, (Vol. ii. p. 83,) is a powerful caustic, and was at one time much used by surgeons, in cases of cancerous and other morbid conditions, in which it was advisable to destroy the parts. It was the basis, too, of several applications to cancers of a secret character — as the pow- der of Frere Cosme; and one of a Dr. Hugh Martin, of this country— the Pate de Rousselot, Plunkett's paste, Febure's wash, &c. &c. When appropriately applied, it causes the death of the part, and, on the separation of the slough, a healthier action of the parts be- neath is sometimes induced. Its precise chemical influence on the tissues does not appear to be know7n. It would seem, however, im- portant, that the caustic should be so strong as to completely disor- ganise, otherwise the poison is apt to be absorbed. Cases, indeed, are recorded, in which it has proved fatal in this manner; and it has not even been applied in all cases with impunity, when the skin was whole. On these accounts the arsenical caustic is but rarely em- ployed in cancer, lupus, onychia maligna, and the other affections, in which it was at one time much used by surgeons. Absorption is thought to have occurred most frequently from bleeding surfaces. The former pharmacopoeias of the United States had a Ceratum Arsenici, composed of Arsenious acid, in very fine powder, a scruple; Simple cerate, an ounce ; which was sometimes used as a dressing to cancerous ulcers. It has been dismissed in the last edition, (1842.) According to Mr. Carmichael, Arse'niate of Iron acts more pow- erfully on the vitality of cancerous formations than any other agent. Of late he has employed a compound of this salt and phosphate of iron, — half a drachm of the former to two drachms of the latter, and six drachms of lard. This is applied by means of a camel's hair pencil, and not over the whole surface of the ulcer when it is exten- sive ; or it may be applied spread on lint. I'odide of Ar'senic has been used with advantage in the form of ointment, (Arsenic, iodid. gr. iij ; Adipis, |j ;) in cases of phagedenic tuberculous lupus. 47. Hydrar'gyri Chlo'ridum Corrosi'vum ; 48, Hydrar'gyri EUTROPHICS. 279 Iod'idum Rubrum ; and 49, Hydrar'gyri Ox'idum Rubrum, are oc- casionally used as caustics to malignant growths and ulcers; but their application in this manner will be referred to under another head. (See Eutrophics.) 50. Liquor Ammo'nije (Vol. i. p. 493,) is likewise applied occa- sionally in cases of the bites of rabid animals, so as to destroy the surface with which it comes in contact. 51. Creasote (Vol. i. p. 490,) has also proved beneficial as a caustic — applied pure, or di- luted w7ith water—in atonic, foul and offensive ulcers, in scrofulous caries, sloughing carbuncle, cancerous ulcerations, lupus, and con- dylomata. When undiluted, it may be applied by means of a camel's hair pencil. 52. Nitro-Muriate of Gold has been applied to cancerous tu- mours and ulcers. It is prepared by dissolving six grains of chloride of gold in an ounce of aqua regia, and is applied like other corrosive agents, — care being taken that it is confined to the parts to be acted upon. VII. EUTROPH/ICS. Eutrophics defined—Alteratives—Modify the function of nutrition—Sorbefacients— Therapeutical application of eutrophics—Pressure—Friction—Special eutrophics. It has been at all times admitted, that there are agents, which, when taken into the system in small doses, may act on morbid struc- tures and conditions, so as to occasion their removal, without any sensible evacuation or operation. To such remedies, the term alter- atives, (Svnon. Alterantia, Alloiotica,) has generally been applied ; but it need scarcely be said, that in admitting such a class of thera- peutical agents, the greatest caution is necessary, lest we should assign to the insensible influence of the remedy what ought to be ascribed to the recuperative power, which the system, and every part of it possesses, and to which the author has had occasion to allude more than once in the course of these volumes. Perhaps there is no class of remedies that is more interesting and more diffi- cult to be understood. The term alterative has, however, been used indefinitely ; and in reality every agent that has thus far been considered, seeing that it must modify or alter, directly or indirectly, one or more of the functions, must be considered an alterative. Tonics — as has been seen — induce their effects by the impression they make on the ner- vous system ; yet that impression is exerted slowly, and is not accom- panied by any sensible evacuation ; hence they seem to belong pro- perly to the class of alteratives. In a modern work, indeed, the defi- nition of these two classes of agents has been given in a manner 280 EUTROPHICS. somewhat different from the common acceptation. " There are agents," say MM. Trousseau and Pidoux, " which afford to the or- ganic elements something that survives the primary impression of the medicine; at times this is a constituent element, or a more perfect functional aptitude: these take the name of Tonics. At others, on the contrary, they change the character of the blood, ren- der it less adapted for interstitial nutrition, and for furnishing ele- ments for acute or chronic phlegmasiae : these take the name of alter- atives." As the author is desirous of classifying under one head the different internal remedies which are capable of modifying the fluid of the circulation, so that when it permeates the intermediate system of vessels :t may impress them differently, and thus alter morbid actions that may be taking place in them, he has adopted the term Eutrophics for this class of therapeutical agents. Eutrophics — from ««> " well," and t/>o*« "nourishment" — may then be defined—-agents whose action is exerted on the system of nutrition, without necessarily occasioning manifest increase in any of of the secretions. There are but two ways, perhaps, in which alteratives can exert their agency on the system ; the one is through the new impression they make directly on the nerves ; the other, through the way of ab- sorption. Tonics, it is probable, act in the former manner; eutro- phics, which occasion the absorption of the solid parts of the body, — most substances, indeed, which impress new activity on the capil- lary action, — generally in the latter. If corrosive sublimate or arsenic be given in small doses, oft re- peated, in obstinate cutaneous affections, we may discover that the eruption fades gradually away, and that, after a time, the parts are restored to health. The same thing happens, if we administer sac- charine solutions in the manner described hereafter. All this occurs without any manifest evacuation, and is, therefore, referable to eutrophic agency. The mode, in which this is probably exerted, is by the changes produced in the circulating fluid by the substances in question. The altered fluid entersthe intermediate circulation; changes the character of the nutrition accomplished there, by the new impression made on the capillary vessels ; and in this way a new action is assumed by them, which breaks in upon the old ; the affinities are modified; and harmony succeeds to the irregularity of action previously existing. It is in this way, that we explain the efficacy of mineral waters, and of many other agents, which have had the reputation of ' purifying the blood ;' and which doubtless impress changes on that fluid. We know, from direct experiment, that the presence of saline matter in the blood is essential to its due constitution, and conversion in the lungs; and we can readily conceive, that the saline sub- stances, contained, in a dilute state, in mineral waters, may pass into the venous system by imbibition, and so modify the con- stitution of the fluid of the circulation, that when it attains the intermediate circulatory system— in which all nutrition is effected — EUTROPHICS. 281 the modified pabulum may so impress the organs that preside over nutritive exhalation, that new vigour may be communicated to the function, and old morbid cachexies, or dyscrasies— as they are more frequently termed by the German writers — may disappear. " Though great allowance," says a modern observer, Mr. E. A. Jennings, "must be made for the effects of change of air, relaxation from busi- ness, change of habits, and other accidental circumstances, yet all candid observers must acknowledge, that when due allowance has been made for all these circumstances, a large residuum of cases re- mains where the most surprising good effects have been produced by a course of mineral waters. From the effects generally produced by them on the kidneys, it is evident, that a large portion of the water is absorbed, and it is probable that their good effect is to be attributed as much to the alteration they produce in the chemical character of the blood, by entering into its composition, as to the increase they occasion of the secretions of the bowels. My own observations and analyses would favour this opinion, but they are, at present, too few to enable me to express any decided opinion upon the subject." At one time, it was a common belief, that the condition of the blood could be extensively modified by the infusion of various sub- stances into it; but the plan is rarely adopted at the present day, It was even advised formerly, that blood should be taken from an- other individual, and transfused into the blood-vessels to ' alter' the objectionable qualities of the circulating fluid ; but, at this time, transfusion of blood is only employed when the blood-vessels have been drained — by uterine hemorrhage, for example. Fresh excita- tion has thus been communicated to the organs, and the patient has appeared to rally, in some instances, where hope had been almost abandoned. It is obviously only in diseases of a chronic character, that eutro- phics can be employed. One of the essential elements of their ope- ration is time. None of them can act immediately, if we except the alterative effect of change of air, society, and scenery, the influence of which on morbid conditions—kept up by habit, as it were — is often as rapid as it is striking ; but these are tonic agencies. The reflecting practitioner will readily see, that in adopting any plan of alterative management, he must be guided by those great principles, which have been canvassed in the preceding chapters and sections, and especially in the one devoted to the consideration of Revellents. Some of the revellents, employed in protracted disease, are altogether eutrophic. Of this nature are the preparations of mercury and iodine, administered to break in upon the morbid catenation in febrile, in- flammatory, syphilitic, and other disorders, which have run on for a length of time ; hence the eutrophic treatment of syphilis by mercury has been by modern syphilographers termed the revellent, in contra- distinction to the simple treatment. The class of sorbefacients has been admitted by a few writer on 24* 282 SORBEFACIENTS. therapeutics. It appeared to the author to be necessary in order to explain the operation of a multitude of medicinal agents, and was accordingly received into the first edition of his General Therapeu- tics ; but farther reflection has induced him to class those agents under the head of Eutrophics. They are defined— agents that pro- mote absorption: for, however it may be effected, the result of their successful operation is to give occasion to the taking up of that which has been deposited ; yet this is unquestionably accomplished by the modification wdiich they impress on the function of nutrition. To understand the mode in which their agency is exerted, it may be well to inquire briefly into some of the phenomena of absorption and nutrition. In another work, (Human Physiology,5th edit., p. 591,) the author has entered, at length, into the consideration of absorption, of which there are three great varieties—first, that which is exerted by the skin and mucous membranes, and which, of course, includes ehylosis, — secondly, that which is effected upon secreted fluids, which are termed ' recrementitial,' or, in other words, which are required to pass again into the mass of blood ; — and thirdly, that which is concerned in the taking up of solid parts, in the function of nutrition. Every argument induces the belief, that from the commencement of existence until its final cessation, perpetual changes are taking place — both of absorption and deposition — which affect the de- composition and renovation of each organ, as well as of the differ- ent recrementitial fluids of the economy. The precise character of the apparatus, by which nutrition — as this important function has been termed — is accomplished, we have no means of knowing. Almost all admit, that the old matter must be directly or indirectly taken up by absorbents, and the new be deposited by arteries ; but, as the precise arrangement of these minute arteries and absorbents is imperceptible to the eye, even when aided by optical instruments, their disposition has given occasion to much controversy. The gene- rality of anatomists and physiologists conceive deposition to be effected by the minute arterial ramifications; but some presume, that inconceivably small vessels are given off from the capillary arteries, which constitute a distinct order, and whose function it is to exhale the nutritive deposit. Hence, these vessels have been termed ex- halants or nutritive exhalants, although, when the term is used by waiters, they do not always pledge themselves to the existence of any distinct set of vessels, but merely mean by it the capillary ves- sels, whatever may be their nature, which are the agents of nutri- tion, and separate from the blood, bone where bone is needed: muscle, tendon, ligament, &c, as the case may be. A like discordance has existed regarding the precise agents of decomposition. All admit, as has been seen, that the absorbents re- ceive the product of absorption, but all do not conceive that the act on of taking up solid parts is accomplished immediately by the absoibents. Some indeed, believe, that there is a kind of spongy MODUS OPERANDI. 283 tissue, termed a * parenchyma,' and that this sponge is situate at the extremities of the lymphatic vessels : they affirm, that it is a vital sponge or vital parenchyma,— absorbing, in other words, by virtue of the vital properties residing in it; but they maintain that the solid parts of the body are broken down by the same agents — the extreme arteries — which secreted them ; and, that, being reduced to the proper fluid condition, they are imbibed by the sponge, and transmitted into the lymphatics. The author has elsewhere shown, that all this arrangement is sup- posititious, and that we know not positively how the exhalants and absorbents are disposed in the capillary system. Independently of anatomical considerations, it does not seem probable, that the same vessels are endowed with antagonising powers,—both of pulling down, and of building up ; although it is probable that the texture of a part to be absorbed is modified by the secretion of some fluid, as we know to be the case, when adventitious coagula are removed from the brain. The cellular tissue, condensed by the pressure, forms a membrane surrounding the coagulum, and this membrane se- cretes a fluid, w7hich reduces the clot to the liquid state, so that it can be absorbed. An attentive examination of the functions of absorption and nu- trition seems to lead to the conclusion, — that the chyliferous and lymphatic vessels form only chyle and lymph respectively, refusing the admission of almost every other substance ; that the veins admit every liquid, which possesses the necessary tenuity, and that, wjhilst all the absorptions— which require the substance acted upon to be decomposed and transformed — are effected by the chyliferous and lymphatic vessels, those that require no alteration are accomplished directly through the coats of the veins by imbibition. The agents to which the absorption of decomposition, or—what has been termed —' interstitial' or ' organic' absorption, should be referred, can, therefore, be readily deduced. As it is exerted on solids, and as these cannot pass through the coats of the vessels, in their solid condition, it follows, that other agents than the veins must accomplish the process ; and, again, as we never find, in the lym- phatic vessels, any thing but lymph, and as we have every reason to believe, that an action of selection is exerted at their extremities, similar to that of the chyliferous vessels on the heterogeneous sub- stances exposed to them, we naturally look to the lymphatics as the sole organs, concerned in the absorption of solids. With regard to the absorption of recrementitial humors, less diffi- culty exists. Where they possess the necessary tenuity, they may pass into the blood-vessels by imbibition, or they may be taken up bv the lymphatics, and conveyed into the circulation. " It is obvious, that, in the case of all these fluids, a nice balance must exist between the quantity exhaled and that which is taken up ao-ain by the absorbents, and if, from any cause, the balance should be destroyed, so that the exhalants are in a state of super-excitation. 284 EUTROPHICS. — or the absorbents in a state of diminished action, whilst the ex- halation is healthy, — accumulation of fluid may arise ; and hence, the dropsical effusion into serous or cellular cavities—constituting hydrothorax, hydrops pericardii, ascites, &c. — may either be of an active or more passive kind, and the treatment may have to be essen- tially modified accordingly. But these — as the author has before observed — are not the only causes that give rise to such accumulations. A viscus of the thorax or abdomen may, from protracted irritation, become engorged, indu- rated, or obstructed, and from this mechanical cause, the circulation through it may be impeded. Accumulation of blood in the vessels — in other words, turgescence, or congestion —supervenes ; and the watery portions transude. These are the w7orst kind of dropsies, because they arise from organic mischief, which does not itself admit perhaps of cure. The activity of absorption is much modified by the state of reple- tion, or the contrary, of the vessels, as well as by the condition of the vessels themselves, as regards the presence or absence of excitement. If fluid be forced into the blood-vessels, so as to induce artificial plethora, and any absorbable fluid be thrown into the cavity of the peritoneum of a living animal, absorption is apparently null, or, at least, imperceptible ; but if blood-letting be practised, so as to dimi- nish considerably the amount of the circulating fluid, the liquid, thrown into the cavity of the peritoneum, is seen to disappear gra- dually as the blood is withdrawn. Hence, we infer, that blood- letting must be an important remedial agent in many cases of dropsy ; and the same remark applies, although to a less extent, to every kind of depleting agent. That the energy of absorption is materially modified by the con- dition of the absorbing surface is well exemplified, as a modern writer, Professor Jackson, of Philadelphia, has observed, in the con- gestions, and consequent remora of the circulation, so frequently ex- isting in the gastro-intestinal mucous membrane in the advanced period of fevers, in which " medicinal substances, and remedies ad- dressed to that surface, fail to produce their effects. Patients in this state cannot be salivated ; the mercurial medicine remains on the surface to w7hich it is applied ; stimulants, diuretics, diaphoretics, disappoint of their expected operation. Even fluids cease often to be absorbed, and accumulate in the stomach and intestines, where they are found with the remedies administered before death." The same fact is signally exhibited in malignant cholera, in which it is impossible to produce absorption—in the advanced stages of the disease at least—by any agency, and hence, it has been proposed to throw fluids immediately into the mass of blood by injection, —a course, which has not, however, fulfilled all the ends, that were at one time, somewhat extravagantly, expected from it. Cases of hypertrophy of different organs afford an example of that loss of compensation between the exhalants and absorbents, which has MODUS OPERANDI. 285 been described as a cause of dropsy. The writer, to whom refer- ence has just been made, considers it " extremely equivocal," whether dropsy be ever the result of a suspension of absorption alone, or simply from a loss in the equipoise of secretion or exhalation, and absorption. No facts, he thinks, justify the conclusion. But the fact, that certain agents do so modify nutrition as to occasion the taking up of hypertrophied parts, appears to be a sufficient reply to this. The exhalants are already too much excited, and yet a peculiar ' stimulant' gives occasion to the predominance of absorption, — of course by acting on a different set of vessels than the exhalants; for, if the excitant property were exerted upon them, the hypertrophy ought to augment, rather than diminish, — a circumstance, which seems to refute the idea, that the exhalants fulfil the double function of depositing and breaking down, in nutrition ; and confirms the almost universally received opinion, that the exhalants are endowed with the former office — the absorbents with the latter. Connected with the subject of hypertrophy, M. Andral has the fol- lowing judicious remarks, wdiich accord with .the views that have always been entertained and taught by the author. " If from the simple observation of the phenomenon of hypertrophy, we pass to the study of its causes, what do we find ? Do we consider that we haveexplained the formation of this state by a greater afflux of blood than common towards the part which is to be hypertrophied ? This congestion of blood may doubtless be conceived to play some part in the production of the hypertrophy. But, theoretically speak- ing, it neither appears to me to be the sole nor even the necessary condition. It is not the sole condition ; for the unusual appeal of blood towards an organ might take place in vain ; it w7ould but engorge it without changing its tissue if there was not, in the organ itself, an augmentation of the ordinary assimilative force ; in this last condition, if I may use the expression, the assimilative force elabo- rates more actively the materials which the blood carries to it, and in order that it may draw them in superabundant quantity into its nutri- tive whirlpool, (tourbillon nutritif,) it is necessary to suppose that more blood arrives at it in a given time. But is this excess of assi- milative force itself necessary for the production of every hypertro- phy, and may we not conceive cases, in which this force, remaining the same, there is a diminution of that other force, called disassimi- lating, (desassimilatrice,) by virtue of which the molecules of the solids are incessantly separated, to enter again into the mass of blood whence they had been drawn ? Is it not owing to this, that more than one case of hypertrophy, ineffectually treated by emollients, and blood-letting, have disappeared under the influence of stimulating substances, (iodine, mercury, &c.)?" From these theoretical con- siderations, we arrive at the observation of facts, from which we may deduce the following conclusions. First. Hypertrophy is pro- duced by the .simple fact of an augmentation of habitual activity in the exercise of the functions of organs. Secondly. Other hypertro- 286 EUTROPHICS. phies occur in consequence of active hyperaemia, — acute, but par- ticularly chronic. In such case, we observe, that at times the hyper- trophy exists only in the tissue, which has been irritated and in a state of hyperaemia; and, at others, after the return of the latter to its healthy state, the neighbouring tissues, which were slowly modi- fied in their nutrition, remain diseased, and hypertrophied. This may be proved in many cases of phlegmasia of the internal and external tegumentary membranes. Thirdly. There are cases of hypertrophy in the production of which we can only from analogy with the preceding cases admit the existence of a stimulus — phy- siological, or pathological — in the organ in wdiich it is situate. We say, then, that there is nutritive irritation in such organ ; but why might we not say as well, that there is a diminution of activity in its regular action of decomposition ? In both these opinions I see only hypothesis. If such be the case, let not the therapeutics be supported exclusively on either of these opinions; but, taking the hypertrophy for fact, seek experimentally for the means of combating and destroy- ing it. Thus, iodine has been found a remedy for hypertrophy of the thyroid gland; and mercury has been found capable of destroy- ing certain exostoses, which are a true hypertrophy of the osseous tissue. Moreover, amongst those hypertrophies, whose cause has not been proved to be an antecedent or actual stimulation of the organ which is the seat of it, some consist of a purely local affection; some appear to be intimately connected with the general nutritive movement; they are only, so to say, one of the prominent expressions, that indicate or reveal the profound modifications, which the nutritive movement has undergone in every molecule of the body. Scrofu- lous individuals are in this category. Amongst the different groups of morbid phenomena presented by these individuals, — w7ho has not remarked the simultaneous hypertrophy, w7hich the thyroid gland, the brain, several parts of the osseous system, the liver, the tongue and the upper lip undergo in them ? he would appear to us but little of a physiologist, who in each of these modifications of nutrition, saw only a local affection, and restricted his endeavours to the removal of it." Therapeutical application of Eutrophics. From what has been said, the therapeutical application of eutro- phics may be intelligible. Were we possessed of remedies, which act specifically on particular parts of the system of nutrition, all that would be requisite would be — to select them according to the precise topical affection. As yet, however, w7e know of scarcely any such agent that exhibits its special properties on any particular organ or tissue. Iodine is, perhaps, the only one. Its action appears to be exerted on the system of nutrition generally, but more especially on that of the thyroid gland or body, when enlaro-ed. Where the object is to promote the absorption of any accumulation MENTAL EUTROPHICS. 287 of recrementitial fluid — as in the case of dropsical collections —the sorbefacients we employ affect the system generally, and, through it, the pathological condition, which gives occasion to the accumulation. Hence, in active dropsies, blood-letting is doubly indicated. It reduces the erethism of the exhalants, and, by diminishing the quantity of circulating fluid, adds materially to the absorbent energy; for, it has been seen, that in experiments on animals, fluid is observed to be taken up from the serous cavities of a living animal, as the blood is made to flow from a vessel. Somewhat in the same manner, cathartics exert their beneficial agency, as well as diuretics. They detract from the fluid of the circulation; but, in addition, like cathartics, they occasion a concentration of vital activity towards the organ on which their specific stimulation is exerted, and in this way, give occasion to the imbibition of the exhaled humour. The effect of mercury is to bring on a new action in the glandular and follicular systems, on which it seems to act as a specific excitant. In this way, it also becomes eutrophic, and it is one more frequently perhaps employed than any other, if wre except iodine. Any local stimulant may be indirectly the cause of the disappearance of morbid parts, by modifying the nutrition of the body ; but there are few, if any agents, which act by stimulating specifically the absorbent sys- tem of the part; they generally produce their effect, by occasioning a concentration of vital activity towards some other part of the sys- tem, and, under this operation, absorption is rendered more active. Experience seems to show, that the administration of the alkalies is followed by sorbefacient effects, and Dr. G. Burrows, in his Gul- stonian lectures, for 1834, attributes their agency in promoting ab- sorption to their acting on the parts to be absorbed, as they act on the kidneys, and out of the body,—namely, to their rendering the parts more soluble, and, consequently, more readily absorbed. But there are agencies, which modify nutrition indirectly, not by any change which they induce in the fluid of the circulation, and which may, therefore, be called Indirect Eutrophics. The effect of tonics has been already referred to. The influence of the nervous system, as a modifier of nutritive action, is strongly exemplified, when powerful impressions are made upon it. Of this, we have ex- amples in the effect of the imagination in discussing tumours of various kinds. Some of these growths are possessed of but little vitality ; and, if the nervous and vascular influence be detracted from them, they speedily die. This is the way in which charms remove warts. It is a common popular superstition, that a dead man's hand, rubbed on a wen, or an enlarged gland, may dispel it; and such is the occasional result: and in the same manner, Perkinism, touching for the king's evil, &c, &c, become sorbefacient agencies. It appears, consequently, that any thing—of a physical or moral nature — which concentrates the vital activity on any part of the or- ganism, may diminish the amount of exhalation in another part, and at the same time modify, perhaps, the function of absorption ; and, 288 EUTROPHICS. that under this change in nutrition, parts may be reduced in bulk, morbid tumours disappear, and dropsical accumulations be absorbed. It is a general rule, applicable, perhaps, to every organ in the body, that its nutrition becomes augmented under appropriate exer- cise, and that inaction is attended with more or less atrophy. This is manifested in the muscles of the arm of the prize fighter and fencer, which, in comparison wdth those of mankind in general, appear to be in a state of hypertrophy. There are, however, certain secre- tions, which are more plenteously effected during inaction, and the absence of all stimulation, — the secretion of fat, for instance; ac- cordingly, if we are desirous of fattening animals, or of inducing artificial obesity, we keep them at rest, and in total obscurity, in order that they may not even experience the slight stimulation of light, in augmenting the cutaneous or other secretions. In like man- ner castration and spaying dispose to obesity, by removing those ex- citations, which the venereal passion engenders, and, hence, the proverbial fatness of the eunuch, both in man and animals. These two cases of nutritive exhalation are constantly opposed to each other. Exercise developes the muscular fibre, whilst want of it aug- ments the exhalation of the fluid, wdiich is deposited between the muscular fibres and fasciculi; and which gives the rotundity we so much admire in the delicate muscles of the female. In the one case, we have hypertrophy of the organ exercised ; in the other, hyper- trophy of the adipous exhalation. The influence of exercise and inaction on the production of fat has been accounted for ingeniously by a very recent writer, Liebig. " A cow or a sheep in the meadow," he observes, " eats almost without interruption, as long as the sun is above the horizon. Their system possesses the power of converting into organised tissues all the food they devour beyond the quantity required for merely sup- plying the waste of their bodies. All the excess of blood produced is converted into cellular and muscular tissue; the graminivorous animal becomes fleshy and plump, while the flesh of the carnivorous animal is always tough and sinewy. If we consider the case of a stag, a roe deer, or a hare, animals which consume the same food as cattle and sheep, it is evident, that when well supplied with food, their growth in size, their fattening, must depend on the quantity of vegetable albumen, fibrin or casein, which they consume. With free and unimpeded motion and exercise, enough of oxygen is ab- sorbed to consume the carbon of the gum, sugar and starch, and of all similar constituents of their food. But all this is very differently arranged in our domestic animals, when, with an abundant supply of food, we check the process of cooling and exhalation, as we do when we feed them in stables, where free motion is impossible. The stall-fed animal eats, and reposes merely for digestion. It de- vours in the shape of nitrogenised compounds far more food than is required for reproduction, or the supply of waste alone ; and at the same time it eats far more of substances devoid of nitrogen than is PRESSURE. 289 necessary merely to support respiration and to keep up animal heat. Want of exercise and diminished cooling are equivalent to a deficient supply of oxygen; for when these circumstances occur, the animal absorbs much less oxygen than is required to convert into carbonic acid the carbon of the substances destined for respiration. Only a small part of the excess of carbon thus occasioned is expelled from the body in the horse and ox, in the form of hippuric acid; and all the remainder is employed in the production of a substance, which, in the normal state, only occurs in small quantity as a constituent of the. nerves and brain. This substance is fat." " The flesh of wild animals is devoid of fat; while that of stall-fed animals is covered with that substance. When the fattened animal is allowed to move more freely in the air, or compelled to draw heavy burdens, the fat again disappears. It is evident, therefore, that the formation of fat in the animal body is the result of a want of due proportion between the food taken into the stomach and the oxygen absorbed by the lungs and the skin." It follows from these remarks, that if we are desirous of rendering the nutrition of an organ more active, we must take measures for keeping it in appropriate action ; and that, on the other hand, if we desire to diminish the nutritive exhalations, whose office is subsi- diary to the organs, we must inculcate the due employment of cor- poreal exercise, with the view of augmenting the depuration by the cutaneous and pulmonary transpirations. A sorbefacient influence — employed by the surgeon especially — is Pressure. If a fractured arm be kept firmly bound by splints and bandages, for the ordinary period of a few weeks, the arm is found to be much attenuated when the splints are removed, in consequence of the modification of nutrition induced by the pressure. A know- ledge of this and similar facts has led the surgeon to employ pressure in cases of ulcers, tumours, and morbid growths, where the application is at all feasible ; and, in this way, extensive ulcers have been made to heal, and large tumours to disappear. A Mr. Young, of London, acquired much celebrity, in cases of scirrhus and cancer, by this mode of treatment, and although, in such cases, it must unfortunately too often fail, good effects were certainly produced by it in his hands, as they have occasionally been in those of others. It is, however, in the less malign kinds of morbid growths, that the remedy is most effectual, — more so, indeed, than perhaps any other plan of treat- ment. But it is not alone in cases of hypertrophies of the kind referred to that pressure has been employed. Methodically used, it has been found useful in dropsical infiltrations into the cellular membrane of the lower extremities, as well as in ascites, and dropsical affections of other splanchnic cavities. In enlargements of the ovaries, and other tumours within the abdomen, methodical compression has like- wise been of essential benefit. In some cases of ovarian enlarge- vol. n.—25 290 SPECIAL EUTROPHICS. ment, the author has found an appropriate bandage around the ab- domen of great service. Not only has it supported the parietes of the abdomen and the contained parts, in sudden shocks, but it ap- pears to have even lessened the hypertrophy. Of late years, compression has been recommended in inflammatory affections, as in acute rheumatism ; in phlegmonous and erysipelatous inflammation of the extremities ; in severe burns; in inflammation of the synovial apparatus, orchitis, &c. ; and in many cases it has been productive of great advantage ; — acting probably in two ways—first, by diminishing the circulation in the intermediate system of vessels concerned in the pathological condition ; and secondly, by restoring tone to the over-dilated vessels. Friction is another remedy, belonging to the division now under consideration, and it is one often had recourse to by the surgeon with signal benefit. After violent sprains, in which much fluid has been effused into the cellular membrane, there is no mode of medication which occasions the absorption of the effused fluid so rapidly as rub- bing the part with the hand simply dipped in flour, or covered with some liniment. The object of dipping the hand in flour is to pre- vent the abrasion, which would necessarily result from the friction ; and, in the generality of cases, liniments are of no other service. This, at least, applies to the simple oleaginous liniments ; but, where exciting substances are added, some sorbefacient influence may be ex- erted by them. To produce the full sorbefacient effect, in the cases mentioned, the friction must be continued for a long time, — for at least half an hour; — and it must be repeated as the case may re- quire. In Scotland, there are old women, who obtain a livelihood by this kind of dry rubbing, and whose celebrity is such that the au- thor has known respectable patients go from a border county of England to Edinburgh to be operated on by them. From all that has been said, it is clear, that we have, in the class of eutrophics, a number of valuable remedial agents, that may be adapted to various states of disease, which — as in the case of dif- ferent cachexies — may have resisted other modes of management. SPECIAL EUTROPHICS. HYDRAR'GYRI PR^PARA'TA.--PREPARATIONS OF MERCURY. There are but few articles in the lists of the Materia Medica, that are possessed of equal interest with mercury, or that perform so im- portant a part in the history of medicine ; and although it is considered less essential in syphilis, since it has ceased to be regarded as an ' antidote' to that malady, it is still one of the most valuable of the- rapeutical agents. Mercury is considered to have been first employed HYDRARGYRI PRJEPARATA. 291 by the Arabians, but only as an antiparasitic or destroyer of vermin ; and externally in cutaneous affections. Paracelsus is said to have first introduced its internal employment. When mercurials are given in small and repeated doses, their action is soon observed to be exerted on the secretory apparatus ; and perhaps preceding— certainly accompanying — this action, more or less excitement may be observed, if we carefully note the condition of the circulatory apparatus ; so that the biliary, salivary, and pan- creatic fluids, and the fluids of the gastro-enteric mucous membrane, are secreted in larger quantity. Nor would its action seem to be restricted to this portion of the organs of secretion : the cutaneous and urinary depurations are likewise augmented ; and under this increase of the secretions, nutrition becomes modified, so that the ab- sorbent system appears to be more active, and fluids that have accu- mulated in cellular or serous cavities, or solid matters that have been deposited so as to constitute hypertrophies of various kinds, disap- pear under its employment. At times, however, a true mercurial fever is excited, under which, as under other febrile conditions, the various secretions are diminished in quantity, and modified in cha- racter. When carried still farther than this, their peculiar preference of action on the salivary glands and the parts about the mouth is ex- hibited. These assume an unwonted energy of secretion, so that several pints, in cases of excessive mercurial ptyalism, may be dis- charged in the course of the twenty-four hours. The precursory phenomena usually are, — tenderness, tumefaction, and pale rosy colour of the gums, except at the very margins, wdiere they are deep red. The gums gradually fall away from the teeth, and a white secretion occupies the portion of the tooth from which they have subsided. The mouth becomes sore ; the tongue swollen ; the teeth are tender when pressed against each other, and are loose ; the breath acquires a characteristic foetor, and a coppery taste is ex- perienced. In this state, the mouth is said to be unequivocally " touched" by mercury; and it wTould be well if the effects could be thus limited. Either by accident or design, they may, however, extend much farther; the salivary glands may become tender and tumefied, and increase their secretion profusely ; and, as when once induced, ptyalism is an affection that generally continues unmodified by medicine, or is self-limited, enduring for days and sometimes for weeks, the whole system suffers, partly from the extent of discharge, but still more, perhaps, from the suffering and irritative fever that accompany it. At one time, it was supposed, that the mercury is thrown off in the fluid of the ptyalism ; but careful analysis by skilful chemists has entirely failed in detecting the smallest particle of the metal in that fluid. Such are the phenomena induced by mercury, when exhibited for the cure of disease ; and they may be induced at any time, and on any person, except on the rare few who are unsusceptible of its action, 292 SPECIAL EUTROPHICS. provided the mercury be continued sufficiently long. Some persons, however, are unusually impressible to it, and are salivated by very small quantities ; and the author has observed, more especially in public practice, that particular seasons and local influences have ren- dered patients exceedingly susceptible, so that a few grains of the Pilula Hydrargyri have caused salivation ; when, at other times, a long protracted use of a more active preparation of mercury would have been required to induce the same effect. There are some persons, too, who are salivated whenever they take a few grains of calomel. In some constitutions, again, mercury acts as a true poison, causing what has been termed mercurial erethism, or a febrile condi- tion characterised by great adynamia ; in which, on the occurrence of some emotion or exertion, the individual suddenly expires. (J. Pearson.) The author saw a fatal case of this kind in which the mercurial erethism was induced by the application of the Unguentum hydrargyri oxidi rubri to a sore on the leg. In this case, there was, likewise, the vesicular eruption to which the name Eczema mercu- riale or Hydrargyria has been given, and which is unquestionably induced by mercury in particular persons. Besides these effects, a train of phenomena, strikingly like those of syphilis, have been ascribed to the action of mercury. To the aggregate of these, the names Hydrargyriasis, mercurial disease or cachexy, and by some pseudo-syphilis, have been assigned. Amongst them may be enumerated— mercurial iritis ; sloughing ulceration of the fauces; inflammation and caries of the bones; periostitis ; mer- curial tremors, cachexia, &c. ; but much difficulty in appreciating the precise causes of some of these, — whether, for example, they should be ascribed to syphilis or to mercury — arises from the fact, that mer- cury has generally, in such cases, been prescribed. Some, indeed, affirm, that caries of the bones never occurs in syphilis unless where mercury has been given ; but the remark stands in need of confirm- ation. The effects of the ptyalism occasioned by mercury are sometimes awful ; — sloughing of the soft parts of the mouth and throat; loss of the teeth ; caries of the jaw bones ; adhesion of the cheeks to the gums; and ligamentous bands preventing the depression of the lower jaw. Awful cases of deformity are, indeed, occasionally witnessed from the abuse of this potent agent. Formerly, these cases succeeded generally to its administration for syphilis ; now, we witness them more frequently as the sequelae of the treatment of remittent and other fevers, in which it is the custom, with some, to administer calomel in excessive quantities. As to the mode in which the effects of mercury are exerted on the system, not much difference of opinion exists. That it is absorbed is shown by the fact, that metallic mercury has been discovered in the bones and other parts when salts of mercury had been taken freely. It has likewise been found in the blood, although it is not easy to detect any inorganic substance when it is mixed — as in the HYDRARGYRI PRJEPARATA. 293 blood— with compounds of organisation ; and that it is given off by transpiration is shown by the fact, that a gold watch, worn by one who is taking mercury, becomes coated with the metal. The precise nature of the action of mercury on the animal econo- my has been a matter of dispute. We have seen that it passes into the mass of blood, and, doubtless — like eutrophics in general — modifies the condition of that fluid, so that it exerts dynamically a new action on the systems of secretion and nutrition ; but of the pre- cise mode in which this is accomplished, we know no more than we do of the modus operandi of other articles of the class, or indeed of any of the classes of therapeutical agents. It was elsewhere stated, (Vol. i. p. 261,) that mercury has been ranked amongst sialagogues, by some ; and it has been seen, that salivation is one of the remote effects of its administration ; and that this result is never necessary, and rather to be deplored, inas- much as the increased discharge exhausts and irritates, without pro- ducing the necessary benefit. It is sufficient if the mouth be touched, and if this action be kept up for a sufficient length of time, to have all the benefit, which mercury is capable of accomplishing. To produce this result various methods are adopted. Perhaps the best of all is to rub in the Unguentum Hydrargyri according to the rules hereafter advised. In this way no danger exists of disturbing the bowels, and the only inconvenience is the sustained and repeated friction. This friction is usually made on the inside of the thighs or of the arms, in consequence of the epidermis being thinner there, so that the mercury can be more readily forced through it, and come in contact with the absorbents of the true skin. For a similar rea- son, calomel has been rubbed on the inside of the cheeks and gums, care being taken not to swallow the saliva, for fear of inducing diar- rhoea. Calomel, sulphuret of mercury, and the protoxide, have like- wise been used in the way of fumigation for the same purpose; and ptyalism has resulted from their employment in this manner, after their internal use and friction had been tried in vain. After all, however, it is so much more easy to take the remedy internally, that in the generality of cases — in order to produce the full eutrophic effects of mercury —this method is adopted, — unless it should act upon the bowels, so as to prevent the constitutional effect from taking place. The most common preparation prescribed for this purpose is the mild chloride, and next to it the pilulae hydrargyri. Generally, the effects of the mercury will be perceptible on the gurns in the course of a few days ; but at times it is exceedingly difficult to produce any manifestation of its action. Should the diseased con- dition yield under its use, this is not a matter of moment; but if it be desirable to exeite a more decided action, remedies may be em- ployed that favour absorption, — such as blood-letting and emetics, — under the operation of which mercurialism often declares itself speedily, and occasionally to such an extent as to favour the idea that an accumulation may have taken place in the system. Often, 25* 294 SPECIAL EUTROPHICS. after the internal use of mercury has been tried in vain, its effects will be rapidly developed, when inunction is employed along with it. Whilst the patient is under the effects of mercury, his diet should be regulated ; and he should be careful to avoid partial and irregu- lar exposure to cold and moisture. The system is rendered impres- sible, and rheumatic and other disorders have resulted from a ne- glect of these precautions, which have rendered the individual a cripple for life. In regard to the treatment to be pursued during the existence of mercurial ptyalism, and for the removal of its sequelae, the author must refer to another work, (Practice of Medicine, 2d edit., Vol. i. p. 574, Philad. 1844.) The diseases, in wrhich the eutrophic virtues of mercury have been witnessed, are numerous. Difference of sentiment has existed in re- gard to its use in fevers. At the commencement of none of them is it perhaps advisable, except as a cathartic; but in after stages, es- pecially when mischief exists in any organ, or when the morbid actions appear to continue, as it were, from association, the new ac- tion, which it induces, is often most salutary. It is difficult, how- ever, to affect the mouth in these cases, even when the internal use of the remedy is conjoined with the external ; and it has been af- firmed by some, that when we do succeed in ' touching' the mouth, it is rather an evidence of the previous subsidence of febrile action, than that the benefit has been caused by the mercury. Howsoever this may be, the occurrence of approaching ptyalism in such cases is favourable ; and some observers have affirmed, that death rarely takes place after salivation has been once established. The author has, however, seen more than one case to the contrary. The rou- tine practice in many parts of this country, and in tropical climates, is to give calomel in excessive doses from the very commencement of the affection. In inflammations, mercury has been greatly employed, — generally, perhaps as a cathartic, but often as a eutrophic. It has been else- where remarked, (Vol. i. p. 181,) that large doses of calomel are looked upon as sedative ; and with this view, likewise, it has been prescribed in inflammation, and occasionally, also, in fever. At- tempts have been made to show, that it is more advantageous in inflammations of particular organs than of others — in the phlegmasiae of serous membranes, rather than in those of mucous membranes, although, by the way, the contrary has been maintained by some ; — that it is especially valuable in diphtheritic inflammations, by the power which it possesses of diminishing the plastic properties of the blood,— and that, therefore, it has been presumed, it may prevent a farther effusion of membraniform matter — as in croup — and favour the softening and absorption of that wdiich has been already poured out; — that its eutrophic action is more exerted upon particular organs, as the liver,; and hence, especially after blood-letting, it has been regarded an admirable remedy in hepatitis, acute and chronic HYDRARGYRI PRjEPARATA. 295 — especially in that so common in hot climates, and particularly in India ; but the same principle probably is at the basis of its beneficial agency in all these cases. By the new action, which it causes in the system generally, and in the secretory and nutritive functions especially, it operates as a revellent, and derives from the morbid action going on in a part of the organism. We can hardly suppose its effects to be exerted in any other manner in syphilis. Scarcely an observer of the present day regards mercury as an "antidote" to that affection. It has been shown indisputably, that in the large mass of cases, the disease is removable without a particle of mer- cury ; and when mercury is considered to be advisable, where the disease is making frightful progress, it is freely administered under the belief, — that being a most potent article and capable of exciting a new and absorbing morbid condition of the system, it may thus so far interfere with the vice in the whole system of nutrition as to completely change the pathological condition. It is now rarely employed, except in such cases. Some there are, indeed, and men of no little weight in the profession, who denounce mercury, and affirm that it is never necessary, and always injurious in every case of syphilis; but the author has seen instances in which nothing but a eutrophic remedy, possessed of such potency, w7as capable of arresting the progress of the disease. Iodine and other articles had been tried in vain; and the diseased action subsequently yielded to the establishment of mercurialism. Yet he admits, that these cases are rare. A remark is necessary regarding the powers ascribed to mercury of diminishing the plastic properties of the blood. Were it really possessed of such powers we should expect a diminution in the pro- portion of the fibrinous element under its use ; yet such is not the fact. M. Andral examined the blood in different cases of mercurial stomatitis, and discovered an increase in the quantity of fibrin cor- responding to the severity of the local phlegmasia and the degree of febrile action exerted on the system. The salutary operation of mercury in the phlegmasia? is, therefore, probably dependent wholly upon its revellent powers, — acting, in this respect, like an ordinary blister. In almost every form of cachexia, mercury has been administered, and, where cautiously given, evil can scarcely result from it. Many of these cachexias are accompanied by an impaired state of all the functions, which the irritation of mercury is calculated rather to develope ; even when the new action induced by it might hold out prospects of benefit in respect to some of the phenomena. Tubercu- losis, for example, is evidently favoured by impaired or defective nutrition ; and can be developed under influences, which are capable of inducing this. Hence, if salivation should be produced accident- ally or by design, it could scarcely fail to prove injurious. In the tuberculous, or the scrofulous cachexia, mercury is, therefore, rarely employed ; nor can its full action be considered well adapted 296 SPECIAL EUTROPHICS. for the chlorotic, scorbutic, rhachitic, hydropic, or the cancerous. Still, accidental circumstances may arise in all of these to render the cautious administration of mercurials advisable ; as, for example, where the dropsy is dependent upon or accompanied by morbid de- positions, which require the induction of a new action in the system of nutrition. When cholera appeared in this country, much was said of the good effects to be derived from the employment of mercury, especially after blood-letting had been premised; and perhaps — after all — as much benefit was to be expected from such a combination as from any that could be devised. The blood-letting was calculated to di- minish the excited action of the vessels of the lining membrane of the intestines ; and the new action — induced by the influence of the remedy, where this could be exerted — was well adapted for arresting it. The disease w7as, in too many cases, wholly intractable. Mercury was, however, often administered to an extent, which admits of no adequate justification. Pounds of calomel were given in a single case ; and inunction was extensively combined with it. The mor- tality was much alike, how7ever, and w7e have not sufficient evidence to determine, that the progress of the disease was materially modified by any particular mode of management. Wherever a complaint appears endemically, epidemically, or sporadically, and assumes a malignant aspect, and especially if it be accompanied by visceral hyperaemia or inflammation running rapidly to disorganisation, mercury is had recourse to ; and often judiciously. Unless these cases can be arrested by a powerful revellent or eu- trophic agency, they necessarily proceed speedily to a fatal termi- nation. It is impossible to depict every case in which this valuable agent — valuable when properly prescribed, most injurious when carelessly given—is capable of affording benefit. In all chronic affections, that are characterised by morbid depositions or hypertrophies, its use is invoked, unless special considerations should seem to forbid it. It has even been recommended in paralysis — encephalic paralysis ; and Dr. Pereira states, that he has seen hemiplegia, with impaired vision and hearing, headache, and cramps of the extremities, recover under its use, after blood-letting, purgatives, &c. had failed. The patient, a young man, was kept under its influence for two months. Still, much can scarcely be expected from it in the generality of such cases. In all the neuroses, it has been used ; and the new condition, in- duced by it, may be beneficial; such appears to have been the occa- sional result in neuralgia. 1. HYDRAR'GYRUM.—MER'CURY. Metallic Mercury is found either pure, constituting native or virgin mercury, and existing in the form of globules in the cavities of other HYDRARGYRUM. 297 ores of the metal, or combined with silver; but it is chiefly obtained from bisulphuret of mercury or native cinnabar; the principal mines of which are at Idria, and at Almaden in Spain ; at Durasno, in Mex- ico ; near Azogue, in New Grenada; and near Huancavelica, in Peru. From this it is obtained by distillation with iron or lime. Native mercury is separated by distillation from its associated im- purities. * Of 314,286 pounds of mercury imported into England in 1831, 269,558 pounds, according to M'Culloch, were brought directly from Spain ; and 13,714 pounds from Gibraltar: of the latter a part was derived from Carniola, and a part from Spain ; 31,014 pounds were imported from Italy ; only 192,310 pounds were retained for home consumption. It comes to this country chiefly from the Atlantic ports of Spain, particularly Cadiz. A considerable portion is also received from Trieste. In the year ending September 1832, the value of the quicksilver imported into the United States exceeded two hundred and sixty-three thousand dollars ; a large portion of which was again exported to Mexico, Chili and China. (Wood & Bache.) The specific gravity of mercury is 13.5 : it should be wholly vola- tilised by heat, and dissolved without residue, by nitric acid. When pure—,as it ought to be for pharmaceutical purposes — a globule, made to roll over white paper, should leave no trace. Pure sul- phuric acid, agitated w7ith it at common temperatures, and afterwards evaporated, leaves no residue. Difference of sentiment has existed in regard to the effect of me- tallic mercury wThen swallowed ; but there can be little doubt that it is wholly devoid of action on the economy. It is affirmed, indeed, that when it has been long retained in the bowels, it has exerted in- jurious effects ; and this is possible, owing to the metal becoming oxidised, and uniting perhaps with the gastric acids. It has been elsewhere remarked, that a decoction of quicksilver has been ad- vised as anthelmintic, but it is probably inert. Empirically, large quantities of quicksilver have been given in obstinate obstruction of the bowels; and it has been conceived to be especially adapted for cases of intussusception ; but it can obviously be of no avail in the progressive form; and could searcely fail to be injurious in the retro- grade. Moreover, we have no phenomena by which we can judge accurately which form exists in any particular case. At the present day, metallic mercury is never prescribed. When applied externally, mercury would seem to have occasion- ally exerted its specific effects upon the system. A fatal case is re- corded, in which salivation was induced by wearing at the breast, for six years, a leathern bag containing a few drachms of liquid mer- cury, as a prophylactic against itch and vermin. Workers in mercury have been long known to be subject to various affections of the nervous system especially; of which one of 298 SFECIAL EUTROPHICS. the most remarkable is a form of shaking palsy, or mercurial tremor or trembling; and should the affected workman persist in his occupation, it is apt to end in fatal apoplexy or epilepsy. This condition is met with not only in those who are engaged in quicksilver mines, but in making looking-glasses, barometers, &c, and it is not easily removed. Difference of sentiment, however, exists on this point; for whilst one writer, Dr. Christison, states, that the tremors are cured easily, though slowly; another, Dr. Pereira, affirms, that he has not seen the least benefit obtained by remedial means, although various modes of treatment were tried. One of the most striking cases of the effects of mercurial vapour is the following. In 1810, the Triumph man- of-war, and the Phipps schooner, received on board several tons of quicksilver, which had been saved from the wreck of a vessel. In consequence of the rotting of the bags, the mercury escaped, and the whole of the crews became more or less affected. In the course of three weeks, two hundred men were salivated ; two died, and all the animals, cats, dogs, sheep, fowls, a canary bird, and even rats, mice and cockroaches were destroyed. The question in these cases arose, whether the mercury, to produce this action, were merely in a state of division, or w7ere oxidised. It has already been seen, that metallic mercury appears to be devoid of any action on the organism; and hence it does not seem probable, that when finely divided it could exert any. Some, how7ever, think, that when finely divided, it is poisonous; others believe that its action is dependent upon a portion of the metal being oxidised. It has been found, indeed, that the vapour disengaged from mercury at atmospheric temperatures contains some oxide. 2. HYDRAR'GYRUM CUM CRETA. — MER'CURV WITH CHALK. (Hydrargyr. ^iij ; Creta praparat. gv, rubbed together till the globules disappear.) The prevalent opinion is, that w7hen mercury is triturated writh chalk, the metal is merely divided mechanically ; but from its effects upon the economy, and for other reasons stated elsewhere, (Vol. i. p. 183,) it is probable that a portion at least is oxidised. It is generally obtained by our druggists from abroad'— and the author has seen specimens, which were evidently adulterated with red oxide of mercury, and which, in some cases, excited the most violent vomiting and purging. This is one of the mildest of the mercurials ; resembling blue pill in composition and act:on, but weaker than it. Eight grains contain three of mercury. Like the blue pill, it exerts its action on the upper part of the intestinal canal, and promotes, by continuous sym- pathy, the secretion from the liver; the chalk acting at the same time as an antacid. It is, likewise, often administered as a eutro- phic in syphilitic affections of childhood ; in enlargement of the me- senteric glands; and in all chronic affections, in which a mercurial eutrophic may be indicated. PILULE HYDRARGYRI. 299 The dose is from gr. v to Jss at night, or night and morning, in any thick vehicle. The usual dose to children, is gr. iij to gr. v. A The Dublin Pharmacopoeia has an Hvdrar'gyrumcum Magne'sia, which is prepared by rubbing mercury and manna, of each two parts, and carbonate of magnesia, one part, together, until the globules disappear. It is employed in similar cases with the Hydrargyrum cum Cretd. It is not officinal in the Pharmacopoeia of the United States. 3. PIL'UL^E HYDRAR'GYRI. — MERCU'RIAL PILLS. The mode of forming these pills, and their properties as cathar-* tics, have been described elsewhere, (Vol. i. p. 183.) It was there stated, that a portion of the mercury probably experiences oxida- tion, and that the therapeutical effects may be dependent upon the oxide. When employed to induce the eutrophic effects of mercury, five or ten grains may be given night and morning, and be repeated until the mouth exhibits its agency. Should it run off by the bowels, a small quantity of opium—say one-fourth of a grain — may be added to each dose. Suspended by means of mucilage, it was for- merly recommended by Plenck, and the mixture was called, after him, Plenck's solution. It was prescribed by him as an anti-syphilitic. 4. UNGUEN'TUM HYDRAR'GYRI. — MERCU'RIAL OINTMENT. (Hydrargyr. Ibij ; Adipis ^xxiij ; Sevi ^j ; rubbed until the glo- bules disappear.) The remarks, made on the composition of the preparations last mentioned, are equally applicable to this, which is also called Blue Ointment, or Blue Unguent, or Unction. When properly prepared, it is of a bluish gray colour, becoming darker by age, and should afford no traces of globules when rubbed on paper. It contains half its weight of mercury, but is said to be frequently prepared with a smaller quantity of the metal; and in order to communicate to it the requisite shade of colour, sulphuret of antimony, indigo, or Prussian blue is sometimes intermixed. Occasionally, too, a small quantity of sulphur is added, by which the extinction of the metal is facilitated. In such cases, the oint- ment is blacker than it ought to be, and the smell of sulphur is ap- parent. Mercurial ointment has been given internally, in the form of pill; but it possesses no virtues over the mercurial pill, and is, of course, a more objectionable form for internal administration. It is, there- fore, rarely employed in this manner in this country. It is rubbed in, either alone, or associated with some mercurial, when the object is to affect the system. With this view, a drachm may be rubbed in 300 SPECIAL EUTROPHICS. on the inside of the thigh or arm, for fifteen minutes, night and morning. Where the object is to affect the system speedily, it may be applied to blistered surfaces, or be placed, in addition, in the axillae. Where practicable, the friction should be made by the pa- tient himself; but if this should not be convenient, or desirable, the attendant may cover his fingers or hand with oiled bladder, to pre- vent himself from becoming affected by the mercurial. Occasionally, a troublesome eruption is brought out by the friction. This soon, howrever, passes away, and in the mean time a fresh surface may be chosen. Mercurial ointment is employed as a dressing to syphilitic ulcers, and is rubbed on various morbid growths to facilitate their ab- sorption. A Compound Liniment of Mercury — Linimentum Hydrar- gyri Compositum, is in the London Pharmacopoeia. It is made of Mercurial ointment and Lard, _of each ^iv; Camphor gj ; Alcohol f. ^j ; Solution of ammonia f. ^iv : the camphor being first rubbed with the spirit, then with the lard and ointmeut of mercury, the so- lution of ammonia is added, and the whole is wTell mixed together. It has been affirmed, that it induces ptyalism more readily than the common mercurial ointment, owing to the camphor and ammonia; but it is rarely used for this purpose. It is more frequently em- ployed as a discutient to tumours, and in chronic affections of the joints. 5. EMPLASTRUM HYDRAR'GYRI. — MERCU'RIAL PLASTER. (Hydrarg. gvj ; 01. oliv., Resin, aa 51J ; Emplastr. Plumbi, Ifej. The oil and resin are melted, and, when cool, are rubbed with the mercury until the globules are extinguished ; the melted lead plaster is then added.) The mercurial plaster in its chemical composition is circumstanced like the last article. The London College adds a little sulphur to facilitate the extinction of the metal; but the composition becomes, of course, changed by it. Mercurial plaster, spread upon leather, is applied as a discutient to syphilitic and other tumours ; especially to buboes. It is also applied over the abdomen in cases of disease of any of the organs of that cavity, especially in chronic hepatitis. In rare cases, the mercury is absorbed, and ptyalism has resulted from it. A Plaster of Ammoniacum with Mercury is officinal in the British Pharmacopoeias. It is used in similar cases. HYDRARGYRI 0XIDUM RUBRUM. 301 6. HYDRAR'GYRI OX/IDUM NIGRUM. —BLACK OXIDE OF MER'CURY. The mode of forming this preparation has been referred to else- where, (Vol. i. p. 183.) When newly prepared, it is black, or nearly so ; but, as met with in the shops — having been exposed to light — it is generally olive-coloured, being partly resolved into metallic- mercury and peroxide. It is wdiolly dissipated by a strong heat, and metallic globules are sublimed. Black oxide of mercury is rarely prescribed internally; nor is it well adapted for internal use, by reason of its uncertain composition. Hence, it has been expunged from the Edinburgh Pharmacopoeia. It is capable, however, of exciting the ordinary eutrophic effects of mercury, when given in the dose of one grain to three, two or three times a day. An ointment is sometimes prepared of it, (Hydrarg. oxid. nigr. p. i.; Adipis, p. iij.;) which may be used in the same cases as the Unguentum Hydrargyri. It is a better preparation as a fumigating agent to syphilitic ulcers than the sulphuret, which is more frequently, however, employed, in consequence of sulphurous acid being formed when the sulphuret is used, which may be irrita- ting. To induce salivation, it was employed by Mr. Abernethy in the following manner. Place the patient in a vapour bath, in a com- plete suit of under garments, with a cloth around his chin. Two drachms of the oxide are then put on a heated iron within the machine in which the patient is sitting. After continuing the bath for about fifteen or twenty minutes, the body is found covered with a whitish powder. The patient should now be placed in bed, lie in the same clothes till morning, and then go into a tepid bath. Mr. Abernethy affirms, that in this manner he has known salivation pro- duced in forty-eight hours. Black oxide of mercury is the basis of the well-known Black wash, (Hydrarg. chlorid. mit. ^ss ; Liquor, calcis, Oss.) In this case, the black oxide is precipitated, and chloride of calcium remains dissolved. It is much used as a wash for syphilitic sores. 7. HYDRAR'GYRI OX'IDUM RUBRUM.—RED OXIDE OF MER'CURY. Red oxide, Bin'oxide, Deut'oxide, or Per'oxide of mercury, or Red precip'itate, is prepared by dissolving mercury, with a gentle heat, in nitric acid previously mixed with wrater, and evaporating it to dry- ness. The mass is then rubbed into powder, and heated in a very shallow vessel, till red vapours cease to arise. The dry mass, first obtained, is the nitrate of peroxide of mercury, the nitric acid of which is decomposed and driven off by the agency of heat; and by continuing the process till ruddy fumes of nitrous acid cease to be disengaged, the red oxide is obtained pure. It is in orange-red crystalline scales, which are wholly soluble in chloro- vol. ii.—26 302 SPECIAL EUTROPHICS. hydric acid. On the application of heat, it yields oxygen, and the mercury either runs into globules or is wholly dissipated. Red oxide of mercury is so powerful an irritant, and so harsh and uncertain in its action, that it is very rarely prescribed internally. It has been used as a eutrophic in syphilitic cases, in the dose of from a quarter of a grain to a grain, associated or not with opium. Ex- ternally, it is applied in the form of powder, in syphilitic and other sluggish ulcers, or made into an ointment. It is the basis of the Yellow wash, or Phagedenic wash, much used in syphilitic and sluggish ulcers, and applied by means of lint wetted with it. (Hy- drarg. chlorid. corrosiv. gr. xv ; Liquor, calcis. Oss.) The red oxide is occasionally used to destroy pediculi. UNGUEN'TDM HYDRARGYRI OX'IDI RUBRI, OINTMENT OF RED OXIDE OF MER'CURY. (Hydrarg. oxid. rubr., in pulv. subtiliss. ^j ; Unguent, simpl. §viij.) This ointment undergoes a change of colour and of character by being kept, — its beautiful red colour being changed to a black, owing to the deoxidation of the red oxide of mercury. It is a common application to syphilitic and other indolent sores, in which it appears to act simply by its excitant properties. It is likewise used as an excitant in ophthalmia tarsi, and may be employed at night by means of a camel's hair pencil. The gluing together of the tarsal edges of the eyelids is, in this way, prevented. It is, likewise, much used in porrigo, and other chronic cutaneous eruptions. Red oxide of mercury is used in the preparation of the Hydrar- gyri Cyanuretum of the Pharmacopoeia of the United States. 8. HYDRAR'GYRI. CHLO'RIDUM MITE.—MILD CHLORIDE OF MER'- CURY. Mild chloride of mercury or calomel — whose general properties are described elsewhere, (Vol. i. p. 180) — is capable of exerting all the effects of the mercurials, and is more used in this country for that purpose than any other preparation. It is astonishing, indeed, how much of this agent has been given almost, if not altogether, empirically in formidable diseases, as in cholera. It would seem to exert no irritating agency in enormous doses ; for where an ounce was taken by mistake, the only effects were slight nausea and faint- ness, and neither salivation nor any approximation to it. followed. It has been administered in three drachm doses, often repeated, and has appeared, in such quantities, to be sedative rather than irritant. It is a common idea, that these huge doses have only been given in the western and southern parts of the United States; but such is not the fact. " I have now before me," says Dr. Pereira, " reports of eighteen cases of spasmodic cholera, admitted in the year 1832, into the Cholera Hospital of Bethnal Green, in this metropolis, (London,) HYDRARGYRI CHLORIDUM MITE. 303 in which enormous quantities of calomel were employed by the house-surgeon, Mr. Charles Bennett, (formerly one of my pupils,) with very slight physiological effects. When a patient was brought into the hospital, two drachms of calomel were immediately given, and afterwards one drachm, every one or two hours until some effect was produced. In 17 out of 18 cases in which this plan was tried, the vomiting and purging diminished, and the patients recovered. Several of them took from 20 to 30 drachms without the subsequent ptyalism being at all excessive. In one case (a female, aged 36 years,) 30£ drachms were administered within forty-eight hours: moderate ptyalism took place and recovery. In the unsuccessful case, which I have alluded to, 53 drachms of calomel were admi- nistered within forty-two hours, without the least sensible effect." As a gentle eutrophic, calomel is prescribed in very small doses — half a grain for example, night and morning—in diseases of the glan- dular system, and in chronic cutaneous and other affections, that de- mand an alterative agency. It is likewise given in small doses, fol- lowed by a cathartic like the blue pill, in hepatic diseases; in which it probably acts, by revulsion, in two modes ; first, through its pecu- liar excitant agency on the lining membrane of the stomach and duodenum, (see Vol. i. p. 181,) and secondly, through its insensible action on the secretory system in general. When prescribed even in the small doses above mentioned, it soon produces its peculiar effects on the system. To accomplish this, however, it is generally associated with opium, to prevent its affecting the bowels. The fol- lowing form is often employed by the author in syphilis; — Hydrarg. chlorid. mil. gr. vj; Pulv. opii, gr. iij; Creta praparat. dy, Confect. rosar. q. s. ut fiant pilulae xij. ' Dose, one, night and morning, until the mouth is slightly affected. Occasionally, however, it is given much more freely and more frequently, where the desire is to pro- duce full ptyalism speedily; but the author has generally found, that small quantities given at long intervals — not less than four or five hours — touched the mouth sooner than when it was administered much oftener, and to a greater extent. It has been maintained, in- deed, by one observer, that when given every three or four hours, in doses of five or six grains, it is exceedingly difficult to salivate with it; as the mercury passes off rapidly by the skin. Calomel is sometimes used as a local application ; being suspended in mucilage, and employed as a gargle in syphilitic sore throat; but it is more frequently employed in the form of ointment in syphilitic sores ; and likewise as a local application, to induce a new action in the parts, in various chronic cutaneous diseases. Dr. Pereira states, that were he required to name a local agent pre-eminently useful in skin diseases generally, he would fix on this; — Hydrarg. chlorid. mit. 3J ; Adipis, 5J. It certainly is a useful application in these cases, but the author has not been led to estimate it so highly. 304 SPECIAL EUTROPHICS. 9. HYDRAR'GYRI CHLO'RIDUM CORROSI'VUM. —CORRO'SIVE CHLO- RIDE OF MER'CURY. Corro'sive chloride, Corro'sive mu'riate, Bichlo'ride, Mu'riate or Oxymu'riate of mercury, or Corro'sive sub'limate, is made by boiling Mercury with Sulphuric acid, until the sulphate of mercury is left dry. When cold this is rubbed with chloride of sodium, and sub- limed. In this process, double decomposition occurs, — the products being bichloride of mercury which sublimes, and sulphate of soda which remains behind. As usually met with, corrosive chloride of mercury is in colour- less crystals, or crystalline masses, which sublime without leaving any residue; and are entirely soluble in water, alcohol and ether. Its solubility in water is variously stated. It requires, howrever, about three times its weight of boiling water, and eighteen or twenty times its weight of cold water. Its solubility is increased by the acids, especially the chlorohydric, and by the alkaline chlorides, hence, muriate of ammonia is occasionally added to lotions of which it forms a part. Corrosive chloride of mercury is a most virulent corrosive poison, acting as a powerful caustic, by reason of its affinity for the albumi- nous and other constituents of animal matters. In smaller doses, it is employed therapeutically as a eutrophic ; and in syphilitic diseases is preferred by some ; exerting often a most beneficial effect upon them, without salivation or any other disagreeable result. Oc- casionally, indeed, it irritates the gastro-intestinal organs, producing nausea, tormina and purging; but this may generally be obviated by administering it carefully or by combining it with opium. It is less likely to induce salivation than any other mercurial, and this is one cause of its being so extensively employed in syphilis ; — con- cealment being important; and salivation leading to strong suspicion of the nature of the affection, for which it is prescribed. It may be given in every stage of syphilis, but has had more re- putation in the secondary form, and especially in chronic cutaneous affections of a venereal kind. In such cases, it may be prescribed either in the form of pill made with crumb of bread, or in solution, — from l-16th to l-12th of a grain for a dose, repeated three or four times a day, and taken on a full stomach ; or in the form of the offi- cinal solution given below. It is frequently combined w7ith sarsa- parilla, and other vegetable eutrophics, not only in syphilitic affec- tions, but in rheumatic and neuralgic conditions, and in chronic cutaneous diseases in general; and certainly often succeeds in modi- fying the morbid state of the nutritive actions of the part, so as to remove the last, frequently after they have resisted other remedies. Externally, it is occasionally used as a gargle in venereal sore throat; as a wash to syphilitic ulcers, and in different chronic cutaneous HYDRARGYRI I0DIDUM. 305 diseases, as well as in ophthalmia of a venereal nature. The strength of these lotions may vary from half a grain to two or three grains to the ounce. It may be applied to the throat by means of a camel's hair pencil. 10. HYDRAR'GYRUM AMMONLVTUM.— AMMO'NIATED MER'CURY. Ammoniated mercury, ammonio-chloride of mercury, muriate of ammonia and mercury, cosmetic mercury— more commonly knowm under the names, white precipitate of mercury or white precipitate — is prepared by dissolving corrosive chloride of mercury in distilled water, with the aid of heat, and, when the solution is cold, adding solution of ammonia. The precipitate, when washed till it is taste- less, and dried, is the ammoniated mercury. As met with in the shops, it is in powder or in pulverulent masses, of a white colour; without smell, and of a taste which is at first earthy, and afterwards metallic. It is insoluble in water and alcohol. Ammoniated mercury is never used at the present day as an in- ternal agent. In the form of ointment, it is applied to chronic cutane- ous eruptions, and as an excitant to ulcers, especially when of a syphilitic character. It is also used to destroy pediculi, either in the form of ointment, or rubbed up with hair powder, in the pro- portion of one part of the ammoniated mercury to four parts of powdered starch. UNGUENTUM HYDRARGYRI AMMONIATI, OINTMENT OF AMMO'NIATED MER'- CURY. (Hydrarg. ammoniat. gj; Unguent, simpl. §iss.) Used in the cases above mentioned. 11. HYDRAR'GYRI IOD'IDUM. — I'ODIDE OF MER'CURY, Iodide or Protiodide of mercury is made by rubbing mercury and iodine together in certain proportions, with sufficient alcohol to form a paste, and continuing the trituration until the globules disappear. The iodide is then dried in the dark, with a gentle heat, and kept in a well stopped bottle, whence the light is excluded. The mercury, in this process, combines with the iodine, and the combination is facilitated by the alcohol, which dissolves a part of the iodine, and forms the remainder into a paste. Iodide of mercury is a greenish yellow powder, which is insoluble in water or alcohol, but is soluble in ether, and slightly so in a watery solution of iodide of potassium. It is a powerfully irritant poison; but in small therapeutical doses is capable of exciting the ordinary alterative and sialogogue effects of the mercurials. By some, it has been supposed to be especially 26* 306 SPECIAL EUTROPHICS. efficacious in cases in which there is a union of scrofula and sy- philis in the same person; but, according to Dr. Christison, " all hitherto positively known relative to these notions is, that iodide of mercury is capable of producing the physiological effects of mercu- rials. It has been given in syphilis and in scrofula, when occur- ring singly; and in chronic cutaneous affections of various kinds." It is not, perhaps, so often used in this country as the red iodide. The London Pharmacopoeia contains twro preparations — the Pi- lule Hydrargyri Iodidi ; (Hydrarg. iodid. 3j ; Confect. rosa canin. 3 iij ; Zingib. pulv. 3j- Five grains contain one of iodide ;) and the Unguentum Hydrargyri Iodidi ; (Hydrarg. iodid. ^j ; Cera alba, |ij ; Adipis, §vj,) which is employed as a dressing for scrofulous ulcers, or for syphilitic ulcers in scrofulous individuals ; and like- wise as an application in lupus, and other congenerous affections of the skin. The dose of iodide of mercury is a grain, which may be gra- dually carried to three or four. 2. HYDRAR'GYRI IOD'IDUM RUBRUM. — RED I'ODIDE OF MER'CURY. Red i'odide, Bini'odide, Deuti'odide, or Peri'odide of mer'cury, is made by dissolving corrosive chloride of mercury, and iodide of po- tassium, in proper proportions, in water; mixing the solutions; col- lecting the precipitate on a filter, and, having washed it with dis- tilled w7ater, drying it with a moderate heat, and keeping it in a well stopped bottle. In this process, chloride of potassium remains in solution, and the red iodide is precipitated. Red iodide of mercury is of a beautiful scarlet red colour. It is insoluble in water, sparingly soluble in alcohol, but very much so in certain saline solutions, of which those of iodide of potassium, and corrosive chloride of mercury are most remarkable. With other al- kaline iodides — as iodide of potassium — it forms a class of dou- ble salts, called hydrar'gyro-i!odides, or i'odo-hydrar'gyrates. In its therapeutical effects, this preparation resembles the corro- sive chloride of mercury, whilst the iodide resembles calomel. It maybe given in the same cases as the iodide, but requires great cau- tion in its administration. The author has frequently administered the red iodide in public and in private practice, in cases where an active modifier of the system of nutrition appeared to be demanded, and where a combination of the potent remedies — mercury and iodine—suggested itself. In chronic glandular enlargements, es- pecially of the liver and spleen, and in habits where the use of mer- cury was not contra-indicated, both it and the iodide have proved extremely serviceable. Perhaps there are no preparations, which, under the circumstances in question, merit more attention. It rea- dily excites ptyalism. It may be given internally in the dose of one-sixteenth of a grain HYDRARGYRI SULPHURETUM RUBRUM. 307 gradually increased to one-fourth of a grain, in the form of pill, or it may be dissolved in alcohol, (Hydrarg. iodid. rubr. gj ; Alcohol. ^iss. Dose, ten to twenty drops ;) or in ether, (Hydrarg. iodid. rubr. ^j ; Aether, sulphuric. 5iss. Dose, ten to twenty drops.) In the form of ointment, it has been found very efficacious in scrofulo-venereal ulcers, syphilitic swellings of the lymphatic glands ; scabies ; carcinomatous ulcerations ; goitre, condylomata, &c. The London Pharmacopoeia has an Unguentum Hydrargyri Biniodidi, (Hydrarg. iodid. rubr. ^j ; Ceraflava ^ij ; Adipis §yj.) which requires to be reduced, when applied to delicate parts, or to painful ulcerations. 13. POTAS'SII FODO-HYDRAR/GYRAS. — I'ODO-HYDRAR'GYRATE OF POTAS'SIUM. Iodo-hydrar'gyrate of potas'sium, Hydrar'gyro-i'odide of potas'- sium, I' odo-hydrar'gyrate of lod'uret of potas'sium, or Hydrar'gyro- iodide of potas'sium, may be made for medical use in the following manner — Hydrarg. iodid. rubr. gr. iv; Potassii iodid. 9j ; Aqua destillat. f. ^j. Dose, five drops, three times a day. By the union of the two iodides, a soluble double salt is formed, in which the red iodide of mercury acts the part of an acid, and the iodide of potas- sium that of a base. It does not appear, that this preparation possesses any essential, or, indeed, any advantage over the iodides of mercury, and accord- ingly it is not much used. It may be prescribed in the same cases. 14. HYDRAR'GYRI SULPHURE'TUM NIGRUM. —BLACK SULPH'URET OF MER'CURY. Black sulph'uret of mer'cury, Sulph'uret of mercury with sulphur, or AZ'thiop's min'eral, is made by rubbing together equal quantities of mercury and sulphur till the globules disappear. It is a black, tasteless powder, devoid of smell, and insoluble in water. It is wholly dissipated by heat. Black sulphuret of mercury is a feeble mercurial, and is rarely ad- ministered so as to affect the system with mercury. It has been given, indeed, in considerable doses, and for a great length of time, with scarcely any effect. When prescribed at all, it is generally in the glandular affections of children, and in chronic cutaneous diseases, especially in scabies ; in which the sulphur is probably the most active ingredient. Its dose is from gr. v to gss repeated two or three times a day. 308 SPECIAL EUTROPHICS. 15. HYDRAR'GYRI SULPHURE'TUM RUBRUM. —RED SULPH'URET OF MER'CURY. Red sulph'uret or Bisulph'uret of mer'cury, Cin'nabar or Vermilion, is made by mixing mercury wTith melted sulphur, in due proportions, over the fire ; rubbing the mass, when it begins to swell, into powder, and subliming. By the agency of heat, the mercury and sulphur unite and form the black sulphuret; which is converted by subli- mation into red sulphuret. Cinnabar occurs in nature, but is never used for therapeutical purposes. That of the shops is always prepared in the mode above- mentioned. It is met with in two forms — in mass, when it is a ponderous dark brownish-red substance of metallic brilliancy, very friable, and leaving a vermilion streak when scratched with the nail, — and in powder, when it is likewise heavy, and of a well known red colour. It is devoid of taste and smell, and is entirely volati- lised by heat. Red sulphuret of mercury may be used in the same cases as the black sulphuret, but it is rarely given internally. It is most com- monly employed as a fumigating agent in syphilitic affections of the throat. Half a drachm may be thrown upon a hot plate, and be directed into the fauces by breathing over it. In this manner it not only produces a local excitant agency, but salivation where it is de- sirable that this should be done speedily. Ptyalism, thus induced, has at times been so violent, that it is rarely used. The sulphurous vapour, too, is so irritating, as to be improper for those of weak lungs ; and the black oxide is preferred where fumigations are considered to be advisable. Should it be desired to give the red sulphuret internally, from ten grains to half a drachm may be prescribed. 16. HYDRAR'GYRI CYANURE'TUM. — CYAN'URET OF MER'CURY. Cyanuret of mercury, Bicyanide or Prussiate of mercury, is prepared by boiling together ferrocyanuret of iron, red oxide of mercury, and distilled water, in proper proportions, for half an hour, and filtering. The residue is washed with distilled water, and again filtered. The solutions are then mixed, and evaporated, so that crystals may form. These maybe purified by solution and recrystallisation. In this pro- cess, the cyanogen of the ferrocyanuret of iron combines with the mercury of the red oxide; and the iron unites with the oxygen of the oxide. Cyanuret of mercury is in transparent crystals, wdiich are square prisms, and wholly soluble in water, but very little so in alcohol. They are devoid of smell, but have a strong metallic taste. This prepar?tion has been used as an antisyphilitic, and by some UNGUENTUM HYDRARGYRI NITRATIS. 309 is preferred to the corrosive chloride, in consequence of its greater solubility, and the capability of more speedily affecting the system by it. It is said to be liable to excite vomiting, and, therefore, it is advisable, that a small quantity of opium or a few drops of laudanum should be added to each dose. Some, however, have not deposed favourably in regard to it, whence it has been inferred, that there must be some uncertainty in its preparation. It has been used ex- ternally in the form of ointment, (Hydrarg. cyanuret. gr. xij ; Adipis, 5J ;) in chronic cutaneous affections, and in syphilitic ulcerations ; and has been employed as a gargle in syphilitic sore throat. (Hy- drarg. cyanur. 9ss ; Decoct, sem. lini, Oj.) The dose of the cyanuret is one-sixteenth of a grain, gradually in- creased to half a grain, three or four times a day, made into a pill with crumb of bread ; or, it maybe given in solution. The Liqueur antisyphilitique of Chaussier is made as follows : — Hydrargyr. cya- nuret. gr. viij ; Aqua destillat. Oj. Each fluidounce contains half a grain of the cyanuret. 17. UNGUENTUM HYDRAR'GYRI NITRA'TIS.—OINTMENT OF NITRATE OF MER'CURY. Ointmeut of nitrate of mercury or Cit'rine ointment is formed as fol- lows : — Hydrarg. sj ; Acid, nitric, f. %x] ; 01. bubuli, f. gix ; Adi- pis, 3iij. The mercury is dissolved in the acid, and to the melted lard and oil the solution is added. This ointment is said to have been proposed originally as an imitation of a nostrum, well known by the name Golden eye ointment. When freshly prepared, this ointment has a beautiful golden yel- low colour, a soft consistence, and a nitrous odour ; but in process of time it acquires a dirty greenish hue, and becomes so hard as to be unfit for use, unless mixed with lard. This appears to be owing to the hardening of the olive oil by the nitrate of mercury. To di- minish this objection, neat's foot oil is substituted in the Pharma- copoeia of the United States with advantage. Dr. Wood states, that he has had in his possession for more than a year a pot of ointment, made according to the above process, and although it has partially assumed a greenish colour, it preserves a uniform, soft, unctuous consistence. It ought not to be stirred with an iron spatula, or be brought into contact with iron in any manner, as the iron will be corroded, and the ointment be discoloured. Ointment of nitrate of mercury is a valuable application in many chronic cutaneous diseases, — as lupus, porrigo, herpes, psoriasis, impetigo, lepra, &c. It is frequently, also, used in cases of ophthal- mia tarsi, being applied by means of a camel's hair pencil, and spread upon lint as an application to syphilitic and other foul and phage- denic ulcers. Except in the last cases, however, the ointment gene- rally requires to be reduced with at least one or two parts of lard. 310 SPECIAL EUTROPHICS. 18. HYDRAR'GYRI SULPHAS FLAVUS.—YELLOW SULPHATE OF MER'CURY. This preparation — the general properties of which have been de- scribed elsewhere, (Vol. i. p. 130,) — has been given as an altera- tive mercurial in chronic cutaneous affections; and in syphilis, to produce the specific effects of mercury ; but it is sometimes harsh in its operation : it is now, therefore, almost abandoned ; and has been pronounced by Dr. Christison an unnecessary mercurial; and one that may be expunged from the Pharmacopoeias without inconveni- ence. The dose as a eutrophic is from a quarter to half a grain, made into a pill with crumb of bread. iod'ini pr^para'ta.—preparations of i'odine. i 19. IOD'INUM.—I'ODINE. This article constitutes one of the most important gifts from che- mistry to therapeutics. It was totally unknown until 1812, when Courtois, a manufacturer of saltpetre, discovered it; but it was mainly through the labours of Gay-Lussac and Sir Humphry Davy, that its chemical relations were duly appreciated. Since then it has been found to be very largely distributed ; having been discovered in a great number of vegetables belonging to the family Algae; in many marine mollusca, in sea-water, and in several mineral-waters. In Great Britain, it is said to be exclusively manufactured at Glas- gow, from the kelp of the west coast of Ireland, and the Western Islands of Scotland. (Pereira.) According to Dr. Traill, the greatest quantity is produced by kelp made from drift weed, which is in a great measure composed of Fucus digita'tus, and F. Lo'reus ; — cut- weed, which consists of F. vesiculo'sus and F. serra'tus, yielding much less of it. One hundred tons of Caithness kelp yield, according to the experience of a manufacturer, 1000 pounds of iodine, or about a 224th part. (Christison.) It is always prepared on the large scale, and hence is placed in the Materia Medica list of the Pharmacopoeia of the United States. Iodine is procured from the mother-water of the soda derived from sea-plants, by different processes in different manufactories. A cer- tain portion of it is readily obtained by heating the liquid with sul- phuric acid, wdiich decomposes the iodide of the- alkali, and violet fumes of iodine are disengaged, which may be condensed in a re- ceiver. For the process the reader is referred to the various works on chemistry. Iodine is in crystalline scales, of a bluish-black colour, and metallic lustre. When heated, it melts, and is volatilised in purple vapour, whence its name from /Wk, " blue." It is wholly soluble in alcohol I0DINUM. 311 and in ether; and is very slightly soluble in water, requiring 7000 parts of that fluid. Its great characteristic property is the production of a blue colour when it meets with starch. In consequence of its high price, it is very liable to adulteration ; and it is said, that coal, black lead, oxide of manganese and charcoal have been added to it, but neither Dr. Christison nor Dr. Pereira has met with any of these impurities, which would remain behind when heat wTas applied, and admit, therefore, of easy detection. Water is the chief adulterant; and its unusual presence may be suspected, if the iodine adheres to the sides of the bottle in which it is kept. Dr. Christison states, that until within the last eighteen months, he has not met w7ith any British iodine that has not contained between 15 and 20 per cent, of water. The smell of iodine is similar to that of chlorine, with which it accords in its property of destroying vegetable colours. It colours the skin yellow, which colour gradually disappears. In regard to the effects of iodine on the economy, discrepancy exists amongst observers, although great care appears to have been taken in the experiments. Those of Magendie and Orfila would seem to show it to be an irritant to man in moderate doses; but, on the other hand, Dr. Gully affirms that he gave as much as f. ziij of the tincture daily, and did not observe any effect, and Dr. Kennedy, of Glasgow, gave 953 grains in the form of tincture within eighty days, without the health of the patient—a girl —seeming to be affected by it. It is certainly, however, an irritant when applied topically, staining the surface yellow, as before remarked, and causing rubefaction, itching and desquamation. When inhaled, too, it acts as an excitant expectorant. (See Vol. i. p. 253.) Like eutrophics in general, it passes into the mass of blood, and exerts its action on the tissues by the modifications induced by it in that fluid. That it is received into the blood admits of positive proof. It has been detected in the urine, sweat, saliva, milk and blood, and in every case, it was found in the state of iodide ; so that M. Cantu infers its action on the body to be chemical, by abstracting hydrogen. Two drachms, according to Dr. Buchanan, were given to a young man labouring under blennorrhoea, and as soon as the medicine made its appearance in the urine, blood was drawn from the arm. On examining it, both the serum and the crassamentum were found deeply impregnated with iodine. The same quantity was given to a boy affected with dropsy of the knee-joint. About five hours after it had been taken, a very small puncture wTas made, and upwards of twelve ounces were drawn off by a cupping-glass. It contained iodine in abundance. To an old man, who had a very large hydrocele, two drachms of iodide of potassium were given over night; and the same quantity the following morning. On tapping him, some hours after he had taken the last dose, more than thirty ounces of serum were drawn off, containing a large quantity of. iodine. 312 SPECIAL EUTROPHICS. When iodine is continued for a length of time, it is said by some to produce a train of phenomena indicating its injurious action on the organism, to which the terms iodosis, iodinia, and iodism have been applied. Observers have not agreed as to the precise phe- nomena which characterise this condition, but most of them mention — irregularity in the functions of the digestive organs, — at times, diarrhoea; at others, constipation ; gastrodynia ; violent vomiting ; excessive emaciation ; anxiety ; depression of spirits, and symptoms similar to those of hypochondriasis ; obscurity of vision ; hardness of hearing; palpitations; tremors; absorption of the mammae of the female, and of the testes in the male ; — yet Dr. Buchanan affirms, that although he has given iodine very largely, he has never seen any of the unpleasant results that have been ascribed to it. He asserts, that he has never seen its use " followed by wasting of the the testes or mammae, by palpitations ; faintness ; excessive debility; hurried, anxious breathing ; dinginess of the surface ; copious clammy sweats ; increased menstrual discharge, or an oily appearance of the urine, which are enumerated amongst the symptoms characterising the supposed affection, termed iodism." From the testimony, how- ever, of observers of eminence, we can scarcely doubt, that such an affection may be induced, and become dangerous to life ; yet it must be rare ; for although the author has administered iodine very freely, he has seldom seen symptoms ensue, w7hich he was disposed to refer to it; except such as so nauseous an article was likely to cause in the stomach. As respects the wasting of the mammae and the testes, it must be extremely unfrequent. Neither Magendie nor Pereira nor Ricord nor Kluge — the two last of whom have given it very largely in the hospitals of Paris and Vienna — has seen it; but Magendie remarks, that it is common in Switzerland. The author's own ex- perience coincides with that of those gentlemen. He has pre- scribed it, and seen it prescribed largely, both in public and private practice ; yet no such result has supervened in a single instance. Lugol, indeed, asserts, that his emaciated patients became fatter under its use ; and Coindet and Formey found it increase the appe- tite. Ulceration of the mouth, and salivation, are said to have been pro- duced by it. As a valuable eutrophic, iodine exerts its power in various dis- eases — not only when given in its pure state, but in its combination with the alkalies — especially the iodide, and the iodureted iodide of potassium. The therapeutical remarks, that apply to the one, are equally applicable, therefore, to the others. Perhaps in no disease have its virtues been more marked than in goitre, in which it has been unquestionably more successful than any other remedy. In another w7ork, the author has referred to many individuals who have deposed to the valuable services it has rendered; and it may be added, that Mr. Bramley, whilst in Nepal, amongst the Himalaya mountains, and under unfavourable circumstances, IODINUM. 313 cured 57 out of 116 cases, and brought 34 more into a fair way towards ultimate recovery. (Christison.) The author has succeeded in every case of soft goitre in which he has prescribed it; in two or three, the hypertrophy returned, but it was again dispersed under the use of the remedy. When the tumour has acquired a cartilaginous hardness, although it may be diminished under the use of iodine, it can rarely or never be wholly removed; but under such circum- stances, every other remedy would be found equally fruitless. Generally, it exhibits its effects in three weeks; but, at times, not until it has been persevered with for four or five; after which the improvement is often signal. It may be given either in the form of the tincture, or of Lugol's solution, and may be rubbed on the part at the same time ; but the author has always found the tincture suffi- cient. It has been advised by some, that a bleeding should be practised; and if little or no effect appears to be produced by the iodine, this may be desirable to facilitate absorption; but it is not usually necessary. It is worthy of recollection, that burnt sponge was long celebrated for its powers over goitre, before iodine was dis- covered ; and the same was the fact in regard to certain brine springs — as that of Salzhausen. In the enlargement of other glandiform ganglions — as of the spleen and mesenteric ganglions ; and in enlargement of different glands, as of the liver, mammae, testes, submaxillary gland, &c, iodine has been used freely, and although the benefits derivable from it are not as marked as in goitre, they have often been considerable. In scrofulosis, it has attained great celebrity. Whilst mercury has been esteemed, by some, the great remedy for syphilis, they have equally given the preference to iodine in scrofula ; and, in many forms of the cachexia, it is often very successful; but it re- quires to be persevered in for a considerable time. It has been equally celebrated in the constitutional forms of syphilis, and espe- cially in mercurial cachexia, in which cases the iodide of potas- sium, in large doses, is usually preferred. In tuberculous cachexia, it has had testimonials in its favour; but, like every other remedy, it must generally fail in that intractable condition, especially as we meet with it in tubercular phthisis. In such cases, it has been not only given internally, but has been inhaled in the manner described elsewhere, (see Vol. i. p. 253 ;) but, as the author has there re- marked, his experience has not been favourable to it. It has like- wise been given largely in the cancerous cachexia, and especially in cancer of the uterus; but although its revulsive influence has seem- ed, occasionally, to check the disease for a time, it has almost al- ways— if not always—recurred. In dropsy, it has been often given in consequence of its manifest influence, in many cases, in modifying nutrition, and thereby occasioning absorption. It would seem to be especially indicated in cases of dropsy that are depend- ent upon induration or other organic disease of some viscus, as of the liver, &c. Some have affirmed it to be an excellent hydropic in vol. n.—27 314 SPECIAL EUTROPHICS. every form of the disease—hydrothorax, ascites, hydrocele, hydro- cephalus— acute or chronic, hygroma, &c, either administered internally or applied externally. In nervous diseases, the testimony is somewhat discordant; but in almost every form of cutaneous dis- ease, it has been highly extolled by many, and spoken doubtfully of by some. In these cases, the internal should be associated with the external use. The iodine, by passing into the capillaries, and mo- difying the condition of the circulating fluid, impresses their sensi- bilities differently, so that a new action is often induced in them, and the result is favoured by the new impression made by the ex- ternal application of an ointment, or of a solution of it, to the parts affected. Iodine has likewise been given in several affections which it is difficult to classify—as incontinence of urine, leucorrhoea, dis- charges from the nose, scorbutic states of the gums, mercurial sali- vation, stricture of the oesophagus, affections of the mucous mem- brane of the middle ear, chronic inflammation of the lachrymal gland, impotence, and as an efficacious remedy in checking or con- trolling the ulcerative process, — the most active phagedenic ulcers often yielding in a surprising manner to its influence, and assuming a healthy, granulating appearance. Of late, the iodide of potassium, in large doses and long con- tinued, has exhibited great power over acute, and especially over chronic rheumatism, and it has been occasionally used with suc- cess in the tophaceous and other articular enlargements occurring in gout. As a local application, iodine is a most useful agent in many dis- eases. In cutaneous affections of various kinds, the tincture, applied pure or diluted — as the case may require — has been of eminent service — as in lupus, porrigo, impetigo, &c; and a recent writer, Mr. John Davies, has advised it in various diseases, to fulfil the same objects as nitrate of silver. For example, he paints the part with a camel's hair pencil, dipped in the tincture, in erysipelas ; phlegmon; sloughing of the cellular membrane after phlegmonous erysipelas ; acute inflammation ; anomalous pains ; chronic inflammation and en- largement of the joints; inflammation of the absorbents; anthrax ; boils ; buboes ; malignant ulcers of the tongue and tonsils ; scro- fulous swelling of the glands ; chilblains ; lacerated, contused, and punctured wounds ; burns and scalds ; gouty and rheumatic swel- lings ; fistulous openings; malignant or adventitious excrescences; stings of wasps ; disease of the spine ; ununited fractures ; orchitis; chronic ophthalmia ; opacities of the cornea ; dissection wounds, &c. — in many of which affections it doubtless acts as an ordinary excitant; and the same may be said of it as an injection in hydro- cele, in which the tincture has been employed in the proportion of one or two drachms to an ounce of water, with considerable suc- cess. In regard to the different preparations of iodine, practitioners do not all accord as to which is deserving of the preference. The iodu- IODINUM. 315 retted iodide of potassium, in the form of Lugol's solution, has generally been selected; but, of late, the iodide of potassium has been more employed perhaps. A modern writer, Dr. A. Buchanan, is inclined to place them in the order of therapeutical value as fol- lows : — iodide of starch, hydriodic acid (iodine,) and iodide of potassium ; although he admits, that the superiority which he as- cribes to the first is, perhaps, owing to his having prescribed it most frequently. The action of all is, however, similar : and the only mode, he thinks, of explaining such similarity of action on the body of substances so dissimilar in nature, is by considering the hydriodic acid as the active principle,—free iodine being imme- diately converted in the stomach into hydriodic acid. It has been imagined by many, that when iodine disagrees, it is owing to free iodine acting on the stomach, and hence the tincture has been regarded as an objectionable form ; but the same symptoms are said to have resulted from the use of the iodides. Dr. C. J. B. Williams, however, is disposed to ascribe them to free iodine exist- ing in these preparations also; to obviate which, it has been recom- mended, that the patient should take a piece of bread or biscuit after each dose, — the starch combining with the free iodine, and forming a harmless compound. It may be sufficient to direct, that they should not be taken on an empty stomach. Should morbid phenomena arise, that are referable to the remedy, it must, of course, be dis- continued. Iodine is not readily given in substance, in pill or powder. Its dose is about half a grain. Externally, it is applied in the form of tincture, ointment, or watery solution, or in baths or fumigations. Frictions with it readily occasion considerable irritation of the skin, which commonly passes away soon, when the friction is suspended for a while. After bathing any part of the cutaneous surface, painful rubefaction often ensues, w7hich is usually followed by perspiration and sleep. Dr. Pereira says, that the most effectual method of em- ploying iodine externally is the endermic, — applying an ioduretted ointment to the cutis vera after the epidermis has been removed by a blister. The plan is not, however, often used. TINCTU'RA IOD'INI, TINCTURE OF IODINE. (Iodin. §j; Alcohol, Oj.) It has been urged as an objection to this formula, that its strength is apt to vary ; that it deposits iodine in the crystalline form ; under- goes decomposition wThen exposed to solar light—the iodine taking hydrogen from the alcohol and forming hydriodic acid, which acts on the spirit, and forms a little hydriodic ether ; and moreover, that the free iodine is deposited when water is added, and may irritate the stomach ; but the last objection is the least forcible of all, as such a result is, undoubtedly, very rare. To obviate these objections, however, the next preparation has been introduced — the simple tincture being chiefly used as an external application. Sixteen minims of the tincture contain one grain of iodine, and the ordinary 316 SPECIAL EUTROPHICS. dose is ten to twenty drops, three times a day, gradually increased, in sugared w7ater, or in wine. The mode of employing it externally has been already mentioned. TINCTU'RA IOD'INI COMPOSITA, COMPOUND TINCTURE OF IODINE. (Iodin. |ss ; Potassii iodid. gj; Alcohol. Oj.) The iodide of potassium is added in this preparation to prevent the deposition of free iodine. The dose is ten to twenty drops, gradually increased. UNGUENTUM IOD'INI,OINTMENT OF I'ODINE. (Iodin. gr. xx; Alcohol.nixx ; Adipis, gj.) This ointment, when rubbed repeatedly on the skin, induces a pustular eruption. Should it be desirable to avoid this, the strength must be reduced by an additional quantity of lard. UNGUENTUM IOD'INI COMPOSITUM, COMPOUND OINTMENT OF I'ODINE. (Iodin. 3ss ; Potass, iodid. 3j ; Alcohol, f. 3j ; Adipis, gij.) To be employed in the same cases as the last. 20. POTAS'SII IOD'IDUM. — I'ODIDE OF POTAS'SIUM. Iodide or Iod'uret of potas'sium, or Hydri'odate of potas'sa, accord- ing to the Pharmacopoeia of the United States, is made by mixing iodine with distilled water, adding iron filings so as to form iodide of iron, which is decomposed by carbonate of potassa ; thus forming carbonate of iron by precipitation, and iodide of potassium in solution, which, by evaporation, yields crystals. Iodide of potassium, thus made, is in white or transparent crystals, w7hich are wholly soluble in two-thirds of their weight of water at 60°. The solution dissolves iodine, forming ioduretted iodide of potassium. The iodide is likewise soluble in alcohol. It is exceed- ingly liable to adulteration both from faulty manufacture and fraud. Dr. Pereira states, that in 1829 he analysed a sample, which con- tained 77 per cent, of carbonate of potassa: Dr. Christison affirms, that he has seen specimens which contained only 9.5 per cent, of the pure salt; and it would appear, that at one time most of the iodide of potassium, used in Great Britain, was of this composition. In such case, it is said to be granular and deliquescent. (Christison.) Ten grains of the pure iodide in solution decompose 10.24 grains of nitrate of silver. The medical properties of iodide of potassium are identical writh those of iodine, than which it is now more frequently prescribed. It may be given in very large doses, without producing any unpleas- ant effects ; yet occasionally it seems to act as an irritant, and there- fore caution ought to be indulged, especially as it has been shown that the salt is very liable to adulteration. Dr. Buchanan affirms, that he has given it in doses of gss, and the only precaution he ob- served was to make the patient drink freely of diluents. He gave it FERRI I0DIDUM. 317 in these large doses to determine some physiological questions in re- gard to its absorption. Two drachms were taken by a young man affected with gonorrhoea, and as soon as the medicine made its ap- pearance in the urine, blood was drawn from the arm. On examin- ing the blood, both the serum and crassamentum were found deeply impregnated with iodine. It has been given internally, in all the cases in which iodine has been prescribed ; and it is the favourite preparation in large doses, in syphilitic, syphiloid, and other cachexiae; and in rheumatism. Lugol appears to have used it mainly as a sol- vent to iodine, and considered it inferior to the latter as a therapeu- tical agent; but no chemical or other prepossession can set aside the overwhelming testimony that has been adduced in its favour. The author has given it largely, and has certainly obtained from it all the advantages which the preparations of iodine are capable of affording. A case of salivation by it has been published. The ordinary dose is three grains, three times a day. The author has not exceeded twenty grains for a dose; but it has been carried to a much greater extent. It is given in the state of solution, (Potass. iodid. 3j ; Aqua destillat. f. ^j. Dose, fifteen drops three times a day,) associated generally with the use of an iodine ointment. Most fre- quently, however, iodine is added to form an ioduretted iodide, as in the LIQUOR IOD'INI COMPOSITE, COMPOUND SOLUTION OF I'ODINE. (Iodin. 5yj; Potass, iodid. ^iss; Aqua destillat. Oj.) This solution, also called Compound solution of iodide of potassium and Solution of ioduretted iodide of potassium, is commonly used as Lugol's solution. The ordinary dose is ten or fifteen drops, three times a day, in sugared water; but it may be carried much farther. Lugol himself had so- lutions of various strengths, both for internal and external use. The formulae for the Tinctura iodini composita, and the Unguentum iodini compositum, which are ioduretted iodides of potassium, have been given before, (p. 316.) 21. FERRI IOD'IDUM. — I'ODIDE OF IRON. The general properties of iodide of iron have been described under the head of Tonics, (Vol. ii. p. 61,) and it was there stated, that the salt is especially adapted for cases in which there appears to be torpor in the system of nutrition. It has been given in various cachexiae — the scrofulous, cancerous, scorbutic, tubercular, and hydropic; and has often proved highly serviceable. It appears to be one of the best remedies we possess, wherever a eutrophic and tonic agency is needed. The dose of the LIQUOR FERRI IODIDI, (Vol ii. p. 62,) as a eutrophic, 27* 318 SPECIAL EUTROPHICS. is ten drops, three times a day, in sugared water, gradually increasing the quantity. 22. PLUMBI IOD'IDUM. —I'ODIDE OF LEAD. Iodide of lead is formed, according to the London Pharmacopoeia, by the double decomposition of iodide of potassium and acetate of lead. The precipitate formed is iodide of lead. It is of a bright yellow colour, devoid of taste and smell, and very sparingly soluble in cold water. It dissolves in boiling water, from which it chiefly separates, as the solution cools, in the form of minute, shining, yellow, crystalline scales. Iodide of lead is not an irritant, even when applied to a denuded surface ; nor is it an active agent, when administered internally. It has been given in the dose of a quarter or half a grain in scrofulous affections of the glands, joints, &c, made into a pill with confection of roses. It is applied externally, in the form of ointment, in scrofulous and other indolent swellings, in the way of friction. An UNGUEN'TUM PLUMBI IOD'IDI, (Plumb, iodid. |j ; Adipis, gviij ;) is offi- cinal in the London Pharmacopoeia. Some other preparations of iodine are likewise used — 23, the Iodide, and 24, the Red Iodide of Mercury, which have been al- ready described, (Vol. ii. pp. 306 and 307.) 25. Iodide of Arsenic hasbeen frequently used in phagedenic tuber- culous herpes, in the form of ointment, (Arsenic, iodid. gr. iij; Adipis, gj.) It has been also given internally with success in lepra and impetigo, in the dose of one-tenth of a grain. It is a very poisonous substance, and requires to be administered with caution. 26. Iodide of Mercury and Arsenic, the mode of preparing which is given elsewhere, (see the author's New Remedies, 4th edit. p. 357, Philad., 1843,) has been recently prescribed largely as a eutrophic in chronic cutaneous diseases — as psoriasis, lepra, lupus, and in scrofulous and syphilitic affections. It has, likewise, been used externally in the same diseases. 27. Iodide of Barium, administered in small doses, has been found serviceable in scrofulous and other cachexiae, in which the chloride of barium is indicated. Biett gave it in cases of scrofulous swellings, and applied it externally. (Barii iodid. gr. iv; Adipis, ^j.j 28. Sesqui-iodide of Carbnon has been used with advantage in cases of enlarged glands in the form of ointment, (Carbon, sesqui- iodid. ^ss; Cerat. 3yj;) and also in lepra and porrigo. BR0MINUM. 319 29. The Iodides of Quinia and Cinchonia have been employed for the cure of scrofulous tumours, in cases where iodine and to- nics are indicated. Iodide of quinia may be prepared, according to Dr. A. T. Thom- son's form, by triturating together in a mortar 164.55 grains of pure quinia, and 126.3 grains of iodine, — the latter being added to the former until the whole is intimately mixed; and then boiling the mixture in a moderate quantity of distilled water at first, adding more by degrees, until as much is added as will give one grain of the iodine for each fluidrachm of the solution. Iodide of quinia, in solution, is of a pale straw colour, limpid, evolving a faint odour of iodine, and impressing upon the palate the bitter of quinia. The real nature of the salt contained in the solu- tion has not been determined by Dr. Thomson. 30. Iodide of Ammonium was introduced into medical practice by M. Biett, as a valuable agent in chronic cutaneous diseases, and especially in lepra and psoriasis. It is used in the form of ointment: (Ammon. iodid. 9j— 3J ; Adipis |j.) As the ointment is readily decomposed, it ought to be freshly prepared, and be excluded from the air. 31. Iodide of Starch is a favourite preparation with Dr. Bu- chanan, of Glasgow; but it is rarely employed. The dose is gss, gradually increased. 32. SUL'PIIURIS IOD'IDUM, I'ODIDE OF SULPHUR, is officinal in the last edition of the Pharmacopoeia of the United States. It is formed by heating slightly a mixture of iodine and sulphur in certain propor- tions. It is a dark substance, very deliquescent, and resembling, in appearance, sesquisulphuret of antimony. It is entirely dissipated by heat, and when boiled in water, iodine escapes with the vapour, and sulphur is deposited nearly pure. Iodide of sulphur is not given internally, but it forms an excel- lent application in many chronic cutaneous diseases. It has been found especially efficacious in psoriasis, when applied in the form of friction. It has also been used with success in lepra vulgaris, acne indurata, porrigo, lupus, herpes pustuloses labialis, &c. The author has found it the best application in some cases of inveterate porrigo of the scalp ; and regards it as an excellent local application in chro- nic cutaneous affections in general. The ointment may be made of Iodide of sulphur 9j —3ss ; Lard or simple cerate ^j; Oil of Ber- gamot gtt. x. The inhalation of the vapour of the iodide was employed by Dr. Copland in a case of humoral asthma, w7ith temporary advantage. It has, likewise, been used as a fumigation in cases of atonic ulcers, and in chronic cutaneous affections. With this view, the sulphur and the iodine may be combined extemporaneously — say four parts of iodine to one part of sulphur. 320 SPECIAL EUTROPHICS. 33. BRO'MINUM.— BROMINE. Bromine, Bromin'ium, Bromin'eum, which was discovered in the year 1826, and obtains its name from B^o^o?, " a stench or smell," is greatly allied in its chemical properties to chlorine and iodine ; and in its medical virtues to the latter. It is met with chiefly in sea- water, and in certain animal and vegetable substances that live therein. It has, likewise, been found in many mineral waters, of this and other countries, and especially in the salt springs — as of Salina, by Professor Silliman, and of Kenawha, by the author's late friend, Professor Emmet, of the University of Virginia. Bromine is in the secondary list of the Pharmacopoeia of the Uni- ted States, (1842,) and may be obtained by various processes, which are given elsewhere, (New Remedies, 4th edit. p. 107; also Pereira.) In the bittern or mother liquor of sea-w7ater, from which chloride of sodium has been separated by crystallisation, bromine exists in the state of bromide of magnesium ; this is decomposed by passing a current of chlorine through the bittern, which unites with the mag- nesium. The bromine dissolves in ether, and the solution is treated with solution of potassa, by which bromide of potassium and bro- mate of potassa are formed. In the mean time, the ether becomes colourless and pure, and may be employed in dissolving fresh por- tions of bromine. When a sufficient quantity of the salt has been obtained, it is mixed in a retort with black oxide of manganese, and slightly diluted sulphuric acid, which occasion the disengage- ment of bromine in reddish, very acrid vapours, that are con- densed in an appropriate receiver by means of ice or snow. Bromine, at the ordinary temperature, is a fluid of a blackish red colour, when regarded in quantities ; but of a hyacinth red, when placed in a thin layer between the eye and the light. Its smell is powerful and disagreeable, resembling that of chlorine, and its taste strong. It colours the skin yellow — the colour gradually disappear- ing. Its specific gravity is 2.966. It dissolves in very small quan- tity in water, in greater proportion in alcohol, and in still greater in sulphuric ether. Bromine — as already remarked — resembles iodine in its thera- peutical relations, and, like it, belongs to the class of irritant poi- sons. A recent writer, Dr. Glover, places it intermediate in physio- logical properties between chlorine and iodine, but more nearly re- lated to the former than to the latter. In medicinal doses, it has been administered in the same cases as iodine. It is far less fre- quently employed, however. It maybe prescribed mixed with water, in the proportion of one part of bromine to forty parts of water. Of this, five or six drops may be given in syrup, three or four times a day, gradually increasing the dose. 34. Potas'sii Bro'midum, Bromide of Potas'sium, or Hydrobro'- SP0NGIA USTA. 321 mate of Potas'sa, is an officinal preparation in the London Pharma- copoeia, and the mode of preparing it is an exact counterpart for that of preparing iodide of potassium. It may, likewise, be made by dissolving bromine in alcohol, and adding potassa, until the spirit begins to change colour; then evaporating, and heating to redness. Bromide of potassium crystallises in cubes or rectangular four- sided tables, which are devoid of smell, and are of a pungent saline taste, similar to common salt, but more acrid. It is very soluble in both hot and cold water, and slightly so in alcohol. The solution of bromide of potassium dissolves no more bromine than pure water, in which respect it does not resemble iodide of potassium. The effects of bromide of potassium on the economy appear to re- semble those of iodide of potassium. It has been used in goitre, scrofulous affections, enlarged spleen, chronic cutaneous diseases, &c, but is not much prescribed. Its dose is from four to ten grains, three times a day. It may be given in sugared water. An ointment (Potass, bromid. ^ss—zj ; Adipis, ^j ;) has been rubbed on scrofulous swellings, and applied to cutaneous affections. Magendie adds bromine to it. (Potass. bromid. gr. xxiv; Bromin. gr. vj—xij ; Adipis, ^j.) 35. Bromide of Iron is made by heating equal parts of bromine and iron filings under water, filtering the fluid as soon as it becomes of a greenish colour, and evaporating to dryness. The reddish resi- due — again dissolved in water, and evaporated — is the bromide of iron. It has a brick red colour ; dissolves readily in water; is deli- quescent in the air, and has a very styptic taste. It may be used in the same cases and doses as iodide of iron. 36. The Protobromide, and 37, the Deutobromide of mercury resemble respectively, in their remedial powers, the iodide and red iodide of mercury. They are very little used. The testimonials in their favour are referred to in another work, (New Remedies, edit. cit. p. 341.) 38. SPON'GIA USTA.—BURNT SPONGE. Cal'cined or burnt sponge is prepared by taking a convenient quan- tity of ordinary sponge, cutting it into pieces, and beating it to sepa- rate extraneous matters from it; burning it in a close iron vessel until it becomes black and friable, and then rubbing it into very fine powder. Preuss calcined 1000 parts of sponge ; of these, 343,848 parts were destroyed by heat. The residue consisted of carbon and insoluble siliceous matters, 327.0; chloride of sodium, 112.08; sulphate of lime, 16.430; iodide of sodium, 21.422; bro- mide of magnesium, 7.570; carbonate of lime, 103.2; magnesia, 322 SPECIAL EUTROPHICS. 4.73 ; protoxide of iron, 28.720 ; and phosphate of lime, 35.0. If good, it ought to evolve the violet vapour of iodine, when heated in a flask with sulphuric acid. Since the discovery of iodine, burnt sponge has been almost laid aside as a medicinal agent. Its virtues are, doubtless, mainly de- pendent upon the iodine and bromine which it contains; yet a part may be owing to the animal charcoal, wdiich—as shown elsewhere— has been found efficacious in similar cases; and we can therefore understand, that burnt sponge may have occasionally proved ser- viceable after iodine had failed. It has been chiefly given in goitre, and in scrofulous affections, and in chronic cutaneous diseases. Its dose is from one to three drachms in syrup, molasses or honey. 39. O'LEUM JECORIS ASEL'LL—CODLIVER OIL. Codliver oil — also called O'leum Mor'rhua and Cod oil — is ob- tained, for commercial purposes, from several of the fishes belonging to the Genus Gadus; Ord. Malacopterygii thoracici; but especially from the codfish, coalfish and burbot. Several varieties of the oil are met with in commerce, which differ from each other by their lighter or darker hue, and their greater or less transparency. According to Riecke, the oil is obtained by exposing to the sun the livers of the fishes, above mentioned, cut in slices; and col- lecting the oil that runs out. The first obtained is the yellow oil, Oleum jecoris aselli flavum. If the livers are running gradually to putrefaction, the oil becomes of a chestnut brown colour— Oleum jecoris aselli subfusco-flavum ; and, lastly, after the oil has been ob- tained by these methods, some can still be procured by boiling the livers, which constitutes the Oleum jecoris aselli fuscum. One of these only, according to Dr. Pereira, and the same applies, we be- lieve, to this country, is to be met with in commerce in London. It is, probably, the second variety ; and is used by curriers for dress- ing leather. In Germany, the first variety seems to be most em- ployed. On analysis, it has been found to contain iodine and bromine in small proportion. In Belgium, the liver of the ray—Raj'a Pastina'ca, R. clava'ta and R. batis, is employed. It is said to contain more iodine, and to be less offensive than codliver oil. Codliver oil has long been a popular remedy in Germany, espe- cially in Westphalia — as well as in Holland, and, to a less extent, in England. It is of a repulsive taste, and generally induces nausea; yet patients are said to become soon accustomed to it; and children often take it without much repugnance. Where the stomach is readily disordered, it is rarely retained; but its retention is said to be facilitated, if a little claret be taken after it. The effect, which CARB0 ANIMALIS. 323 it induces upon the system of nutrition, when cachexia exists, is similar to that of eutrophics in general. It, doubtless, furnishes a modified chyle, and of consequence a modified blood : this induces a new action in the tissues, which it laves ; acting in these respects, like sugar, both dietetically and therapeutically. It has been sug- gested by some, that its remedial powers are owing to the iodine which it contains; but this is not believed by others. It has been brought forward with high encomiums in scrofula and rickets, and in every form of chronic rheumatism, in tuberculous cachexia, chronic cutaneous diseases, &c. It has likewise been used externally in opacities of the cornea, — a drop or two being placed on the cornea with a camel's hair pencil; and in various chronic cutaneous diseases. In some trou- blesome affections of the skin, especially of the hands, conjoining the characters of impetigo, with erysipelatous redness and swelling, and inducing severe sufferings, Dr. Marshall Hall speedily succeeded in restoring the textures to a healthy condition by its external use, after other remedies had been tried fruitlessly. For rhagades and chaps, he says, it is a preventive and a speedy cure, and it is produc- tive of great benefit in eczema, and other affections accompanied by excoriation and fissures of the skin. The dose of codliver oil is from half a tea-spoonful to three spoon- fuls two or three times a day. To children it is given by tea-spoon- fuls. Its unpleasant taste can scarcely be corrected by admixture with other agents ; for which reason it is preferred by some to give it in its pure state, and to take peppermint lozenges afterwards. It is also recommended to be given with coffee, lemon-juice, warm table beer, or in emulsion. 40. CARBO ANIMA'LIS. — AN'IMAL CHARCOAL. Animal charcoal may be prepared from any animal substance ; but, as directed in the Pharmacopoeia of the United States, it is ob- tained from bones, and constitutes the Ivory black of commerce. This is, however, in an impure state, and accordingly, a process for the CARBO ANIMA'LIS PURIFICA'TUS is contained in the Pharmacopoeia 01 the United States, which consists in pouring muriatic acid, previously mixed with water, gradually upon the charcoal, and digesting with a gentle heat for two days, occasionally stirring the mixture. The charcoal, which subsides, is washed frequently with water, until it is entirely freed from acid, and is then dried. Animal charcoal is an ancient remedy, which Dr. Christison erroneously affirms to be now entirely abandoned. It is, indeed, much used in Germany, at the present day, as a eutrophic in scrofulous and cancerous affections; and like burnt sponge — although it con- tains no iodine — has been employed with success in goitre, It has been suggested, that farther trials might show, that it may be used in the place of iodine; but it is doubtful, whether the properties of 324 SPECIAL EUTROPHICS. the two substances can be regarded as at all analogous ; and whether animal charcoal be possessed of any other properties than those usually ascribed to charcoal. It is given in doses of from half a grain to three grains two or three times a day, mixed with sugar, or liquorice powder. It has, also, been sprinkled on the callous edges of cancerous ulcers ; and has been used in the form of ointment, as a discutient, in scrofulous sw7ellings. It is employed in many processes of pharmacy as a de- colorising agent. 41. CAL'CII CHLO'RIDUM. —CHLORIDE OF CAL'CIUM. Chloride of calcium, Hydrochlorate or Muriate of lime, w7hich — as its name imports — is a compound of chlorine and calcium, is made by saturating muriatic or chlorohydric acid w7ith carbonate of lime; drying the salt, exposing it to heat, and then keeping it in well stopped vessels. It is not in the list of preparations, but in that of the Materia Medica of the Pharmacopoeia of the United States. It exists in sea water, and in many mineral springs; in some of which it is considered to constitute the active ingredient, as in the springs of Airthrey, Pitcaithley, and Dumblane in Perthshire, Scot- land. (Christison.) It is also obtained from the residuum of cer- tain officinal preparations, as from the manufacture of carbonate of ammonia, solution of ammonia and spirit of ammonia; from which, indeed, it is usually procured by the manufacturing chemist. Chloride of calcium is colourless, slightly translucent, solid, hard, friable, deliquescent, and wholly soluble in water. Its taste is bitter acrid and saline. In large doses, chloride of calcium appears to be an irritant poison, but in small doses, it has been administered, and with ad- vantage, in scrofulous cases, as a eutrophic. With this view, it must be continued for some time. It has been considered as one of the most important ingredients in many mineral waters, that have seemed to be beneficial as alteratives. It is generally given in the form of LIQUOR CAL'CII CHLO'RIDI, SOLUTION OF CHLORIDE OF CALCIUM, Solution of .Muriate of lime. (Marmor. in frustul. ^ix ; Acid, muriat. Oj ; Aq. destillat. q. s. The acid is mixed writh half a pint of water, and the marble gradually added ; chloride of calcium is formed in the manner previously mentioned; which is dissolved in its weight and a half of distilled water, and the solution is filtered.) The dose is from f. 3ss to f. 3j gradually increased. It may be taken in sugared water or in milk. Chloride of calcium is sometimes also used as a wash to scrofulous sores and chronic cutaneous affections. (Calcii chlorid. 3J — ij ; ARSENICI PRiEPARATA. 325 Aqua destillat. f. 3 viij;) and, also, in the form of ointment, (Calcii chlo- rid. 3J ; Adipis, §j ;) in similar cases. 42. BA'RII CHLO'RIDUM. — CHLORIDE OF BA'RIUM. Chloride of barium, or Muriate of baryta, Bar'yta murias, is made by gradually adding Carbonate of Baryta to diluted muriatic acid, to saturation ; filtering the solution, and evaporating, so as to form crys- tals, which are right rhombic plates or tables; sometimes double eight-sided pyramids. Its density is 2.82, and taste disagreeable and bitter. It is wholly soluble in water — 100 parts of w7ater at 60° dissolving 43.5 of the crystallised salt, —at 222°, 78 parts. It is slightly soluble in the alcohol of the pharmacopoeias, but is said to be insoluble in pure alcohol. In large doses, chloride of barium acts like the acro-narcotic poisons — and may induce death. In small medicinal doses, its effects appear to be analogous to those of chloride of calcium, and it has been given in the same cases. It has been chiefly prescribed in scrofula ; but, at times, in other dyscrasies ; and in chronic cutaneous diseases, bronchocele, &c. It has been used as a topical application in chronic cutaneous affections, and as a collyrium in strumous ophthalmia, and in opacities of the cornea ; and, as an ointment (Barii chlorid. gr. iv ; Adipis, ^j) has been applied to strumous sores, and to chronic cuta- neous affections. It is usually administered in the form of the LIQUOR BA'RII CHLO'RIDl, SOLUTION OF CHLORIDE OF BARIUM. Solution of Muriate of Baryta. (Barii chlorid, ^j ; Aqua destillat. f. ^iij.) The dose of this solution is five drops three times a day, gradually in- creased till it induces nausea or vertigo ; when the dose should be diminished. It is much employed in pharmacy, as a test for sulphu- ric acid and the sulphates. ARSEN'lCI PR^EPARA'TA. -- PREPARATIONS OF AR'SENIC The various preparations of arsenic are possessed of eutrophic virtues, and when continued for a proper length of time so alter the function of nutrition as to remove diseased actions, which have been going on, often unmodified by other agents. In chronic cutaneous diseases, — for example, lepra, psoriasis, impetigo, &c, arsenic has been found a most valuable agent; and often the beneficial results have occurred without any other manifest effects having been pro- duced by the remedy. In all cases, however, the results should be watched, and if any of the phenomena that have been referred to elsewhere, (Vol. ii. p. 83,) and that are fairly ascribable to the ad- ministration of the arsenic, be observed, it must be discontinued, or the dose be diminished, as the case may seem to require. This, in- deed, applies to all cases in which arsenic is given as a eutrophic ; vol. n.—28 326 SPECIAL EUTROPHICS. inasmuch as — like every other remedy belonging to the class — a protracted use of it is necessary before wre can expect to break in upon the vice in the system of nutrition. It is as a eutrophic, too, that arsenic has been recommended in syphilis, syphiloid and rheu- matic affections, and in cancer, in which it would seem to have oc- casionally rendered service. 43. ACIDUM ARSENIO'SUM. — ARSE'NIOUS ACID. ArsenijOiis acid — wdiose properties have been detailed elsewhere, (Vol. ii. p. 83,) — is the form in which arsenic is generally adminis- tered in the above mentioned diseases, in which it may he given in the dose of one-tenth to one-eighth of a grain, made into a pill w7ith crumb of bread ; or the LIQUOR POTAS'SJE ARSENI'TIS (Vol. ii. p. 85,) may be given in the dose of eight or ten drops two or three times a day. The Pilulae Asiatica or Asiatic pills are made of Arsenious acid, gr. Iv ; Black pepper powder, ^ix ; Gum arabic, sufficient to make 800 pills, each of which contains about one-twelfth of a grain of arsenious acid. They are much employed in India, in cases of syphi- lis, elephantiasis, and other cutaneous diseases. 44. ARSE'NIAS AMMO'NLE. —ARSE'NIATE OF AMMO'NIA. This preparation is made by taking arsenic acid one part, dissolv- ing it in water, and adding pure or carbonated ammonia sufficient to saturate it; — or, as follows:—take of arsenious acid, one part; nitric acid, four parts ; muriatic acid, half a part,— saturate the solu- tion with carbonate of ammonia, and let the arsenical salt crystallise. This salt has been employed in several inveterate cutaneous diseases, and especially in psoriasis inveterata. One grain may be dissolved in an ounce of distilled water; and 20 to 25 drops of the solution be begun with daily, gradually increasing the dose, until it reaches a drachm or more in the twenty-four hours. The Arseniate of soda — in solution termed Aqua arsenicalis Pearsonii, and by the French Solution de Pearson — is possessed of the same properties as arseniate of ammonia. Of the virtues of the Iodide of Arsenic, and the Iodide of Mercury and Arsenic, the author has already treated, (Vol. ii. p. 318.) 45. FERRI ARSE'NIAS. — ARSE'NIATE OF IRON. Arseniate of iron— which occurs naturally as scorodite, and is pre- pared artificially by double decomposition, according to a process given elsewhere — (New Remedies, 4th edit. p. 267, Philad. 1843,) has been recommended both as an internal and an external remedy in cancerous formations. Its external application has been given al- ready, (Vol. ii. p. 280.) It has been prescribed internally in the form of pill, (Ferri arseniat. gr. iij; Extract, gentian. 3iss ; Syrup, vel AURUM METALLICUM. 327 Aquae, q. s. ut fiat massa in pilulas xlviij dividenda. Dose, one, three times a day.) AURI PR-EPARA'tA. -- PREPARATIONS OF GOLD. The preparations of gold have long been used in medicine, but they had been wholly abandoned, until they were revived upwards of thirty years ago by M. Chrestien; since which they have been much employed, and some of them are received into the Pharmaco- poeias of Continental Europe. They all agree in their action on the economy. The effects of some of these preparations in large doses are corro- sive ; but in medicinal doses, they have exhibited valuable eutro- phic virtues. The secretions appear to be increased ; and occa- sionally actual salivation ensues, which differs from; that induced by mercury— being always slow in appearing, and by no means so ex- hausting ; nor do troublesome ulcerations occur; whilst the saliva is thinner, and not so tenacious. An aural fever like the mercurial, can also be caused by it. Possessed of these properties, it is not surprising, that the prepar- ations of gold should have been prescribed in the same diseases as mercury. The testimony of many observers is recorded in their fa- vour in syphilis. It would seem, that their action is slow. In some forms of scrofula, too, — as strumous ophthalmia, and strumous por- rigo, — they would seem to have been efficacious. Experiments, however, have been discordant, even in regard to the activity of some of the preparations — the chloride or muriate of gold having been given in large doses by MM. Baudelocque and Velpeau, with- out inducing any irritant effects. They have, likewise, been pre- scribed in scirrhous and cancerous affections rubbed upon the gums ; or in cancer of the uterus, rubbed on the labia pudendi. In every form of cachexia, they have been prescribed ; but they are not much used ; and one weighty objection to them—in the absence of any decided superiority over other agents — is, that they are extremely expensive. 46. AURUM METAL'LICUM. — METAL'LIC GOLD, has been given largely, and, according to some, successfully, but, according to others, it has no action on the economy. It would be strange, indeed, if a substance, so difficult of oxidation, should have any effect. It has been prescribed in the dose of from a quarter of a grain to a grain. Gold powder — Pidvis auri— may be obtained by amalgamating gold and quicksilver, and driving off the latter by heat. It may also be prepared by throwing it down from a dilute solution in nitre-muriatic acid by means of green sulphate of iron. From one to three grains, mixed with powdered starch, have been rubbed on the tongue. 328 SPECIAL EUTROPHICS. 47. AURI CHLO'RIDUM.—CHLORIDE OF GOLD. This preparation, called also Mu'riate of gold and Terchlo'ride of gold, is received into several of the European pharmacopoeias. It is made by digesting one part of gold leaf in three parts of nitro-mu- riaticacid in a sand bath, and evaporating gently to dryness. This is one of the most active salts of gold, greatly resembling corrosive muriate of mercury in its operation on the economy. Even a tenth of a grain, according to Orfila, has induced unpleasant irrita- tion of the stomach; yet, we have seen, it has been given to a much greater extent without inconvenience. It has been prescribed both in- ternally and externally, in syphilitic, hydropic, strumous and other ca- chexiae. Its dose is one-sixteenth to one-twelfth of a grain, gradually but slowly increased ; or it may be rubbed on the gums. It has also been applied externally in the form of ointment, (Auri chlorid. gr. iv : Adipis, 3j ;) or as a collyrium in scrofulous ophthalmia, (Auri chlorid. gr. ij; Aqua, f.gvj.) 48. AURI ET SO'DII CHLO'RIDUM.— CHLORIDE OF GOLD AND SO'DIUM. This salt — called also Mu'riate of gold and so'dium, and Au'ro- terchlo'ride of so'dium — is likewise in some of the pharmacopoeias of Continental Europe. It may be prepared by dissolving four parts of gold in aqua regia, and evaporating the solution to dryness; adding thirty-two parts of water, and one part of chloride of sodium, and evaporating to one-half. On cooling, crystals will form. It is milder than the last preparation, but may be employed in similar cases, doses, and modes of administration. 49 AURI CYANURE'TUM. — CYAN'URET OF GOLD. Cyan'uret, Cy'anide, or Tercy'anide of gold, may be prepared by carefully adding a solution of cyanuret of potassium to one of chlo- ride of gold, until a precipitate — cyanuret of gold — ceases to fall. It has been given in powder, mixed with gum arabic powder or sugar, in the dose of from one-sixteenth to one-tenth of a grain and more ; or rubbed on the gums, associated w7ith orris powder, in syphilis and scrofula. It may, likewise, be prescribed in solution. (Auri cyanuret. gr. iij ; Aqua f. 3viiss ; Alcohol, f. 3ss.) Dose, a tea- spoonful twice a day, gradually increased. 50. AURI IOD'IDUM. — I'ODIDE OF GOLD. Iodide of gold is directed, in the French Codex, to be made by adding a solution of pure Iodide of potassium to a solution of Chlo- ride of gold. The iodide of gold, which is precipitated, is collect- ARGENTI PRjEPARATA. 329 ed on a filter, and washed with alcohol to remove the excess of iodine precipitated with it. It has been used in the same cases as the other active preparations of gold, in the dose of from one-fif- teenth to one-tenth of a grain. It may also be made into an oint- ment, and be applied to syphilitic ulcers. 51. AURI OX'IDUM. — OXIDE OF GOLD. Oxide, Teroxide, or Peroxide of gold, or Auric acid, is directed in the French Codex to be prepared by boiling four parts of cal- cined magnesia with one part of terchloride of gold and forty parts of distilled water. The oxide is then washed, first with water to remove the chloride of magnesium, and afterwards with dilute nitric acid to dissolve the excess of magnesia. It has been administered in the dose of from one-tenth of a grain to a grain in the same cases as the other preparations of gold. These are the chief preparations of gold that have been employed in medicine. For a more detailed account of their reputed virtues, see the author's New Remedies, edit. cit. p. 83. 52. ARGEN'TI PR^EPARA'TA. — PREPARATIONS OF SILVER. Of late years, various preparations of silver have been introduced into practice as eutrophics in the same diseases as the preparations of gold, and especially in syphilis, by M. Serre, Professor of Sur- gical Clinics at Montpellier. He employed the chloride, cyanuret, and iodide ; divided metallic silver, the oxide, and the chloride of ammonia and silver. At first, these w7ere administered iatralepti- cally ; the chloride, the cyanuret, and the iodide in the quantity of one-twelfth of a grain ; the chloride of silver and ammonia in the quantity of one-fourteenth of a grain ; and the oxide of silver, and divided silver in the dose of one-eighth and one-quarter of a grain, respectively. These doses were often found, however, to be too small; he, therefore, raised those of the chloride and the iodide to one-tenth and one-eighth of a grain. The other preparations were augmented in the same proportion, with the exception of the chlo- ride of silver and ammonia, which required more precautions than any of the others. M. Serre gave them internally also.* The result of the observations of others has not confirmed those of M. Serre. M. Ricord employed the various preparations, made ac- cording to the formulae of M. Serre, in the same doses; but not be- ing able to observe any effect that could be fairly ascribed to those agents, he ventured upon considerably larger doses — as much, for example, as twelve grains a day of the iodide and cyanuret—-but without any marked results. In this country, the preparations of silver have been but little used in syphilis, nor do they appear to merit special attention. For 28* 330 SPECIAL EUTROPHICS. the testimony adduced in their favour, and the mode of preparing and exhibiting them, see the author's New Remedies, 4th edit. p. 62. 53. The Preparations of Plat'inum, it is affirmed, possess pro- perties analogous to those of the preparations of gold and silver. 54. FERRI PRiEPARA'TA. —PREPARATIONS OF IRON. The various preparations of iron are employed occasionally in cancerous and other cachexiae, as well as in lupus, and chronic cu- taneous diseases; but the subcarbonate of iron, (Vol. ii. p. 53,) is calculated to answer all the purposes of the other chalybeates. It has been prescribed, in very large doses, in enlargements of the spleen, accompanying or succeeding to intermittents, and often with excellent effect. It may be given in doses of from gr. x to zj and more, three times a day. 55. ALKA'LIA.—AL'KALIES. Alkalies have been long employed under the idea that they ren- der the blood thinner, and might soften down obstructions and re- move tumours; hence they have been freely exhibited in all hyper- trophied conditions of the lymphatic ganglions and of the glandular organs; but they are not much relied upon at the present day, although they doubtless have considerable power in modifying the condition of the circulating fluid, and consequently, that of the tis- sues which it bathes. In various cachexiae— the syphilitic and the strumous especially—they have been considered by many to have proved extremely serviceable. Like mercurials, too, they are pre- sumed to exert a beneficial action on the blood when given in diph- theritic inflammations, or those that are apt to end in the extravasation of an albuminoid secretion. Hence, they have been administered in croup and in diphtheritis in general. Under similar views in regard to their powers as eutrophics, they have been prescribed in chronic cutaneous diseases, and wherever it has been desirable to excite a new action in the system of nutrition generally or partially. With these views, any of the alkalies may be given; but the Liquor Potassje is most frequently chosen. It may be prescribed in the dose often drops, gradually increased to f. z] or more. (See Vol. i. p. 296.) 56. AC'IDA MINER.VLIA.—MIN'ERAL ACIDS. Nitric Acid, (Vol. ii. p. 71,) does not perhaps possess any pro- perties wdiich especially adapt it as a eutrophic; yet it is the acid which, by common consent, appears to be selected. It has been CHLORINUM. 331 extensively used in syphilitic cachexia, as a substitute for mercury; and has unquestionably been of service, especially where mercury has not agreed. It may not, however, have exerted any energetic action on the disease ; for it is now admitted, that syphilis can, in the generality of cases, be cured without the use of that mineral. Much reliance is not now placed in it, howrever, although it is still occasionally prescribed. It has, likewise, been given internally in chronic liver disease, especially in India ; but it is not clear that its beneficial agency in such cases is not owing to its tonic influence on the stomach. It is not unfrequently used as a tonic in chronic dis- ease, and in convalescence from acute diseases, either alone or asso- ciated with bitter infusions. The dose of the dilute acid of the Pharmacopoeia of the United States is from gtt. xx to gtt. xl three times a day. An ointment of nitric acid, (Vol. ii. p. 261,) is used in various chronic cutaneous diseases, especially in porrigo and scabies, and as an application to syphilitic sores. ACIDUM NITROMURIAT'ICUM, NITROMURIAT'IC ACID. (Acid, nitric, f. giv ; Acid. Muriat. f. ^viij.) This acid has been introduced into the last edition of the Pharmacopoeia of the United States. It is also termed Nitro-hydrochloric acid, and Aqua regia. It has been used as a eutrophic in the same cases as nitric acid, and is employed also ex- ternally in syphilis and chronic liver affections. It is applied in the form of pediluvia, — the legs, thighs, and body being, at the same time, sponged with it. An ounce and a half of the acid may befadded to a gallon of water, and the patient may keep his feet in the bath for twenty or thirty minutes. It produces more or less pricking of the surface, and is said at times to induce soreness of the mouth and increased flow of saliva. The effects of the bath have been ascribed to the chlorine evolved. The dose of the nitromuriatic acid in the above mentioned cases may be ten or fifteen drops diluted with water, two or three times a day. 57. CHLO'RINUM oh CHLORIN'IUM.—CHLORINE. Chlorine is most commonly prepared by mixing intimately three parts of dried chloride of sodium with one part of oxide of manganese; and then, in a retort, adding as much sulphuric acid, previously mixed with its own weight of water, as will form a mixture of the consistence of cream. By applying a gentle heat, chlorine gas is evolved copiously, and may be collected over water. In this pro- cess, the chloride of sodium is decomposed, and the oxide of man- ganese parts with a portion of its oxygen to convert the sodium into soda ; with which, as well as with the oxide of manganese, the sul- phuric acid unites, and the chlorine is set free in the form of gas. Chlorine gas is of a greenish yellow colour, of a peculiar strong, 332 SPECIAL EUTROPHICS. disagreeable, stifling odour; and is irrespirable, except when very largely diluted with air. Of its effects when inhaled, mention has been made under Expectorants, (Vol. i. p. 252.) Fumigations of chlorine gas were particularly recommended, about twenty years ago, by Dr. Wallace, of Dublin. They would seem to resemble, in their action, the nitric and nitro-muriatic acid baths ; the latter of which has been supposed to owre its efficacy to chlorine. It has been used advantageously in chronic liver diseases, especially w7here there is disordered secretion of the liver; and in many other morbid conditions, as hypochondriasis, cachexiae, and in all affections in which a prolonged excitation of the skin, and a restoration of its suppressed or impaired functions could be esteemed serviceable ; — hence in old cases of syphilis, scrofula, chronic rheu- matism, chronic cutaneous affections — as lepra, psoriasis and scabies — and in many of these it has been highly beneficial. Aqua Chlo'rini, Solu'tion of chlorine or Liquid oxymuriat'ic acid, and is contained in many pharmacopoeias. It is in those of Edinburgh and Dublin. In the former, it is directed to be pre- pared as follows : — Take of muriate of soda, gr. 60 ; sulphuric acid, (commercial,) f. ^ij ; red oxide of lead, gr. 350 ; water, f. §viij. Triturate the muriate of soda and the oxide together ; put them into the water contained in a bottle with a glass stopper ; add the acid ; and agitate occasionally till the red oxide becomes almost white. Allow the insoluble matter to subside before using the liquid. Chlorine water has been occasionally given internally in chronic diseases of the liver ; in many chronic cutaneous affections ; and in various cachexiae, especially the syphilitic and strumous. In a di- lute state, it has been used as a w7ash in skin complaints, and in atonic and malignant ulcers — partly, however, with the view of cor- recting the foetor, in which cases — as will be seen hereafter — it often serves a highly useful purpose ; with this view, however, some of the chlorinated preparations are most frequently employed. It has been used, also, like the nitro-muriatic acid, as a bath in hepatic and syphilitic diseases. Chlorine water is very liable to be decomposed, and therefore it ought never to be prescribed in quantity larger than is necessary for the twenty-four hours, as, by frequently opening the vial in which it is contained, decomposition readily ensues. The vial should be put into a dark place, and be surrounded by black paper. The dose of the Aqua Chlorini of the British pharmacopoeias is f. jss to f. ^ss. An ointment is sometimes prepared with it ; (Aqua chlorin. p. j ; Adipis, p. vij ;) which is used in scabies. It is made, also, into a liniment, (Aq. chlorin. %j ; 01. oliv. ^j ;) wdiich is used in scabies, porrigo and herpes ; and, at times, is prescribed as a gargle in ulceration and chronic inflammation of the mouth and fauces. CALX CHLORINATA. 333 58. CALX CHLORIN A'T A.— CHLO'RINATED LIME. Chlorinated lime or Chloride of lime, Hypochlo'rite, Chlorite or Oxymu'riate of lime, bleaching powder, is a compound resulting from the action of chlorine on hydrate of lime. It is prepared on a very large scale for the use of bleachers ; and, therefore, is amongst the list of articles of the materia medica in the Pharmacopoeia of the United States. The London College has, however, a form for its preparation, which consists in passing the vapour of chlorine into lime, until it is saturated. The chlorine is disengaged by the ac- tion of chlorohydric acid on oxide of manganese. The nature and composition of this chemical is a subject of dis- pute ; and hence the term chlorinated lime, which has been adopted by the London, Edinburgh, and United States Pharmacopoeias, in place of chloride of lime. It is of a grayish white appearance, pulverulent, dry, or but slightly moist, and wholly dissolved by chlorohydric acid with the disengagement of chlorine. It is often of very inferior quality, either owing to the lime having been insufficiently charged with chlorine, or to its having been exposed to the air, so that chlo- ride of calcium and carbonate of lime result. Chlorinated lime — like chlorine, on w7hich its virtues are really dependent—has been administered in scrofulous cachexia, and es- pecially in scrofulous swellings ; it is rarely, however, given inter- nally as a eutrophic. Externally, it is applied in many cases, — in torpid ulcers of various kinds — the phagedenic, scrofulous, syphili- tic, cancerous, gangrenous, &c, in which it acts as an excitant or antiseptic. It is employed, also, in strumous swellings of the glands, joints, &c, in goitre, and in various chronic diseases of the skin. Dr. Christison affirms, that he never uses any other remedy in itch. " A solution, containing between a fortieth and sixtieth part of chlo- rinated lime, applied five or six times day, or continuously with wet cloths, allays the itching in the course of twenty-four hours, and generally accomplishes a cure in eight days." When given internally, the dose may be gr. j to gr. iv, two or three times a day, in pill or in solution. When applied externally, it may be dissolved in water in various proportions, (f. jj to f. ^ss to f. §viij of water.) In cases of itch, the strength has sometimes been — chlorinated lime, Z.YY], water, Oj. In the form of ointment, (Calcis chlorinat. gj ; Adipis, ^j,) it has been rubbed on scrofulous swellings, goitre, &c, and it has been occasionally applied as a cata- plasm, (Calcis chlorin.; Sodiichlorid. aa Jss ; Aqua destillat, Oss; Farina sem. lini, q. s. ;) to scrofulous tumefactions of the joints. Chlorinated lime enters into the formation of the next prepara- tion. 334 SPECIAL EUTROPHICS. 59. LIQUOR SOD.E CHLORINA'T^E.— SOLUTION OF CHLO'RINATED SODA. This preparation, called also Hypocjilor'ite of soda, Labarraque''s Soda disinfect'ing liquor, and Oxymur'iate of soda, is made by dissolving carbonate of soda in water, and chlorinated lime in a separate portion; setting the latter aside until the dregs subside: then decanting the liquor, and mixing the two solutions ; again de- canting the clear liquor from the ^precipitated carbonate of lime by passing it through a linen cloth, and keeping it in bottles secluded from the light. Solution of chlorinated soda, thus prepared according to the di- rections of the Pharmacopoeia of the United States, is a colourless liquid, having a slight odour of chlorine. Its taste is astringent; and like chlorine, and all the chlorinated preparations, it destroys vegetable colours. In regard to its chemical constitution, the same remarks are applicable as were made on chlorinated lime. In its therapeutical properties, chlorinated soda resembles chlori- nated lime, and has been given both internally and externally in the same cases. It is preferred, however, for internal, whilst chlorinated lime is generally chosen for external use. The dose is from ten drops to a fluidrachm in plain or sugared wa- ter. When used externally, it is generally diluted with from five to ten parts of water, as an application to chronic cutaneous diseases, ulcers of various kinds, burns, &c. 60. SULPHUR. The general properties of sulphur have been described before, (Vol. i. p. 156.) As a eutrophic, it is mainly used in chronic cuta- neous diseases, and especially in scabies, in wdiich it is employed both internally and externally. Associated with guaiacum, it is sometimes prescribed in gout and acute rheumatism, (see Vol. i. p. 319,) in which case it is presumed to act as an excitant diaphoretic. Dr. Pereira states, that after an attack of acute rheumatism, when the joints were left in a swollen and painful state, he has seen sul- phur prove highly useful; but this was only in one case. The'popular form in which it is taken, mixed with ardent spirit, would adapt it rather — if it be adapted at all — for the chronic form of those dis- eases. It certainly passes through the cutaneous capillaries, and is disengaged from them, as is evidenced by a silver watch becoming blackened, when sulphur or a sulphuret is taken : but the quantity passing through any particular portion of the capillaries, at any one time, must be exceedingly minute, and incapable, perhaps, of ex- erting much medicinal agency on cutaneous or other local affections, Hence, the external use is always, in such cases, combined with the internal. SULPHUR. 335 Under chlorinated lime, (Vol. ii. p. 335,) it was stated that Dr. Christison had found it an adequate substitute for sulphur in scabies, but, on the whole, sulphur is the most certain application. It is, how- ever, so offensive, and its odour is generally considered to reveal so completely the nature of the disease for which it is used; that every endeavour has been made to discover some agent that may be equally sure, and less objectionable. The discovery of the the itch insect—Acarus scabiei—has led to the supposition, that the modus operandi of sulphur, in the cure of scabies, may consist in its destroying the parasite. The precise connexion, however, of the insect with the itch, is not yet clearly ascertained ; and, moreover, sulphur— as already remarked—has been found efficacious in other chronic cutaneous diseases. Sulphur has long been regarded by the people as a great eutrophic or purifier of the blood, and even at this day it is often given in families with this view, at spring and fall. Either SULPHUR or SULPHUR PR^CIPITATUM (Vol. i. p. 158,) may be prescribed in the dose of 3SS to >y, and more, in milk ; or it may be mixed with molasses, equal parts of each, and a tea-spoonful be taken night and morning. Bitartrate of potassa is sometimes added to it. As elsewhere remarked, sulphur, when converted into sulphurous acid by burning, and applied to the cutaneous surface in the form of an air bath, is often a valuable remedy. As such it has been used in various diseases in which an excitant influence to the skin is in- dicated. In cutaneous diseases of an inveterate kind, as scabies, im- petigo, and the different squamous affections, it has succeeded when other remedies had failed. The gas is exceedingly irritating, and, therefore, it must be prevented from entering the air passages. Sulphur is, however, most frequently employed externally, in one of the following forms. UNGUENTUM SIIL'PHURIS, SULPHUR OINTMENT, (Sulphur, Ifej ; Adipis, Ifcij.) This ointment, also called Itch Ointment, Brimstone Oint- ment, is the mildest form that is used, and especially applicable to scabies in children. Both this and the next preparation may be rub- bed over the affected parts, before the fire, night and morning, for five or six days, the patient wearing the same clothes. He may then be thoroughly washed, and have an entire change of clothes. In the generality of cases, three or four thorough inunctions will be sufficient; and, according to some, only one, provided the body be covered all over with it. Some essential oil, as the oleum limonis or oleum bergamii, is added at times; but the smell of the sulphur is always predominant. UNGUENTUM SUL'PHURIS COMPOS'ITUM, COMPOUND SULPHUR OINTMENT. (Sulphur. 3J ; Hydrarg. ammon. ; Acid. Benzoic, aa 3J; 01. Ber- o-amii, Acid, sulphuric, aa f. 3J ; Potassce nitrat. 31); Adipis, fbss.) This is a more irritating itch ointment. 336 SFECIAL EUTROPHICS. The Compound sulphur ointment, of the London Pharmacopoeia, is formed of Sulphur, tbss ; Veratr. alb. pulv. ^ij; Potass, nitrat. 3J ; Sapon. mollis, ffess ; Adipis, fbiss ; 01. Bergamii, n\,xxx. 61. POTAS'SII SULPHURE'TUM.— SULPH'URET OF POTAS'SIUM. Sulphuret of potas'sium, Hepar sulph'uris, or Liver of sulphur is made by rubbing carbonate of potassa, previously dried, w7ith sulphur, in due proportions; melting the mixture in a covered crucible over the fire ; pouring it out, and, when cold, keeping it in a well-stopped bottle. This is the mode of preparation adopted in all the British Pharmacopoeias, as well as in that of the United States. It is of a brown- ish yellow colour when freshly broken. Its taste is acrid, bitter, and alkaline. It is devoid of smell when perfectly dried, but, when moistened, it acquires the odour of sulphohydric acid. Under ex- posure to the air, it takes oxygen, and undergoes changes, which end ultimately in the formation of sulphate of potassa, and free sul- phur. It is soluble in water, to which it imparts an orange yellow colour, and a strong sulphureous odour. The stronger acids de- compose it, throwing down sulphur, and disengaging sulphohydric acid. In large doses, sulphuret of potassium is an acro-narcotic poison; but in medicinal doses, it has been administered in chronic cuta- neous diseases. It is supposed, also, to be possessed of eutrophic powers in diphtheritic affections, and in glandular enlargements of a scrofulous character. It has, likewise, been used externally in va- rious skin diseases, especially in scabies, in which sulphur is so beneficial. The dose may be three to ten grains, made into pill and given three times a day ; or it may be dissolved in syrup. In the form of bath, it has been used in skin complaints in the proportion of one part of the sulphuret to one thousand of water. A lotion, (Potass. sulph. 3ij; Aqua, Oj) ; and an ointment, (Potass, sulphur. 3ss; Adipis, 3J,) are sometimes used. 62. ANTHRAKOK'ALI. This article was introduced in 1837 by Dr. Polya of Pesth. Two forms are employed, the simple and the sulphuretted. The former is prepared by dissolving carbonate of potassa in 10 or 12 parts of boil- ing water, and adding as much slaked lime as will separate the potassa. The solution, thus obtained, contains only caustic potassa. The filtered liquor is placed on the fire in an iron vessel, and suffered to evaporate until neither froth nor effervescence occurs, and the liquid presents a smooth surface like oil. To this is added the levi- gated coal in the proportion of 160 parts to 192 parts of potassa. The mixture is stirred, and removed from the fire, and the stirring POTASSAE CHLORAS. 337 is continued until a black homogeneous pow7der results. This is kept in a dry place. To obtain the sulphuretted anthrakokali, 16 parts of sulphur must be accurately mixed with the coal, and the mixture be dissolved in the potassa as directed above. By M. Polya anthrakokali was prescribed as a eutrophic in chronic cutaneous affections. It is also said to have been given beneficially in scrofula and chronic rheumatism. The dose of the simple and sulphuretted preparations is a grain and a half three times a day. 63. FULIG0K7ALL This is a substance analogous to the last. It is prepared by boiling for an hour 20 parts of potassa, and 100 parts of shining soot, in powder, in,a sufficient quantity of water. The decoction is then suffered to cool. It is diluted with water, so that filtration may be better accomplished ; is filtered, evaporated, and dried, and then en- closed in dry and warm bottles. A sulphuretted fuligokali is prepared of fuligokali 60 parts ; po- tassa 14 parts ; and sulphur, 5 parts. The sulphur and potassa are dissolved in a little water; the fuligokali is then added, and the whole is evaporated ; the residuum being dried and enclosed in dry and warm bottles. Fuligokali has been prescribed both internally and externally, but chiefly in the latter mode, in various chronic cutaneous diseases. An ointment may be made of either the simple or the sulphuretted article, by mixing one or two parts with thirty of lard. M. Gibert ascribes to them resolvent, detergent, and slightly excitant virtues. Mr. E. Wilson thinks it probable that both anthrakokali and fulip^ kali owe much of their therapeutic agency to the alkali which forms their basis. He has employed fuligokali in several cases, and espe- cially in psoriasis palmaris, and with more success than he has ob- tained from the usual remedies. What might be regarded as a weak solution of fuligokali, has been used for a long period by Drs. Physick, Dewees, and others, under the names of medical lye, soot-tea, alka- line solution, and dyspeptic lye (Mr. Duhamel, in Amer. Journal of Pharmacy, Jan., 1843. 64. POTAS'SA CHLORAS.—CHLORATE OF POTAS'SA. Chlorate, oxymu'riate or hyper oxy mu'riate of potassa may be pre- pared by passing chlorine gas slowly through a cold solution of po- tassa placed in a Woulfe's bottle. The liquid is allowed to stand for twenty-four hours in a cool place, and is then found to have de- posited crystals of chlorate of potassa ; which are drained, washed with water, dissolved in hot water and recrystallised. Professor Graham advises, that carbonate of potassa should be mixed intimately vol. ii.—29 338 SPECIAL EUTROPHICS. with an equivalent quantity of dry hydrate of lime, and the mixture be exposed to chlorine gas. The products are carbonate of lime, chlorate of potassa, and chloride of potassium. Chlorate of potassa may be separated by crystallisation. Chlorate of potassa crystallises in nearly rhomboidal plates. It has a cool taste, somewhat similar to that of nitre. One hundred parts of water at 59° Fah. dissolve six parts. This salt was at one time largely prescribed in consequence of its presumed action as a eutrophic, by imparting oxygen to the blood. Experiments have, however, shown, that it has been detected in the urine of patients who have taken it, which, of course, negatives the presumption. Finding that the salt gives a beautiful arterial colour to venous blood, Dr. Stevens prescribed it in fever, cholera, and other malignant diseases in which there appeared to be a deficiency of saline matter in the blood, but the testimony in favour of it is by no means potent. Recently, Dr. Henry Hunt has extolled it in can- crum oris — gangrenous stomatitis—given in solution, or divided doses, to the extent of from 20 to 60 grains in the twenty-four hours, according to the age of the child. It lessens — he says — the foetor and salivation, and promotes the granulation of the sores. Chlorate of potassa has been considered, also, as a diuretic and refrigerant, and to resemble nitrate of potassa, than which it is probably not possessed" of greater or of other virtues. The dose is from ten grains to half a drachm. 65. CAN/THARIS.—SPANISH FLIES. Cantharides — elsewhere described (Vol. i., p. 276,) — have been occasionally used in chronic cutaneous diseases—as lepra, psoriasis, and chronic eczema, and the squamous diseases of the skin. Biett and Rayer recommend it strongly ; but the objection to it is the irri- tation which it is apt to induce in the gastric and urinary organs. Its good effects are perhaps owing in part to the revellent influence which it exerts on these portions of the economy ; but they may also be dependent upon the modification induced by it on the blood, and through it on the morbid actions going on in the tissues. With this view, it should be given in small doses, not exceeding a grain, two or three times a day, in the form of pill; or ten or fifteen drops of the Tinctura cantharidis. 66. SAC'CHARUM. — SUGAR. The main properties of sugar were described in the first volume of this work, under Demulcent Expectorants, (p. 241.) It is as an agent, capable of modifying the functions of nutrition, that it has now to be regarded ; and the author is prepared to say, frOm an expe- rience of many years, that it is one of the most important agents for this purpose that we possess. In the first edition of his " Gene- ral Therapeutics" (1836,) he stated, that in many forms of ca- SACCHARUM. 339 chexia he had succeeded in producing a thorough revolution in the system of nutrition, by allowing the patient a certain quantity of sugar, formed into a syrup, and given to the adult in such quantity, that three or four ounces of the sugar might be taken daily, and for a long period — five or six weeks at the least. Under this diet or medi- cine,— for it is better, in order to infuse confidence, to give it as medicine, and to medicate it by the addition of a little rose-water, or some aromatic oil, — the patient has rapidly gained weight, and the action of the system of nutrition has been so much changed, that the cachexia, induced by poor living, and a residence in confined un- healthy situations, as well as that which characterises atrophy without any manifest cause, has been removed ; a complete renovation has taken place ; inveterate cutaneous diseases have disappeared, and old ulcers have filled up and cicatrised. The sugar, in these cases, appears to act as a substantive and adjective aliment — that is, it fur- nishes a richer and more abundant chyle ; and, moreover, puts the digestive organs in a condition to derive a larger quantity of nutriment from the food than they would otherwise do, — or it acts as a con- diment. It is in consequence of this altered condition of the circu- lating fluid, that the action of the vessels of nutrition into which it passes is modified, and the pathological catenation that constitutes the cachexia is broken in upon. If sugar be added to venous blood out of the body, it changes it to a bright arterial hue. (Hege- wisch.) When the functions of nutrition are morbidly affected, as in chronic cutaneous eruptions, there are two great methods in which we may reach the disease, — the one is by the application of external remedies to the diseased capillaries,—the other, by changing the impression made upon them internally by the fluid that circulates within them. Sugar — like arsenic, creasote, iodine, and other eutrophics—acts in the latter way. The great success wdiich the author has met with in the removal of inveterate eruptions from the administration of sugar, has induced him to infer, that many of the alterative syrups — officinal and empirical — may be mainly, and some of them wholly indebted for their efficacy to the sugar which they contain ; especially as he has not noticed the same good effects, wdien the other ingredients of many of these syrups have been given without the sugar. In the number of the American Medical Intelligencer for April 15, 1837, is published the case of a lady, from a distant city, who visited Philadelphia to place herself under the care of an eminent professional friend, who advised her to consult the author. Four years previously, her husband, who was a dissolute character, had contracted syphilis, and communicated it to her. She had applied to several physicians, but without experiencing much relief. Ulcerations existed on various parts of the body. There were nodes on the tibia and forehead; added to which she had been unable to sleep, in consequence of severe pains in the bones, for the eighteen months prior to her arrival in Philadelphia. In order that full opportunity might be afforded for 340 SPECIAL EUTROPHICS. her recovery, she took a house, had her furniture sent to her, and determined to reside during the winter in Philadelphia. She had already taken various forms of mercurials, and amongst the rest, the corrosive chloride of mercury, in the use of which she had persisted for a long time. It was, however, directed again by the author, so that she should take one-sixteenth part of a grain three times a day; and in addition to this, she was ordered to dissolve a pound of rock candy in a pint of water, and to take a wine-glassful four times a day. Under this course, the ulcers soon began to heal; the nodes disappeared; the pains in the bones ceased; her nights were passed in comfort; and at the end of five w7eeks, she was so well, that she determined to rejoin her family; quitted her house; removed her furniture, and went away with feelings of perfect recovery. She was recommended, however, to persevere in the plan advised. Since then, the author has not heard from her. Many similar cases have occurred to the author in which he has found the eutrophic influence of the saccharine treatment most sig- nally manifested. The remedy, however, is so simple, that it may be difficult to induce practitioner or patient to place much confidence in it; but if the former will reflect upon the indications which he desires to fulfil, and on the effect, which sugar is capable of inducing, like the other eutrophics wThose properties have been considered, he ought not to hesitate to admit it, and the result w7ill gratify, and, in many instances, astonish him. At the recommendation of the author, it has been prescribed by many physicians, and with results analogous to those he has described. A case of almost hopeless cachexia in a child has been published by Mr. Row- botham in the London Lancet, in which a diet of fruits and saccharine matter, — as honey, sugar and treacle — " snatched from the grave, and from a state, which perhaps no mortal was ever in before, and restored to health and life;" and according to the British and Foreign Medical Review, for Oct. 1842, in a treatise on rheumatic diseases had appeared at Leipzig in 1841, by Dr. Greiner, in which there is a " warmth of eulogium on sugar as one of the direct means of im- proving the blood," which " somewhat surprised " the reviewer. Dr. Greiner, it appears, strongly recommended it in both acute and chronic rheumatism, where sthenic excitement prevails, and anti- phlogistic means are indicated; but to be useful — he states — it must be taken in doses of from one to two ounces, three or four times daily in syrups, conserves, or plain. In the different diseased conditions for which the author administers it to modify the action of the vessels of nutrition, he is in the habit of recommending it in the form of syrup — either of the officinal syrup of the pharmacopoeia, or of one made extemporaneously by dissolving a pound of rock candy in a pint of water. Of this, a wine-glassful may be taken three or four times a day, between meals, and the quantity may be gradually increased. It is proper that the individual should take animal food along with it, otherwise scorbutic SARSAPARILLA. 441 cachexia may be induced; but the quantity of vegetable food may be diminished. The only accident that is apt to arise during its ad- ministration is diarrhoea; which soon, however, passes off, if the sugar be discontinued for a short time. It need scarcely be said that in morbid states, which have endured for a great length of time, no great benefit can be derived excepting from a persistence in the use of the remedy. Accordingly, much benefit may not be perceived until four or five weeks have elapsed, when, if advantage is to be derived, it will begin to appear. 67. SARSAPARIL'LA. This much employed root is referred, in the United States' Phar- macopoeia, to Smilax officinalis, and other species of Smilax; Sex. Syst. Dioecia Hexandria ; Nat. Ord. Similaceae ; a genus of creep- ers growing on moist river banks and woods in the hotter parts of North and South America, especially in Mexico, Columbia, Guiana, Brazil, and the Southern States of the Union. At least three species seem to be made out as furnishing the sarsaparilla or sarza of com- merce :— 1. Smilax officina'lis, which grows in New Granada, on the banks of the Magdalena, is transmitted in large quantities to Car- thagena and Mompox, whence it is shipped to Jamaica and Spain, 2. Smilax syphilitica, which was found by Humboldt and Bonpland in New Granada, and by Von Martius in the Brazils, and which is exported to Europe from the ports of Brazil. 3. Similax med'ica, which grows on the Eastern slope of the Mexican Andes, and is car- ried to Vera Cruz for exportation. There are still other species of similax; — for example, Smilax sarsaparilla, w7hich is a native of the Southern States ; but there is no evidence that it yields any of the sarsaparilla of the shops ; and the root would assuredly be dug up, and introduced into the market, if it had been found to possess the same properties as the imported article. (Wood & Bache.) Another species has been recently men- tioned by Piippig, under the name Smilax corda'to-ova'ta. It grows in Brazil, and supplies, in that country, a part of the root which is used in medicine. All the species of sarsaparilla plant have a rhi^ zoma, which sends out numerous long horizontal roots or runners, and these roots constitute the sarsaparilla of the shops. Several varieties of sarsaparilla are met with in European com^. merce, all of which have been described by recent pharmacologists, Of these, the most important are the following : — 1. Jama'ica Sarsaparil'la, Red, or Red-bearded Sarsaparilla, which is probably the root of Smilax officina'lis, and is made up in bundles of about a foot or a foot and a half long, and four or five inches broad, the roots scarcely equalling in thickness a goose-quill, and distinguished from the other varieties by the red colour of the epidermis. It receives the name Jamaica sarsaparilla, owing to its being sent thither from Honduras. Occasionally, it is exported from 29* 342 SPECIAL EUTROPHICS. Guatemala. This is the most esteemed variety in English pharmacy. 2. Hondu'ras Sarsaparil'la, or Mealy Sarsaparilla, is exported directly from Honduras bay, and some of it scarcely differs from Ja- maica sarsaparilla. Generally, the roots are folded, and formed into bundles two or three feet long, in which roots are found of inferior quality, with stones, pieces of wood, &c. The colour is dirty or grayish-brown. The epidermis is thin, and within it is a thick, white, amylaceous layer, which gives to it a mealy appearance when broken, — whence one of its names. Its botanical source is not accu- rately determined. It is the variety most commonly used in this country. 3. Brazil' Sarsaparil'la, Lisbon, Port'ugal, or Rio Ne- gro sarsaparilla, strongly resembles the last variety in its form, co- lour, and mealiness ; but it is generally exported unfolded, and tied in cylindrical bundles, three to five feet long, and about a foot in diameter. It has fewer radicals or rootlets than either of the other varieties. It is supposed to be the produce of Smilax syphilitica, and perhaps, also, of S. ovato-cordata, and is exported from Maran- ham chiefly. Being sent to Portugal, and especially to Lisbon, it obtains a name from those places. 4. Lima, or Valparaiso Sarsa- parilla was originally exported from Lima, but is now frequently obtained from Valparaiso, and at times from Costa Rica. Dr. Pereira states, that he knew of one importation of 99,000 lbs. from the last place. It is an inferior variety, commonly imported in large bundles, and resembles somewhat the Jamaica or Honduras variety. It is imported folded in bundles of about three feet long and nine inches in diameter, with the rhizoma or chump in the interior of the bundle. Its colour is brown or grayish-brown. Its botanical source is not known; but it has been presumed to be from Similax offici- nalis. 5. Vera Cruz Sarsaparilla indicates by its name the place whence it is exported ; but it is said not to be often met with. The roots are not folded, and have the rhizoma or chump attached. They are thin, tough, of a light grayish-brown colour, and devoid of starch in the cortex. It is the produce of Smilax med'ica. Besides these chief varities, other minor sarsaparillas are described by pharmacologists, but they are not of much interest to the physi- cian. Smilax China, or China root, a native of Japan, has been employed in the same cases as sarsaparilla. Sarsaparilla, as met with in the shops, is almost devoid of odour, but possesses a mucilaginous slightly bitter taste, and, when chewed for some time, causes a sensation of acridity in the mouth and fauces, which persists for a considerable period. According to Dr. Hancock, the Rio Negro sarsaparilla, which in his opinion is the only kind that possesses any activity, has a peculiar nauseous acrimony, which no other sarsaparilla possesses ; but if Dr. Hancock be right, the large quantities of the other varieties, which are alone prescribed by many physicians — who are notwithstanding ready to depose to its valua- ble properties— must have been devoid of action on the economy ; and if, as has been thought, the root is efficient in proportion as it SARSAPARILLA. 343 possesses the acrimony described above — which is said to be a vo- latile, easily destructible principle — then almost all the preparations, so long given, and implicitly relied on by many, must — as regards the sarsaparilla — have been wholly inoperative. Such might be the case with the Decoctum sarsaparilla compositum, and the Syrupus sarsaparilla compositus of the Pharmacopoeia of the United States, and with the decoctions and extracts of other pharmacopoeias in which heat is employed. According to Dr. Hancock, if the sarsa- parilla be really of good quality — which, however, he adds, is very seldom the case with w7hat is to be got in Europe —the only correct preparations of it are, — an infusion of the bruised root made by keeping it for some hours at 212° without boiling, and one prepared slowly without heat at all. These facts would of themselves throw strong doubts in regard to much of the testimony that has been brought forward in favour of this article of the Materia Medica; nor is any light thrown on the subject by the investigations of the chemical analyst. It has been repeatedly examined, but discrepant statements of its composition have been the result. It seems to contain Volatile oil of sarsapa- rilla, which has the odour and acrid taste of the root; Smi'lacin, called also Par'iglin, Salseparin, and Parallin'ic acid, which ap- peared to Palotta to act as a sedative in doses of two to thirteen grains; resin, and extractive, on which it has been thought a part at least of the medicinal properties depend, and starch. Smilacin is procured by decolourising a concentrated hot alcoholic tincture of sarsaparilla by animal charcoal. On cooling, the tincture deposits impure smilacin, which can be purified by repeated solution and crys- tallisation. The active principles of sarsaparilla reside chiefly in the cortical portion. They are imparted to water and to dilute alcohol. The quantity of sarsaparilla consumed is very great. In the year 1840, duty was paid in England on 121,814 lbs.; and the countries from which it was obtained in 1831 are thus stated by Dr. Pereira from a parliamentary return : — Portugal, ... - 16,110 Italy and the Italian Islands, - 107 British Northern Colonies, - 71 British West Indies, - 45,063 United States of America, - 29,122 Mexico, ---. - 43,254 Guatemala, - . 14 Brazil, - - 31,972 Peru, - 11,141 Total import, - 176,854 Returned for home consumption, - 107,410 344 SPECIAL EUTROPHICS. Dr. Christison states, that in 1821, the apothecary of one of the great London Hospitals informed him, that he had paid at that time .£1500 for a single year's consumption of it. Were wfe to be guided by the quantity consumed, sarsaparilla ought to be esteemed a most valuable therapeutical agent; yet the author has much difficulty in speaking positively on the subject. If he were to judge from the results of his own observation, he would say, that it is inert; and a consideration of the remarks already made in regard to the different varieties of the drug, and forms of prepara- tion, would tend to a similar conclusion ; yet when he observes so many persons offering their testimony in its favour, he is not pre- pared to decide, as Cullen did, that it is totally devoid of medicinal efficacy. Much, doubtless, is to be ascribed to the diet and regimen generally associated with it; much, in syphilitic and syphiloid dis- eases, to its frequently leading to the exclusion of mercury; and much, the author is disposed to think, to the substances that are as- sociated with it. "No donbt" — say the authors of a very recent work—Messrs. Ballard and Garrod—" chronic cutaneous affections, glandular swellings, enlargements and painful diseases of the joints, bones, fasciae, &c, sometimes disappear under its use ; but still we must suspend our judgment respecting the part which it takes in their cure, until the influence of time, regulated diet, and other medicinal agencies usually combined shall have been correctly ascertained." In public and in private practice, the author has carefully watched the effects of sarsaparilla, given singly, in infusion and in extract, but he is not prepared to say that he has, in a single instance, observed effects that could be fairly referred to it. Such has not been the case when the syrup of sarsaparilla has been exhibited largely; but here a considerable quantity of saccharine matter was taken along with it, to which the author is disposed, for reasons elsewhere given, (see Saccharum, Vol. ii. p. 340,) to refer the therapeutical agency. The remark of Mr. Lawrence, that physicians have no confidence in it, but surgeons a great deal, is not sufficiently explained by the cir- cumstance mentioned by Dr. Pereira, that physicians are much less frequently called in to prescribe for those forms of disease, in the treatment of which surgeons have found sarsaparilla so efficacious. Moreover, Dr. Christison remarks, that if the fact be applicable to London, it does not apply elsewhere, and not to Edinburgh certainly, where some of the most eminent surgeons have abandoned it except us a placebo. " My own opinion," says Dr. Christison, "deduced from not unfrequent opportunities of practice in the Edinburgh In- firmary, where syphilitic and mercurio-syphilitic cases come under the cognisance of the physician chiefly, is, that the question—con- fessedly a difficult one, like that relative to the action of alterative remedies in general — is still far from being satisfactorily decided ; that more careful observations are required, more especially in refer- SARSAPARILLA. 345 ence to the now acknowledged efficacy of simple non-mercurial treatment in secondary, pseudo, and mercurial syphilis; and that the probability is much in favour of the drug turning out very inferior in virtue to what its admirers imagine;" and he adds, that the ques- tion is not unimportant in an economical point of view, seeing that so much of it is consumed. Perhaps there is no article of the Ma- teria Medica which is employed so lavishly and so frequently had recourse to in chronic diseases when the practitioner is in doubt what to do. As a eutrophic, it has been chiefly had recourse to in cachexiae of various kinds, but especially in the syphilitic; and is, at times, asso- ciated with mercury, especially with the corrosive chloride. When employed alone, it offers an exemplification of the simple mode of treating syphilis, in contradistinction to the revellent by mercury, iodine, &c. It has, likewise, been freely given in syphiloid affections and in chronic cutaneous diseases; and, in the form of syrup, has been frequently efficacious, in the last affections especially. Whenever, indeed, a modified action in the system of nutrition generally has appeared to be indicated, it has been prescribed. It may be given in powder, in the dose of 3SS to 3J> three or four times a day; but it is not often prescribed in this form. When fresh, the root is said to induce nausea and vomiting; and signs of narcosis have resulted from it: but in the state in which it is met with in the shops, it rarely or never disagrees except from quan- tity. A fact, mentioned by Dr. Pereira, may render the practi- tioner cautious indirecting the powder: — viz., that some drug- gists employ, in its preparation the roots from which the ex- tract has been obtained. This powder, is, of course, almost devoid of taste. iNFU'SOI SARSAPARIL'LH, INFU'SION OF SARSAPARILLA. (Sarsaparill. contus. 3J; Aqua bullient. Oj ; — prepared either by maceration or by displacement with cold w7ater.) The dose of the infusion is f. ^iv to f. 3VJ two or three times a day. DECOCTUM SARSAPARILLA COMPOSITUM, COMPOUND DECOCTION OF SARSAPA- RILLA. (Sarsap. incis. et contus. gvj; Sassafras, incis., Guaiac. lign. rasur., Glycyrrhiz. contus. aa. Ij; Mezer. incis. giij; Aqua, Oiv. Boil for a quarter of an hour, and strain.) This preparation is an imitation of the Lisbon Diet Drink, which was long celebrated in all oases in which sarsaparilla was indicated ; its powers being enhanced — it wras conceived — by the addition of the sassafras, guaiacum, and meze- reum, which were supposed to possess analogous properties. If the objections made to the application of a boiling heat be well founded — as they are generally admitted to be — decoction must be an im- perfect mode of preparation. The dose of this preparation is f. |iv 346 SPECIAL EUTROPHICS. to f. gvj three or four times a day. The syrup or extract is often associated with it. SYRUPUS SARSPARIL'LE COMPOSI'TUS, COMPOUND SYRUP OF SARSAPARIL'LA. (Sarsaparill. contus Ifeij ; Gupiac. lign. rasur. ,§iij 5 R°s- centifol., Senna, Glycirrhiz. contus. aa I ij; 01. sassafras, 01. anisi, aaniv; 01. gaultheria, nyij; Alcohol, dilut. Ox; Sacchar. ibviij. The first five articles are macerated in the alcohol for a certain length of time, and by means of a water-bath the filtered tincture is evaporated to four pints; to the filtered liquor the sugar is added, so as to form a syrup; the oils being added at last. It may, also, be made by dis- placement, according to the form in the United States Pharmacopoeia,) Dr. Christison considers the simple syrup of sarsaparilla to be " an unnecessary addition to the list;" and Dr. Thomson remarks, that it can be better and more easily supplied by rubbing up a few grains of the extract with some simple syrup. The preparations of the British College are, probably, inert as regards the sarsaparilla, as the boiling cannot fail to destroy any virtues that it may possess. This objection does not apply so much to the process of the United States pharmacopoeia; yet the heat of the water-bath may affect its virtues. The roses and volatile oils are added for the sake of flavour. There is no question whatever that this syrup has been productive of good effect in many cachexiae, but the author is not prepared to say how much of this is ascribable to the sarsaparilla and guaiaeum, and how much to the saccharine matter, which is sometimes given very freely. The ordinary dose is, however, f. 3ss to f. gj three or four times a day. It may be substituted for the Sirop de Cuisinier. EXTRACTUM SARSAPARUM, EXTRACT OF SARSAPARIL'LA. (Prepared, ac- cording to the Pharmacopoeia of the United States, by displacement, by means of diluted alcohol and w7ater, evaporating the filtered liquor to the proper consistence.) It is very questionable whether any extract of sarsaparilla can be possessed of much virtue. If the properties reside in volatile matter, it must be driven off by the long coction. The Edinburgh and Dublin Colleges have a Fluid extract of sarsaparilla, in which the concentration is not carried so far. A little dilute alcohol is added to make it keep. The dose of the extract of sarsaparilla of the Pharmacopoeia of the United States is from ten to twenty grains, three or four times a day. Dr. Pereira, contrary to most observers, states his belief, that when the ordinary extract of sarsaparilla of the London and Dublin Phar- macopoeias is properly prepared from Jamaica sarsaparilla, it is a most valuable and efficient remedy. He recommends, that, when given, it should be rubbed down with water, and flavoured by the tincture of orangepeel, or by some volatile oil, as oil of cloves, allspice, lemon or cinnamon. The author has used it extensively, but he cannot accord with that gentleman in his high appreciation of it. ARALIA NUDICAULIS. 347 A Compound extract of sarsaparilla is kept in the shops, which is made by mixing writh Extract of sarsaparilla, an Extract of meze- reon bark, Liquorice root, and Guaiacum shavings, adding a small quantity of Oil of sassafras. Three quarters of an ounce of this to a pint of water are considered to equal in virtues a pint of the com- pound decoction of the British Pharmacopoeias. 68. GUAI'ACI LIGNUM-—GUAFACUM WOOD. The general properties of guaiacum wood have been described under Excitant Diaphoretics, (Vol. i. p. 317.) As a eutrophic, it has been given, like sarsaparilla, in syphilitic and syphiloid diseases, and in most forms of cachexia. It is less relied on, however, than sarsaparilla, and is usually associated with it. In chronic cutaneous affections, it has also been freely administered. It is probably pos- sessed of very little efficacy. There is no separate preparation of it in the Pharmacopoeia of the United States, but the Edinburgh and Dublin Colleges have a De- coctum Guaiaci, which is considered to be the relic of the old De- coction of the woods. In the pharmacopoeia of the former, it is made as follows : — Guaiacum trimmings, 5iij; Sassafras, rasped, ^j ; Liquorice root, bruised, Ij; Raisins, J^ij ; Water, Ox. Boil the guaiacum and raisins with the water to five pints, adding the liquor- ice and sassafras towards the close ; then strain. The dose of this is f. %iv to I viij and more, three or four times a day. Guaiacum wood enters into the composition of the Decoctum sar- saparilla compositum, and the Syrupus sarsaparilla compositus of the Pharmacopoeia of the United States. 69. MEZE'REUM. —MEZE'REON. Mezereon belongs, like guaiacum wood, to the excitant diapho- retics, and its general properties have, consequently, been described elsewhere, (Vol. i. p. 319.) It is given in the form of decoction — the Decoctum Mezerei of the Edinburgh and Dublin pharmaco- poeias, which is made as follows : — Mezereon bark, in chips, 31J ; Liquorice root, bruised, ^ss ; Water, Oiij ; boil gently to Oij. The dose is f. ^iv to f. ^viij, three or four times a day. Mezereon enters into the same officinal preparations as guaiacum wood, and is as seldom given alone. 70. ARA'LIA NUDICAU'LIS. — FALSE SARSAPARIL'LA. This is the root of Ara'lia nudicau'lis, False sarsaparilla, Wild sarsaparilla or Small spikenard ; Sex. Syst. Pentandria Pentagynia; Nat. Ord. Araliaceae ; an indigenous perennial plant, which grows 348 SPECIAL EUTROPHICS. throughout the greater part of the United States, flowering in May and June. It is officinal Fis- 28- in the secondary list of the Pharma- copoeia of the Uni- ted States; is about as thick as the little finger; more or less contorted ; of a yel- lowish brown co- lour externally ; of a fragrant odour, and an aromatic saccharine taste. False sarsaparilla has not been analy- sed, but appears to possess properties that might entitle it to rank with guaia- cum and mezereum amongst excitant diaphoretics. The common belief is, that, like them and Araiia nudicauiis. sarsaparilla, it may . . be employed also as a eutrophic in syphilitic and syphiloid diseases, and in chronic cutaneous affections especially. The author has never prescribed it, nor has he seen it prescribed. The root of Ara'lia racemo'sa or Amer'ican spikenard, is said to resemble Araiia nudicauiis in properties, 71. SAS'SAFRAS RADI'CIS CORTEX.—BARK OF SAS'SAFRAS ROOT. This agent — like guaiacum wood and mezereon — was at one time supposed to be possessed of powerful eutrophic virtues es- pecially m syphilitic and chronic cutaneous diseases; and it is still associated with the articles above mentioned, and with sarsapa- rilla, in one officinal preparation of the Pharmacopoeia of the United States, the Decoctum sarsaparilla compositum. Its properties — both diaphoretic (Vol. i. p. 320,) and eutrophic — are probably altogether dependent upon the volatile oil, which it contains ; but its agency is very limited, and it is now never given alone in the very cases in which it Was formerly so much extolled. DULCAMARA. 349 Oil of sassafras forms part of the Syrupus sarsaparilla compositus of the Pharmacopaeia of the United States. 72. DULCAMA'RA. — BITTERSWEET. Bittersweet, of the Pharmacopoeia, is the stalks of Sola'num dul- cama'ra, Woody nightshade or Biltersweet; Sex. Syst. Pentandria Monogynia; Nat. Ord. Solanaceae; — a perennial climbing plant, which is com- Fls- 29, mon in Europe, and in this country, both wild and cultivated ; flowering from June to August. The stalks — which are the only officinal portion — are collected in autumn, after the leaves have fallen off. When bruised in their fresh state they have a disagreeable odour, which is lost by dry- ing. The taste is at first bitter, and after- wards sweet, which gives occasion to their name. As we meet with the dried stalks in the shops, they are rugous externally, having a greenish-gray epidermis, an in- terior light woody portion, and a central light, and spongy pith. Bittersweet imparts its properties to water and to alcohol; but the tincture is never employed. It has been subjected to analysis, and found to contain a sweet- ish bitter extract—■ to which, from these qualities, the name Pieroglyc'ion, Dulca- marin or bittersweet principle has been given, — an alkaloid of narcotic proper- ties, termed Sola'nia or Solani'na, besides other unimportant ingredients. Bittersweet has been used in the . ,, ... Solanum dulcamara. same class of cases as sarsaparilla, meze- reum, guaiacum and sassafras; and is probably not possessed of more powers than the feeblest of these. Were the author to be guided by the results of his own experience, he would say that it is almost devoid of action on the economy. He has seen it chewed by boys in large quantities, and has chewed it himself when a boy, without observing any effect from it, except what was caused by its saccharine and gummy matter. The decoction, the extract and the fruit have all been given in large quantities, with no more effect; yet the solania, which has been separated from it, is said to have killed a rabbit in the dose of two grains. Certainly, more testimony is needed, before it can be regarded as possessed of much efficacy; especially when we are told, by Chevallier, that an article, having, vol u.—30 350 SPECIAL EUTROPHICS. according to all, little or no narcotic power, occasioned narcotism in a young man, when he merely carried a bundle of it on his head! Dr. Wood, — who considers, that its use is now nearly confined to the treatment of cutaneous eruptions, particularly those of a scaly character, as lepra, psoriasis, and pityriasis, in which he thinks it is often decidedly beneficial, especially when combined with minute doses of antimonials, — states, that he has observed, in several in- stances, when the system was under its influence, a dark purplish colour of the face and hands, and, at the same time, considerable languor of the circulation. Such effects have not been observed by the author, nor are they recorded by others ; but whatever rests on the authority of Dr. Wood is deserving of consideration, and may lead to farther investigation. Dulcamara is given in the form of the officinal decoction; and is administered in all the cachectic conditions that require the employment of the vegetable agents last described. The cachexiae in which it is now mainly prescribed, however, are those accompanied by chronic diseases of the skin. _ DECOCTUM DULCAMAM, DECOCTION OF BITTERSWEET. (Dulcamar. contus. 3J ; Aqua, Oiss, boiled to a pint.) The dose may be f. ^ij to f. ^iv three or four times a day. 73. JUGLANS CINE-R'EA.—WALNUT. The leaves of the walnut have been highly extolled of late by M. Negrier as superior to all other antiscrofulous remedies. The extract of the leaves, which may be ranked in the class of slightly aromatic bitters, he found to be almost alwrays efficacious in scrofulous affec- tions, and in no case did it appear to exert any unpleasant action on the economy. Their efficacy is doubtless, however, overrated by him ; and their main virtues would appear to be those of the aromatic bitter tonics. 74. MUDAR. Under the name Mudar or Madar, a medicine was imported into Europe from India, which is the bark of the root of Calot'ropis gi- gante'a or Ascle'pias gigante'a, Nat. Ord. Asclepiadaceae, wdrich is a native of Hindusthan, but has been introduced into the West Indies, where it is now naturalised. It appears to have been used in India in the same cases as sarsaparilla; — for example, in syphilitic and syphiloid diseases, chronic cutaneous affections, &c. The powdered root—mudar — is given in doses of from gr. iij, to gr. x, three times a day, gradually increased until it induces some degree of nausea and vomiting. It is not employed in American practice. EUTROPHIC OINTMENTS. 351 75. HINDES'MUS IN'DICUS.-COUNTRY SARSAPARIL'LA, (OF INDIA.) This plant, called also Periplo'ca In'dica, Ascle'pias pseudo-sar'sa. In'dian or scented sarsaparilla; Nat, Ord. Asclepiadaceae, is like- wise a plant of Hindusthan, which has been erroneously referred to Smilax aspera. (Pereira.) The root has been employed as a substi- tute for sarsaparilla. It is given in infusion, (Hindesm. Indie, ^ij ; Aq. bullient. Oj; to be taken in the course of the twenty-four hours.) The decoction, extract and syrup have been used ; but the heat necessary for their preparation is said to injure the medicine. The author knows nothing of it from his own observation. Topical Eutrophics. 1. Eutrophic Ointments. In the general remarks on eutrophics, it was stated, that there are various external agencies, which give occasion to modification in the functions of nutrition of a part, and which must, therefore, be re- garded as belonging to this division of medicinal substances. Every local excitant is capable of effecting this to a greater or less extent; and hence the various excitant applications, that are made to ulcer- ated surfaces, and to chronic cutaneous affections, must be regarded as eutrophics, — for example, the Ceratum resina, (i. 477;) the Ceratum resina compositum, (i. 477 ;) the Ceratum sabina, (ii. 269;) the Unguentum cantharidis, (ii. 268 ;) Unguentum creasoti, (i. 492;) U. cupri subacetatis (ii. 273;) U. Galla. (ii. 121;) U. hydrargyri, (ii. 299;) U. Hydrargyri ammoniati, (ii. 305 ;) 17. hydrargyri nitra- tis, (ii. 309;) U. hydrargyri oxidi rubri, (ii. 302;) U. iodini, (ii. 316 ;) U. iodini compositum, (ii. 316;) U. mezerei, (ii. 271;) U. sul- phuris, (ii. 337;) U. sulphuris compositum, (ii. 337.) There are a few officinal preparations, however, which have not yet been described, and which belong to this division of the subject. 76. UNGUENTUM PICIS LIO/IM, TAR OINTMENT. (Picis liquid,, Sevi, aa. Ibj melted together.) This ointment is a common application in chronic cutaneous affections, especially in porrigo and psoriasis. It may be applied several times in the day; — the good effects of most ointments of the kind being greatly dependent upon their repeated application. The Oil. of Tar, obtained from tar by distillation, is sometimes used in the same cases. 77. UNGUENTUM TAB'ACI, TOBACCO OINTMENT. (Tabac. recent, concis. 5j; Adipis, fbj. The tobacco is boiled in the lard until it becomes friable, and is then strained.) This ointment is officinal only in the 352 SPECIAL EUTROPHICS. Pharmacopoeia of the United States. It is used on account of its sedative properties in irritable ulcers; but it is also employed in various chronic cutaneous diseases, especially in scalled head. Great caution is, however, needed, inasmuch as the constitutional effects of the remedy may be induced by the topical application. (See Tabacum, Vol. i. p. 126.) 78. UNGUENTUM VERA'TRI ALBI, OINTMENT OF WHITE HEL'LEBORE. (Veratri albi in pulv. 3r,ij; 01. hmon. n\xx ; Adipis, Jviij.) On account of the disagreeable qualities of sulphur ointment, this preparation is substituted for it in cases of scabies; but it is by no means so effective; and it is affirmed, that when applied to raw surfaces, danger exists of the system being affected by the absorption of the poisonous principle — veratria, (Vol. ii. p. 192.) Hence especial care is needed when both this and the last preparation are used in children. ^ 79. UNGUENTUM ZINCI OX'IDL OINTMENT OF OXIDE OF ZINC. (Zinci oxid. ^j ; Adipis, ^vj.) This ointment is frequently used as a mild appli- cation to various chronic cutaneous diseases, as well as in cases of ophthalmia, especially that which affects chiefly the tarsus. It is often applied, also, to excoriations; and occasionally as a dressing to ordinary ulcers, although not by any means as frequently as the 80. CERATUM ZINCI CARBONA'TIS, CERATE OFCAR'BONATE OF ZINC. (Zinci carbon, praparat., Cera flava, aalfess; Adipis, tbii.) This is an imitation of an old and popular dressing for ulcers, recommended by Turner, and termed generally Turner's Cerate. It is commonly used as a "healing salve;" and is applicable to the same cases as the Unguentum zinci oxidi. ZINCI CAR'BONAS, CAR'BONATE OF ZINC, is the native impure carbonate, commonly called Lapis Calaminaris and Calamine. ZINCI CAR'BONAS PRiEPARA'TUS, PREPA'RED CAR'BONATE OF ZINC, Prepared Calamine, is made by heating carbonate of zinc to redness, and afterwards pulverising it, in the same manner as prepared chalk. 81. CERATUM PLUMBI CARBONA'TIS, CERATE OF SUBACETATE OF LEAD. (Liq. plumbi subacetat. f. ^iiss; Cera alba, ^iv; 01. oliv. f. §ix5 Camphor. £ss-) This is the old Ceratum Saturni or Goulard's Cerate, which has been most commonly used as a cooling dressing to wounds and ulcers, as a dressing to burns, scalds, and blistered surfaces; and likewise, as an application to irritable cutaneous dis- eases. The following ointment is used in similar cases. 82. UNGUENTUM PLUMBI CARBONA'TIS, OINTMENT OF CAR'BONATE OF LEAD. (Plumbi carbon, in pulv. subtiliss. §ij; Unguent, simp/icis, Ibj.) EUTROPHIC OINTMENTS. 353 2. Compressing Eutrophics. The effects of compression in modifying the function of nutrition have been referred to in the general considerations on eutrophics. This is accomplished either by appropriate bandages methodically applied — methodical compression, as it has been termed — or by ad- hesive plasters. Of the latter, the following are generally used. 83. EMPLAS'TRUM PLUMBI. —LEAD PLASTER. Lead plaster or lith'arge plaster is made by boiling semivitrifled oxide of lead or litharge, in very fine powder, with olive oil and water, until the oil and oxide of lead unite into a plaster. The wrater appears to be necessary to favour the union of the oleic and margaric acids with the oxide of lead — the plaster itself seeming to be a mixture of oleate and margarate of lead. Lead plaster or Diachylon is the most unirritating of adhesive plasters, and can be borne by those on whom the emplastrum resina? excites great irritation. It is much used by the surgeon in cases of wounds, to bring the edges together, and protect the parts from the air, and to exert methodical compression in cases of ulcers, tumours, &c, and of orchitis and other inflammations in which it is desirable to employ pressure. It is by no means, however, as adhesive as the next plaster, which is, accordingly, more employed for the formation of strapping. 84. EMPLAS'TRUM RESI'N^.-RESIN PLASTER. (Resin, in pulv. ffess; Emplastr. plumbi, tbiij; melted together.) The resin occasions this plaster to be more adhesive, and hence its common name of Adhesive plaster. It is used for the same purposes as the Emplastrum plumbi. Jt sometimes irritates the skin so much as to occasion excoriation and ulceration. In such cases, the lead plaster has to be substituted. Besides the above plasters, there are some others that are em- ployed as " discutients," to dispel morbid growths, either of the in- teguments or of internal organs. In both cases, they act as eutro- phics — modifying the nutrition of the part with which they are placed in contact,— partly by pressure, and partly by exciting a new- action in the cutaneous capillaries. In cases of internal tumours, their main efficacy is probably induced in the latter mode. The officinal plasters that are employed as discutients are the following:— 85. EMPLAS'TRUM AMMONFACI.— AMMO'NIAC PLASTER. (Ammoniac. Iv ; Aceti, Oss ; made into a plaster by solution, and 30* 354 SPECIAL EUTROPHICS. evaporation.) The therapeutical properties of ammoniacum have been described elsewhere, (Vol. i. p. 224.) This plaster is excitant, and is much used as a discutient in tumours — scrofulous and others. It is often prescribed by the surgeon, " as a very useful application to the house-maid's swollen knee." (Pereira.) It occasionally ex- cites considerable irritation of the cutaneous surface, and has to be removed. The Emplastrum Galbani Compositum, (Vol. i. p. 401,) and the Emplastrum Hydrargyri, (Vol. ii. p. 300,) are used in analogous cases. The following plasters are employed chiefly to give support, but they may also act as discutients. 86. EMPLAS'TRUM FERRI.—IRON PLASTER. Iron plaster, Emplastrum rob'orans or Strengthening plaster was long supposed to give tone by virtue of the iron which it contains. It is composed of Subcarbonate of iron, ^iij; Lead plaster, tbij; Bur- gundy pitch, fbss. It is very questionable, however, whether the iron be of any advantage. This plaster gives support to weakened parts; and, by the new action which it excites in the vessels of the skin, it may be serviceable in dispersing tumours. The simple Bur- gundy pitch plaster possesses probably all its virtues. 87. EMPLAS'TRUM SAPO'NIS.—SOAP PLASTER. (Sapon. incis. tbss ; Emplastr. plumbi, tbiij.) This plaster is fre- quently applied to tumours of various kinds as a discutient, and like- wise to afford mechanical support. The same may be said of the 88. CERA'TUM SAPO'NIS.—SOAP CERATE. (Liquor plumbi subacetat. Oij ; Saponis, 3vj ; Cera alba, £x ; 01. oliv. Oj ; made into a plaster by proper evaporation and admixture.) 3. Eutrophic Liniments. It was before remarked, (Vol. ii. p. 290,) that many of the lini- ments— those which are wholly oleaginous — are indebted for their eutrophic virtues to the rubbing; and that friction with the dry hand, methodically used, is capable of accomplishing whatever the lini- ments can. Some of them, however, contain exciting ingredients, which enable them to act as revellents; but there is this objection, that friction with them cannot be sufficiently long continued ; for it is an important matter, whenever a liniment is directed to remove any morbid formation or exudation, that the friction should be con- tinued as long as the skin will well bear it; and, as before men- tioned, under such circumstances, friction even with the dry hand dipped in flour is capable of producing surprising results. COMPRESSING EUTROPHICS. 355 The officinal liniments, most frequently had recourse to as discu- tients, are the following: 89. LINIMENTUM CAM'PHOR^E. — CAMPHOR LLVIMENT. (Camphor, ^ss; 01. oliv. f. ^ij.) This is frequently used in glan- dular and other swellings; the camphor comunicating excitant pro- perties to the oil. 90. LINTMEN'TUM SAPO'NIS CAMPHORA TUM. — CAMPH'ORATED SOAP LINI'MENT. (Sapon. vulgar, giij; Camphor, gj; 01. rosmarin.; 01. origan. aa f. 5J; Alcohol. Oj.) This is well known under the name Opodeldoc, and is used as an application to sprains, bruises, and as a revellent in cases of rheumatic pains. Where there is much effusion of fluid in the first cases, the friction occasions its absorption. The camphor and essential oils communicate excitant properties to it. It is rubbed on glandular swellings to promote their discussion. 91. TINCTU'RA SAPO'NIS CAMPHORATA. — CAMPH'ORATED TINC- TURE OF SOAP. (Saponis. rasur. ^iv; Camphor, gij; 01. rosmarin. f. gss; Alcohol. Oij.) This is the Soap liniment of the shops, which is much used in the same cases as the last preparation. 92. ELACTRIC'ITY, GAL'VANISM, ELECTRO-MAG'NETISM. A'cupuncture and Gal'vanopuncture, considered under Exci- tants, (Vol. i. 498,) act also as local eutrophics. Of late, the last has been highly recommended by Dr. Shuster, who maintains, that " galvanic electricity and the electro-magnetic fluid, when employed by acupuncture, constitute at once the most powerful and inoffensive medicinal agents that we possess." He recommends it in hydrocele, ascites, (idiopathic or symptomatic of curable lesions,) hydrothorax and articular dropsies; and thinks its use may be extended to chronic hydrocephalus, dropsy of the pericardium, and the greater part of dropsical effusions; — also to lipomatous, steatomatous, atheromatous and melicerous tumours, and to serous and synovial cysts; con- gestions and indurations, — chiefly those of the lymphatic glands; of the testes and epididymis; indurations of the cellular tissue; in the vicinity of certain kinds of ulcers; to the parietes of fistulous tracts; certain indolent tumefactions; and he conceives there would be nothing irrational in attacking cancerous affections in the same way; — and lastly to goitre. There can be no doubt, that the function of nutrition may be modified by these excitants, and that, in some of the cases mentioned, a marked sorbefacient agency may be exhibited. 356 CHEMICAL AGENTS. SECTION VII. AGENTS WHOSE ACTION IS PROMINENTLY CHEMICAL. The agents, which have thus far been considered, produce their effect altogether by the impression they make on the vital properties of the tissues. It is on this account, indeed, that the epithet vital has been applied to them. Those, which have to be examined under this division, exert their effects chemically upon the substances with which they come in contact; and, in this manner, they may modify the vital properties indirectly. There are some, likewise, that effect chemical changes on parts endowed with vitality, and in this way produce as marked an influence on the vital manifestations, as many of those agents to which the epithet vital is attached. The author has before observed, that so long as the tissues, which compose the body, are possessed of vital endowments, they resist the changes that would inevitably occur, were this influence withdrawn. The animal body is composed of materials, which are extremely prone to decomposition; but, so long as it is alive, the tendencies to change are controlled by the principle of life, so that putrefaction cannot take place. In like manner, a resistance is presented by it to the influence of chemical agents, unless these agents be in such concentration as to act as powerful irritants or to disorganise the parts with which they are brought in contact. But this resistance is only within certain limits. We have the most unquestionable evi- dence, that [changes may be effected even in the circulating fluid, — changes which are palpable to the senses, — and we must conse- quently admit, that if modifications can be produced by chemical influences in a fluid, whence every organ and tissue of the body are formed, a greater or less change may be occasioned in those vessels, whose function it is to form such organs and tissues, and by which the functions of calorification and secretion are accomplished. Of the changes, produced in the blood by chemical agents, we have marked examples in the different tints occasioned by exposure to various gases, as well as in the appearances, which that fluid pre- sents after certain solutions are thrown into the veins. It has been said, indeed, that any one, who believes in such changes, must con- sent to be ranked amongst the humoral pathologists, — the beings of a bygone period ; but this reproach has lost, at the present day, all its terrors. Pathologists have discovered, that in flying from humo- rism to solidism, they have, as in similar cases, wandered from the paths of true observation; and they have exhibited the triumph of judgment and candour over folly and prejudice, by amalgamating the two doctrines, where amalgamation was practicable, and rejecting from each such views as had not borne the test of experience and re- flection. The present period may be termed eminently eclectic; for, although exclusives occasionally arise amongst us, they are rare, and CHEMICAL AGENTS. 357 have— when we take the world at large — but few followers. Many of those, too, who would blush to be esteemed humourists, still believe in critical discharges, and efforts of nature, although they would, at the same time, spurn the idea, that any substance could get into the blood, without occasioning the most disastrous results. Yet the phenomena of exanthematous fevers must be, with such individuals, a source of intense difficulty. In any view of the subject, they are sufficiently difficult of explanation; but, in the one we are canvassing, the difficulties are absolutely overwhelming. In the case of smallpox inoculation, a minute portion of variolous matter is inserted under the cuticle, is brought in contact, in other words, with the corpus papillare, and with the divided vessels of that body, and we can predict that, in a proper subject, a fever will break out, in a certain number of days after inoculation; and that after a definite period an eruption will make its appearance, which will go through its regular stages of increment, maturation and de- clension, leaving the patient, after a time—which, in favourable cases, equally admits of prognostication — perfectly well. It is as- suredly not easy to conceive how this extensive secretion of morbid poison can take place, without presuming, that the action of the vessels of nutrition has become modified by the condition of the fluid circulating in them ; and that this fluid has had its condition changed by the reception into it of the variolous matter. Still, although'we admit this, there is much to be explained, — both as regards the exanthematous fevers and those that are unaccompanied by cutaneous affections. Of late years, a much greater degree of attention has been paid to morbid conditions of the blood, and to the effects of therapeutical agents upon it; and now, that the horror of the humoral pathology has abated, and indeed almost vanished, fresh investigations w7illbe made into its varying condition in disease, and into the best methods for restoring it to the healthy state. In the case, assumed above, the smallpox taint must evidently have been received into the blood, and by the action of this fluid on the capillaries, and on the nerves distributed to them, the exan- thematous fever resulted. In other cases, the capillaries and the nerves connected with them may be first morbidly impressed, and, successively, the condition of the circulating fluid may be modified. Of this we have examples in all the active hyperaemiae, and in every febrile irritation, which is the consequence of derangement in any portion of the intermediate system of vessels. In one or other of these modes, all fevers—miasmatic or common — are probably in- duced. The different classes of chemical remedies are not all as important as certain of the divisions of vital agents, that have been consi- dered. Yet some of them are deeply interesting, although gene- rally but little understood by the student, in consequence of their consideration seeming to require a greater amount of chemical knowledge than is actually the case. 358 ANTACIDS. When iodide of iron or creasote is added to blood out of the body, it coagulates the albumen of the blood, and renders it solid ; and when administered therapeutically, it is probable, that effects somewhat analogous may be produced on the blood wdiilst circu- lating in the vessels, and that, by increasing its tendency to coagu- late, these may be efficient agents in scurvy, and in hemorrhages, especially of the passive kind. (See Vol. ii. p. 61.) Some chemical agents operate altogether upon the contents of or- gans, in the same manner as if they were placed in contact with such contents out of the body, and it is, therefore, but necessary to know the chemical character of these contents to adapt the remedy accordingly. This is the case with antacids. Others, again, as dis- infectants or antiseptics, are of more complex operation. Escharotics, — defined to be ' agents,: which destroy the vitality of the part to which they are applied, and erode or decompose the animal solid,' — are ranked by therapeutists under this division ; but as they are often employed to exert their effects upon distant parts of the organism, in the same manner as epispastics in general, the au- thor considered it advisable not to separate the discussion of their operation, as chemical agents, from that of their dynamic or vital action. It will, consequently, be unnecessary to recur to them, under this division. 1. ANTACIDS. Definition of antacids—Great generation of acid in dyspepsia—Acids always in the healthy stomach—Morbid acidity, how induced—Predominance of acidity in children —Antacids only palliatives—Special antacids, These may be defined — " Agents, that obviate acidity in the stomach or elsewhere, by combining with the acid, and neutral- ising it." Where acids are present in the stomach, antacids affect them as they would out of the body ; but where conditions exist, which are dependent upon the formation of acid elsewhere than in the stomach, or where the acid has to be acted upon through the medium of the circulation — as in the calculous diathesis, of one kind, before re- ferred to, (Vol. i. p. 295,) — the precise modus operandi is not so simple. We should hardly be right, perhaps, on this account in de- * ducing, that the sole operation of antacids is of a purely chemical character. Although their immediate action may be such, they may likewise, when taken into the circulation, so modify the vessels of nutrition — the capillary exhalants and absorbents — as to produce an alteration even in the tissue of organs ; and, along with change of air and other physical and moral influences, be the means of re- storation to health, where the gouty or lithic acid diathesis exists. The generation of an unusual quantity of acid in the stomach is ANTACIDS. 359 one of the most ordinary symptoms of dyspepsia. It is indicated by acid eructations ; violent heartburn ; and marked effervescence, when a carbonated alkali is taken ; — the acid, in the stomach laying hold of the alkaline base, and the carbonic acid being given off, in such quantity, occasionally, as to sting the nose— much in the same man- ner as champagne or any brisk fermented liquor. In a state of health, two acids are always present in the stomach, after food has been received into the organ, or indeed when any substance — not entitled to the name of aliment—is present there. They are the chlorohydric or muriatic, and the acetic; and the quan- tity of the latter is considerable. Now, if these acids accumulate from any cause, they may give rise to all those signs, that indicate the existence of an undue quantity of acid in the organ. In such case an antacid can obviously only palliate the symptoms, although it may do this successfully for the time. From an early period of life, the author has been very subject to this painful affection, — so much so, that he has generally carried a carbonated alkali about with him, — and although, after errors in regimen, the suffering has occasionally been to such an extent as to approach vomiting, in no instance has he failed to allay the uneasy sensation by an adequate quan- tity of the alkali; and it has not usually been necessary to repeat the dose. To effectually remove the complaint, we must inquire narrowly into the causes that may have occasioned the unusual generation of acid, and attack those : the presence of acid, in undue quantity, can only be regarded as a symptom of some pathological condition. Now, we observe heartburn under two very opposite aspects. In one, the lining membrane of the stomach is inflamed, and we have a true case of chronic gastro-enteritis : in the other, there is sufficient evidence of the different functions being affected asthenically. In the former state, the organs, whose office it is to secrete the gastric fluid, are inordinately excited, and this excitation has to be allayed by the ap- propriate employment of depletives and revellents : in the latter, we have to remove the atonic condition of the mucous and muscular coats, which gives occasion to the too long detention of the food in the stomach, and to a tardy action of the gastric secretions and func- tions upon it. A want of attention to the existence of these two pathological con- ditions, which give rise to very similar symptoms, and require a patient diagnosis, is the cause of much of that empiricism, which prevails in the treatment of dyspepsia. Under any circumstances, it is often extremely difficult of management, but the difficulty is largely augmented by ignorance on those points. At one time, it was — and still is, by many — conceived, that whenever a predominance of acidity in the stomach is met with, it is owing to the elements of the food reacting upon each other;-— to the food being detained so long in the organ, that its elements enter into new affinities ; and, accordingly, that the acid is, in such cases, the 360 ANTACIDS. direct product of the aliment employed ; and, as saccharine sub- stances generally produce the effect most markedly, the position has been considered to be confirmed. A slight examination of patholo- gical facts will show the fallacy of this view of the subject. Every dyspeptic, liable to heartburn, must have observed, that when par- ticular articles of diet have been taken, he has felt uneasiness almost immediately after they have reached the stomach ; and when it has been impossible for time to have been afforded for the transition through the vinous and acetous fermentations. This transition is not effected in an instant; yet, almost instantaneously, after a w7eak sac- charine solution has been taken, the dyspeptic experiences the car- dialgia : and if he has recourse to his carbonated alkali, the presence of an acid is unequivocally demonstrated. The fact of the generation of acid being favoured by particular articles of diet rather than by others has been noticed by every dys- peptic, and has been a puzzling circumstance to them as well as to the medical attendant. As acid is equally evinced, whether certain animal matters—as melted or empyreumatic butter — or saccharine substances be taken, it has been an interesting question to deter- mine the precise character of the acid formed ; — which, on the idea of its being produced from the reaction of the elements of the food on each other, ought to differ in these different cases. This perplex- ity is strikingly exhibited in a well told case of dyspepsia, compli- cated with other affections, which is given by Dr. Paris. The fol- lowing are the patient's own words — "I find that the perpetual recurrence of my old headaches leaves me nothing for it but to turn them into a subject of amusement. I have been reading some spe- culations about muriatic acid in the human stomach, and would like very much to know what acid is in mine ; and I wish you would put me in the way of testing it, for I can obtain any quantity. If it is a vegetable acid, how* does it get into giblet soup, or salt beef, or fresh butter, cum multis aliis'J If it is an animal acid, I know of none except the phosphoric, and I have no idea of making a match-box out of my viscera, so I vote at once it is not that: if it is a vegetable acid, how comes it that I may eat a dozen ripe peaches, and be none the worse for them ; but wo to me if I eat a buttered muffin ! Ergo, I infer that it is not wdiolly the acetic acid ; and if not, what else can make sweet tea, or anything like ale, beer, or porter, perfect poison to me ? As for an animal acid, there is no poison for me like strong broth, or soup; ergo, there must be some villany in that. I was told, the other day, that baked meat would disagree with me, and I find this to be the case. Now7, for the muriatic acid, which I strongly suspect to be the one under which I suffer, for the action on my teeth, when I am sick, is too sharp for any thing less pungent, I find that if I eat salt meat, an acid is immediately formed in my stomach, and yet I can take any quantity of salt with my meat, without being the worse for it: how can this happen ?" The true explanation of these pathological phenomena would ap- CAUSES OF ACIDITY. 361 pear to be, that there are certain articles of diet, which — when they come in contact with the lining membrane of the stomach of a dyspeptic — excite the organs, whose office it is to secrete the gastric- acids, so that a larger amount of those acids is formed, and in this way acidity is produced, but not from the reaction of the elements of the food on each other. Under this view of the subject, the acids, met with in the stomach, ought to be the same, whatever may be the character of the food, and this is probably the case ;—the chlorohydric acid always, perhaps, predominating, as it does in health, and giving rise to the strongly acid effect occasionally pro- duced on the teeth by the eructations, which every dyspeptic must have experienced. This is generally—if not universally the case — in dyspepsia ; but there are articles of diet, which, under particular circumstances, may be- come so suddenly acid, that acidity may be induced by them, with- out the supposition of undue secretion of the proper gastric acids. Milk is one of these. This fluid, it is well known, becomes acid almost instantaneously, when the air is highly charged with electri- city ; and there is reason to believe, that something similar may occur in the stomach, particularly in children. The predominance of acidity is so great in infancy, that, as elsewhere remarked, most of the diseases of childhood have been ascribed to it: such predomi- nance may be partly owing to the cause just assigned, and partly to augmented secretion of those acids, which, as has been shown, always exist in the stomach, in the state of health. In children, the presence of unusual acid is easily detected: — the smell of the breath ; the odour and taste of the regurgitations ; the smell of the alvine evacuations, and their green colour, sufficiently indicate it. This greenness is owing to an admixture of acid with healthy bile, although it has been invoked to demonstrate the existence of disor- der in the biliary system. If we take healthy bile and add chloro- hydric acid to it out of the body, a green colour is produced by the union. It is obvious, then, that, in this case, we should be egre- giously in error, were we to give remedies which are conceived to modify the condition of the biliary organs, and that all our endea- vours should be confined to the removal of the condition of the gastric apparatus, which occasions the acid predominance. In adults, a certain degree of acidity is perhaps present, when not indicated by the ordinary symptom, — heartburn. It may be the cause of that irritability of the stomach, characterized by vomit- ing, whenever food is received into the organ, as well as of the headache, and sleeplessness, which we find to be relieved by full doses of the carbonated alkalies. In those cases of gastric irrita- bility, and in the sleeplessness in question — which consists of watching without any apparent bodily indisposition — half a drachm or two scruples of the bicarbonate of soda act, at times, with sur- prising efficacy ; the vomiting ceases in the one case ; sleep follows vol. n.—31 362 ANTACIDS. in the other; and all the uneasy feelings, in both cases, speedily vanish. From what has been said, it will be manifest, that antacids can be regarded merely as palliatives. When administered to neutralise acid in the stomach, they can act only on that which is in the organ : they cannot prevent the formation of more. To cure the cardialgia radically, the pathological condition, which gives occasion to the undue secretion of the acids, must be obviated. This, we have seen, is sometimes inflammatory, but, in by far the majority of cases perhaps, the excited condition of the organs, by which the gastric acids are secreted, is accompanied by a state of asthenia of other parts of the stomach. The muscular coat has its energy impaired; and, by restoring the balance, by the appropriate administration of tonics and gentle excitants — singly or combined — accompanied by the adoption of an appropriate regimen, the symptoms are relieved, and, if the plan be properly persisted in, often entirely removed ; but no plan of treatment, which does not combine an attention to diet and regimen, can prove effectual. As the pathological cause of cardialgia is commonly asthenic, it can be understood, why the union of antacids with tonics — as of magnesia or bicarbonate of soda with charcoal, or bitters — is so generally useful in that affection. Amongst the different alkalies and alkaline earths, the therapeutist has ample choice to adapt his remedies to the various complications that may arise. If he desires a simple antacid, to be administered singly, or along with some vegetable bitter, he chooses the liquor potassa, the liquor calcis, or the bicarbonates or carbonates of potassa or soda: but if he wishes, at the same time, to produce some degree of excitation in the mucous coat of the stomach, and through it on the muscular coat, he selects ammonia or its carbonate. The car- bonates are the milder preparations; but, occasionally, uneasiness is felt from the extrication of the carbonic acid gas, w7hich is given off as soon as the alkali meets with the gastric acids; the gas, at times, instead of passing off through the upper orifice of the stomach, pro- ceeding into the small intestines, and giving rise to colic, and to much intestinal disturbance. No such effect can be produced by the exhibition of the pure alkalies, which may be given in a state of proper dilution. The same thing, of course, applies to the alkaline earths, and for this reason, pure magnesia, or that from which the carbonic acid has been driven off by heat; and lime water, which, when pure, contains no carbonic acid, are, in those cases, to be pre- ferred. As regards these earths, too, the practitioner has a ground of preference, which cannot be lost sight of. The salts formed by the union of the gastric acids with magnesia are possessed of laxa- tive properties ; whilst those, formed by the union of lime with the same acids, are of a contrary character. If, therefore, the predom- inance of acidity be accompanied with constipation, or appear to SPECIAL ANTACIDS. 363 demand the use of laxatives, the former earth is selected; whilst the latter may be indicated under opposite circumstances. With respect to the diet and regimen, which may be advisable in these cases, much will depend on the individual — as regards diet especially. Substances, which are easily managed by the digestive powers, and which individual experience has shown not to be ' dys- peptic,' must be taken ; and as for other articles, that may not have been made the subject of experiment in the individual case, the author must refer to another work for details regarding their com- parative digestibility. (Human Health, p. 179, Phil ad. 1844.) Of the proper regimen he has spoken, partly in that work, and partly under the head of ' Revellents,' in the present volume. Nothing is so markedly salutary, in these cases, as a thorough change of all the physical and moral circumstances surrounding the individual; and every dyspeptic must have noticed the freedom from his usual ail- ments, which he has experienced during the exercise of body and mind, which travelling affords. Of course, the more varied the scenery and the atmospheric conditions, the greater is the revulsion produced by travelling; but in countries not possessed of all those advantages, mere travelling exercise, with due attention to diet, is perhaps the most beneficial agency that can be invoked by the dys- peptic. This is a subject, however, which belongs more particularly to Special Therapeutics, and has, therefore, been canvassed else- where. (Practice of Medicine, 2d edit., vol. i. p. 88. Philad. 1844.) Independently of the presence of acidity in the stomach, a con- dition of the system may exist, which may require the use of anta- cids ; but this matter has been treated under the head of Antilithics. SPECIAL ANTACIDS. 1. SODJG BICAR'BONAS. — BICAR'BONATE OF SODA. Bicarbonate of soda is prepared by causing a stream of Carbonic acid, obtained from marble by the addition of dilute sulphuric acid, to pass into an appropriate box containing Carbonate of soda, until this is fully saturated. It is a white and opaque salt — the crystals, when perfect, being oblique rectangular prisms. As generally met with, however, it is a white crystalline mass, or a whitish powder. Its taste is slightly alkaline. It is wholly soluble in water. Bicarbonate of soda has the same properties as the bicarbonate of potassa, but it is more prescribed as an antacid. It is certainly much less disagreeable than either the carbonate of potassa or of soda, and the stomach is likely to suffer less from its protracted use than from that of either of those salts. " It is often resorted to," says Profes- sor F. Bache, " in calculous cases, characterised by predominant 364 SPECIAL ANTACIDS. uric acid ; and from its higher neutralising power, on account of the smaller equivalent of soda, it may be considered preferable as an antacid to the corresponding salt of potassa." Its dose, as an antacid, is from gr. x to ^j. It may be taken in water, or in the mineral water of the shops, in which case it resem- bles the Liquor Sodje Effervescens of the London Pharmacopoeia. 2. SOD^J CAR'BONAS. —CAR'BONATE OF SODA. Carbonate of soda is manufactured on a large scale, and, there- fore, has been classed amongst the articles of the Materia Medica in the Pharmacopoeia of the United States. It may be procured from Barilla, an impure carbonate of soda obtained by burning plants of the order Chenopodiaceae ; from Kelp, which is obtained by burning plants of the order Algaceae ; or from the decomposition of sulphate of soda. When freshly prepared, carbonate of soda is in colourless crystals, which slightly effloresce in dry air, and dissolve in twice their weight of water at 60°, and in less than their own weight at 212°. The crystals are generally large* and are oblique rhombic prisms. They have a cooling alkaline disagreeable taste. Carbonate of soda possesses medical virtues identical with those of the carbonates of potassa, and the salt last mentioned ; but it is not so often employed as the bicarbonate, which is less disagreeable, whilst it is equally efficacious as an antacid. The dose may be from gr. x to ^ss. SODJ CAR'BONAS EXSICCA'TUS, DRIED CAR'BONATE OF SODA. (Prepared by exposing Carbonate of soda to heat in a clean iron vessel, until it is thoroughly dried, and rubbing it into powder.) The only advantage in this preparation is, that it admits of being made into pills, when it is advisable to combine it with tonics. It is about twice the strength of the carbonate. 3. POTAS'SA BICAR'BONAS. —BICAR'BONATE OF POTAS'SA. Bicarbonate of potassa—Sal aeratus—often improperly called Sal aratus — is made by dissolving Carbonate of potassa in Distilled water, and passing Carbonic acid through the solution until it is fully saturated. The liquor is then filtered, and evaporated by a gentle heat, until crystals form. The carbonic acid is obtained from marble by the action of dilute sulphuric acid. Bicarbonate of potassa is in white crystals, which are wholly solu- ble in water. It has a slightly alkaline taste, is soluble in four times its weight of w7ater at 60°, but is insoluble in alcohol. It undergoes no change on exposure to the air. LIQUOR POTASSJE. 365 This salt may be used as an antacid in the dose of gr. x to 3J ; but it is by no means as often prescribed as the bicarbonate of soda. 4. POTAS'SA CAR'BONAS. —CAR'BONATE OF POTAS'SA. Impure carbonate of potassa — POTAS'SjE CAR'BONAS DIPU'RUS — is known in commerce under the name Pearlash. It is principally ob- tained from the lixiviation of wood ashes. To prepare the carbonate of potassa, pearlash is dissolved in water, and filtered ; and the solu- tion is evaporated in an iron vessel, until the salt granulates. It is generally kept in this granular state, owing to the difficulty of crys- tallising it. It is often called Subcarbonate of potassa, and Salt of tartar ; although the latter term is more appropriate to the Potass^ Carbon as Purus. It has a strongly alkaline urinous taste ; is very soluble in water, but insoluble in alcohol; and attracts water freely from the air, so as to become liquid, and form the Oleum tartari per deliquium. The dose of the carbonate of potassa, as an antacid, is from gr. x to £ss, in sweetened water. It is, however, more disagreeable than the bicarbonate ; and, owing to its more active alkaline charac- ter, is apt to do more injury to the lining membrane of the stomach when used very frequently. It is, therefore, not so often employed as an antacid as the bicarbonates of soda and potassa. Pure Carbonate of Potassa —POTAS'SA CAR'BONAS PURUS, or Salt of tartar, more preperly so called — is directed in the Pharma- copoeia of the United States to be made by rubbing Bitartrate of potassa and Nitrate of potassa separately into powder ; then mixing and throwing them into a brass vessel heated nearly to redness, that they may experience combustion. From the residue, the pure car- bonate is formed in the same manner as the carbonate. In regard to its medical virtues, they are precisely the same as those of the carbonate. Pure carbonate of potassa enters into the preparation of the Liquor Potass^: Arsenitis. LIQUOR POTASS! CARBONA'TIS, SOLUTION OP CAR'BONATE OF POTAS'SA, (Po- tass, carbonate, ffjj ; Aqua destillat. f. 3xij.j This is a simple solu- tion of an ounce of carbonate of potassa in an ounce of distilled water, and is hardly worthy of its place as an officinal preparation, The dose is rc\x to f. 3J, in water or milk. 5. LIQUOR POTAS'SA. —SOLUTION OF POTAS'SA, Solution of potassa or Soap lye— Lixiv'ium sapona'rium — is pre- pared by dissolving Carbonate of potassa in distilled water; slaking lime with another portion of water; mixing the hot liquors ; boiling for a short time; setting aside, and pouring off the supernatant clear liquor, wdiich must be kept in well-stopped bottles of green glass. 30* 366 SPECIAL ANTACIDS. If not preserved from the contact of air, it becomes converted into a solution of carbonate of potassa, owing to the absorption of car- bonic acid: the direction to keep it in green glass bottles is owing to its acting slightly on white flint glass. The specific gravity of the liquor potassae of the Pharmacopoeia of the United States is 1.056. It is limpid, colourless and devoid of smell, but has an acrid taste. When rubbed between the fingers, it has a soapy feel, owing to its partly dissolving the epidermis. Solution of potassa is used, at times, as an antacid, but owing to its causticity it is not so often prescribed as the carbonates of soda and potassa, which are equally effective as neutralisers of acid. The dose is from ten to thirty drops, given in infusion of orangepeel, veal broth, or in table beer, that is not acid. Like all the alkalies, it is often associated with the vegetable tonics, under the compound view referred to in the general considerations of antacids. (Vol. n. p. 359.) 6. LIQUOR AMMO'NLE. — SOLUTION OF AMMO'NIA. This preparation, whose general properties are described else- where, (Vol. i. p. 492,) may be given as an antacid, whenever it is desirable not only to neutralise redundant acid, but, likewise, to stimulate the stomach to greater energy. Its dose may be from gtt. v to gtt. xx, in a wine-glassful of water. 7. AMMO'NLE CAR'BONAS.—CAR'BONATE OF AMMO'NIA. Carbonate of ammonia (Vol. i. p. 494,) is possessed of the same properties as the last preparation. It may be given, in the dose of from five to ten grains, in the form of pill, or in solution. A good vehicle for the pilular form, in cases of atonic dyspepsia, is the ex- tract of gentian. 8. MAGNE'SIA. Magne'sia, Calcined magne'sia, (Vol. i. p. 159,) is an excellent antacid; — the salt, resulting from the union of the gastric acids with it, being laxative. It is, hence, well adapted for cases in which too great a secretion of the gastric acids exists along with constipation, or a tendency thereto. It is devoid of irritating properties, and is, therefore, calculated for most cases in which there is a predominancy of acid. It may be given in the dose of from gr. x to gr. xxx. When very frequently used, it is said to have accumulated in the bowels, so as to give rise to ileus; but these cases must be exceed- ingly rare. The best vehicle for its administration is milk. TROCHIS'CI MAGNESIA, TROCHES OF MAGNE'SIA. (Magnesia, §iv; Sacchar. tbj ; Myristic. in pulv. 3J; Mucilag. Tragacanth. q. s.; to be made ANTALKALIES. 367 into troches, each weighing ten grains.) These lozenges are bene- ficial in acidity of the stomach, accompanied by constipation. The same properties belong to 9. MAGNE'SLE CAR'BONAS. — CAR'BONATE OF MAGNE'SIA, the dose of which is likewise the same. 10. CRETA.—CHALK. CRETA PRIPARA'TA, PREPARED CHALK. (Vol. ii. p. 144,) is an excellent antacid, especially — as before remarked — where it is desirable, that the resulting compound, from the union of the acid wTith the antacid should be possessed of an astringent action. The dose, as an antacid, may be from ten to forty grains or more, three or four times a day, in sugared water, or in any vehicle. TROCHIS'CI CRETJE, TROCHES OF CHALK. (Cretapraparat. |iv ; Acacia, in pulv. 5j ; Myristic. in pulv. ^j ; Sacchar. in pulv. ^vj. To be made into troches each weighing ten grains.) These lozenges may be used wherever chalk is indicated as an antacid. 11. LIQUOR CALCIS. —LIME WATER. Lime-water (Vol. ii. p. 145,) is often an efficient antacid, in the same cases as chalk; the compound, formed with it and with chalk by the gastric acids being identical. It may be taken either alone, or mixed with milk; and, in this form, is serviceable, especially where acidity exists along with diarrhoea or a tendency thereto. Its dose is from f. ^ij to f. §iv, or more, several times a day. II. ANTAL'KALIES. Definition of antalkalies — Cannot often be needed — Alkaline state of the Habit — Mode of improving defective nutrition — Special antalkalies. This class of medicines is unimportant, inasmuch as circumstances but rarely arise, which can be conceived to indicate their use. " Free alkalies," it has been asserted by Dr. A. T. Thomson, " are rarely pre- sent in the stomach." It may be questioned, whether they be ever met with in that organ, in health. It is not, indeed, easy to con- ceive of their presence there, unless we consider, that the gastric solvent varies materially in character, so that at one time it shall be the very antithesis to what it is at another. In the case of fistulous opening into the stomach, to which the author has more than once 368 ANTALKALIES. referred, opportunity "was afforded for examining the gastric secre- tions under various circumstances of sickness and of health. In every case, the acid character wTas marked. The chlorohydric and acetic or lactic acids were always contained in it in considerable quantity. The idea that free alkalies may exist in the stomach doubtless rests mainly on the affirmations of Dumas and others, who have asserted, that the 'gastric juice' was acid or alkaline, according as the dog — the animal experimented on — was fed on animal or on vegetable diet. But these experiments were made on dogs ; and on the mixed secretions from the lining membrane of the supra-diaphragmatic por- tion of the alimentary tube, from the salivary glands, and the sto- mach itself; and, besides, they do not seem to have been performed with care or accuracy, as the best testimony certainly is in favour of the gastric secretions — in the case of man — being always acid. Should, however, the acid secretion be arrested from any cause, neutral indigestion may supervene, which may require the use of acids for its removal. In the absence of all secretion of acids, we can, indeed, understand, that there may be an alkaline condition of the secretions in the stomach, derived from the saliva. It has been long maintained, that an alkaline state of the whole habit may exist, and this is considered to be indicated by " the che- mical quality of the urine, accompanied with paleness of the coun- tenance, lassitude, irregular bowels, — sometimes costive, some- times too relaxed, — and a tendency to hysteria in females." Men- tal as well as corporeal causes, diseases affecting the spinal cord, whether in the loins, back, or neck, or whether paralysis be present or not, it is said, produce an alkaline state of habit, which is dis- played in the urine. But the inferences, deducible from the con- dition of the urine, are not as clear as they might appear to be. Its character varies from numerous causes, and, even in health, we no- tice the greatest difference. At times, it may be acid — at others, alkaline. Except as regards its colour, transparency, and deposi- tions, we cannot say much ; and, indeed, great obscurity rests on the causes of these qualities. On this account it is, that uroscopy is not as much attended to, at the present day, as it w7as formerly, or as it ought to be. Of late, its microscopic characters in health and disease have been studied, but we have yet much to learn in regard to it. The condition of the urine differs materially according to the vary- ing condition of the functions of nutrition, and a state of the system may exist, which might, perhaps, be esteemed of an alkaline charac- ter, and is capable of being best rectified by the administration of acids. Professor Chaussier, of Paris, in a letter to M. Broussais, has affirmed, that in all states of disease or of prolonged irritation the secretions become alkaline. He observes : " From a great number of researches and experiments, wdiich I formerly made, it has ap- peared to me: First. That in general, in a state of health, all the soft parts and the greater proportion of the fluids of the animal body are more or less acid ; or, if it be preferred, have a tendency to red- SPECIAL ANTALKALIES. 369 den test papers: Secondly. That others appear to be neither acid nor alkaline: Thirdly and finally: that some (as the semen) are alkaline. But, in a state of disease or prolonged irritation, all con- tract an alkaline quality, which renders them capable of changing the test papers to a green colour; thus, the perspiratory humour, which in a state of health is alwrays acid, sometimes assumes an al- kaline character. The urine which in a state of health immediately reddens litmus paper, becomes evidently alkaline, if the kidneys or bladder are in a state of irritation or inflammation : in some cases it even contracts a strong ammoniacal odour, which is perceptible at some distance. It is the same with all the excretions, which are augmented by any grade of irritation. Thus, in some cases of co- ryza, the humour, which flows from the nostrils, is so acrid as to occasion the swelling of the upper lip, which is generally regarded as a sign of a scrofulous constitution. It is the same as regards the excretions from the bronchia or lungs, which always, when the irri- tation or the disease becomes violent, assume an alkaline character, and give a green colour to test papers. The humour, which flows from ulcerated cancer or other analogous affections, is also more or less alkaline: it has even appeared to me, that in a healthy subject, having a suppurating wound, the pus of which is laudable, this pus will not, or at least will only feebly, redden test papers, but if the suppurating surface be wiped several times, or if it be irritated in any other way, it soon furnishes a clear serosity, which then changes the papers to a green colour." It was from views, similar to those of Chaussier, that many of the older pathologists considered those cases of inveterate cachexia, which exhibit so strongly a firmly implanted vice in the nutritive functions of every part of the frame, to be evidences of a predom- inant alkalescency, that could only be removed by the administration of acids. These views have almost passed away, but we ought not to lose sight of the pathological fact, that such a vice may be accom- panied by an alkaline condition of the urine, in the same manner as one form of the calculous diathesis — also dependent upon faulty nutrition — is indicated by deposits of the phosphates from the urine. It is, however, to the removal of the derangement of the function of nutrition, that our attention — as pathologists and thera- peutists — has to be directed. SPECIAL ANTALKALIES. The remedies adapted for the removal of alkalescency, are Acids — mineral and vegetable — associated with the various tonic and revulsive agencies, described under the head of Antilithics. (See Vol. i. p. 294.) 370 DISINFECTANTS. III. DISINFECTANTS. Stxon. Antipestifera, Antiputrescents. Definition of disinfectants—Antiseptics—Modus operandi of disinfectants—Bad effects of odorous fumigations—Of heat, mineral acid vapours and the chlorides as disinfect- ants—Use of antiseptics—Special disinfectants. The term disinfectants has been restricted by Dr. A. T. Thomson to those agents, that are capable of neutralising morbific effluvia; but as he has used it synonymously with antiseptics, the definition is manifestly not sufficiently comprehensive. Under this head we shall, therefore, in addition, consider substances that maybe esteemed Antiseptics — or agents that are capable of removing any incipient or fully formed septic condition of the living body, or of any part of it. To inquire fully into the subject of disinfection, it might be ad- visable to investigate every form of atmospheric vitiation, whether it consist in the presence of some known noxious gas; of those ter- restrial emanations that give rise to intermittent fever; or of the effluvia that appear to proceed from one labouring under a disease presumed to be communicable, and are capable of producing the same disease in one exposed to their influence. The author has en- tered pretty fully, however, in another work, into the history of physical agents that influence human health; and he will, conse- quently, confine himself chiefly, in this place, to some observations on the mode of disinfecting or purifying any confined space from morbific miasmata — terrestrial or animal. (Human Health, p. 61, Philad,, 1844.) It is manifest, that every such disinfecting agent must be capable of chemically combining with the effluvia, and thus of depriving them of their morbific properties. In no other way can we conceive that disinfectants can act. Although we are entirely unaware of the precise character of the tertium quid— if it may be so called — which emanates from a body labouring under a contagious disease, and produces a like affection in another body exposed to it, we have the best possible evidence, that such an emanation or miasm is given off; and should this — in the condition in which it is exhaled — come in contact with a fit recipient, disease will almost certainly result. The emanation must, therefore, have its very nature destroyed, and the product of the decomposition be altogether harmless. This is not the place to enter into a discussion as to what diseases are unquestionably contagious. Much that is erroneous has doubt- less been written and conceived on the subject. It is sufficient to know, that a locality is considered, from any cause, to require disin- fection, to render it important to inquire into the means for accom- plishing this object. There are few agents, which can be employed with well founded expectations of success as disinfectants. Many that are used are DISINFECTANTS. 371 positively injurious, exerting no destructive effect on the noxious emanations, whilst they interfere with the purity of the air, and thus favour their pestiferous agency. Of these, burnt sugar may be re- garded as one. It is often employed with the view of concealing other odours; but it can obviously do so merely by its odour over- powering them; whilst the amount of adventitious matter in the air of the apartment is augmented by it, where proper ventilation is not adopted; and, where it is, the ventilation is more effective, when these presumed disinfectants are not employed. Even where true disinfectants are used, it is highly necessary, that the air of the sick chamber should be changed by the adoption of a thorough system of ventilation. Every such agent adds a material to the air of the apart- ment, that ought not to be suffered to remain, and is, consequently, so far deteriorating ; whilst many of them are so penetrating as to in- duce much irritation in the respiratory organs, and, under certain circumstances, their employment may obviously be followed w7ith marked disadvantage. They may disinfect the air, yet occasion mischief from their own irritating qualities. Fortunately we have become acquainted with the properties of several substances, whose disinfectant agency is signal, whilst they are devoid of these incon- veniences. What has been said, regarding the effect of burnt sugar, applies equally to many other substances, that were, and still are, much used as disinfectants, — such as benzoin, camphor, and different aromatic substances. They are not more efficacious, and they are equally liable to the disadvantages attendant upon its employment. Heat has long been esteemed a powerful disinfectant; but its reputation has chiefly reposed upon certain notions connected with its power of changing the condition of the atmosphere during epidemics. Hence, in times of spreading sickness, it has been advised to light large fires with the view of destroying effluvia, which might be supposed to exist in the air. The coincidence that occurred between the last visitation of the plague in London, in 1665, and the great fire in 1666, has been esteemed, by some to favour this view; but the pre- sumed cause is insufficient to account for the effect. Although the heat might have destroyed the morbific miasms — wdiich in the case in question is doubtful — it could not have prevented the recurrence of the evil. Its subsequent non-appearance seems to have been owing to other causes ; — a better system of ventilation and draining was adopted ; the streets were widened ; common sewers were estab- lished ; and paving was every where introduced ; — circumstances that are adequate — even without sanitary regulations, which were rigidly enforced, but whose agency was more than doubtful — to account for the change. But, although heat can scarcely be used with advantage for puri- fyinc districts suffering under epidemic or contagious maladies, there can be no doubt whatever, that it is capable of disinfecting confined spaces, and bodies imbued with morbific miasms. In some modern 372 DISINFECTANTS. experiments, by Dr. Henry, of Manchester, England, he found, that substances, impregnated with the matter of contagion, and exposed to elevated temperatures, — namely, from 200° to 204°, for a con- siderable length of time, — were rendered incapable of communica- ting disease, even when they consisted of clothes that had been worn during the whole period of a contagious malady. He inclosed the substances to be disinfected in air-tight canisters, and exposed them to dry heat for a certain time; and he esteems this process to be supe- rior to exposing them to gases, inasmuch as gases may be arrested by compressed materials, whilst no arrangement can prevent the trans- mission of caloric. The agent he employs is steam, and this is passed between the sides of a tin copper box, and an outer case of the same material. The most delicate goods cannot be injured by the appli- cation of the degree of heat disengaged by this means. At one time, the mineral acid vapours—muriatic, nitric, and ' oxymuriatic' — as it was then termed — were almost solely em- ployed as disinfectants, and they are efficacious agents. For the discovery of the powers of the nitric acid vapours, Dr. Carmichael Smythe received the disproportionate reward of ten thousand pounds, according to some, (A. T. Thomson,) — five thousand, according to others, (Pereira,) — from the British Parliament; — yet, strange to say, chlorine, in some form, has so completely taken its place, that we rarely hear, at the present day, of its employment. Acid gases are liable to the objection, that they are extremely irritating when respired; indeed, in a state of concentration they are completely irrespirable. They cannot, therefore, be used in the sleeping apartments of the sick, although they may be beneficially employed, after patients have been withdrawn, and the object is to disinfect the chamber. They ruin polished metallic surfaces, but this can be effectually obviated by painting the surfaces with a compost of starch. The inconveniences, attendant upon the use of the acid gases, and of chlorine disengaged in the ordinary way, are obviated by using the chlorinated preparations— of lime and soda especially—for the discovering of the disinfecting properties of which we are indebted to M. Labarraque — an ingenious French pharmacien—who, in the year 1824, fully established their title to the reputation of being our best disinfecting materials. In these preparations, the chlorine is retained by such a feeble affinity, that even the carbonic acid of the air is sufficient to displace it. The chlorine is, in this way, gradu- ally given off, and the base unites with the carbonic acid to form a carbonate. All that is necessary to be done, is — to expose the chlorinated lime, or the solution of chlorinated soda in flat shallow vessels, in the sick room, as occasion may require. Indeed, as- persions with a solution, not containing more than one tw7o-hundredth part of chloride of lime, have been found adequate to the disinfection of the wards of a large hospital. Where bodies, which have remained for some time in the earth, ANTISEPTICS. 373 have to be exhumed, the strength of the solution must be increased, and it may be well to dip a cloth in the liquid, and envelop the body in it, moistening the cloth occasionally with the solution. There is no object requiring disinfection for which the chlorinated preparations are not appropriate. Where excrementitious matters have to be retained in the bed chamber, the offensive odour is neutralised by throwing one of them into the vessel and around the chamber; and the great advantage of this mode of disinfection is, that it may be used in the chambers of the sick, without the disengaged chlorine exciting any inconvenience. By these methods, morbific effluvia may be acted upon and de- stroyed, and if due ventilation be practised, all the seeds of disease may often be effectually removed. Thus much as regards the agents, that are chiefly employed to disinfect the air of confined situations, or substances that have imbibed contagious effluvia. It yet remains to touch briefly on those agents that are esteemed capable of removing any incipient, or fully formed septic condition in the living body, or in any part of it. Connected with this subject, it is important to bear in mind the results of experiments, instituted by Dr. Stark, which show, that when pieces of cloth, of different colours, are exposed to odorous particles emanating from bodies, some absorb a larger amount of particles than others. His experiments exhibit, that black and dark blue absorb twice as much as white; and he infers, with probability, that contagious emanations may be subject to similar laws with odorous emanations, and that, accordingly, in times of contagious maladies, black is the worst colour, that could be worn. " Next, therefore," he says, "to keeping the walls of hospitals, prisons, or apartments occupied by a number of individuals, of a white colour, I should suggest that the bedsteads, tables, seats, &c, should be painted white, and that the dresses of the nurses and hospital attendants should be of a light colour. A regulation of this kind would possess the double advantage of enabling cleanliness to be enforced, at the same time that it presented the least absorbent surface to the ema- nations of disease." The humourists of old believed, that the animal body can undergo putrefaction or a septic change, even whilst the principle of life is still pervading it; and many of their pathological notions were based upon the belief of such a conversion having taken place in the hu- mours ; but, in the sudden change from humourism to solidism, these notions were exploded, and it was considered the height of absurdity to believe such a thing possible. The principle of life was con- ceived to counteract every septic tendency, and, indeed, to render any such condition impracticable. Within certain limits, these views are accurate. We can scarcely imagine a condition of the living body in which all its parts shall vol. n.—32 374 ANTISEPTICS. be putrid. Putrefaction cannot be fully formed, unless the principle of life is extinct; but that a putrescent state may be present in the yet living body is evidenced by numerous facts. The condition of the organism, in those fevers that have been called putrid, in the worst cases of scurvy, and where individuals have been exposed for a sufficient length of time to a putrid atmosphere, sufficiently ex- hibits, that a septic change may be effected, between which and putrefaction the same relation may be conceived to exist as between gangrene and sphacelus; — in the former of which the part may be considered in a state of suspended animation, admitting of resusci- tation ; whilst, in the latter, the principle of life is extinct, and the mischief, therefore, irretrievable. The analogy holds good, too, in a therapeutical relation. The remedies, that are appropriate in a case of gangrene, are equally indicated in putrescency of the system ; whilst in fully developed putrefaction — as in sphacelus or true mortification or death of a part— no therapeutical agent can be pos- sessed of any efficacy. Of the various signs of death — many of which are so equivocal — putrefaction is the most satisfactoy; and when the ordinary signs have been wanting, it has been advised to keep the body above ground, until there could be no doubt, from the evidence of the senses, that its elements were beginning to yield to the play of new affinities. Granting, that such a septic tendency may exist in the organism under particular circumstances, we can conceive, that antiseptics may be needed in two contingencies: first, to obviate such septic. tendency; and secondly, to correct the offensive character of any of the tissues or secretions that may have become putrid, and thus prevent them from reacting on the system. For fulfilling the first object, the most opposite management may be requisite in different cases. If we inquire into the causes of the positive death of parts, to which the name mortification has been given, we find them to be numerous: they may consist in excessive action of vessels; in great irregularity of circulation, and innervation; in the use of certain agents as food, — ergot of rye, for example, &c. &c; and, accordingly, as the causes are various, the means to be adopted for their removal must be equally so. Hence, anti- phlogistics may, in one case, be antiseptics; whilst in another, tonics and stimulants may be demanded.' It is not, however, to the agents just mentioned, that we ordi- narily apply the term antiseptics. Its acceptation is usually confined to agents that are employed when signs of putrescency or of decom- position have already manifested themselves, and when the object is both to destroy the offensive character of the tissues or secretions, and to arouse the vital energies, so as to enable the function of nutrition to take fresh activity, and throw off the morbid and morbific degeneration. For this purpose, the different vegetable tonics, and especially the cinchona, with the mineral acids are generally exhibited, with the view of inducing a new action in the function of innervation, SPECIAL DISINFECTANTS. 375 and, through the improved haematosis, of enriching the vital fluid, so that, when it reaches the capillaries, — under the amelioration, oc- casioned by these combined changes, — the organs of nutrition may assume fresh activity, and if a portion of the organism has become dead, and consequently extraneous, a separation of the dead from the living portions is more readily accomplished. It is in this way, pro- bably, that most of the internal antiseptics act; whilst by passing into the mass of blood, and being exhaled through the different emunctories, they may, at the same time, correct any septic con- dition or tendency, which the different tissues or fluids may have acquired. There are some antiseptics, however, whose action cannot be ex- plained in this manner. It can obviously be only the modus operandi of such as enter the blood-vessels — wholly or in part. Charcoal probably exerts its efficacy altogether on the first passages, and through them on the rest of the frame. It is difficult to conceive, that it can act in any manner through the medium of the circulation : whilst the chlorides, mineral acids, creasote, &c, produce their effect in the compound mode above described. In like manner, when these and other agents are applied exter- nally to gangrenous or gangrenoid parts, their operation is equally complex. They first of all disinfect, by acting chemically on the parts with which they come in contact; and, as a general rule, stimulate the vital energies of the tissues, until these assume a new action, and throw off the morbid condition and degenerations. It is with this view, that antiseptics are employed in gangrene, sphacelus, foul ulcers, &c. &c. Some of them would seem to act merely as disinfectants. Such is, probably, the case w7ith charcoal. When applied to a gangrenous or sphacelated part, it scarcely, perhaps, retards the progress of putrefaction. It merely destroys the putrid emanations, and thus prevents them from reacting injuriously on the system. SPECIAL DISINFECTANTS. In considering the different disinfectants, it may be convenient to divide them into two classes: —the first, including those that are employed to disinfect apartments, clothing, &c.; and the second, dis- infectants of the living body or antiseptics. a. Disinfectants of apartments, clothing, &c. 1. CHLO'RINUM.—CHLORINE. Fumigations of chlorine have long been used for the purpose of destroying the matter of contagion, and of preventing the spread of 376 SPECIAL DISINFECTANTS. contagious diseases. Towards the close of the last century they were proposed by Guyton de Morveau, and hence have been called the Guytonian or Guyton Morveau fumigations. The following method was employed by Dr. Faraday for disin- fecting the general penitentiary at Milbank, Westminster. One part of common salt was intimately mixed with one part of the black ox- ide of manganese; the mixture was placed in a shallow earthen pan, and two parts of oil of vitriol, previously diluted with two parts by measure of water, were poured upon the mixture,— the whole being stirred with a stick. Chlorine continued to be liberated for four days. The quantities of ingredients employed were 700 pounds of common salt; the same amount of the oxide of manganese, and 1400 pounds of sulphuric acid. Chlorine is supposed to act by abstracting hydrogen from mias- mata ; but we are not yet sufficiently instructed in the nature of the miasmata themselves, to enable us to pronounce positively on this matter. Were they proved to consist of sulphuretted hydrogen, we could readily comprehend the agency of the chlorine, which speedily decomposes that gas ; but we are yet altogether in the dark in regard to the nature of malaria of all kinds ; although ready to admit that an unusual quantity of sulphuretted hydrogen may occasionally be found in the air of malarious regions, as we know it is in places which are certainly not malarious. Chlorine — as disengaged in the mode described above — is ex- tremely irritating when breathed, and cannot, therefore, be used in the sleeping apartments of the sick, although it may be employed beneficially after they have been withdrawn, and the object is to disinfect the chamber. It certainly has great power in destroying offensive odours, but, as remarked under chlorinated lime, it has yet to be proved whether it be capable of preventing the extension of spreading diseases. The Aqua Chlorini, (Vol. ii. p. 334,) is occasionally sprinkled in the sick chamber to purify the atmosphere during the prevalence of contagious or other diseases. 2. CALX CHLORINA'TA.—CHLO'RINATED LIME. Chlorinated lime or chloride of lime — whose main properties have been described under Eutrophics, (Vol. ii. p. 335,) has been much used for purifying the air of the wards of hospitals, jails and ships,— a little of a solution (Calcis chlorinat. 3J; Aqua, Oj ;) being sprinkled, from time to time, on the floor; or shallow vessels, con- taining the chloride, being placed in different parts of the room. It is used, also, for disinfecting clothing, furniture, &c, care being taken that due ventilation is practised. In anatomical investiga- tions, this agency has been most useful, especially where a body has been exhumed after having been a long time buried. Some time ACIDUM NITRICUM. 377 before dissection, the body may be enveloped in a cloth wetted with the solution mentioned above, which must be kept wet by sprinkling it from time to time. It is doubted, and even denied, that its use is productive of any advantage in preventing the spread of infectious, contagious or epi- demic diseases. It has, indeed, been affirmed to be positively inju- rious, by deteriorating the atmosphere; and in this there may be truth, unless the precautions, above mentioned, for due ventilation be taken. In various cases, in which such diseases have prevailed, it has destroyed all offensive odour, but the extension of the malady has not been prevented. Chlorinated lime has, likewise, been used to disinfect privies, and to destroy the unpleasant smell from sewers, drains, and from those occupations in which putrid animal substances are employed. 3. LIQUOR SOD^E CHLORINA'T^E— SOLUTION OF CHLO'RINATED SODA. Chloride of Soda or Labarraque's Soda Disinfect'ing Liquid — whose general properties have been described elsewhere, (Vol. ii. p. 336,) has been used as a disinfectant in the same cases as chlorinated lime. It may be diluted with water, in the proportion of one ounce of the solution to a pint. 4. ACIDUM MURIAT'ICUM.—MURIAT'IC ACID. Ga'seous muriat'ic, chlorohy'dric or hydrochlo'ric acid, is procured, for the purpose of disinfecting, by mixing twelve parts of muriatic acid with fifteen parts of chloride of sodium, moistened before the acid is added. In this process, the water is decomposed, — its oxy- gen going to the sodium and forming soda, and the hydrogen uniting with the chlorine, and escaping as muriatic acid gas. The sulphuric acid unites with the soda formed, and remains as sulphate of soda. Muriatic acid gas has a pungent odour, an acid taste, and is very irri- tating to the respiratory passages when inhaled. It is a colourless, invisible gas, but fumes in the air, owing to its affinity for aqueous vapour. This gas has been much employed as a disinfectant, but its agency has been doubted ; and it is certainly less used than chlorine. When it is desired to disinfect an apartment, portions of the mixture men- tioned above may be placed in shallow vessels about the room. 5. ACIDUM NI'TRICUM.—NITRIC ACID. The vapour of nitric acid, (Vol. ii. p. 71,) may be employed as a disinfecting agent; but although — as before remarked — the first proposer of it — Dr. Carmichael Smythe — received an exorbitant 32* 378 SPECIAL DISINFECTANTS. reward, it has now almost wholly given way to chlorine, to which it is supposed, by most persons, to be inferior. A recent writer, how- ever, Dr. Christison, thinks it is probably the best of the disinfecting gases or vapours; " for," he remarks, " it may be disengaged throughout the air of an apartment without the previous removal of the sick ; and as the acid destroys all animal textures and principles with which it comes in contact, its vapour can scarcely fail to de- stroy equally all invisible animal effluvia." It may be set free by mixing equal parts of nitrate of potassa and sulphuric acid, and placing the mixture in shallow vessels about the room. Half an ounce of nitrate of potassa, and the same quantity of sulphuric acid, are said to be sufficient to disinfect a cubic space of ten feet. 6. ACIDUM SULPHURO'SUM.—SULPH'UROUS ACID. Sulphurous acid is sometimes used as a disinfectant of chambers and clothes. It is prepared by simply setting fire to sulphur, and introducing the vessel containing it into the room to be purified. It is employed to fumigate clothes that have been used by one affected w7ith itch, and is very effective for this purpose. 7. CALOR'IC. Enough has been said on the method of employing heat as a disin- fecting agent in the general remarks at the head of this section, (p. 370.) b. Disinfectants of the Living Body.—Antiseptics. 8. ALU'MIN^E SULPHAS.—SULPHATE OF ALU'MINA. Of late years, M. Gannal has discovered, that the aluminous salts are eminently possessed of the property of preserving animal mat- ters ; " their bases combining with geline to form a special compound, the acid being set free." He found the aluminous deliquescent salts to be of all saline substances those that afforded the most satisfactory results. The acetate of alumina and chloride of aluminum succeeded with him perfectly ; and a mixture of equal parts of these two salts proved to be an excellent injection to preserve dead bodies. He gives, however, the preference to the simple sulphate of alumina, which is of ready preparation, and moderate price. It may be made by the direct combination of alumina and sulphuric acid. The salt contains 30 per cent, of the former to 70 of the latter. A kilo- gramme — about two pounds, eight ounces and a drachm and a half Troy — dissolved in two quarts of water, was sufficient, in winter, to preserve a body fresh, by injection, for three months. To pre- serve it for a month or six weeks, it was not even necessary to inject the blood-vessels, — an enema of one quart, and the same quantity CALX CHLORINATA. 379 injected into the oesophagus were entirely sufficient for this purpose. In hot weather, the solution must be stronger or in greater quantity, and it may be injected into the carotids. It has been chiefly to prevent putrefaction in the dead body, that the salts of alumina have been employed ; but they might, doubtless, be used with great advantage as external applications in all cases that require the topical employment of antiseptics. At the author's suggestion, they were so used at the Philadelphia Hospital, and were found to have an excellent effect in ulcers re- quiring an antiseptic and detergent applications. Two drachms of the sulphate to half a pint of water forms a good wash in such cases, but it may be made much stronger than this. After lecturing on patho- logical specimens, the author has found a saturated solution of the salt remove the offensive odour from his hands more speedily and effectually than any other antiseptic. 9. CHLO'RINUM. —CHLORINE. The vapour of chlorine has been recommended to be inhaled in cases of gangrene of the lungs, in which it has been found decidedly beneficial, correcting the foetor of the breath and expectoration, and, therefore, calculated to obviate not only the local but the constitu- tional symptoms. The aqua chlorina, (Vol. ii. p. 334,) has been given in various diseases as an antiseptic, — for example, in typhus fever ; malignant anthrax ; scarlatina maligna ; malignant dysen- tery ; cancrum oris ; gangrene of the lungs, &c. &c. Owing to the facility with which it experiences decomposition, it should not be prescribed in larger quantity than is necessary for twenty-four hours. The average dose in this time may be f. |j. It has been also used as an ablution to prevent venereal infection ; to foetid ulcers to cor- rect the unpleasant odour, and excite a new action of the parts, and as a gargle in putrid sore throat. Baths of chlorine have likewise been advised as an excellent means for preventing plague. 10. CALX CHLORINA'TA. —CHLO'RINATED LIME. Chlorinated lime has been given in various affections in which the use of chlorine as an antiseptic has been indicated. Both inter- nally and externally, it has been employed in gangrenous ulcers ; foetor oris ; gangrene, and other affections of the lungs, accompanied by great foetor of the breath and expectoration ; foetid eructations ; malignant dysentery, and typhus. It may be administered in the form of pill or dissolved in sugared water, — the dose being from gr. j to gr. vj, several times a day. Externally, it has been employed in various cases; — in foetid atonic ulcers; ozoena; cancrum oris; gangrene — both common and hospital; offensive conditions of the mouth no matter whence arising; putrid sore throat, and wherever an antiseptic has appeared to be 380 SPECIAL DISINFECTANTS. demanded. It may be employed as a lotion of varied strength, form 5J to ^ss to Oss of water, the solution being decanted to remove the particles of lime from it, unless where it is considered advisable to permit the lime to remain, and be deposited upon the surface to which the solution is applied. In cases of very offensive discharges from the bowels, it may also be added to an enema, in the quantity of ten or fifteen grains or more. Dentifrices are likewise made of it, and lozenges. 11. LIQUOR SODjE CHLORINA'T^E. —SOLU'TION OF CHLO'RINATED SODA. This solution is used as an antiseptic in the same cases as chlori- nated lime, and has been, like it, prescribed both internally and ex- ternally. It is preferred, however, by many for internal adminis- tration. The dose may be from ten drops to f. 3J in plain or sugared water. When applied externally, as an antiseptic to ulcers, &c, it may be diluted with from five to ten parts or more of water. 12. ACIDUM MURIAT'CUM. — MURIAT4C ACID. Liquid Muriat'ic, Chlorohy'dric, or Hydrochlo'ric acid, is obtained by subjecting a mixture of Chloride of sodium and Sulphuric acid to distillation, and condensing the chlorohydric acid gas in water con- tained in the receiver. The rationale of the process is the same as that for chlorohydric acid gas, (p. 377.) It is, indeed, an aqueous solution of that gas, and, in the Pharmacopoeia of the United States, is directed to be of the specific gravity 1.16. When pure, it is colourless, and is entirely volatalised by heat. When diluted with distilled water, it yields no precipitate either with chloride of barium, which throws down a white precipitate if sulphuric acid be present; and it does not dissolve gold leaf even with the aid of heat, as it would do if chlorine were there. Muriatic acid has been given internally in affections exhibiting a septic tendency, as in cynanche maligna, typhus, and cancrum oris; when it is usually associated with tonics, as cinchona or quassia. As a topical application, it has been used in cancrum oris, ulcerated sore throat, and foul ulcers. In the first case, it is sometimes ap- plied slightly diluted ; in the latter, more largely so. The proportion in a gargle may be from f. 3SS to f. jij of the acid to f. |vj of water. Internally, it may be given in the dose of from ^Iv to i^lxx, properly diluted with water. AC TDUM MURIAT'ICUM DILU'TDI, DILUTED MURIAT'IC ACID. (Acid, muriat. f. 51V; Aqua destillat. f. §xij.) The specific gravity of this acid is 1.046. CREASOTUM. 381 The Sulphuric and Nitric Acids, properly diluted, are used in similar cases. 13. CARBO LIGNI. — CHARCOAL. Charcoal—whose general properties have been described already, (Vol. ii. p. 50,)—is possessed of strong antiseptic powers; and, like- wise, exerts a decided tonic influence on the organism; hence it has been prescribed in dyspepsia, accompanied with fetid eructations; but has not been given internally to correct a septic tendency else- where than in the alimentary tube, as it is wholly insoluble. It is added to dentifrices partly on account of its power of correcting foetor, and partly because it is well adapted, as a gritty powder, for cleansing the teeth. To fetid and putrescent ulcers it is most com- monly applied in the form of poultice, mixed with crumb of bread and linseed meal. The dose of charcoal is from twenty grains to a drachm or more, given in syrup and water, or in the mineral water of the shops sweetened. U. CREASO'TUM. — CRE'ASOTE. The name creasote, (*f«*c, "flesh," and m»f) "preserver,") suffi- ciently indicates the antiseptic powers which it possesses. It is rarely or never given, however, internally, for this purpose ; but is sometimes applied to foul indolent ulcers, in which it both stimulates the parts to a better action, and prevents the putrefaction of secreted matters. It may, also, be used as a wash for the mouth in cancrum oris, and in putrid sore throat. Its strength may vary from two to six drops to the ounce of water. A creasote wash is sometimes used for the mouth to correct fetid breath, especially when it arises from detention of the secretions and of extraneous matters in carious teeth. The Empyreumatic Acetic, or Pyroligneous, Acid, (Vol. ii. p. 133,) is of unquestioned efficacy as an antiseptic—the creasote which it contains being, doubtless, the main agent. It has been used in gangrene and sphacelus; in sloughing offensive sores, cancrum oris, and in all cases of offensive discharges, and where antiseptics are indicated. It may be given internally in the dose of from five to thirty drops, three or four times a day, in water. Externally, it may be applied pure or diluted. It is also employed, at times, in the way of cataplasm, as an ordinary antiseptic solution. The strength may be f. £ij of the acid to f. ^vj of water. In cancrum oris, it may be used of double the strength, or even pure. 382 MECHANICAL AGENTS. 15. CINCHO'NA, SULPHATE OF QUI'NIA, AND TONICS AND ASTRIN- GENTS IN GENERAL. All the different tonics have been given internally-, and —■ as well as most of the astringents — have been applied externally to foul ulcers, and to gangrenous conditions. A poultice of powdered cin- chona is a common application in such cases. The decoction of cin- chona with acid is frequently used as a gargle to ulcerated sore throat. (Decoct, cinchon. f. ^vj; Acid, muriatic, f. 3ss.) 16. CERE VIS'LE FERMENT'UM.—YEAST. When an infusion of malt or wort is subjected to fermentation, a dirty greyish-brown substance gradually separates, forming a frothy scum and sediment, which constitute Yeast or Barm. This appears to possess chemically many of the properties of gluten. It has been prescribed internally in the dose of f. |j to f. ^ij, in typhus fever, and in scarlatina maligna, as a tonic and antiseptic, either alone or mixed with camphor water. It has, also, been given in the way of injection in typhoid tympanitis ; but it is not much employed. Of the Yeast Cataplasm, as an application to foul, ill-conditioned ulcers, mention has been made under another head. (See Vol ii. p. 202.) SECTION VIII. AGENTS WHOSE ACTION IS PROMINENTLY MECHANICAL. Modus operandi of mechanical agents—May effect the vital operations—The least im- portant of our therapeutical resources. Similar remarks to those that were indulged in under the division of chemical agents are equally applicable here. Although the classes, commonly ranked under the head of mechanical agents, may exert many of their properties in a purely mechanical manner, they still affect dynamically the vital properties of the tissues and secre- tions— and often in a marked manner. In no other way, indeed, can we explain the effect of a demulcent, when given to allay irrita- tion of the lining membrane of the air passages. The substance can come in contact only with that part of the pulmonary or gastro-pul- monary mucous membrane, which invests the top of the larynx. The portion of the membrane, actually affected with inflammatory irritation, cannot be reached by it; yet its effects are unequivocal; a soothing influence is exerted, and the cough, which is often nothing more than a symptom of bronchitic affection, is allayed. Many of the other agencies of demulcents, when used for the removal DEMULCENTS. 383 of internal disease, are equal exemplifications of the modification im- pressed upon the vital operations; and, therefore, in strictness of language, neither of the classes, usually ranked under this division, ought to be exclusively assigned to it, notwithstanding that some of their operations may be wholly mechanical;—as where a demul- cent is used to shield or varnish an inflamed part, or a diluent to render less irritating any morbid secretion or deleterious substance. Mechanical agents are generally esteemed the least important of our therapeutical resources, and perhaps they may be so. There are many morbid conditions, however, which admit of manifest relief from them; and, occasionally, all our therepeutical endeavours are restricted to their employment. I. DEMUL'CENTS. Stnon. Emollients, Relaxants. Definition of demulcents—Of emollients—Not remedies of any activity—Therapeutical application—Are digested in the stomach—Therapeutical use of emollients—Special demulcents. By most writers on therapeutics, the class of Demulcents has been separated from that of Emollients ;—the former being made, by Dr. Paris, to comprise those agents " wdiich are capable of shield- ing sensible surfaces from the action of acrid matter, by involving it in a mild and viscid medium;" whilst the latter includes—"sub- stances, whose application diminishes the force of cohesion in the particles of the solid matter of the human body, and thereby renders them more lax and flexible." Their consideration, however, em- braces so many points in common, that it may be well to keep them united ; bearing in mind, at the same time, that they are capable of producing the effects comprised in both of the above definitions, and that they are often employed accordingly. Dr. A. T. Thomson uses the word demulcents synonymously with emollients and relaxants, and defines them "substances, which diminish the vital tension of tissues and lessen acrimony by lubricating, softening, and rendering more flexible the solid part of the body." Demulcents—as employed for the first of the purposes referred to by Paris—are not remedies of any activity ; but they are agents, that may be employed with advantage in the various forms of disease to which the French have appropriated the name catarrh; — that is, in increased discharges dependent upon inflammatory or other irritation of mucous membranes. Yet, their efficacy must obviously differ somewhat, according to the facility with which they may be made to come in contact with the seat of the increased discharge, or of the inflammatory irritation. Accordingly, in gastro-enteritic affections, they are perhaps most beneficially employed ; and, since the views 384 DEMULCENTS. of Broussais have been before the medical world, demulcents have been more frequently used in those affections than formerly. It has been a reproach, indeed, against the medical practice of that cele- brated systematist, that he confines his remedial efforts too frequently to shielding or varnishing the lining membrane of the stomach, by the substances belonging to the class under consideration ; but what- ever doubt may be had respecting the effects of demulcents in such cases, there can be but ltttle that their use occasionally prevents the practitioner from the adoption of more perturbating means, and there- fore that the demulcent medication is often, negatively, of essential utility. Even where the enteritic affection is seated lower down the tube than in the portion which suffers under the gastro-enteritis of Brous- sais, demulcents may be useful. When it is in the mucous mem- brane of the stomach, the demulcent has its nature and action at first unchanged ; but when the seat of the disease is lower, the agent un- dergoes either stomachal or duodenal digestion, or both; and there- fore its modus operandi must be materially modified. In the latter case, the soothing effect is exerted on the membrane lining the supra- diaphragmatic portion of the tube and the stomach; and by con- tinuous sympathy, the effect is propagated along the membrane to the portion affected by the inflammatory irritation. It is in this mode that dietetic demulcents may be serviceable in enteritis, even when it is far down the tube—as in the mucous mem- brane of the large intestines—in cases of dysentery. They exert an immediately soothing influence on the gastric mucous membrane, and in addition, the excrementitious portion which is sent on through the canal is as devoid of irritating qualities as any faecal matter can be. Hence, the farinaceous decoctions — as of arrow-root, sago, tapioca, &c. — become not only dietetic, but medicinal agents, be- longing to the class under consideration ; and they are therefore placed by pharmacologists in the class of demulcents. These are cases, in which the remedial agent is made to come in contact — directly or indirectly — with the diseased part; and it will be readily understood, that the remarks apply to every condition of the gastro-pulmonary mucous membrane, or, indeed, of any mu- cous membrane, where similar circumstances exist; but, not unfre- quently, demulcents are prescribed for affections of mucous mem- branes with which they cannot be brought into immediate contact — or, perhaps, into contact at all — inasmuch as they must previously pass into the blood, and be eliminated by some emunctory, before they can attain the seat of the disease. Such must be the case, where demulcents are administered by the mouth, for the cure of affections of the urinary organs. To produce any effect, they must enter the circulation unchanged. This, it has been seen, cannot be the case ; and, much as it conflicts with vulgar belief, and even with the opi- nions of many practitioners, it may be laid down as a fact, that the different mucilaginous drinks — as gum water, flaxseed tea, &c, DEMULCENTS. 385 Administered in gonorrhoeal and other inflammatory irritations of the urinary organs — exert no more remedial agency than so much pure water. They act altogether as diluents. The mucilage is digested, and goes to the formation of chyle, being taken up by the chyli- ferous vessels in the small intestines; whilst the water, with which the mucilage was combined, enters the abdominal venous system by imbibition. Such is the inference which the author has deduced from repeated examination of the urine, when mucilaginous drinks have been freely taken; and the same deductions have been made from similar observations by Dr. Paris. "In parts," he observes, " beyond the reach of the first passages, and to which no fluid can arrive but through the medium of the secretions, it is very difficult to explain the principle upon which their beneficial operation can depend ; and it seems indeed highly probable, that they act in such cases as simple diluents, for the process of digestion must necessarily deprive them of their characteristic viscidity. The administration of demulcent drinks in gonorrhoea is probably of no further service, in assuaging the ardor urina, than an equivalent quantity of pure water; although Dr. Murray observes, ' it is sufficiently certain that many substances, which undergo the powers of digestion, are afterwards separated in their entire state from the blood by particular secreting organs; and there is,' continues he, 'no gland which has the power more particularly than the kidneys; substances, received into the stomach and digested afterwards, passing off in the urine with all their peculiar properties.' This is undoubtedly true ; but mucila- ginous substances rarely or never pass off in this manner; if they evade the assimilative functions, they pass through the alimentary canal, and are thus eliminated. I can state, as the result of experi- ment, that the urine undergoes no change, except in the relative proportion of its water, by the copious and repeated administration of mild mucilages. Dr. Saunders has very justly remarked, that " the long list of ptisans, decoctions, &c, usually prescribed upon these occasions, generally owe their virtues to the watery diluent itself." * Yet it is hard to abandon opinions, that have been cherished for ages, and are apparently supported by experience; and hence we oc- casionally witness attempts made to support the practice by the no- tion, that a part of every demulcent may escape digestion, and enter the current of the circulation. " But substances," says Professor Thomson, " that produce a demulcent effect are taken into the sto- mach, and apparently act upon distant organs. A question arises, suggested by the nature of the substances, what effects has digestion upon them ? Undoubtedly, a large portion of almost every demul- cent taken into the stomach is digested ; but some part of them, at least, escapes this process, and is carried into the system." But even if we admit, that a small portion of the demulcent may pass into the system — of which, however, we have no evidence — we are amply justified in inferring, that the quantity must be too vol. ii.—33 386 DEMULCENTS. minute to exert any influence upon distant organs; that, consequently, whatever effect is induced is through the agency of the water with which the demulcent is combined, and that the demulcent itself acts, in such cases, as a simple nutrient only. Next to affections of the lining membrane of the digestive appa- ratus, those of the membrane lining the air passages are most fre- quently treated by demulcents — along with other agents, according to the greater or less urgency of the case. In these affections, it would not seem, that much advantage ought to be expected from such agents, unless the inflammatory irritation be seated so high up in the larynx, that the demulcent can come in contact with it; but experience shows, that here, as in inflammatory irritations of the lower part of the intestinal tube, benefit may be derived through the means of continuous sympathy ; — that is, by soothing the top of the larynx, the salutary influence may extended lower down, and may relieve the cough, although the seat of the pathological affection, which occasions it, may be in the minute bronchial ramifications. Hence it is, that emulsions, mucilages, syrups, troches, &c, are so commonly prescribed with benefit, in cases of cough. But the agency of these substances has already been fully treated of. (See Vol. i. p. 235.) As regards Emollients, or agents whose application diminishes the force of cohesion in the particles of the solid matter of the body, and thereby renders them more lax and flexible, — much of their operation must obviously be mechanical. When we rub an emol-* lient substance into a part, which is unusually rigid, the substance in- sinuates itself between the particles of the tissue, which thus becomes softened and relaxed. Yet, even here, some degree of dynamic ac- tion may be caused by the remedial agent, and a soothing influence be exerted, which may, in some measure, reduce the tension of the organs, through the functions of innervation and circulation of the part. One of the most common cases for the employment of emol- lients is during the progress of a natural process. When the peri- naeum, in parturition, is more than usually rigid, and does not yield readily to the pressure of the head of the child, the obstetrical prac- titioner frequently recommends, that lard should be freely rubbed on the perinaeum, or that the female should sit over the steam of hot water. Often, perhaps, not much effect is exerted by this agency, but, at times, relaxation of the parts and delivery would seem to be expedited by it. In like manner, when severe sprains have been received, we have recourse to immersion of the parts in warmth and moisture. It is well known, that where swelling speedily succeeds any violent torsion of the joints, the pain is by no means so severe as when the same extent of mechanical injury is inflicted without an equal amount of tumefaction. It would seem, therefore, that if we could facilitate this tumefaction, in any manner, we might afford re- lief. Accordingly, in severe sprains of the ankle, if we advise that EMOLLIENTS. 387 the extremity be kept for some time in warm w7ater, we are often gratified to discover, that the agony is rapidly mitigated. It has been properly remarked, by Dr. Paris, that although we may be disposed to consider the principal — if not the whole — of the operation of emollients, in the cases alluded to, to be of a me- chanical character, the beneficial effects of cataplasms and fomenta- tions cannot be so explained ; "for, in these instances, none of the materials can be absorbed through the entire cuticle; and yet the relaxation and consequent ease, which such warm applications pro- duced on inflamed surfaces, is very considerable, but it must be wholly attributed to the relaxing effects of warmth and moisture upon the extreme vessels of the surface, propagated by contiguous sympathy to the deeper seated organs." In previous parts of this work, reference has been made to the effects which caloric of different intensity is capable of producing, and it was then remarked, that its agency is various according to the degree; — heat, greater than that of the human body, stimulating; whilst, when lower than that of the body, it is soothing and sedative. According, therefore, to the amount of heat, will be the effect pro- duced on the vital functions. In inflammations of deep-seated or- gans — as of the peritoneal coat of the intestines — a hot fomenta- tion, although it may excite the organic actions of the part with which it is made to come in contact, may act as a revellent, and, in this way, be beneficial like other revellents ; whilst a warm fomenta- tion, by virtue of the soothing and relaxing influence of the warmth and moisture, may — through the extensive sympathy that exists between every part of the capillary system — have its soothing influ- ence extended to capillaries that are under inflammatory excitement. It may be asked, however, whether, in this case, the inflammation be relieved by contiguous sympathy, or by the general effect, which the relaxant application exerts on the whole capillary system of ves- sels. It is probable, that the result is produced in both ways. It has been seen, that the sedative influence, occasioned by the abstrac- tion of caloric from a part of the frame, — in cases of that excited condition of organic actions, which constitutes fever, — is as effec- tually and surely exerted, as when the cooling medium is made to come in contact with the whole cutaneous surface. In internal in- flammations, the use of soothing fomentations and cataplasms may have a like agency; but a part of the effect is, doubtless, also pro- duced on the suffering organ, through the sympathy of contiguity, although this may not be so much concerned in the curative opera' tion as has been imagined. In the case assumed— of inflammation of the peritoneal coat of the intestines — the capillaries, affected by the disease, and by the local application, have nothing in common. The whole of the anatomical elements are as different as if the remedy were placed upon one of the extremities, and yet the effect is often signal: the main result is manifestly one of revulsion, — the new impression, made on the organs of circulation and innervation of the 388 EMOLLIENTS. part, detracting from the concentration of the vital manifestations ex- isting elsewhere. Lastly, in the modus operandi of emollient cataplasms in external inflammation, we have an example of a more complex agency than might, at first sight, appear. Although the w7armth and moisture doubtless act mechanically, and diminish the cohesion of the parts, the sanative effect is not ow7ing to this circumstanse, but to the soothing influence before referred to. Hence, a warm cataplasm or fomentation is a valuable remedy in many cases of external phleg- masia, even from their very inception. When such inflammation is apt to terminate in suppuration, those applications are universally had recourse to, and as they seem to favour suppuration, they have — by the unprofessional especially — been esteemed improper in ordinary cases of external inflammation, in which suppuration is not threatened, or not to be encouraged. The opinion is, however, erroneous. The effect of the w7armth and moisture of the cataplasm is, in both cases, soothing. In the commencement, therefore, of inflammation, it is a useful agent; and, when the organic actions of the part are so over excited as to threaten some of the less favourable terminations of inflammation, it reduces them to that point, which is requisite for the existence of suppurative action. The vulgar believe, that a cataplasm, in such case, is " drawing," and,that it thus expe- dites the pointing of the abscess. The cataplasm, or the fomentation acts by virtue of its warmth and moisture. Both lessen organic actions, when inordinately exalted ; both diminish cohesion in the parts to which they are applied ; and by virtue of this relaxant pro- perty, if their application,be too long continued, they often occasion sloughing of the integuments and extensive scars. This is not un- frequently the case in inflammation of the mammae ending in suppu- ration ; and, therefore, it is wise to be careful as regards their too protracted use ; — otherwise, the tone of the blood-vessels may be de- stroyed ; the inconveniences, above depicted, be experienced, and convalescence be tedious and distressing. SPECIAL DEMULCENTS. a. Internal Demulcents. 1. ACA'CIA. —GUM AR'ABIC. Gum Arabic — whose properties as a demulcent expectorant have been described elsewhere, (Vol. i. p. 235,) — is one of the demul- cents most commonly employed whenever any of the class are indi- cated; and since the introduction of the doctrines of Broussais, it has been given not only as a nutrient, but as a therapeutical agent in inflammatory affections of the stomach and intestines. The common SPECIAL DEMULCENTS. 389 mode of exhibiting it, is to dissolve an ounce of the gum in a pint of water, and to allow this gum water to be taken ad libitum. It is well adapted for inflammatory affections of the gastro-intestinal mucous membrane, not only on account of its sheathing the inflamed surface, but of its affording a slight and unirritating excrement. 2. LINUM. — FLAXSEED. Flaxseed tea — INFU'SUM UNI — is much prescribed by the pro- fession, in all cases in which demulcents are considered to be indi- cated, and is greatly used by the laity. It possesses the ordinary virtues of the demulcents, and may be employed in the manner advised under Demulcent Expectorants, (Vol. i. p. 243.) 3. SES'AMUM. — BENNE. Ben'ne leaves—whose properties are described under Demulcent Expectorants — are much used, in the southern States especially, to form a mucilaginous infusion, which is a popular remedy in diarrhoea, dysentery, cholera morbus and cholera infantum, as well as in other cases wdiich appear to require the employment of demulcents. It possesses no virtues, however, not equally possessed by gum Arabic, and other mucilaginous demulcents. The mode of preparing the mucilage is given in the first volume, (p. 245.) 4. ULMUS. — SLIPPERY ELM BARK. Slippery elm bark is a demulcent which is much used in diarrhoea, dysentery, cholera morbus and cholera infantum, and in all diseases in which demulcents are considered to be appropriate. It is given in the form of infusion, described elsewhere, (Vol. i. p. 246.) 5. ALTH.'^EA. — MARSHMALLOW. The decoction of marshmallow, (Vol. i. p. 236,) is used in the same cases as gum Arabic. The formula for the Decoctum Althjeje, of the Dublin Pharmacopoeia, is as follows : Alhaa root, dried, ^iv; Raisins, freed from the seeds, ^ij ; Boiling water, Ovij ; to be boiled down to five pints and strained. It may be taken as a drink, in the dose of a pint or more, in the twenty-four hours. 6. SAS'SAFRAS MEDUL'LA. — SAS'SAFRAS PITH. The pith of Laurus sassafras—as elsewhere remarked, (Vol. i. p. 245,) —contains a large quantity of gummy matter, which is im- parted to water, so as to form a mucilaginous solution; and has been used as a demulcent drink in all cases in which those drinks are required. It may be made by adding a drachm of the pith to a pint of boiling water; and may be taken ad libitum. 33* 390 SPECIAL DEMULCENTS. 7. TRAGACAN'THA. —TRAG'ACANTH. Tragacanth, whose properties are fully described elsewhere, (Vol. i. p. 244,) is possessed of demulcent properties, but is very rarely, or never, prescribed as such. 8. GLYCYRRHI'ZA. —LIQ'UORICE ROOT. Liquorice root, whose demulcent properties as an expectorant have been fully described elsewhere, (Vol. i. p. 242,) is occasionally employed in diarrhoea and dysentery, and in affections of the urinary organs, which seem to require the use of a demulcent. It is also added to acrid substances, as to mezereon, with the view of cover- ing their acrimony, and to render them more palatable. It is not often employed, however, as a demulcent; and is of very restricted efficacy. It is given in decoction, (Glycyrrhiz. ^j; Aquce, Oj boiled for a few minutes.) The extract — EXTRAC'TUM GLYCYRRHI'ZE — may be used for the same purpose. The different varieties of sugar possesses analogous properties. 9. CETRA'RIA. —ICELAND MOSS. So much has been said of the general and demulcent properties of Iceland moss, (Vol. i. p. 246,) that it is unnecessary to do more in this place than remark, that it has been employed as a demulcent and nutrient in diarrhoea and dysentery, as well as in affections of the air passages. The same remarks apply, also, to 10. CHONDRUS. —IRISH MOSS, which is used in similar cases, (see Vol. i. p. 247,) and to 11. FUCUS AMYLA'CE US. —CEYLON MOSS. See (Vol. i. p. 248.) 12. HOR'DEUM. —BARLEY. Barley — in the Pharmacopoeia of the United States— means the decorticated seeds of Hor'deum dis'tichon, Common or long eared barley; Sex. Syst. Triandria Digynia; Nat. Ord. Gramineae; which is a native of Tartary, but is cultivated in different parts of the world. When barley — as furnished by the farmer — is deprived of its integuments by a particular process, it constitutes Pearl barley — Hordeum perlatum; and when this is ground to powder, it forms patent barley. Ground barley is barley meal. Pearl barley is the MARANTA. 391 officinal article in the Pharmacopoeia of the United States, as well as in the Pharmacopoeia of Great Britain. Ripe barley corns, according to Einhof, consist of 18.75 per cent. of husk; 70.05 of meal, and 11.20 of water. The husks of barley are said to be slightly acrid and laxative: when deprived of these, barley forms a nutritious aliment, and one that is easy of digestion. In the form of barley water, which is made by boiling it in water, it is much used as a demulcent drink in febrile and inflammatory diseases; especially in the various inflam- matory conditions of the mucous membrane of the air tubes and alimentary canal. The Pharmacopoeia of the United States contains a form for the DECOCTUM HOR'DEI, DECOCTION OF BARLEY. (Hordei §ij; Aqua, Oivss. The extraneous matters that adhere to the barley are directed to be first washed away with cold water; half a pint of the water is then poured upon it, and boiled for a short time. Having thrown away this water, the remainder is poured, boiling hot, on the barley; and the liquid is boiled down to two pints and strained.) The barley is washed with cold wrater, and boiled for a short time, to remove any extraneous substance or flavour, which it may possess. It may be used ad libitum as a nutritive and demulcent drink. The London and Dublin Pharmacopoeias have a Decoctum hordei compositum,— termed "compound," owing to the addition of figs, liquorice-root and raisins, — which is employed in the same cases as the simple decoction. 13. MARAN'TA. —AR'ROWROOT. Arrowroot is the fecula of Maran'ta arundina'cea or West Indian arrowroot; Sex. Syst. Monandria Monogynia; Nat. Ord. Maran- taceae; a plant, which is a native of South America and the West Indies, wThere it is largely cultivated in gardens and provision grounds. The tubers or roots are beaten into a pulp, stirred with cold water, removing the fibres with the hand; the milky juice is passed through a fine sieve, and the starch is allowed to subside in the strained fluid. The fecula is then washed, and dried without heat. This is Arrowroot. Arrowroot is imported from the West Indies, and the northern and western parts of South America, in tin cases, and in barrels and boxes. Bermuda arrowroot is considered to be the best. The quantity, according to M'Culloch, entered in England for home con- sumption, on an average of three years ending with 1831, amounted to 441,556 pounds per annum. It is snow-white, faintly glistening, and devoid of odour and taste; is in powder, or in small pulverulent masses, which, when pressed between the fingers, cause a slight crackling noise. When examined by the microscope, it is found to consist of minute particles, which are generally elliptical, or irregu- 392 SPECIAL DEMULCENTS. larly shaped, having small mammillary processes occasionally pro- jecting from some portion of the surface. Many are only l-2000th of an inch in their longest diameter; others are twice as long; and a few attain l-750th of an inch; but none are larger. The breadth is generally two-thirds of their length. Raspail describes their form as that of a half, a fourth, or a third of a solid sphere, which by no means corresponds with the true form of the granule of West Indian arrowroot. Dr. Carson, of Philadelphia, is of opinion that Raspail examined Florida arrowroot, the granules of which are really of the shape he mentions. Dr. Pereira states, on the authority of Payen, that Raspail has depicted the grains of the fecula of Convolvulus Bata'tas or the Sweet Potato for arrowroot. West Indian arrowroot is said to be often counterfeited by the substitution of the East Indian variety, or of the potato starch, or of the starch of Canna coccin'ea, introduced not long ago into commerce under the name Tous-les-mois. The readiest mode of detecting these frauds, according to Dr. Christison, is by means of a good microscope. The globules of potato starch are very unequal in size, for the most part elliptical, many of them l-500th or l-400th of an inch in length; and some even as large as l-300th. The globules of tous-les-mois are generally elliptical; many of them l-300th of an inch in length, and some even as much as l-200th. On account of the greater size of the globules of these tw7o varieties, they pre- sent to the naked eye a much more glistening appearance than arrow- root ; and this character is said to be sufficient to distinguish them in the hand of an experienced person. Arrowroot is apt to acquire the odour of the ship, which, together with dampness, gives it occasionally a musty taste and odour, that render it unsaleable. These objectionable qualities can be removed by washing it in cold water, and drying it. Arrowroot presents all the chemical characters of wheaten starch, than which it is considered by Prout to be F'g- 30- a lower variety of starch. It makes, how- ever, a much firmer jelly with the same quantity of boiling water, — nine parts of arrowroot being equivalent, in this respect, to fourteen of wheaten starch. As an aliment, arrowroot is considered to be less nutritive than wheaten starch, but more palatable and digestible. No sufficient comparisons have, however, been made between them. Boiled in water or milk, it is a very common, and favourite aliment in febrile and inflammatory affec- tions, in chronic diseases, and in convales- cence from the acute. Lemon-juice, or Tacca pinnatinda. wine, or spirit, is added to the watery de- coction, according to circumstances. In all cases, in which demulcents are indicated, it is especially appropriate MARANTA. 393 as an article of diet. Opinions differ in regard to the action of arrowroot and milk on the digestive function : whilst some believe that its tendency is to constipate, others ascribe to it an opposite ac- tion. Its effects in this respect are not marked. Fig. 31. Different forms of fecula have received the name of arrowroot. Portland arrowroot or Portland sago, is ob- tained from Arum macula'tum ; Brazilian ar- rowroot is the fecula of Jat'ropha man'ihot; and Tahiti arrowroot, or Tahiti or Otaheite salep, is the fecula of Tacca pinnatifida. Particles of Tahiti Ar- row-root. (Pereira ) Fig. 32. Particles of White East Indian Arrow-root. (Pereira.) 14. East Indian arrowroot is the fecula of the tubers of Cur'cuma angustifo'lia, Narrow- leaved turmeric; Sex. Syst. Monandria Mo- nogynia ; Nat. Ord. Zingiberaceae; a plant, which is indigenous in the East Indies. It is commonly white, sometimes pale yellow; less crepitating between the fingers than the best West Indian arrowroot; more frequently mixed with impurities, and composed of larger granules, which are unequal in size, egg-shaped, compressed, often with a very short neck or nipple like projection. Its composition is not ascertained. It does not make so firm a jelly with boiling water as the West Indian variety. Dr. Christison states, that a sample, sent to him from Liver- pool, and represented to have been obtained from the West Indian plant cultivated in Bengal, exactly resembled Bermuda arrowroot, and presented the very same appearance with the microscope. The commercial value of East Indian arrowroot is far below that of the West Indian variety. 15. Florida arrowroot has generally been referred to Maran'ta arundina'cea, the plant that affords the Bermuda arrowroot; but Dr. Carson has shown, that this is an error, and that it is derived from Za'mia integrifo'lia, or Z. pu'mila; Nat. Ord. Cycadaceae, which ap- pear to be only found in Florida. The tubers also contain large quantities of a feculent sub- stance, and are used as an article of food by the Seminole Indians. They are prepared by roast- ing; and were eaten by the white inhabitants, and the army of Florida, as a substitute for potatoes. The fecula is obtained from the tubers in the same manner as ar- rowroot from the tubers of maranta arundinacea. Coarse specimens of the farina of the saw palmetto — chama'rops serrula'ta, were presented to the author some years ago. It was evidently impure, Fig. 33. Particles of West Indian Arrow-root. (Pereira.) 394 SPECIAL DEMULCENTS. and this may account for its inducing bowel complaints in the Indians who use it as diet. Of the rude mode in which the Indians prepare it, the author has given an account in the American Medical Intelligencer, for August 1, 1838, as contained in a letter from General Persifor F. Smith to C. Roberts, Esq., of Philadelphia. Florida arrow-root, as well as the farina, is known in the Southern states by the name coonti or coontie. When compared with the Ber- muda arrow-root, it has a more mealy appearance and feel, and is of a duller white colour, with less of the crystalline lustrous hue. If carefully prepared, however, it is pure white ; but is apt to be lumpy, like the fecula obtained from the tapioca root. (Carson.) Its main characters under the microscope have been already described. 16. Tous-les-mois. Under this name, a fecula has been intro- duced into commerce, which is Fi8- 34- ascribed to Canna coccin'ea; but, according to the Edinburgh Phar- macopoeia, it is the fecula of the root of an imperfectly determined species of canna. It is exported from St. Kitts, and is prepared from the root of the plant. It is distinguished under the micro- scope by the large size of its gran- ules, and by the other characters mentioned under arrow-root. Tous-les-mois has a slightly satiny appearance, and is devoid of the dead white or opaque cha- racter presented by certain amylaceous substances. According to Dr. Pereira, it approaches most nearly to potato starch ; but its par- ticles are larger. It makes a stiffer jelly than arrow-root; for which it may be substituted in all cases. 17. English arrow-root, Common arrow-root, French sago, or Potato starch, is the fecula ob- Particles of Tous-les-mois. (Pereira.) Fig 35. Particles of Potato starch seen by the microscope. (Pereira.) a, Normal starch particle (Fritzsche), b, Irregular ditto. e, d, Particles each having two hila. «./•£• Particles broken by pressure and water; the internal matter remains solid (Payen). tained from the tubers of Sola'- num tubero'sum, the common potato. It is prepared much in the same manner as the other varieties of fecula. The ap- pearance of its granules under the microscope has been re- ferred to under arrow7-root. When carefully prepared, it is equally agreeable, and probably as nutritious as Bermuda arrow- root. It is often, indeed, sub- stituted for it, and when boiled in milk or water, the difference is not easily distinguished. SAGO. 395 18. T\PIO'CA. Tapioca is the fecula of the root of Jat'ropha man'ihot or Jan'ipha man'ihot; Sex. Syst. Monoecia Monadel- phia ; Nat. Ord. Euphorbiaceae ; which is Fig. 36. indigenous in Brazil. It is the Cassava plant of the West Indies. The tuberous root is rasped and pressed, to separate the milky poisonous juiqe, which deposits a fecula; this, when washed and dried in the air, is exported, and is probably the Brazilian arrow-root of commerce. When the fecula is dried on hot plates, it acquires a granular character, and is then termed] Tapioca. The compressed pulp is dried in the chimney, exposed to smoke, and afterwards powdered, when it forms Cas- sava powder or flour ; and when baked in cakes, forms Cassava or Cassada bread. Tapioca is met with in the shops either in lumps or granules, or in powder, and is imported from Bahia and Rio Janeira. Fig. 37. It is an excellent nutrient and demulcent, and is adapted for the same cases as arrow- root. It makes a firmer jelly with boiling water than most feculaceous substances, and requires longer boiling. Particles of Tapioca as seen by the microscope. (Pereira.) A factitious tapioca is met with in the shops, which is in very small, smooth, spherical grains, and is sup- Fi 38 posed to be prepared from potato starch. It is sold under the name of pearl tapioca. (Wood & Bache.) 19. SAGO. Sago is the prepared fecula of the pith of Sagus Rum'phii, — Malay or Rumph'ius's sago palm; Sex. Syst. Monoecia Polyandria; Nat. Ord. Palmae ; which is indigenous in Ma- lacca, and the islands eastward of the Bay of Bengal. It is also ob- tained from Sagus lavis, Unarmed sago palm ; and Sague'rus Rumph'ii, Rumph'ius's wine sago palm. The farina is procured from the pith in the same manner as the feculae already considered. When first obtained by Sagus Rumphii. a. The tree. ft, The shrub. c. Fruit-bearing spadix. d, Ripe fruit. 396 SPECIAL DEMULCENTS. Particle? of sago meal (Pereira.) nated of lime. Fig. 40. subsidence in cold water, it is called raw sago meal. The finest por- tions of this are mixed with water, so as to form a paste, which is rubbed into small grains. Three kinds of sago are met with in the shops, — sago meal, common sago, and pearl sago. Sago meal is in the form of of a fine amylaceous powder, of a whitish colour, with a buffy or reddish tint, and has a feeble peculiar odour. Common or brown sago is in grains of about the size of pearl barley; but Dr. Pereira states that he has seen some as large as green peas. It is of a whitish or brownish white colour. Pearl sago is in small hard grains, of about the size of a pin's head, which are of a pale yellowish white, reddish white, or greyish white colour, or are translucent. It is sometimes bleached with chlo- When the different varieties are examined by the microscope, they appear to consist of oval or more or less ovate particles, many of which are more or less broken in sago meal; in com- mon sago, they are somewhat more broken and less regular in their shape ; and in pearl sago they are ruptured,—peculiarities which are con- sidered to be produced by the process of granu- lation. (Pereira.) Particles of potato sago. (Pereira.) Sago possesses the ordinary properties of starch, and is used as a demulcent and nutrient in the same cases as arrowroot and the other feculaceous substances already considered. A table-spoonful gives the proper consistence to a pint of milk or water. Several species of Cycadaceae, which are allied to the Palmae, contain, in the cellular structure Fig. 41. within their stem, an abundance of starch, wdiich may be separa- ted in the same manner as sago. These species are Cycas circina'- Us, C. revolu'ta, and C. iner'mis. They furnish Japan sago, which, perhaps, never reaches Great Bri- tain or this country. (Pereira.) 20. Salep is not admitted into the pharmacopoeias of Great Bri- tain or into that of the United States. It is the prepared roots of several orchideae, and is some- times sold in powder. The salep of Cachmere is produced from a species of Euloph'ia; that of Europe Cycas revoluta, or the Japan Sago-tree. AVENGE FARINA. 397 from native plants— Orchis mas'cula, 0. latifo'lia, &c. It is pos- sessed of similar properties with tapioca. Of late, certain powders — termed Castillon Powders, from the name of the physician who first employed them — have been pre- scribed in cases of diarrhoea and dysentery ; and, as demulcents, have been productive of advantage. They are formed of sago, in pow- der : salep, in powder; tragacanth, in powder ; of each, four parts ; prepared oyster shells, one part; cochineal, half a part; — divided into powders of one drachm each ; one of which is given three or four times a day. The prepared oyster shells adapt them for certain forms of diarrhoea, (see Vol. ii. p. 144,) and the cochineal is a mere colouring agent. One of these powders mixed with a little milk or water, and then added to a pint of boiling milk or water, forms an article of diet as well as of medicine in these cases. 21. AVE'NiE F A RI'NA. —OATMEAL. Oatmeal is the meal prepared from the seeds of Ave'na sati'va or common oat; Sex. Syst. Triandria Digynia; Nat. Ord. Gramineae the native country of which is unknown, but it appears to grow wild in several places through- Fig. 42. out Europe, and is cultivated there and in this country. Deprived of their covering, oats are termed groats, and, when crushed, Embden groats. According to the analysis of Dr. Christison, oatmeal consists of 72.8 per cent, of starch, 5.8 of saccharo-mucilaginous extract of a feebly sweetish taste, 3.2 of albumen, 0.3 of oleo-resi- nous matter, 11.3 of lignin, in the form of coarse bran, and 6.6 of moisture. Scotch oatmeal, con- sequently, appears to contain nearly five-sixths of nutriment; and the proportion must be greater when the seeds are carefully freed from the husk and integuments before being ground. As a bland farinaceous nutriment, oatmeal is Avena sativa. often made into gruel, and taken in cases of sick- ness — especially in fevers and inflammatory affections. It is gene- rally termed wetter gruel, and may be made by boiling three ounces of oatmeal or groats in three pints of water down to a pint and a half, and straining. It is a favourite domestic article of diet in sick- ness. In Scotland and the north of England, oatmeal is stirred into boiling water, until it has the proper consistence on cooling; when it bears the name of porridge, and is eaten with milk as an article of diet. When the husks, removed from the oats before they are ground, are infused in hot water, and allowed to become sourish, a vol. ii.—34 398 SPECIAL DEMULCENTS. mucilaginous liquid is obtained by expression, which, when concen- trated, forms a firm jelly called sowins, also used as an article of diet. Gruel is a common drink after cathartics, to assist their operation : and it is an excipient for emollient and cathartic enemata. In the United States, especially in the southern and western por- tions, an excellent gruel is made from the farina of Zea mays, Indian or corn meal. * 22. AM'YLUM. —STARCH. Starch is the fecula of the seeds of Trit'icum vulga're , common wheat; Sex. Syst. Triandria Dygynia; Nat. Ord. Gramineae; which is said to be a native of the country Fig. 43. of the Baschkirs, but is cultivated in Europe and thrs country. It is contained, also, in various plants, but is especially abundant in the seeds of the cerealia, of which it forms between sixty and seventy-five per cent. Arrowroot, sago, tapioca, tous-les-mois, po- tato starch, &c, are varieties of it. It is Particles of Wheat starch. never prepared by the apothecary. When pure, wheaten starch is of a white .. A particle Kej.jdge.WBy* colour . deyoid of ^^ &nd almQst of ^^ It is not soluble in alcohol, ether, or in cold water; but with boiling w7ater forms the Decoctum Amyli or Muci- lago Amyli of the British Pharmacopoeias, which is made by boil- ing 4 or 6 drachms of starch in a pint of water for a short time, and is chiefly used as an enema, and an excipient for opium administered in that manner. It is rarely or never given internally. Starch powder or hair powder is occasionally dusted on parts to absorb acrid secretions, and prevent excoriation. 23. AMYG'DALA.—ALMONDS. Almonds, when formed into an emulsion — the MlSTU'RA AMYG'DALjE of the Pharmacopoeia of the United States, (see Vol. i. p. 238,) is used in all cases in which demulcents are indicated ; but, most fre- quently, as a demulcent expectorant. It is often prescribed in dis- eases of the urinary organs, with the view of diminishing the acri- mony of the urine, in which, however, it is probably devoid of all efficacy. An emulsion is sometimes made of the OLEUM AMYGDAUE, (Vol. i. p. 238,) which is employed in the same cases. It may also be pre- scribed in the dose of a tea^spoonful, mixed or not, with syrup; and the same may be said of the OLEUM OLM, (Vol. i. p. 239.) CERA FLAVA—CERA ALBA. 399 24. CETA'CEUM.—SPERMACET'I. Spermaceti, (Vol. i. p. 240,) possesses the properties of the fixed oils; and, besides its employment as a demulcent expectorant, has been occasionally prescribed in diarrhoea and dysentery ; but it has fallen into disuse, and is now never employed except in the prepa- ration of ointments. When used internally, it is given in the form of emulsion, as described in the part of this work above referred to. 25. SEVUM.—SUET. Sevum of the Pharmacopoeia of the United States is the prepared suet of Ovis a'ries, the sheep. It is obtained from the neighbourhood of the kidneys, and is prepared by melting it over a slow fire, and straining through linen or flannel to separate the solid portions. It resembles lard in its properties, but is firmer, and requires a higher temperature to melt it. It has been used in domestic practice, boiled with milk, in diar- rhoea and dysentery, but is almost wholly employed in pharmacy, to give a greater degree of consistence than lard to ointments and plasters. 26. CERA FLAVA.—YELLOW WAX ; ANI) 27. CERA ALBA.—WHITE WAX. Wax was at one time supposed to be a secretion from plants, which was simply transferred to the body of Apis mellifica, the bee; but it has been since proved to be a secretion from the insect itself. A vegetable wax is, however, occasionally secreted by plants. The wax of the bee is intended to construct the comb. It is obtained for medical use, by allowing the honey to drip from the comb ; or by subjecting the latter to pressure ; then melting it in water, so that the impurities may subside, and allowing the wax to cool in moulds. This constitutes Cera Flava or Yellow Wax, which has a grayish yellow colour; a peculiar and rather agreeable odour; scarcely any taste ; consider- able firmness and tenacity, but no greasiness to the touch. It is apt, however, to be adulterated by suet, which gives it a fatty feel, and a disagreeable taste. Adulteration with resin is recognised by its solubility in cold alcohol; and with bean meal or pea meal, starch or any other amylaceous matters, by its insolubility in oil of tur- pentine. The druggists of this city, (Philadelphia,) are supplied chiefly from the Western states and North Carolina — especially from the latter- 400 SPECIAL DEMULCENTS. and from Cuba. Some of an inferior quality is imported from Africa, (Wood & Bache.) Cera Alra, White Wax, is prepared' by exposing yellow wax, in thin layers or ribands, to air, sunshine and moisture, and thus bleaching it; by which process, it loses also in a great measure its odour. As met with in the shops, it is of a white or yellowish white colour ; — the wdiitest varieties having spermaceti mixed with them, which is added by the dealers to improve its colour. It is generally in circular cakes; solid, brittle, devoid of smell, or nearly so, and tasteless. Dr. Christison describes two varieties in commerce—one of which is called German wax, and is imported into Great Britain from Ham- burg. It is rather yellower, somewhat more translucent, harder, and less easily fusible than the English wax, or that which is pre- pared in Britain. The German variety is said to be the more esteemed of the two, especially by dentists and others for moulding, on account of its superior hardness. The greater softness of the English wax appears to be owing to the admixture of spermaceti and fatty matters, added to increase its whiteness. (Christison.) Wax is insoluble in water, in cold alcohol and ether, but dissolves in about twenty parts of ether at their boiling temperatures. It is readily soluble in the fixed and volatile oils ; and combines, by fusion, with fats and resins, so as to form several most valuable topical ap- plications. Wax is now almost wholly used for the formation of cerates, oint- ments and plasters, with the view of giving them tenacity and con- sistence, but it has been prescribed as a demulcent in diarrhoea and dysentery. It may be melted with olive or almond oil, and when in the melted state may be rubbed up with yolk of egg or mucilage, so as to form an emulsion; but it is scarcely ever given at the present day. Myrtle Wax.—A vegetable w7ax is obtained from Myri'ca cerif- era, a plant belonging to the Nat. Ord. Myriceae, which is found in almost all parts of the United States. The fruit is coated with wax, which is separated by boiling the berries in water, and skimming off and straining the melted wax that floats on the surface ; — or, it is allowed to concrete as the fluid cools, and is removed in the solid state. To purify it, it is remelted and strained, and cast into large cakes. It is collected in New Jersey, but more copiously in the New England states, especially in Rhode Island, from which it is sent to other parts of the country. Myrtle wax is of a pale grayish green colour, and is more brittle and unctuous to the feel than beeswax; it has a feeble odour and bitterish taste ; and, in its chemical relations, bears a close resem- blance to beeswax. ADEPS. 401 This variety of wax has been prescribed also in dysentery; a tea- spoonful of the powder being mixed with mucilage or syrup, and given repeatedly through the day. b. External Demulcents. — Emollients. 28. ADEPS.—LARD. Lard, in the Pharmacopoeia of the United States, is the prepared fat of Sus scrofa, the hog, free from saline matter. The fat of the omentum, mesentery and loins is generally selected for tnedical use. To separate it from the membranes in which it is contained, or— to render it, as it is sometimes termed — it is melted over a slow fire, strained through linen or flannel, and is often poured, whilst liquid, into a bladder, where it solidifies on cooling. Salt is sometimes added to it to preserve it, but this has to be separated from it to adapt it for medical use. It may be freed from this salt, by melting it in boiling water. The sensible properties of lard are so well known as not to require description. It ought to have little taste or smell. It is insoluble in w7ater, sparingly soluble in alcohol, but more so in ether and the volatile oils. When melted, it dissolves wax and resin; and is, therefore, much used in the formation of ointments. It is composed of three neutral fatty principles, stearin, margarin, and olein; the first of which is the concrete principle. Recently, lard oil has been made from it. The chief use of lard is pharmaceutical—as a constituent of cerates and ointments. It is sometimes, however, employed as an emollient —for example, rubbed on the perinaeum in cases of parturition, writh the view of relaxing it; or over the affected muscles when they are rigid, as in cases of contractura. In eleemosynary institutions, it is often used as a substitute for simple or spermaceti ointment to dress blisters ; but ow7ing to its containing salt, and being rancid, it is said to have occasioned irritation and ulceration. It is added, at times, to laxative and emollient enemata, under the same circumstances as the fixed vegetable oils; and, like the different pomatums, is used by the accoucheur to smear the finger on making his examinations per vaginam, and by the surgeon for the same purpose in examining the rectum, as well as to smear his instruments. CERA'TUM SIMPLEX. SIMPLE CERATE. (Adipis, J viij; Cera alba, giv.) This is a common emollient dressing to blisters and ulcers, where it is desirable to preserve them moist and free from the contact of air, and of extraneous bodies floating in it. UNGUENTUM SIMPLEX, SIMPLE OINTMENT. (Cera alba, fcj ; Adipis, tfeiv.) Employed in the same cases as the last. 34* 402 EMOLLIENTS. 29. O'LEUM AMYG'DAL.32. — OIL OF ALMONDS. The general properties of almond oil have been given elsewhere, (Vol. i. p. 238,) as well as those of Olive Oil, (Vol. i. p. 239,) which are analogous. It is a frequent addition to enemata—emollient and laxative ; and a common constituent of plasters, cerates, ointments and liniments. It is sometimes rubbed on the skin with the view of relaxing parts; and is applied to inflamed or irritated surfaces, to sheathe them from the irritating influence of the air, and extraneous bodies. It has been recommended to be smeared over the body as a protection against plague; but it is not probable that is of any efficacy; as there is little reason for believing that the morbific im- pression is made through the skin. In surgery and obstetrics, it'is used, like lard, to smear the fingers or instruments that have to be introduced into outlets. UNGUENTUM AQU$ MM, OINTMENT OF ROSEWATER. (Aqua rosa, 01. amygdal, aa f. §ij ; Cetacei, ^ss ; Cera Alba, 3J.) This ointment is sold as cold cream, and is much used as a lip salve, and as an applica- tion to chapped and excoriated surfaces. 30. CETA'CEUM. — SPERMACET.'I. Spermaceti, (Vol. i. p. 240,) like the fixed oils, is an ingredient of cerates and ointments, which are employed as emollients. ^CERATUM CETACEI, SPERMACETI CERATE. (Cetacei, |j; Cera alba, Jiij ; 01. oliv, f. ^vj.) This cerate is a common and mild emollient dressing for blisters, and for simple sores. 31. LINUM. FLAXSEED. Linseed or flaxseed meal, formed either from the ground seed of Linum usitatis'simum, or from the oil cake, which remains after the expression of linseed oil, ground to powder, (Vol. i. p. 243,) is much employed as an emollient poultice. It requires but to be mixed with boiling water until it has the proper consistence. The meal, obtained from the oil cake, is preferred by many to the ground seeds, on account of the latter being more apt to become rancid. Others, however, assign the preference to the former. OLEUM LINI, FLAXSEED OIL, is the oil of the seed expressed sometimes with heat; at others without, or cold drawn: at others, again, the seeds are roasted before being subjected to pressure, with the view of destroying the gummy matter contained in their exterior coating. (Wood & Bache.) Where heat is applied, the oil is less bland; but it would appear to become sooner rancid than oil expressed at a TRITICI FARINA. 403 steam heat of about 200 degrees. From eighteen to twenty pounds of oil, according to Mr. Brande, are obtained by cold expression from one hundred weight of the bruised seed. As usually met with in the shops, it is of a yellowish-brown colour, but it may be rendered quite colourless; it has a peculiar smell and taste; is soluble in 40 parts of cold alcohol, in 5 of boiling alcohol, and in about 1^ of ether. Exposed to the air, it thickens, and gradually dries into a varnish, which gives occasion to many useful applications in the arts. The drying property is much increased, either by boiling it alone, or with litharge, or sugar of lead, or common white vitriol; when it is called drying oil or boiled oil, and is much used by painters. It readily becomes rancid. Linseed oil possesses no virtues as an emollient over olive oil and almond oil; nor is it often substituted for them, except in burns, in which it has acquired an accidental reputation, either applied alone or in conjunction with lime-water, as in the Linimentrm Calcis of the Pharmacopoeia of the United States. (Vol. ii. p. 145.) This liniment acts partly by keeping the parts in a soft state, and therefore by virtue of the emollient properties of the soap, which the liniment really is; but chiefly perhaps by defending the burnt surfaces from the desiccative and irritating influence of the air— the liniment filling up the areolae of the rag on which it is applied, and completely pro- tecting them, in the same manner as if so much raw cotton had been placed over them. 32. SES'AMUM.— BENNE. The leaves of benne are sometimes used in the formation of emol- lient cataplasms. O'LEUM SES'AMI or Benne oil—obtained by expression from the seeds — (Vol. i. p. 245,) possesses the general properties of olive oil, and may be used as an emollient in the same cases. It does not readily turn rancid. 33. TRIT'ICI FARl'NA. — WHEAT FLOUR. Bread — made of wdieaten flour — boiled in milk, forms the com- mon bread and milk poultice; to this a little lard or oil is generally added to prevent its adhering to the surface to which it is applied. It is much employed to promote suppuration, and as an emollient application to irritable ulcers. Bread is also used alone, at times, as a vehicle for other applications; for example, it is moistened with lead water, and is placed within gauze as an application in opth- thalmia and other local inflammations. A decoction or infusion of bran is sometimes used as an emollient 404 DILUENTS. pediluvium; and internally as a demulcent in catarrhal affections especially. In many parts of the United States, the common emollient cata- plasm is made of Indian meal—the farina of Zea mays — boiled with water (mush) or milk. 34. AVE'NuE FARl'NA. —OATMEAL. Oatmeal (Vol. ii. p. 397,) is frequently used as a poultice, in countries where it is more eaten as food than it is in the United States. It forms, when boiled with water, a good emollient poultice; and, with linseed oil cake, the Pulvis pro cataplasmate of the Dublin Pharmacopoeia. 35. ULMUS. — SLIP'PERY ELM BARK. This bark (Vol. i. p. 246,) is sometimes employed as an emollient application in external inflammation ; — the powder being made into a poultice with hot water; or the bark itself applied, after having been previously softened by boiling. 36. O'LEUM BU'BULUM. — NEATS' FOOT OIL. Neats' foot oil is officinal in the Pharmacopoeia of the United States only. It is prepared from the bones of Bos domes'ticus, the ox; by boiling the feet of the animal, deprived of the hoof, for a long time in water, skimming the fat and oil from the surface, and putting them into water heated to the boiling point. " The im- purities having subsided, the oil is drawn off, and, if required to be very pure, is again introduced into water, which is kept for twenty- four hours sufficiently warm to enable the fat which is mixed with the oil to separate from it. The liquid being then allowed to cool, the fat concretes, and the oil is removed, and strained or filtered through layers of small fragments of charcoal free from powder." (Wood & Bache.) This oil congeals with difficulty; and has been introduced into the Pharmacopoeia of the United States as an ingredient in the Unguentum hydrargyri nitratis. (Vol. ii. p. 309.) II. DIL'UENTS. Necessity for drinks — Therapeutical use — Their absorption prevented by certain circumstances — Employment in dropsies, diseases of the urinary organs, &c. A slight observance of the habits and instincts of man sufficiently shows, that drinks or liquids are more imperiously demanded by DILUENTS. 405 him than solids. This is owdng to the constant drain of fluid from the system by the various secretions — the pulmonary and cutaneous transpirations, the urine, &c. — and of the large proportion, which the fluids, composing the animal body, bear to the solids. The necessity for the ingestion of fluids is indicated by thirst, — an internal sensation, in its essence resembling hunger, although not referred to precisely the same organs. The desire, however, can be much modified by habit; for, wThilst some individuals require several gallons a day to satisfy their wants; others, who, by resistance, have acquired the habit of using very little liquid, enjoy good health, and do not experience the slightest inconvenience from its privation. This privation, it is obvious, cannot be absolute, or pushed beyond a certain extent. There must always be fluid enough taken to ad- minister to the necessities of the system. That the sensation of thirst is often greatly dependent upon the quantity of fluid circulating in the vessels is shown by the fact, mentioned by Dupuytren, that he succeeded in allaying the thirst of animals, by injecting milk, whey, water, and other fluids into the veins; and Orfila states, that, in his toxicological experiments, he frequently quenched, in this way, the excessive thirst of animals to which he had administered poison, and which were incapable of swallowing liquids, owing to the oesophagus having been tied. He found, also, that the blood of animals was more and more deprived of its watery portions, as the abstinence from liquids was more pro- longed. Generally, however, the desire for liquids is, within certain limits, an artificial appetite, and, like the desire for solid food, is greatly regulated by the habits of the individual. So powerful, indeed, is the force of custom, that if a person were to habituate himself to take a glass of water every day at a certain hour, the desire would recur daily, with all the force of a primitive instinct. Often, too, thirst is present in conditions bf the system, where we have no reason to presume, that there is a want of fluid, and wrhere it is pro- duced by morbid influences of a totally different character. It be- comes, under such circumstances, a symptom of disease, and is one of the most prominent evidences of every kind of febrile and inflam- matory indisposition; although, like each of the most marked symp- toms of such indisposition, it may be occasionally wanting. The value of drinks, in such cases, is not dependent upon their action as diluents; and, consequently, in this point of view, they do not belong, in strictness, to this division of therapeutical agents. The thirst is owing to the excitement of the organic actions in the mucous mem- brane of the digestive tube, and the good effects of the fluid taken are dependent upon its possessing a temperature calculated to allay such excitement. Hence it is, that cold drinks are greedily sought after, and that warm fluids do not furnish the same marked relief. In this way cold water or any cold drink acts as a refrigerant, and its modus operandi has accordingly been considered under another 406 DILUENTS. head. Water—the chief constituent of all drinks — is an essential component of every circulating fluid, and modern experiments have shown, that it penetrates most, if not all, animal tissues better than any other fluid; and, consequently, passes through them readily, to accumulate in any of its own solutions, — as in the blood; but, whenever there is a high degree of exaltation of organic actions in the mucous membrane of the alimentary canal, absorption is by no means readily affected ; even the physical phenomenon of imbibition appears to be materially retarded. Hence — as previously shown — it is difficult to bring the system under the influence of mercury, in low typhoid conditions, in which there is frequently elevation of the organic actions of the lining membrane of the intestines. The same remark has been made regarding the function of intestinal absorption in malignant cholera. Although attempts have been frequently made to affect the system with mercury; and, by adminis- tering saline solutions, to produce some change in the condition of the circulating fluid, it is extremely doubtful, whether during the violence of the disease, any absorption has been effected; and, in many cases, the agents wTould seem to have remained in the intes- tinal canal until the disease had become somewhat mitigated; after which absorption was resumed, and their effects then became ap- parent. In other— and the generality of— instances they have passed through the bowels unchanged. A medical gentleman in- formed the author, that a practitioner was speaking to him during the prevalence of cholera, of the very great extent to which he had given calomel in that disease. "Well," said the gentleman, " and what became of this enormous quantity of the mercurial?" " Why, it passed through the bowels like so much corn-meal!" Now, it is not easy to see what could have been the agency expected from large doses of a substance, which was visible in the evacuations in such quantity. The fact, however, demonstrates the truth of the remark just made, — that absorption is, in these cases, almost null; and that calomel, like other agents, produces no effect upon the system, until some degree of recuperative energy has been awakened. If, howrever, the passage of diluents into the blood-vessels be re- tarded by a powerfully excited condition of the mucous membrane, it is largely facilitated by any circumstances that give occasion to a diminution in the quantity of the circulating fluid. On this, how- ever, so much has been said under the head of Eutrophics, that it is not necessary to dwell upon it here. It may be remarked, how- ever, that the deficiency of the serous portions of the blood, in most cases of malignant cholera, and the consequent inspissation of the remainder, has suggested the injection of saline solutions into the blood-vessels ; but the remedy has not answered the purpose. It diluted the blood, but did not remove the more important mischief, — the cause, that gave occasion to the profuse separation of the watery portions. It has been a question of some importance, whether diluents should DILUENTS. 407 be freely allowed in cases of dropsy. Without repeating what was before said on the pathology of that affection, it may be remarked, that it would seem proper not to allow fluid too freely, unless as a vehicle for diuretics. Where increased exhalation occurs into any cavity, a corresponding diminution must take place in the mass of the circulating fluids; and if tenuous fluids be freely permitted, the amount may be made up, and the dropsical accumulation be favoured. It is, consequently, better to allow the patient, for common drink, a solution of bitartrate of potassa, which, when flavoured with lemon- peel, and sweetened, proves a grateful diuretic drink ; and yet, as it is medicated, there is not so much danger of its being taken to an injurious extent. Great difference — irrational difference — of sentiment has existed, as regards the proper quantity of drink or of diluents, most favoura- ble to digestion. In strictness, this is a question of hygiene, but it interests the dyspeptic therapeutically also. Where the salivary and other secretions are too sparing to communicate to solid food the due digestive texture, liquids, in proper quantity, favour the gastric ope- rations ; but, if they be taken too freely during a meal, the texture is rendered too soft, and the gastric secretions are so much diluted, that digestion is more difficult. Hence it appears, that an error in quantity, at either extremity of the scale, should be avoided. In many places, it is the custom to hand round lemonade, wine, toddy, punch, &c, before dinner ; but the dyspeptic must carefully eschew7 them. With many, they cause acidity, and before the individual sits down to his repast, the stomach is in a very unfit state for the reception of the various articles sent into it at a fashionable dinner party. Where acrid or poisonous substances have been swallowed, dilu- tion is generally indicated, but discrimination is here required. Some substances act more violently wThen in a state of solution, and hence dry vomiting is advisable to get rid of them ; or, if diluents be per- mitted, they must be removed again as speedily as possible, by the stomach pump, or by one of the direct emetics ; but, where the poi- son is a simple acrid, no doubt can exist regarding the propriety of dilution, and w7e generally have recourse to agents belonging to the class last considered, which not only dilute the deleterious article, but shield the parts from its injurious contact. In diseases of the urinary organs — especially in such as are of an inflammatory nature — diluents are largely used. The author has before remarked, that in such cases demulcents act as mere diluents ; but their use is universal. By weakening the saline compound, which constitutes the urine, diluents prevent the irritation that would otherwise be produced in the inflamed parts, during the passage of that fluid ; and hence they are much used in ardor urina, which term — as stated before — is appropriated to a symptom, — the dis- ease consisting in an inflammatory state of the lining membrane of the urethra, on which the urine — although in a healthy condition — acts as an irritant. 408 DEOBSTRUENTS, ETC. SECTION IX. OF DEOB'STRUENTS, ANT'IDOTES, AND ANTI-PARA SIT'ICS. Deobstruents—Are indirect agents. Alteratives—Their modus operandi — Only used in chronic diseases. Antidotes — Definition of— Are of two kinds — Division of poisonous agents — Therapeutics of poisoning, internal and external — Table of poisons and their antidotes — Antiparasitics. I. DEOB'STRUENTS. Sinon. Dephractica, Deoppilantia, Deoppilativa. When the humoral pathology was universally in vogue, a deob- struent medication prevailed everywhere. It was believed, that, owing to altered consistence of the blood and humours, the small vessels might become obstructed ; and that certain agents, by modi- fying the spissitude of the circulating fluid, might remove such ob- struction, and therefore be entitled to the appellation of Deostru- ents. It is clear, however, that all such remedies must be relative agents only. Obstructions in the capillary system of vessels must depend upon so many causes, that no exclusive plan of medication can be appropriate ; and, accordingly, at the present day, the term deobstruent is almost banished from medical language ; and, when we meet with it, it is too often employed without any precise ideas being attached to it. Formerly, it corresponded with the term ' aperient,' in its general — not in its restricted—acceptation. Now, it is more commonly used conventionally — to express the agent, whatever may be its nature, which renders parts pervious that may have been obstructed. To exhibit the indefinite manner in which it is employed by those who yet retain it, it is sufficient to refer to recent and valua- ble works on the materia medica ; in which we are told that the sulphate of potassa " is deobstruent and cathartic," and carbonate of soda " antacid and deobstruent." From what we know of the effect of alkalies in augmenting the tenuity of the blood, we might under- stand, — if that fluid were too viscid, and if obstructions were caused by such viscidity, — that a deobstruent effect might be exerted by the carbonate of soda; but even if we admit the possibility of such stasis of the fluid of the circulation in the capillary system of vessels, wre have no means of detecting it, and we could not, consequently, pronounce when the remedy is indicated. It is well known, how- ever, that obstructions are generally — if not always — induced by an excited action of the capillaries, which gives occasion to new de- positions— to morbid formations, in other words— over which the agents in question have but little control. But if we admit the deobstruent agency of the carbonate of soda, it is not so easy for us to understand how the sulphate of soda can ANTIDOTES. 409 accomplish a similar result; or why this salt should be considered entitled to the merit of being a deobstruent any more than the whole class of saline agents ; and it would not be an easy matter for those who ascribe such action to the sulphate of potassa to explain dis- tinctly what they-themselves mean by the term deobstruent as contra- distinguished from cathartic in the case in question. The German writers have a division of resolvents (auflosende Mittel,) or liquefacients (verfliissigende Mittel,) which seem to have, in some respects, the signification of deobstruents. " We under- stand," say the Messrs. Schroff, " by resolvents (auflosende Mittel,) those therapeutical agents, that act upon the plastic life of the human organism in such a manner, that they either moderate excessive form- ative impulse, (Bildungstrieb;) or diminish the too firm consistence or cohesion of organic matters, and reduce them to the fluid condi- tion." Under this head are reckoned mercurials, iodine, alkalies, and other agents, which modify the condition of the fluid, and, through it, that of the system of nutrition; and which have, there- fore, been considered, in this work, under the head of Eutrophics. II. ANT'IDOTES. Srxojf. Alexicaca, Alexipharmaca, Alexileria, Theriaca, Counterpoisons. The days of secret poisoning have passed away ; and with them the use of alexipharmics, alexiterics, and theriacs, which encumbered the works on materia medica and pharmacy ; and although it may be admitted, that a Toffania and a Brinvillier might prepare arsenical and other combinations of such a degree of strength, that, when regu- larly exhibited, they might ultimately exert a deleterious agency on the system, such cases must be looked upon as extremely rare, if they ever occur. The term antidote is now employed in the sense of counterpoison. It means an agent, which has the power of destroying—more or less — the deleterious properties of poisonous substances, in the sto- mach or out of it. A modern toxicologist (Christison,) divides them into two kinds ; the one taking away the deleterious qualities of the poison, before it comes within the sphere of vital action, by altering its chemical nature ; the other controlling the poisonous action after it has commenced, by exciting a contrary action in the system. The former are decidedly the most important in a therapeutical point of view. A reference to the table of poisons and their antidotes, given hereafter, will show, that there are very few agents which can be ranked under the latter. Perhaps, all poisonous articles may admit of classification under the three heads of— irritants, narcotics, and acro-narcotics or vol ii.—-35 410 ANTIDOTES. narcotico-acrids. This is the division, that has been employed by Dr. Christison, and by Dr. Beck in his valuable work on Medical Jurisprudence. These terms convey to the mind the symptoms, that may be expected from the individual agents belonging to the respective divisions, as well as their modus operandi. The first, — irritants — under which may be ranged, the vegetable acrids of the classifications of Fodere and Orfila, as well as the corrosives of the same toxicologists — inflame the lining membrane of the diges- tive tube, and destroy by the violent action they excite in that ex- pansion. Some of the class, however, act also on organs more re- mote ; but still — as Dr. Christison has observed — the most promi- nent feature is the inflammation they excite wherever they are applied. The second — narcotics — act but insignificantly on the part to which they are applied. Their influence is exerted on the great nervous centres, — either through the impression they make on the nerves of the part,— on the nerves distributed to the lining membrane of the blood-vessels of the part, or through the agency of the circulation; — all which has been investigated under the sec- tion on narcotics; — and lastly, the acro-narcotics or narcotico- acrids combine the agencies of the other two divisions. They are acrid and narcotic ; — that is, they not only irritate and inflame the lining membrane of the first passages, but affect the great nervous centres injuriously — causing narcosis. Some of the most deadly poisons belong to this division of toxical agents. It fortunately happens, that, therapeutically, the same mode of management is applicable, whatever may be the poisonous agent taken. The great object is to remove the poison as soon as possi- ble,— by the stomach pump, if it be at hand; and, if not, by mechanical irritants applied to the fauces, or by one of the direct emetics ; and here we have to bear in mind the remark, made under diluents, that if the poisonous agent be soluble, dry vomiting should be induced; for if a large quantity of fluid be allowed, and-it be not removed from the stomach on the instant, the deleterious effects of the poison may be exerted with more energy than if fluid had been denied. When the stomach-pump is at hand, the organ can be well washed out, without the fluid remaining long enough to admit of the solution of the poison, and its subsequent absorption. The removal of the poison is the object, then, of primary mo- ment ; but, along with this, or subsequently, those agents may be employed, which are known to modify the chemical condition of the poison, by rendering it insoluble or nearly so, — not only in water, but in the gastric secretions. Such are true antidotes, and alone to be* trusted to. "It is chiefly," says Dr. Christison, " among the changes induced by chemical affinities, that the practitioner must look for counter-poisons ; and the ingenuity of the toxicologist has thence supplied the materia medica with many of singular efficacy. When given in time, magnesia or chalk is a complete antidote for the mineral acids, and oxalic acid ; albumen for corrosive sublimate ANTIDOTES. 411 and verdigris ; bark for tartar emetic ; common salt for lunar caustic ; sulphate of soda or magnesia for sugar of lead and muriate of baryta; chloride of lime or soda for liver of sulphur ; vinegar or oil for the fixed alkalies, and these substances act either by neutralising the corrosive power of the poison, or by forming with it an insoluble compound." It need scarcely be said, that any therapeutical agents, which add to the activity of absorption, must be improper whilst a soluble poi- son is in the stomach, or is applied to any solution of continuity on the surface of the body. Blood-letting, being one of the most ener- getic sorbefacients, ought to be carefully avoided, except where the poison is a purely local corrosive. In cases of external poisoning, a cupping-glass is applied to the wound, or a ligature is put round the limb, above the seat of injury, — on similar principles. The cupping-glass not only prevents absorption, but draws the blood from the wound, and with it the poison; whilst it compresses the nerves surrounding the wounded part, and may thus, — in accor* dance with the views of Messrs. Addison and Morgan, — prevent the impression made by the poison on the sentient extremities of the nerves from being transmitted along them. Lastly : — The practitioner may have to attend to the effects of the poison upon the functions, and to remove morbid phenomena that may have been induced by it. These have to be treated on general principles. In the state of exhaustion, occasioned by the hydrocyanic acid, diffusive stimulants are given: in the narcosis, induced by opium, the cold douche may be needed ; and, where in- flammatory symptoms appear, after the poison has been removed from the stomach, blood-letting and the whole class of antiphlogistics may be demanded. The following Table was prepared for the first edition of the General Therapeutics, at the author's request, by Dr. Wm. R. Fisher, — at the time a resident of Baltimore, — a gentleman whose scientific attainments wrere ample, and whose attention had been zealously and usefully directed to the chemical and other relations of Toxico- logy ; some of the results of which are contained in the pages of the American Journal of Pharmacy. Soon afterwards, he was appointed Professor of Chemistry in the University of Maryland ; and subse- quently in the College of Pharmacy of Philadelphia; which situation he resigned in order to commence the study of divinity preparatory to taking holy orders. Desirous of affording Dr. Fisher an oppor- tunity for revising the table, the author corresponded with him; and a few days after he received what proved to be Dr. Fisher's last suggestions, the author had the regret to learn, that an attack of apoplexy had terminated his brief but useful career. 412 TABLE OF POISONS AND THEIR ANTIDOTES. TABLE OF POISONS AND THEIR ANTIDOTES. CLASS FIRST. —INORGANIC POISONS. 1. Acids. 2. Alkalies and their compounds. 3. Bromine. 4. Earths and their compounds. 5. Empyreumatic Oils. 6. Ethers. 7. Gases. 8. Glass or Enamel, pounded. 9. Iodine. 10. Metals and their compounds 11. Phosphorus. 12. Vapours. CLASS SECOND. —ORGANIC POISONS. A. VEGETARLE. 1. Acro-Narcotics. 2. Irritants. 3. Narcotics. 4. Proximate Principles of Vegeta- bles. B. ANIMAL. 1. By change in constitution, or dis- ease. 2. Fishes. 3. Insects. 4. Serpents. CLASS I. —INORGANIC POISONS. I. ACIDS. POISONS. f Acidum Aceticum. Acetic Acid. j Acidum Arsenicum. Arsenic Acid. t Acidum Arseniosum. Arsenious Acid. j" Acidum Botulinicum. Botulinic Acid. See Sausage Poison. Acidum Carbonicum. Carbonic Acid. See Gases. t Acidum Chlorohydricum. Chlorohydric Acid. ■J- Acidum Citricum. Citric Acid. Acidum Hydrocyanicum. Hydrocyanic Acid. \ Acidum Muriaticum. Muriatic Acid. t Acidum Nitricum. Nitric Acid. t Acidum Oxalicum. Oxalic Acid. f Acidum Phosphoricum. Phosphoric Acid. Acidum Prussicum. Prussic Acid. •j- Acidum Sulphuricum. Sulphuric Acid. Acidum Sulphurosum. Sulphurous Acid. See Gases. t Acidum Tartaricum. Tartaric Acid. ANTIDOTES. Magnesia. Carbonate of Magnesia. Hydrated oxide of Iron. Carbonate of Soda Carbonate of Potassa. Carbonate of Lime. Ammonia. Chlorine, (liquid.) See Acidum Chlorohydricum. Carbonate of Lime. Magnesia. Carbo- nate of Magnesia. Lime Water. Magnesia. Carbonate of Lime. See Acidum Hydrocyanicum. Magnesia — Carbonate of Magnesia — Carbonate of Lime. Carbonate of Lime — Carbonate of Potassa. thil'coJntf'T P°iSOnS 8re marked thust IndiSenous plants*. Exotic plants introduced into JVhere no antidote is placed opposite an article, it means, that there is no established antidote TABLE OF POISONS AND THEIR ANTIDOTES. 413 II. ALKALIES AND THEIR COMPOUNDS. Fixed Oils. Vinegar. Lemon Juice. POISONS. ANTIDOTES. f Ammonia Liquor. Solution of Ammonia. Fixed Oils— Vinegar. — Lemon Juice. t Ammonia Arsenias. Arseniate of Am- monia. f Ammonia Arsenis; Arsenite of Am- monia. \ Ammonia Murias. Muriate of Am- monia. j" Potassa. Caustic Potassa. f Potassa Arsenias. Arseniate of Potassa. t Potassa Arsenis. Arsenite of Potassa. t Potassa Bichromas. Bichromate of Carbonate of Potassa. Carbonate of Soda. Potassa. f Potassa Carbonas. Carbonate of Pot- Lemon Juice. Vinegar. assa. \ Potassa Hydrobromas. Hydrobromate of Potassa. \ Potassa Hydriodas. Hydriodate of Potassa. \ Potassa Nitras. Nitrate of Potassa. j Potassii Sulphuretum. Sulphuret of Chloride of Sodium. Chloride of Soda. Potassium. \ Soda. Caustic Soda. Fixed Oils. Vinegar. Lemon Juice. III. BROMINUM. Bromine. t Hydrobromas Potassa. of Potassa. Hydrobromate IV. EARTHS AND THEIR COMPOUNDS. f Barii Chloridum. Chloride of Barium. \ Baryta. Barytes. f Baryta Carbonas. Carbonate of Baryta. ■j- Baryta Nitras. Nitrate of Baryta. Calx. Quicklime. Sulphate of Magnesia. Sulphate of Soda. Dilute Sulphuric Acid. Dilute Sulphuric Acid. Sulphate of Magnesia. Sulphate of Soda. Mineral or Soda Water (artificial) ? Ef- fervescing draught! V. EMPYREUMATIC OILS. Creasote. Oleum Adipis Empyreumaticum. Empy- ' reumatic Oil from Lard. Oleum Cornu Cervi Empyreumaticum. Oil of Hartshorn—Dippefa Animal Oil. Oleum Picis Liquida. Oil of Tar. Oleum Tabaci Empyreumaticum. Empy- reumatic Oil of Tobacco. Oleum Terebinthinae. Oil of Turpentine. Fusel Oil. Albumen 1 Fixed Oils. Vinegar. Lemon Juice, VI. ETHER8. ^Ether Nitricum. Nitric Ether. ^Ether Sulphuricum. Sulphuric Ether. 35* 414 TABLE OF POISONS AND THEIR ANTIDOTES. VII. GASES. POISONS. f Ammoniacal. f Arseniuretted Hydrogen. Carbonic Acid. Carburetted Hydrogen. f Chlorine. f Muriatic or Chlorohydric Acid. f Nitric Oxide. f Nitrous Acid. f Oxygen. Sulphuretted Hydrogen. f Sulphurous Acid. ANTIDOTES. Inhalation of Ammonia or Ether. Inhalation of Ammonia cautiously. Inhalation of Ammonia cautiously. Inhalation of Chlorine cautiously. Inhalation of Ammonia cautiously. VIII. fGLASS, OR ENAMEL, POUNDED. tlX. IODINUM. Gluten. Wheat Flour. Starch. Iodine. \ Potassii lodidum, Potassa Hydriodas. Iodide of Potassium, Hydriodate of Potassa. Astringent Infusions. Astringent Infusions and Decoctions. Chloride of Sodium. (See Acidum Arseniosum.) X. METALS AND THEIR COMPOUNDS. Antimonium. Antimony. t Antimonii Chloridum, A. Murias. Chlo- Astringent Infusions. ride of Antimony, Muriate of Anti- mony, t Antimonii Oxidum. Oxide of Anti- mony. t Antimonii et Potassa Tartras. Tar- trate of Antimony and Potassa. "r Antimonii Vitrum. Glass of Antimony. Argentum. Silver. t Argenti Nitras. Nitrate of Silver. t Arsenicum. Arsenic. \ Arsenias Ammonia. Arseniate of Am- monia. f Arsenias Potassa. Arseniate of Pot- assa. f Arsenias Soda. Arseniate of Soda. \ Arsenis Ammonia. Arsenite of Ammo- nia. | Arsenis Cupri. Arsenite of Copper. f Arsenis Potassa. Arsenite of Potassa. f Arsenici Oxidum Album. White Oxide (See Acidum Arseniosum.) of Arsenic. \ Arsenici Oxidum Nigrum. Black Ox- ide of Arsenic. f Arsenici Sulphuretum Flavum. Yellotv Sulphuret of Arsenic. f Arsenici Sulphuretum Rubrum. Red Sulphuret of Arsenic. Aurum. Gold. f Auri-Nitro Murias. Nitro Muriate of Sulphate of Iron. Gold. TABLE OF POISONS AND THEIR ANTIDOTES. 415 POISONS. Bismuthum. Bismuth. f Bismuthi Subnitras. Subnitrate of Bis- muth. Chromium. Chrome. f Bichromas Potassa. Bichromate of Potassa. Cuprum. Copper. \ Cupri Acetas. Acetate of Copper. f Cupri Arsenis. Arsenite of Copper. ANTIDOTES. Milk — Mucilaginous Drinks. Carbonate of Potassa— Carbonate of Soda. Albumen — Sugar — Iron. Hydrated Oxide of Iron. Carbonate of Soda. Carbonate of Soda. Albumen — Gluten — Gold finelydivided in dust, with fine iron filings ? f Cupri Carbonas. Carbonate of Copper. Albumen — Iron. f Cupri Oxidum. Oxide of Copper. Albumen — Iron. f Cupri Sulphas. Sulphate of Copper. Albumen — Iron. Ferrum. Iron. ■j- Ferri Murias. Muriate of Iron. f Ferri Sulphas. Sulphate of Iron. Hydrargyrum. Mercury. \ Hydrargyri Chloridum Corrosivum. Cor- rosive Chloride of Mercury. f Hydrargyri Cyanuretum. Cyanuret of Mercury. f Hydrargyri Nitras. Nitrate of Mer- cury. f Hydrargyri Oxidum Rubrum. Red Ox- ide of Mercury. \ Hydrargyri Sulphas Flavus. Yellow Sulphate of Mercury. f Hydrargyrum Ammoniatum. Ammo- niated Mercury. Osmium. Osmium. f Osmii Chloridum. Chloride of Os- mium. f Palladium. Palladium. \ Palladii Chloridum. Chloride of Pal- ladium. Platinum. Platina. \ Platini Chloridum. Chloride of Pla- Muriate of Ammonia. Una. Plumbum. Lead. \ Plumbi Acetas. Acetate of Lead. | Plumbi Carbonas. Carbonate of Lead. \ Plumbi Oxidum Rubrum. Red Oxide of Lead. \ Plumbi Oxidum Semivitreum. Semi- vitrified Oxide of Lead. Stannum. Tin. f Stanni Chloridum. Chloride of Tin. Zincum. Zinc. y Zinci <'hloridum. Chloride of Zinc. ■j- Zinci Oxidum. Oxide of Zinc. ■j- Zinci Sulphas. Sulphate of Zinc. Sulphate of Magnesia — Sulphate of Soda — Phosphate of Soda. Dilute Sulphuric Acid 1 Milk. Carbonate of Magnesia — Carbonate of Soda. f XI. PHOSPHORUS. Copious draughts containing Magneeia. 416 TABLE OF POISONS AND THEIR ANTIDOTES. XII. VAPOURS. POISONS. f Antimonial. f Arsenical. f Bromine. f Iodine. Lead. Mercurial. ANTIDOTES. CLASS II. — ORGANIC POISONS. A. VEGETABLE. I. ACRO-NARCOTICS. * yEthusa Cynapium. Common FooVs Parsley. * Aconitum Napellus. Monkshood. * Agaricus, 5 species. Mushrooms {poi- sonous.) * Amanita Muscaria. Truffles (poisonous.) * Anagallis Arvensis. Meadow Pimper- nell. Anda Gomesii. * Apocynum Androsamifolium. Dogs- bane. * Aristolochia Clematitis. Birthwort. Arnica Montana. Leopard's Bane. * Asclepias Syriaca. Swallowort. t Atropa Belladonna. Deadly Nightshade. * yEscuIus Ohioensis. Buckeye. BruceaAntidysenterica. False Angustura Bark. Cerbera, 3 species. Cerbera. Charophyllum Sylvestre. Bastard Hem- lock. Chaillotia Toxicana. Ratbane. * Chenopodium Murale. Wormseed. * Cicuta Maculata. American Hemlock. t Cicuta Virosa. Water Hemlock. Cissus. Cissus. Cocculus Indicus. Fish berries. Colchicum Autumnale. Meadow Saffron. * Conium Maculatum. Hemlock. Coriaria Myrtifolia. Myrtle-leaved Su- mach. Curare. Indian War Poison. Cynanchum Erectum. Cynanchum. ytisus Laburnum. Laburnum. * Datura Stramonium. Thorn Apple. * Digitalis Purpurea. Foxglove. Ergot. See Secale. * Ervum Ervilia. Bitter Fetch. * Gaultheria Procumbens. Wintergreen, (oil of.) Hamanthus Toxicarius. Bromine — Chlorine — Iodine. Bromine — Chlorine — Iodine. Bromine — Chlorine — Iodine. Bromine — Iodine. Bromine — Chlorine — Iodine. Bromine — Chlorine — Iodine. Bromine— Chlorine — Iodine. Bromine — Chlorine — Todine. Common Salt — Sugar. Bromine — Chlorine — Iodine. Bromine— Chlorine— Iodine. Infusion of Yellow Bark. * Bromine, Chlorine, and Iodine, are said lobe antidotes in ih« «iir.i~;,i„ ___ ,■ are therefore affixed to all those plants *„icb areYnown ££,2?. ^l$E%$£y'*" **' TABLE OF POISONS AND THEIR ANTIDOTES. POISONS. Helleborus Niger. Black Hellebore. Hypophyllum Sanguinaria. Puddock Stool. Ipecacuanha. Ipecacuanha. Lathyrus Cicera. Lathyrus. Laurus Camphora. Camphor. * Lobelia Inflata. Indian Tobacco. * Lolium Temulentum. Darnel. * Melia Azederach. Pride of China. Mercurialis Perennis. Mountain Mercury. Nerum Oleander. Common Oleander. * OEnanthe Crocata. Hemlock Dropwort. * Nicotiana Tabacum. Tobacco. * Passiflora Quadrangularis. Barbadine, Piscidia Erythrina. Jamaica Dogwood. Polygala Venenosa (of Java.) * Rhus Radicans. Poison Vine, ■f Rhus Toxicodendron. Poison Oak or Sumach. * Robinia Pseudo-acacia. Locust Tree, * Ruta Graveolens. Rue. * Sanguinaria Canadensis. Blood Root, Scilla Maratima. Squill. Sea Onion. + Secale Cornutum. Ergot, Spurred Rye. * Sium Latifolium. Procumbent Water- Parsnip. * Spigelia Marilandica. Pink Root. Strychnos Ignatii. St. Ignatius's Bean. Strychnos Nux Vomica. Nux Vomica. * Symplocarpus Foetida. Skunk Cabbage, Ticunas. Extract of Various Plants. — S. America. Tieute. Upas tieute tree (of Java.) | Triticum Hybernum. Wheat {diseased.) Upas Antiar. Tree in Java. Veratrum Album. White Hellebore. * Veratrum Viride. American Hellebore, Woorara. War Poison of Guiana, * Zea Mays. Maize {diseased.) ANTIDOTES. Bromine — Chlorine — Iodine. Infusion of Galls. Bromine — Chlorine — Iodine. Bromine— Chlorine —Iodine. Bromine— Chlorine — Iodine. Bromine — Chlorine — Iodine. Bromine — Chlorine — Iodine. II. IRRITANTS. * Anemone Pulsatilla. Wind Flower. * Arum Maculatum. Wake Robin, Bryonia Dioica. Bryony, * Caladium Seguinium. Dumbcane. * Calla Palustris. Water Arum. * Caltha Palustris. Marsh Marigold, % Chelidonium Majus. Celandine. * Clematis Vitalba. Virgin Bower. Convolvulus Jalapa. Jalap. Convolvulus Scammonia. Scammony. Croton Tiglium. Purging Croton. £ Cucumis Colocynthis. Colocynth. Cyclamen Europaum. Sow Bread. Daphne Gnidium. Spurge Flax. Daphne Mezereum. Mezereon. t Delphinium Staphisagria. Stavesacre. Doica Palustris. Swamp leather wood. * Equisetum Hyemale. Scourgrass. Bromine — Chlorine — Iodine. Bromine — Chlorine — Iodine. Bromine — Chlorine — Iodine. Bromine — Chlorine — Iodine. 418 TABLE OF POISONS AND THEIR ANTIDOTES. POISONS. Euphorbia Officinarum. Euphorbium Spurge. * Gratiola Officinalis. Hedge Hyssop. Hippomane Mancinella. Manchineel. Hura Crepitans. Sand Box. * Hydrocotyle Vulgaris. Marsh Penny- wort, Jatropha Curcas. Indian Nut. Jatropha Manihot. Cassada. * Juniperus Sabina. Savin (oil of.) * Juniperus Virginiana. Red Cedar (oil of.) Momordica Elaterium. Squirting Cucum- ber. t Narcissus Pseudo-Narcissus. Daffodil. Pastinax Sativa. Common Parsnip. * Pedicularis Palustris. Marsh Lousewort. * Phytolacca Decandra. Poke. Piper Cubeba. Cubebs. Plumbago Europaa. Toothwort. * Ranunculus Acris, and other species. Crowfoot. Rhododendron Chrysanthemum. Oleander. + Ricinus Communis. Castor Oil Plant. Sambucus Ebulus. Elder. t Sedum Acre. Stone Crop. Stalagmitis Cambogioides. Gamboge. $ Tanacetum Vulgare. Tansy (oil of.) ANTIDOTES. Bromine — Chlorine — Iodine. Bromine — Chlorine — Iodinj Bromine — Chlorine — Iodine. III. NARCOTICS. * Acta Spicata. Baneberry. Amygdalus Communis. Bitter Almond. * Amygdalus Persica. Peach. Gelseminum Nitidum. Yellow Jessamine. Helonias Erythrosperma. Fly Poison. Hyoscyamus Albus. White Henbane. * Hyoscyamus Niger. Black Henbane. * Kalmia Latifolia. Mountain Ivy. Lactuca Virosa. Strong Scented Lettuce. Opium, and proximate principles. * Papaver Somniferum. Poppy. See Opium. Paris Quadrifolia. Herb Paris. * Prunus Caroliniana. Wild Orange. * Prunus Lauro-Cerasus. Cherry Laurel. Prunus Nigra. Black Cherry. t Prunus Padus. Cluster Cherry. * Prunus Virginiana. Wild Cherry. * Solanum Dulcamara. Bitter Sweet. * Sorbus Acuparia. Mountain Ash. * Taxus Baccata. Yew. Bromine ■ Bromine Chlorine -— Iodine. ■ Chlorine — Iodine. Infusion of Galls. Bromine — Chlorine — Iodine. IV. PROXIMATE PRINCIPLES OF VEGETABLES. Aconitia, see Aconitum. Atropia, see Atropa. Brucia, see Brucea. Codeia, see Opium. Colocynthin, see Cucumis. TABLE OF POISONS AND THEIR ANTIDOTES. 419 POISONS. ANTIDOTES. Daturia, see Datura. Delphinia, see Delphinium. Elatin, see Momordica. Emelia, see Ipecacuanha. Hyoscyamia, see Hyoscyamus, Morphia, and Salts, see Opium. Narcotin, see Opium. Picrotoxin, see Cocculus. Strychnia, see Strychnos. Veratria, see Colchicum. B. ANIMAL. I. BY CHANGE IN CONSTITUTION OR DISEASE. j Bacon. } Cheese. Crabs. f Eels. j Glanders, (infection from horses labour* ing under.) Mackerel. Milk. f Oily Matter from Kipper or dried Salmon. ■j- Oysters. j Pustule Maligne, [flesh of animals la- bouring under.] Putrid Blood, Bile, or Brain. Saliva of the Rabid Dog. -j- Sausage Poison [bloody and white.] II. FISHES. ■ Ballistes Monoceros. Old Wife. ■- Cancer Astacus. Crawfish. ■■ Cancer Ruricolus. Land Crab. ■ Clupea Thryssa. Yellow Billed Sprat, • Coracinus fuscus Major. Grey Snapper, ■- Coracinus Minor. Hyne. •• Coryphana Splendens. Dolphin. ■" Mormyra. Blue Parrot Fish. ■■ Murana Major. Conger Eel. • Mytilus Edulis. Mussel. ■- Ostracion Globellum. Smooth Bottle- fsh. f Perca Major. Barracuda. \ Perca Venenata. Rockfish. f Perca Venenosa. Grooper. \ Physalia. Portuguese Man of War. | Scomber Caruleus. Spanish Mackereti \ Scomber Maximus. Kingfish. | Scomber Thynnus. Bonelta. \ Sparus Chrysops. P or gee. \ Tetrodon Ocellatus. Blower. + Tetrodon Sceleratua. Tunngt 420 TABLE OF POISONS AND THEIR ANTIDOTES. III. INSECTS. POISONS. ANTIDOTES. f Apis Mellifica. Bee, Solution of Ammonia. ■J- Cantharis Vesicatoria. Spanish Fly, f Culex Pipiens. Gnat. { Lytta Vittata. Potato Fly. f QSstrus Bovis. Gad Fly. f Scorpio. Scorpion. f Tarantula. Tarantula. f Vespa Crabro. Hornet. Solution of Ammonia. j Vespa Vulgaris. Wasp. Solution of Ammonia. IV. SERPENTS. f Boa Crotaloides. Copperhead. | Cenchus Mockeson. Mockeson. f Coluber Berus. Viper. t Crotalus, (5 species.) Rattle Snake. t Scytale Piscivorus. Water Viper. ANTIPARASITICS. 421 III. ANTIPARASITICS. Sxir. Antiphthiriaca. Almost all animals and vegetables are subject to parasites; and both are infested not only with parasitic animals, but with parasitic plants. Recent researches, at least, favour the conclusion, that ve- getable growths may be connected wTith certain diseased conditions of the cutaneous surface in man and animals ; and daily observa- tion shows us, that plants are infested both with parasitic insects and vegetables. Of late years, as before remarked, (Vol. ii., p. 337,) the idea has been revived, that scabies, or common itch, is owing to an insect burrowing in the skin, and exciting great irritation and itching; and it has been conceived, that sulphur, veratrum, and the other remedies that may be employed for its cure, may act by de- stroying the " cutaneous vermination." In cases in which but few pediculi exist, the best antiparasitic is cleanliness. In our eleemosynary institutions and prisons, wrhen an infested person is admitted, the hair is cut short, and he is sent to the bath, and'well washed with soap and wTater. Attention of this kind, for a short period, is amply sufficient. In the present mode of wearing the hair, there is no difficulty in removing them ; but for- merly, when the hair wTas plastered down daily by greasy applica- tions, it was so common for parasites to make their nidus there, that the hair-dresser always added some antiparasitic, as the red oxide of mercury, to his pomatum to destroy them. The best antiparasitic course is to examine the head daily, and to use a fine-toothed comb. SPECIAL ANTIPARISITICS. The antiparasitics of the materia medica, most commonly employed, are the red oxide of mercury, which may be used either in the form 3f the Unguentum hydrargyri oxidi rubri, of the Pharmacopoeia, (Vol. ii., p. 302,) or mixed with ten or twenty parts of hair powder: a Mnall quantity of which may be rubbed into the hair ; — the ammo- niated mercury, in the form of the Unguentum hydrargyri ammo- niati, or mixed with starch in the proportions just mentioned ;—the Unguentum hydrargyri; — or the Hydrargyri chloridum mite, mixed with starch powder, which is regarded by some as the best antipara- sitic in cases of pediculus pubis. The Unguentum veratri, (Vol. ii., p. 352,) is used for the same purpose, and, at times, a decoction of vol. n.—36 422 SPECIAL ANTIPARASITICS. tobacco; but the preparations above mentioned are less likely, when cautiously employed, to affect the system injuriously, and are there- fore preferred. COCCU'LUS. Cocculus Indicus of the shops is the fruit of Anamir'ta coc'culus, or Coc'culus subero'sus, Coc'culus In'dicus plant; Sex. Syst. Dicecia Monadelphia ; Nat. Ord. Menispermaceae — a native of Malabar, and the eastern isles &c. of India. The dried fruit is officinal in the Pharmacopoeias of Edinburgh and Dublin. It resembles the bay- berry, and consists externally of a thin, rugous, dark-coloured bitter coat, enveloping a thin bivalve shell or endocarp, within which is a whitish, oily, or bitter kernel, which does not fill the whole shell ; this distinguishes it from the bayberry. (Pereira.) It was formerly brought, from the Levant, and was, therefore, called Coque du Le- vant, or Levant shell; but it is nowT imported altogether from India, chiefly for illegal purposes. Dr. Pereira states, that he found, from a druggist's private books, that in 1834, about 2500 bags were en- tered ; and this, he thinks, was probably much below the quantity imported. The poisonous principle of cocculus is a peculiar bitter matter called picrotoxin, which is very soluble in alcohol and ether, and may be separated by triturating the watery extract of the seeds with pure magnesia, and treating it with alcohol, which dissolves the pi- crotoxin : this may be obtained in an impure state by evaporation. Cocculus is an acro-narcotic, and has long been known as a poison for taking fish, which it stupefies. It is, also, used by fraudulent brewers, with the view of rendering beer more intoxicating, and at the same time bitter, without the employment of hops. In these cases, it is used in the form of extract, so that the fraud is not readily detected. As an antiparasitic, to destroy pediculi, it is em- ployed in the form of powder or of ointment. In India, it is like- wise applied in scabies; and Dr. Christison recommends it as one of the best applications in ringworm of the scalp. The Edinburgh Pharmacopoeia has a formula for an Unguentum Cocculi, which is made as follows: — Take any convenient quantity of Cocculus Indi- cus, separate and preserve the kernels ; beat them well in a mortar, first alone, and then with a little lard ; and then add lard till it amounts altogether to five times the weight of the kernels. It is used to destroy pediculi, and occasionally as a local application in obstinate chronic cutaneous diseases. In the same, cases, an oint- ment of picrotoxin has been prescribed — (Picrotox. gr. x ; Adipis, 3j ;) but some caution is necessary, as the system may become affected both when the picrotoxin is used, and the coculus itself. MINERAL WATERS. 423 ST APHIS A'GRI A. — STAVES'ACRE.' Stavesacre is the seed of Delphin'ium Staphisa'gria, stavesacre; Sex. Syst. Polyandria Trigynia ; Nat. Ord. Ranunculaceae; a na- tive of the south of Europe. The seed is about the size of a grain of wheat, of a somewhat triangular shape, rough, and of a dark brown colour externally ; of a slight, but disagreeable odour, and of a bitter, acrid, hot and nauseous taste. Its main active principle has been separated from it, and is termed Delphinia or Delphinine ; it also contains a volatile oil, which is a powerful emetic in small doses. Stavesacre is an active acro-narcotic, and, like cocculus, has been much used to destroy pediculi, which are readily killed by a wash made of an infusion of the bruised seeds in vinegar, or by an oint- ment of the powdered seeds well mixed with four or five times their weight of lard. An ointment might, also, be made of delphinia, and be used for the same purpose ; but it is so virulent a poison as to require much caution in its employment. The preparations of del- phinia have been used in the same cases as those of veratria. SECTION X. MINERAL WATERS. When we reflect on the multitude of persons who, during the proper seasons, frequent the mineral springs of this and other coun- tries, it must be apparent, that although much good may result, in individual cases, from their employment in appropriate affections, a large amount of evil must result from their indiscriminate use in dis- eases for which they are not adapted: accordingly, every intelligent resident physician at fashionable watering places, has deplored the ignorance of invalids and their medical advisers, which has doomed many a hopeless case to a most inconvenient pilgrimage ; for although the accommodations at such places ought to be adapted expressly for the comfort of valetudinarians, attention appears to be paid rather to the healthy, who are able to enjoy the pleasures of the table, and to minister, therefore, more to the interests of the proprietors. Nothing, indeed, can be more forlorn than the condition of a so- journer at the best of these watering places, when his disease is be- yond the resources of art, and when he is far from all those comforts, that home, and home alone, can afford him. A weighty responsi- bility consequently rests on the medical adviser, who is unpardon- 'able, if he have not previously made himself acquainted, as far as practicable, not only with the exact pathological condition of his patient, but with the remedial character of the mineral waters; and the accommodations of the sanitarium to which he recommends 424 MINERRAL WATERS. him. In the large mass of cases, perhaps, in which he is consulted, the remedy that is clearly indicated is a thorough change of air and of all the circumstances that surround the invalid ; but this is rarely a sufficient ultimate object with the patient; and it becomes import- ant— in order to induce him to travel—to hold out prospects of advantage from a course to be pursued at the end of his journey. In another work (Human Health, p. 125, Philad. 1844,) the author has dwelt upon the eminent advantages to health from simple change of air ; and in the present volume he has taken occasion to refer to its value as a revulsive and tonic agency in numerous diseases. To this, and to a change of diet and regimen, he has been disposed to ascribe much of that benefit which proverbially results from a journey, in the summer season, to any of the sites of our mineral springs. The multitudes of valetudinarians who annually leave their habitations to visit the watering-places of this country and of Europe, and who return to their homes in the enjoyment of health, and full of confi- dence in the virtues of the waters near which they have resided, but of which they may or may not have partaken, afford ample evidence of this beneficial agency. Long before the citizen of one of the atlantic towns of this country reaches the Trans-Alleghany Springs of \ irginia, he has an earnest of the advantage he is about to derive from change of air ; and many a valetudinarian finds himself almost restored during the journey, fatiguing as it is, through the mountain regions, which have to be crossed before he reaches the White Sul- phur, in Greenbrier county. Many persons, too, cannot drink that water with impunity, and, consequently, are indebted for their im- provement chiefly to change of air ; but somewhat, also, to varied scenery and society ; absence from cares of business; and to greater regularity of living than they have been, perhaps, accustomed to. In making these observations, the author does not mean to affirm that mineral waters, as in the case of the valuable spring in question, may not occasionally be important agents in the cure of disease ; but, taking invalids in general, he is satisfied that more is dependent upon change of air and habits than upon the waters. The inhabitant of an atlantic city, and of most of the districts to the east of the Blue Ridge, removes from a hot atmosphere to one which is comparatively cool, and where all the diseases that are common to hot and mala- rious climates are extremely unfrequent, and many of them unknown. The advantage is obvious. He escapes the diseases which might have attacked him, had he remained through the summer in his ac- customed locality ; and hence many of the wealthy families of the lower country are in the habit of spending those months in the moun- tain regions, in which they are especially liable to disease in their own malarious districts. We can thus understand the reputation ac- quired by the inert Bath, and the Matlock waters of England, the latter of which has scarcely any solid ingredient; and yet what crowds flock to these agreeable watering-places; to the former for the perpetual amusements that keep the mind engaged, and cause it to MINERAL WATERS. 425 react beneficially on the corporeal or mental malady ;—to the latter, for the enjoyment of the beauties of nature for which Derbyshire is so celebrated. It is obvious that were such waters bottled, and sent to a distance, so that the invalid might drink them at his own habita- tion, the charm would be dissolved. The garnitures—more import- ant, in this case, than the dish—would be wanting, and the banquet would be vapid, and without enjoyment or benefit. Less than twenty years ago, amidst the bubbles that were engaging the minds and money of the English public, it was proposed to carry sea-water by pipes to London, in order that the citizens might have the advantage of sea-bathing without the inconvenience of going many miles after it. Had the scheme been carried into effect, the benefits from metro- politan sea bathing would not have exhibited themselves comparable in any respect to those of the same agent employed at Brighton or at Margate. It is manifest, then, from what has been said, that neither the waters drunk at a distance, as in Philadelphia, nor any artificial waters, can be taken with the same advantage as the water at the springs ; and if the artificial mineral waters were sent from Philadel- phia, and taken at the source, they would, doubtless, in many cases, produce the same effects as the native water, especially if the invalid did not know that he was taking an artificial preparation. Again: when an inquiry is made into the character of the diseases that are most benefited by a visit to watering-places, it is found that the large mass of them are really such as are removable by simple change of air. Both change of air and the use of the waters are inad- missible during the existence of acute affections; but when the vio- lence of the disease has passed away, and the inflammation-—espe- cially if it be seated in the mucous textures—has become chronic, the beneficial influence of change of air, under proper precautions, is marked. Hence it is that travelling, which combines a modification of the atmospheric influences surrounding the patient, with proper exercise, is so salutary in chronic irritation of the mucous membrane of the intestines and of the bronchia. Many of the cases, indeed, that have been looked upon as phthisis removed by this course, have been chronic bronchitis ; and one of our mineral waters has gained a reputation for the cure of pulmonary affections, which ought rather, perhaps, to be referred to the change of air, and other physical and moral effects that impress the patient. That change of air and of habits is capable, indeed, of accomplish- ing all that our mineral waters can accomplish, is exhibited by the Wassercur of Priessnitz, already referred to, (Vol. ii. p. 213,) in which no article of the materia medica, and nothing but the pure element, is used; and it is found that the cures are mainly effected upon such patients as are in the habit of being sent to watering- places. Priessnitz proposes to cure all diseases that are not in such a stage as to be absolutely incurable by cold water, used externally and internally;-—along with constant exposure to mountain air; ac- 36* 426 MINERAL WATERS. tive exercise; total abstinence from all distilled and fermented liquors; plain coarse food; hard straw mattresses; and in Priessnitz's own establishment, we are told, the patient inhales an atmosphere not of the purest, — being contaminated by a smell, in part arising from the cows which are kept in stables beneath the house, in part from cabi- nets d'aisance upon the staircase, and from the kitchen beneath the common room, which opens into it by a trap-door, through^which the cooked food, as well as the various odours find entrance. Preissnitz lives in the mountains of Silesia ; and when we take into considera- tion the entire change that must be experienced by his patients in their journey thither, and, in the case of the better classes, in their mode of life when they get there, we need hardly be surprised that all those affections that are capable of being removed by revellents should yield to his efforts. The Leintuch, or the application of the wet sheet; the Abreibung, or rubbing down with the same ; the use of the sweating blanket, the patient being packed up in a blanket, feather-bed, and wadded counterpane, until he sweats; the different forms of baths and wet bandages; the drinking of eight to twelve glasses of water daily, each glass holding nearly three quarters of a pint; the coarse hard fare, and the regulated exercise already referred to, are well calculated to induce a new action in the functions, and to afford relief in a multitude of chronic cases. But although in the mass of cases, a journey to, and residence at, any of our mineral springs or at the sea side would prove effective in restoring the invalid, whether the waters were taken or not, it cannot be doubted, that many of them are excellent therapeutical agents, when judiciously employed. The thermal waters have, for example, the important advantage, that whilst the patient is im- mersed in them, they continue of the same temperature ; and hence their advantage over any artificial thermal bath, the temperature of which, under every precaution, must vary ; but it may be questioned, and has been questioned, whether the sulphurous, the saline, the chalybeate, the alkaline, or the ioduretted waters, really possess much more virtue than any analogous artificial solutions would be capable of exerting. It is a common remark, that the small quantity of saline matter contained in mineral waters produces a much greater effect than would result from an artificial solution of the same strength; but this is questionable. The visiter at the Saratoga Springs will take several tumblerfuls of the water at the fountain before break- fast ; but it would not be an easy matter to persuade a patient to drink as much of the artificial water; and until this is done, we have not the necessary elements for a fair comparison. Where many springs are seated near each other, personal in- terest is often sufficient to cause a trial of them all. One spring is reported to be valuable in some particular disease, or class of dis- eases; and another in another; and often it becomes the routine — as in the case of the Trans-Alleghany Springs, of Virginia, — to make a regular tour ; and before the invalid quits the region, he must have MINERAL WATERS. 427 sojourned far a while at the Warm Springs, then at the Hot Springs ; and must stay in turn at the Red Sulphur, the Salt Sulphur and the White Sulphur, finishing with the Sweet Springs, which is a car- bonated water. In this manner, it is difficult to arrive at any correct appreciation of the virtues of any one of them. It is rare, too, for a physician to practise at all of them in turn : he generally establishes himself at some one spring, and is, consequently, unable to make a comparison between them. Too commonly, moreover, his object is merely to practise his profession amongst the assembled visiters; and he may be incapable, either for want of ability, of opportunity, or of inclination to enter upon the task. In the Pyrenees, there are, it appears, upwards of fifty sulphurous springs, to each of which some special virtue is ascribed. The wa- ters of Bonnes are reputed to be best for diseases of the chest; those of Chaudes are, however, preferred by some ; Cauterets, and Bag- neres de Luchon by others. All sulphurous waters, as has been ob- served by recent therapeutical writers, Messrs. Trousseau and Pidoux, are considered everywhere to exert marvellous powers over phthisis. The Red Sulphur Springs of Virginia, have had this reputation for a long time. The White Sulphur waters, and those of the Salt Sul- phur, are doubtless as beneficial; but the fogs, to which the White Sulphur are subject, render it by no means a fitting sojourn for the phthisical valetudinarian. Aix in Savoy, Aix-la-Chapelle and Enghien, enjoy the antiphthisical reputation of sulphurous waters in general. Perhaps—so far as the waters go — the sulphohydric acid causes the good effects, if they be caused by the waters at all, which may admit of question; and if this be the sanative agent, it can be prepared artificially, and ought to exhibit some power over phthisical cases which are treated at home ; yet who would place any confidence in it, without the revulsion that is its accompaniment when it is drunk hundreds of miles away from home ? From the prominent ingredients of mineral waters, we can readily pronounce on their general therapeutical virtues. Some of them are cathartic, others diuretic, others tonic, and others eutrophic. Most of them increase the urinary secretion, but this may be often depen- dent upon the quantity of water taken, which passes into the mass of blood, and is separated by the kidneys. It is by thus entering the blood-vessels that they produce those eutrophic effects to which reference has been made already, (Vol. ii. p. 281,) and that old mor- bid cachexies disappear under their prolonged use. Still, as regards this very action, it is probable, that an equally beneficial result would ensue upon the employment, equally prolonged, of an artificial water of a similar kind, if it had the same extrinsic circumstances associated with it; hence the conclusion to which the therapeutists already quoted, have arrived, can scarcely be esteemed wide of the truth. " We believe," they observe, " that mineral waters are very effica- cious ; we think their power is considerably aided by the change in the hygienic condition of the patient; we are satisfied, that artificial 428 MINERAL WATERS. mineral waters are as efficacious, and, at times, more efficacious, than natural waters, when the patient will take them in the same manner ; but as we cannot prevail upon him to submit at home to the same abnegation, the same change in all his habits, and the same perseverance as at the natural springs, we shall still send, and every body will send, patients to drink, on the spot, waters, which but few will consent to drink anywhere else." MM. Trousseau and Pidoux ought, however, to have added, that even should patients consent to take the remedy freely at home, and submit to the same change of regimen, still, the mutation of atmospheric influences, and the tra- velling exercise in a journey to the springs, especially if at a con- siderable distance, and in a more elevated region—as is the case with the mountain-springs of this and other countries — are thera- peutical agencies of the greatest influence. Under Mineral Waters are classed all those that contain saline or gaseous substances, or both, in sufficient quantity to be possessed of medicinal properties ; or whose temperature differs from that of the ordinary springs of the region. The following table exhibits the temperature and active mineralising ingredients of the chief waters. MINERAL WATERS. 429 TABLE OF SOME OF THE PRINCIPAL MINERAL WATERS. Springs. Where situate. Temperature. Active constituents. Acqui, Piemont. 167° Sulphohydric acid and chloride of sodium. Aix, Piemont, Savoie. 98 Sulphohydric acid. Aix-la-Chapelle Germany. 134 Sulphohydric acid, chloride of sodium, and carbonate of soda. Aix, in Provence, France, (Bouches du Rhone.) 91 Traces of carbonic acid. Aries, France, (Pyren. Ori-ent.) 103 to 145 Sulphohydric acid. Audinac, France, (Arriege.) 67 Sulphohydric acid, sulphate of magnesia. Ax, France, (Arriege.) Thermal Sulphohydric acid. Baden, in Aargau, Switzerland. 167 Sulphohydric acid. Baden, in Swabia, Germany. 112 to 145 Sulphohydric acid, chloride of sodium, sulphate of soda. Bagneres de Bigorre, France, (H. Pyren.) 129 Sulphate of magnesia. Bagneres de Luchon, France, (H. Garonne.) 69 to 148 Sulphohydric acid. Bagnoles, France, (Orne.) 78 to 82 Sulphohydric acid, car-bonic acid, chloride of sodium. Bagnols, France, Lozere. 109 Sulphohydric acid. Balaruc, France, Herault. 116 Chloride of sodium, chlo-rohydrate of magnesia, carbonic acid. Balston Spa, — Sans United States, New- Chloride of sodium, bi- Souci Spring. York. carbonates of soda and magnesia, carbonate of iron, and iodide of sodium. Bareges, France, (Hautes-Py-ren.) 85 to 112 Sulphohydric acid. Bath, England. 112 to 116 Chloride of sodium, sul-phate of soda and car-bonic acid; chiefly cal-careous salts. Bedford, — Anderson's United Sates, Penn- Carbonic acid, • sulphate Spring. sylvania. of magnesia, chlorides of sodium and calcium, carbonate of iron. Bonnes, France, (Bass-Pyren.) 78 to 98 Sulphohydric acid. Bocklet, Bavaria. Carbonic acid, iron. Bourbon-Lancy, France, (Saone et 132 Chloride of sodium, car- Loire.) bonic acid. Bourbon-l'Archam- France, (Allier.) 136 to 140 Sulphohydric acid, car- bault, bonic acid, iron. Bourbonne-les-Bains, France, (Haute Marne.) Chloride of sodium. 430 MINERAL WATERS. Springs. Where situate. Temperature. Active constituents. Bristol, England. 74 Sulphate of soda, chlorides of sodium and magne-sium. Bruckenau, Bavaria. Carbonic acid, iron, Bussang, France, (Vosges.) Cold. Carbonic acid, carbonate of soda, iron. Buxton, 82 Cambo, France, (Basses-Py- C69 Sulphohydric acid. ren.) 262 Carbonic acid, iron. Campagne, France, (Aude.) 80 Sulphate of magnesia, chlorohydrate of mag-nesia. Carlsbad, Bohemia. 121 to 167 Carbonic acid, sulphate of soda, carbonate of soda, chloride of so-dium. Cauterets, France, (H. Pyren.) 123 Sulphohydric acid. Chateldon, France, (Puy de Do-me.) Carbonic acid, iron. Chaudes-Aigues, France, (Cantal.) 191 Carbonic acid, carbonate of soda, chloride of so-diam. Cheltenham, England. Chloride of sodium, sul-phate of soda, sulphate of magnesia, carbonic acid, carbonate of iron. Contrexeville, France, (Vosges.) Carbonic acid, a little sulphate of magnesia, chloride of sodium, and iron. Creuznach, Germany. Iodine, bromine, chlorides of sodium and calcium. Dax, France, (Landes.) 76 to 133 A little chlorohydrate of magnesia, sulphate of soda. Dunblane, Scotland. Sulphate of soda, chlorides of sodium and calcium, and carbonate of iron. Ems, Germany. 83 to 115 Carbonic acid, bicarbon-ate of soda, chloride of sodium. Enghien-Montmo- France, (Seine et Sulphohydric acid . rency, Oise.) Epsom, England. Sulphate of magnesia. Forges, France, (Seine infer.) Iron. Franzensbad, Bohemia, Eger. Sulphate of soda, carbonate of iron, carbonic acid gas. _ Furnas, St. Michael's, Azores. Thermal. Carbonic acid, carbonate of iron. MINERAL WATERS. 431 Springs. Where situate. Gastein, Greoulx, Hall, Harrowgate, Hot Springs, Ischl, Kilburn, Kissengcn, La Marequerie, Lamotte, La-Roche-Posay, Leamington, L'Epinay, Lucca, Luxeuil, Malvern, Matlock, Marienbad, — Kreuz- brunn. Moffat, Mont-Dore, N£vis, Niederbronn, Niton, Temperature Austria, Noric Alps. 118 France, (Basses-Alpes.) 85 to 96 Upper Austria. England. United States, Va. Upper Austria. 107 Bavaria. France, (Seine infer.) France, (Isere.) France, (Vienne.) England. France, (Seine infer.) Italy. France, (Haute-Saone*) England. England. Bohemia. Scotland. France, (Puy de Dome. France, (Allier.) France, (Bas-Rhin.) England, Isle of Wight. 184 94 to 130 125 66 112 Active constituents. Sulphohydric acid. Iodine. Carbonic acid, sulphohy- dric acid. Carbonate of magnesia; chlorides of sodium, and magnesium. Iodine, bromine. Carbonic acid, sulphohy- dric acid; carbonates of lime, magnesia and iron ; sulphates of soda, lime, and magnesia; chloride of sodium. Carbonic acid, chloride of sodium. Iron. Sulphohydric acid. Chloride of sodium, sul- phate of soda, chlorides of calcium and magne- sium. Iron. Carbonic acid, sulphates of alumina, soda, mag- nesia and iron. Chloride of sodium, car- bonate of soda. Carbonates of soda and iron, sulphate of soda, chloride of sodium. Sulphate of soda, carbo- nate of iron, carbonic acid gas. Carbonic acid, sulphohy- dric acid and azote; chloride of sodium. Carbonic acid, bicarbon- ate of soda, chloride of sodium, sulphate of 136 to 148 Cold. Chloride of sodium, sul- phate of magnesia, car- bonic acid. Iron, sulphate of alumina and potassa. 432 MINERAL WATERS. Springs. Where situate. Temperature. Active constituents. Passy, France, (Seine.) Iron. Pfeffers, Swiss Alps. 100 Pitcaithley, Scotland. Chlorides df goditirtt ahd calcium. Plombieres, France, (Vosges.) 132 to 166 Carbonate Of sdda, Sulphate of soda, and chloride of 6odium. Pougues, France, (Nievre.) Carbonic acid, carbonate of soda. Provins, France, (Seine et Marne.) Carbonic acid, iron. Pullna. Bohemia. Sulphates of soda and mag-nesia, chloride of mag-nesium, iron. Pyrmont, Westphalia, Carbonic acid, carbonate of magnesia. Rennes, France, (Aude.) 103 to 121 Carbonic acid, chlorohy-drate of magnesia. Roisdorff, Germany. Carbonic acid, carbonate of soda. St. Amand, France, (Nord.) 64 to 82 C Waters. Carbonic acid, sulphohydric acid. <( Deposit. {Boue,) sul-| phohydric acid, salts of l^iron and magnesia. St. Nectaire, France, (Puy deDdme.) 75 to 103 Carbonic acid, bicarbon-ate of soda, chloride of sodium. St. Pardoux, France, (Allier.) Carbonic acid, iron. St. Sauveur, France, (Hautes-Py-ren.) 76 to 93 Sulphohydric acid. Saratoga, — Congress United States, New- Carbonic acid, chloride of Spring, York. sodium, iodide of so-dium ; bicarbonates of soda and magnssia ; car-bonate of iron, bromide ------Walton or Io- United States, New- of potassium. Chloride of sodium, car- dine Spring, York. bonate of magnesia, iodide of sodium. Sea water; Chlorides of sodium, mag-nesium and calcium ; sulphate of magnesia. Scarborough, England. Sulphate of magnesia, iron. Schlangenbad, Germany, 86 A little carbonic acid and carbonate of soda. Schwalbach, Germany. Carbonic acid, iron. Seidlitz, Bohemia. Sulphate, carbonate, and muriate of magnesia, carbonic acid. MINERAL WATERS. 433 Springs. Where situate. Temperature. Active constituents. Seltzer, Germany. Carbonic acid, chloride of sodium. Seidschiitz, Bohemia. Sulphate of magnesia, car-bonic acid. Spa, Belgium. Iron, carbonic acid. Tarascon, France, (Arriege.) Iron, carbonic acid. Tbplitz, Bohemia. 114 to 122 Carbonate of soda, chlo-ride of sodium, sulphate of soda. Tunbridge, England. Carbonic acid, carbonate of iron, sulphate of mag-nesia. Ussat, France, (Arriege.) 93 to 98 Carbonic acid, chlorohy-drate of magnesia. Vals, France, Ardeche. 96 Bicarbonate of soda, car-bonic acid. Vichy, France, Allier. 90 to 112 Bicarbonate of soda, car-bonic acid. Warm Springs, United States, Vir-ginia. 97 White Sulphur, United States, Va. Sulphohydric acid, carbonic acid, sulphate of mag-nesia. Wisbaden, Germany. 158 to 160 Chloride of sodium. It is impracticable to make a well defined classification of mineral waters, except where they contain — which, as will be seen by the table, is rarely the case — but a single mineralising ingredient. In many it is difficult to say, which exerts the predominant influence. It is the custom to range them into certain classes, which admit of a more ready appreciation of their general properties. Perhaps the least objectionable division is the following: — 1. Simple thermal waters ; 2. Saline aperient waters ; 3. Alkaline waters ; 4. Sulphu- rous waters; 5. Ioduretted waters; 6. Chalybeate waters ; and 7. Carbonated waters. The chief thermal springs of the United States are the Warm Springs and Hot Springs of Virginia ; the Warm Springs of Bun- combe county, North Carolina (94° to 104,) and the Hot Springs of Arkansas, (167° to 210); in England, those of Bath, Bristol, and Buxton. In France, Germany and Italy, they are numerous ; but, as seen by the tables, they are rarely simple; containing, at the same time, various mineral impregnations. On these, their virtues as in- ternal agents are altogether dependent. When applied externally, their effects may vary according to the character of the impregnation; those of simple thermal waters are dependent upon temperature and moisture. They are the same, in other words, as those of warm vol. n.—37 434 MINERAL WATERS. water and hot water baths, whose properties have been mentioned in another part of this work, (see Vol. i., pp. 326 and 498.) They have the great advantage, however, already alluded to — in rheu- matic and other diseases —that their temperature continues the same, whatever may be the duration of the immersion. 2. The saline aperient waters contain chiefly sulphate of soda, sulphate of magnesia, chloride of sodium, and chloride of magne- sium, singly or associated. Most of these are cold springs— as those of Kissengen, Marienbad, Franzensbad, Cheltenham, Leamington, Harrowgate, and Scarborough ; and in this country, the White Sul- phur, Salt Sulphur and Red Sulphur of Virginia. Thermal saline waters are found at Wisbaden, and Baden Baden in the neighbourhood of Wisbaden. The Hot Springs aiid Warm Springs of Virginia contain but little saline impregnation. All these waters act as cathartics and diuretics; but they require to be taken with caution ; for if used too freely, they bring on fever with gastro-intestinal irritation, and a sense of fulness in the head. Their protracted use, too, may be of great advantage in diseases that re- quire the employment of saline eutrophics. 3. The important ingredients in the alkaline waters are bicar- bonate of soda and carbonic acid. Vichy is the most celebrated of these. It is thermal-alkaline ; and so are Mont-Dore, Ems, Top- Htz, Schlangenbad, and Roisdorff. The alkaline springs of this country are cold. Those of Saratoga and Balston are the most cele- brated. 4. In the sulphurous waters the characteristic ingredient is sul- pho-hydric acid ; generally associated with saline substances, but sometimes existing alone, or nearly so, as in the thermal waters of Bareges, the Warm Springs and the Hot Springs of Virginia, &c. The main sulphuro-saline waters are the thermal springs of Aix-la- Chapelle, Aequi, Audinac, &c, the cold springs of Moffat, and Har- rowgate; and the White Sulphur, Red Sulphur, Salt Sulphur, &c, of Virginia. These waters are laxative and eutrophic, and adapted, therefore — both when used internally and externally—for all the cases in which sulphur is needed as a laxative (Vol. i., p. 156,) or as a eu- trophic. (Vol. ii., p. 281.) 5. The ioduretted waters always contain a salt of iodine asso- ciated with chloride of sodium. The chief springs of this kind are those of Saratoga and Balston in this country ; of Woodhall near Ashby de la Zouch in England ; and of Creuznach in Germany. The properties of these waters are therefore dependent upon the joint influence of the iodine and chloride of sodium; and their pro- longed use is beneficial in scrofula, and in other cases, in which the eutrophic agency of iodine, or of chloride of sodium, or of both, is indicated. 6. Chalybeate waters are numerous every where. As is shown by the table, many of the saline aperient waters contain iron in the MINERAL WATERS. 435 form of carbonate or sulphate. The most celebrated of the marked chalybeates abroad, are, Spa, Pyrmont, Schwalbach, Marienbad, Tunbridge wells, &c. ; in this country, Balston, Saratoga, Bedford (Pa.), and Brandywine. As the iron is associated with free carbonic acid in most of the springs, the virtues which the waters enjoy must be dependent upon both. A simple chalybeate water is adapted for all cases in which chalybeates in a great state of dilution appear to be required : the carbonic acid, in addition, acts as an excitant, and, with some, produces exhilaration and an approach to intoxication. Carbonated chalybeates have, therefore, to be used with caution, especially in highly impressible individuals. 7. The simple carbonated waters are altogether indebted to carbonic acid for their efficacy. The Sweet Springs in Monroe county, Virginia, are the best specimen in this country. The tem- perature is 73°. Most of them contain either carbonate of soda or iron, or both ; and their medical efficacy is, of course, partly de- pendent upon the amount of these ingredients. The carbonic acid always, however, communicates decided qualities to them. It gives them their sparkling briskness, and piquant taste ; their excitant agency upon the stomach, and their exhilarating effect upon the whole system. The water at Pyrmont in Westphalia, which con- tains iron, and is highly charged with carbonic acid, is said to be drunk by the country people, partly as a medicine, and partly on account of the kind of intoxication it induces. The Congress and other waters of Saratoga and Seltzer are mainly indebted for their agreeable qualities to the carbonic acid which they contain. This, too, is the pleasant ingredient in the effervescing draught; in soda powders, and in the soda water from the fountain, — and it is to it, that these preparations owe their power of arresting vomiting, when not dependent upon inflammation of the stomach ; and that soda water and Seltzer water aid digestion, when taken during a repast. As a refrigerant, carbonated water has been treated of already. (Vol. ii., p. 214.) The United States Pharmacopoeia has a formula for the AQUA ACIDI CARBON 1CI, CARBON'IC ACID WATER, or Artificial Seltzer water, which is formed by throwing into a suitable receiver nearly filled with water, by means of a forcing pump, a quantity of carbonic acid equal to five times the bulk of the water. The carbonic acid is obtained from marble by means of dilute sulphuric acid. This is the soda water or mineral water of the shops. In regard to the external use ?of mineral waters, much need not be said. They must produce their effects partly by their tempera- ture, and partly by the particular mineral impregnation which they contain. The effects of these will be understood by comprehending the effects of the impregnations themselves. Saline and sulphurous waters stimulate the skin more than pure water of the same tempera- ture ; and the latter exert a valuable agency in chronic cutaneous 436 COMBINATION OF THERAPEUTICAL AGENTS. and other affections in which sulphur is beneficial. The Boue des Eaux or deposit from the sulphurous waters is often an excellent application to various inveterate cutaneous diseases. SECTION XL ON THE COMBINATION OF THERAPEUTICAL AGENTS. Importance of a due attention to principles — Value of authority — Professional quali- fications may be estimated by the prescription — Evils of complexity in prescribing — Rules for prescribing — Table of incompatibles — Doses of medicines — Conclu- sion. The main admitted classes of therapeutical agents, or of those which ought perhaps to be admitted, have now been examined. It is rarely, however, that the practitioner draws his resources, in the management of disease, from one class only. Even in the treatment of febrile and inflammatory diseases — for which sedatives are so admirably adapted — the therapeutist not unfrequently has recourse to some of the classes of excitants. Thus he prescribes emetics, cathartics, diaphoretics, and revellents; and often — when appro- priately prescribed— with marked advantage ; but, under other cir- cumstances, with decidedly evil consequences. Yet, it is obvious, that they cannot be esteemed direct or true antiphlogistics. The actual immediate operation of these evacuants is the opposite of that produced by sedatives or true antiphlogistics: their antiphlogistic effect is only secondary, and, at times, they cause inflammation of the tissues on which their action is immediately exerted, without in- ducing their specific operation. This is, doubtless, one of the modes in which these ' local stimu- lants' prove injurious; but — to take the case of cathartics — even if they excite the secretion of the lining membrane of the intestinal canal, and produce evacuation after evacuation, as is too often done in febrile diseases, the perturbation, which they induce in the economy, may be attended with results any thing but antiphlogistic ; and, ac- cordingly, they are now generally employed in the ordinary fevers of our country, chiefly with the view of keeping the intestinal canal free from morbid secretions and accumulations, — not so much as depletives; whilst the trust of the practitioner is reposed rather in the proper use of sedatives — as blood-letting, general, or local, or both, as the case may require ; refrigerants, nauseants and narcotics ; with a strict inculcation of mental and corporeal quietude — than in the mixed sedative and perturbating plan cf management, which was at one time universal, and still lingers with many of the older practitioners especially. To one who has been taught, that the old method of management is essential, and who has employed no other, the success that attends COMBINATION OF THERAPEUTICAL AGENTS. 437 this milder, more soothing, and more philosophical, treatment may appear incredible. The author can affirm, however, from the re- sults of both public and private experience, that it is so generally successful, that a death from bilious fever, is — in his observation — an uncommon event. Similar testimony is afforded by an ex- perienced observer, Professor Jackson, of Philadelphia, in favour of a mode of management perhaps even less active than the one which the author has inculcated, — so far as regards the employment of local stimulants of the kind referred to. " Follicular enteritis," he says, " known more familiarly under the names of typhoid fever, lyphoid remittent, and bilious fever, I find to be infinitely more man- ageable when treated with occasionally local depletion, as it may be indicated by local symptoms, the expectant method, and alterative doses, than by the perturbating and evacuant plan. Under this course, I rarely see it fatal." The antiphlogistic or sedative treatment is, doubtless, the main stay of the practitioner in febrile maladies ; but still, as shown, under the proper heads, mild evacuants are necessary throughout their whole course ; and, when they become protracted, — upon the prin- ciple of revulsion, agents may be demanded, the propriety of whose use in the earlier periods might be more questionable. In all cases of disease, the physician must investigate the nature of the pathological action which is going on in the tissues. This—- as elsewhere remarked — must be the point of departure for his the- rapeutical indications; and a wise knowledge of the properties of his medicinal agents will enable him to carry into effect those indi- cations ; — but he must not vacillate. Let his therapeutics be guided by great general principles ; and let him not fly from one indication to another, because the pathological condition may not be — or may not seem to be — yielding. If his principles be accurate, his indi- cations will correspond ; and if he be not satisfied with his indications, there can be but little safety for the patient in the empiricism that must necessarily be the rule of conduct under such circumstances. It is an unfavourable index of the attainments of a physician, when he places undue store on some formula or agent for the cure of parti- cular pathological conditions. It is prima facie evidence of faulty observation, and of defective induction. It indicates a mind that searches after facts — too often 'false' — rather than after great principles ; — that is swayed by prepossessions rather than by true experience, — and that ought not to be trusted on trying or unusual occasions. To the possessor of such a mind, the advice of Swift to a young author, — if he had written anything which he thought particularly fine, to strike it out, — might not be inappropriate. The loss of the result of the practitioner's observation, — true or false, would be but trifling, whilst the reception of a false fact, and its admission as a ground of action, might be unfortunate. Primerose, in his work ' on common errors in physic,' (De Vulgi Erroribus in Medkind, Amstelod, 1639,) has a chapter, entitled 37* 438 COMBINATION OF THERAPEUTICAL AGENTS. 1 JYon esse mutanda remedia etiamsi curatio statim, non succedat,' — ' that remedies are not to be changed, although a cure may not im- mediately follow,' — and the remark is as applicable at the present day as it was in his time. If due attention have not been paid to the investigation of the disease, — if any uncertainty exist as to its pathological nature, or as to the powers of the therapeutical agents had recourse to, — or if the physician be thrown off his balance by unreasonable expectations, or by petulance on the part of the patient, — he is apt to fly from one plan of treatment, or from one remedy to another; and, in this manner, to become bewildered. On all these accounts, it will be readily understood, why this fault should be more observable in young practitioners than in old ; and so striking is it apt to be in them, and so fraught with multitudinous evils, that it has been regarded by the author as a solemn duty yearly to caution the student against it; — inculcating, at the same time, the neces- sity for inquiring strictly into the precise nature of the pathological phenomena that present themselves in any case which may fall under his attention, and of well comprehending the effects which his reme- dial agents are capable of exerting on the vital properties in health and in disease ; and when, after an ample investigation, he has laid down his indication of treatment, and decided upon the therapeutical agents that are adapted for fulfilling such indication, that he should not be disheartened, if he find his patient in the same condition at his subsequent visits ; but persevere in his plan of treatment, unless some new and more philosophical view should have presented itself, which may have led him to infer that the indication previously em- braced had been defective. There is no circumstance which is so much calculated to render the young practitioner dissatisfied with the practice of his profession as this vacillation from one remedy to another without adequate rea- son. Instead of daily adding to his stock of valuable practical knowledge, his experience becomes the result of incessant empirical trials with the various articles of the materia medica, and is almost constantly false ; — the danger being, in all such cases, that the agent last prescribed will absorb the whole credit of the cure ; whilst, in many instances, it may have been inoperative, and the successful result may have been owing to that instinctive action of recuperation which is seated in all organised bodies — vegetable as well as ani- mal — and which is capable of repairing injuries, when such injuries do not overstep certain limits. The proper course for the physician to pursue in the treatment of chronic diseases — for to such these remarks are more especially ap- plicable — is well expressed by Hippocrates in his aphorism : ' Omnia secundum rectam rationem facienti, si secundum rationem non succedat, non est ad aliud transeundum, quamdiu id manet quod ab initio visum fuit.' ' He who does every thing in accordance with sound reason need not pass to any thing else — provided the thing does not suc- ceed -according to reason— so long as every thing is in the same state as it appeared to be in the beginning.' COMBINATION OF THERAPEUTICAL AGENTS. 439 It may be requisite, however, at times, to alter the form of a me- dicine, where, as in chronic diseases, the patient has become wearied of so long employing the same form ; and for the reason, also that — without such variation — the remedy may lose its intrinsic powers in consequence of the system having become habituated to it. Connected with this subject, Professor Bigelow, of Boston, has some judicious remarks, which strikingly exhibit the fallacious mode of reasoning, adopted by too many, in their investigation of disease, and of the proper adaptation of remedies. " The foundation of all knowledge is truth. For truth, then, we must earnestly seek, even when its developments do not flatter our professional pride, nor attest the'infallibility of our art. To discover truth in science is often extremely difficult; in no science is it more difficult than in medicine. Independently of the common defects of medical evidence, our self-interest, our self-esteem, and sometimes even our feelings of humanity, may be arrayed against the truth. It is difficult to view the operations of nature, divested of the inter- ferences of art, so much do our habits and partialities incline us to neglect the former, and to exaggerate the importance of the latter. The mass of medical testimony is always on the side of art. Medical books are prompt to point out the cure of diseases. The young stu- dent goes forth into the world, believing that if he does not cure dis- eases, it is his own fault. Yet when a score or two of years have passed over his head, he will come at length to the conviction, that some diseases are controlled by nature alone. He will often pause at the end of a long and anxious attendance, and ask himself, how- far the result of the case is different from what it would have been under less officious treatment than that which he has pursued ; how many in the accumulated array of remedies, which have supplanted each other in the patient's chamber, have actually been instrumental in doing him any good. He will also ask himself, whether, in the course of his life, he has not had occasion to change his opinion, perhaps more than once, in regard to the management of the disease in question, and whether he does not, even now, feel the want of additional light ?-------We are seldom justified in concluding, that our remedies have promoted the cure of a disease, until we know, that cases, exactly similar in time, place, and circumstances, have failed to do equally well under the omission of those remedies; and such cases, moreover, must exist in sufficient numbers to justify the admission of a general law on their basis. Nothing can be more illogical than to draw our general conclusions, as we are sometimes too apt to do, from the results of insulated and remarkable cases ; for such cases may be found in support of any extravagance in me- dicine ; and if there is any point in which the vulgar differ from the judicious part of the profession, it is in drawing premature and sweeping conclusions from scanty premises of this kind. Moreover, it is in many cases not less illogical to attribute the removal of dis- eases, or even of their troublesome symptoms, to the means which 440 COMBINATION OF THERAPEUTICAL AGENTS. have been most recently employed. It is a common error to infer that things, which are consecutive in the order of time, have neces- sarily the relation of cause and effect. It often happens that the last remedy used bears off the credit of having removed an obstruction, or cured a disease, whereas in fact the result may have been owing to the first remedy employed, or to the act of nature uninfluenced by any of the remedies.-------In the study of experimental philosophy, we rarely admit a conclusion to be true, until its opposite has been proved to be untrue. But in medicine we are often obliged to be content to accept as evidence the results of cases which have been finished under treatment, because we have not the opportunity to know how far these results would have been different, had the cases been left to themselves. And it too frequently happens, that medical books do not relieve our difficulties on this score, for a great deal of our practical literature consists in reports of interesting, extraordinary, and successful results, published by men who have a doctrine to establish, or a reputation to build. ' Few authors,' says Andral, ' have published all the cases they have observed, and the greater part have only taken the trouble to present to us those facts, which favour their own views. A prevailing error among writers on thera- peutics proceeds from their professional, or personal, reluctance to admit that the healing art, as practised by them, is not, or may not be, all sufficient in all cases : so that on this subject they suffer them- selves, as well as their readers, to be deceived. — Hence we have no disease, however intractable or fatal, for which the press has not poured forth its asserted remedies.-------It is only when, in con- nection with these flattering exhibitions, we have a full and faithful report of the failures of medical practice, in similar, and in common cases, setting forth not only the truth, but the whole truth, that we have a basis sufficiently broad to erect a superstructure in therapeu- tics, on which dependence may be placed." The present is a period eminently characterised for the accumula- tion of clinical observations ; and much valuable information has been collected; yet, it is to be feared, the advantages in this way obtained have not been without counter-vailing results; and there are, perhaps, too many evidences of the minds of observers having been narrowed down to simple observation of occurrences, instead of being devoted to great general views. Facts have occupied the mind in place of induction. The senses have been engaged, whilst the higher powers of the intellect have, too often, been permitted to remain dormant. The periodical effusions of cases, with the ex professo treatises on medical clinics, are now so numerous and diversified, that the searcher after great principles of pathology and therapeutics scarcely knows at what point to commence his investigations. Were all the recorded Qfacts' registered and detailed by observers of adequate talent and discrimination, the severity of the task would be greatly diminished; but, unhappily, this is not the case; and, hence, the ART OF PRESCRIBING. 441 difficulty, with the searcher after truth, is often extreme. If, indeed, we reflect on the multitude of cases, that have been published in the various periodical and other collections, and on the few—the very few — that are at this day alluded to as authorities on any point, we might have our medical ardour somewhat damped, and justly fear, that all our labour might be fruitless, and that, in a few short years, the results might be consigned to that oblivion, which has shrouded those of our predecessors. That many — perhaps most — of the clinical cases, which have been the emanations of recent and present periods, will meet with this fate, is doubtless ; but still, many must remain ; and a spirit of accurate observation, and of faithful registration of the results of such observation, emanating from dis- tinguished teachers of the day, and ramifying amongst their pupils, in every quarter of the globe, will persist, after they have passed away, and cannot fail fo develope useful results. Facts are the foundation of all true theory — of all great principles of therapeutics — but such facts must be indubitable. The science of medicine has suffered greatly from the questionable and the false. Meteorology is a branch of physical science in which we have the wide distinction between facts and principles clearly shown. Ob- servers have gone on registering the condition of the barometer, the thermometer, and the hygrometer ever since those instruments were first invented, and we have accurate lists announced monthly of the pressure, temperature, &c, of the atmosphere in the chief localities of the civilized globe : they have, as Dr. Samuel Johnson has sar- castically remarked, " registered the changes of the wind, and died fully convinced that the wind is changeable ;" yet notwithstanding the labours of the myriads of observers, scattered over the earth, and notwithstanding that " vapours, and clouds, and storms," have been the theme of investigation — of late, more especially — both here and elsewhere, how few are the principles that can be looked upon as established, and how dispiriting the reflection, that the re- sults of the toilsome industry of so many observers, which — other- wise employed — might have been most profitable, can only be regarded as the products of so much time misspent! In an early part of this work, it was remarked, that where the pathological lesion is understood, the therapeutical indication will be more clear; and, in general, more easily fulfilled. No necessity will exist for complex combinations of different classes of medicinal agents ; or of different agents of the same class. In every case, before prescribing, all agents should be rejected, whose modus operandi has not been well settled by careful, repeated, and unbiassed observation. It has been well remarked, that a medicinal prescrip- tion should carry upon its very face an air of energy and decision, and speak intelligibly the indication, which it is to fulfil, — and that it may be laid down as a position, not in much danger of being con- troverted, that where the intention of a medical compound is ob- 442 COMBINATION OF THERAPEUTICAL AGENTS. scure, its operation will be imbecile. ' Medicus vir prudens nihil preescribat, nisi cujus sufficientem queat reddere rationem, quum re- quiritur; hinc nunquam tumultuario, sed semper ex indicatione prius rite deducta agat.' (Gaubius.) There is, doubtless, truth, too, in the opinion entertained by some, that a practitioner's professional abilities may be estimated somewhat by the character of his prescrip- tion,— the scientific physician not permitting any agent to enter, without some satisfactory reason for its admission. Where no such reason can be adduced, there is usually some deficiency on the part of the practitioner. What can the philosophic individual — profes- sional or not — think of the reasoning—if reasoning it may be called — of the country practitioner in England, who was celebrated for the complexity of the medicines which he gave to his patients — a complexity which was always, as might be expected, in a direct ratio with the obscurity of the cases? "If," said he, "I fire a great profusion of shot, it is very extraordinary if some do not hit the mark:" or of the subject of a similar anecdote, related by Sir Gilbert Blane, who, being asked by his patient, why he put so many ingredients into his prescription, answered, " in order that the dis- ease may take that which it likes best;" a feeling, which would have readily enabled him to range himself under the 'good men and true' of Homoeopathy, the believers in which maintain — as has been elsewhere shown — that there is a marked affinity between every disease and some particular article of the materia medica. Unlike, however, the practitioner in question, they endeavour to dis- cover such agent, and administer it alone in the disease for the re- moval of which it is considered to be specially adapted. Where complexity is indulged, it is obviously impracticable to test, by any kind of experience, the properties of our therapeutical agents, or to discriminate the main sanative ingredients from such as are of no efficacy, or may even counteract them. " It is an opi- nion," says Dr. Holland, "not unfrequent among medical men, that the multiplication of medicines in our hands adds in the same ratio to the power and facilities of practice. This view is admissable only in a very qualified sense. It is, in truth, as correct to say, that the addition of new medicines or preparations, which do not expressly accomplish new purposes, or fulfil more advantageously those already attained, becomes an incumbrance to the practitioner, and an impedi-- ment to the progress of science. It may be alleged, and must be fully admitted, that combinations have often effects not resulting equally from any of their ingredients. This is true as respects many vegetable medieines of powerful action, whether narcotic, purgative, diurectic or alterative. It is especially true as regards chemical reme- dies, where changes of combination may occasionally be calculated upon favouring the effects desired; though much more frequently the facts by which their use is determined are merely empirical in kind. The observation of these facts is obviously one of the most important objects to the practitioner. But, it must be added, one of ART OF PRESCRIBING. 443 the most difficult also; for even in the simpler combinations we can rarely obtain that precise estimate of effects, which is so essential to- the success and certainty of practice; — still less can we do so ira those of a complicated kind. Each new ingredient added to a medi- cine increases in a higher ratio the chances of error, and obscures the evidence by which such error may be detected and removed. And the application of other science to this subject, though never to be lost sight of, is here made so uncertain by being subjected to vital actions, that it must ever be admitted with great caution, and wholly in subordination to experience. Several compound medicines of undoubted efficacy contradict chemical laws, even in the points where it might seem of greatest moment to maintain them." In forming an extemporaneous or magistral formula or prescription, the physician makes use of either the articles of the materia medica, or of preparations that are kept in the shops of the apothecary, the formulae for which are directed in the National Pharmacopoeia, or — in other words — are officinal. At times, one of these articles will answer every purpose which the subscriber has in view ; at other times, it is esteemed advisable to add some agent that may aid its operation; or, it may possess objectionable qualities which may re- quire the addition of some ingredient to obviate or correct them ; and lastly, it rarely happens, that medicines are in a form the most advisable for exhibition; and, accordingly, they require some mate- rial to give them the necessary constitution. Hence, it has been laid down, by most writers on Therapeutics, that every compound for- mula ought to consist of a basis or principal ingredient; an adjuvant or aid to the principal ingredient; a corrigent to modify any objec- tionable qualities of the base or the compound ; and a constituent or excipient to give form to the medicine — the formgebende Mittel of the Germans. The basis and the excipient are the most essential components of a magistral formula, and must almost always, consequently, be pre- sent; yet the latter need not always form part of the prescription as sent to the apothecary. For example, twenty grains of rhubarb may be prescribed as a cathartic ; without giving any directions as to the excipient or constituent. Occasionally, the constituent requires an intermedium, as where copaiba is directed in the form of emulsion: yolk of egg or mucilage in such case is the intermedium, — water the constituent. In the following prescription, all these ingredients are contained : K.—Copaib. f. 5'j. Basis'. Ol.Tereb. f. ^j. Adjuvant. Mucilag. Acaciae, f. ^iij. Intermedium. 01. iVIenth. pip. TTL x. Corrigent. Aqure, f. 5VJ. M. Constituent. yet both the adjuvant and corrigent might be omitted. 444 COMBINATION OF THERAPEUTICAL AGENTS. Frequently with the view of augmenting the action of the base or principal ingredient, the prescriber adds other preparations of the same agent, which may thus take the place both of adjuvant, corri- gent, and constituent; for example, in the following prescription for a cathartic draught: ft.—Infusi Rhei, f. 3xj- Tincture Rhei, f. 5J.—M. The rhubarb is here the 6am in both articles ; the water of the officinal infusion is the main constituent; and the dilute alcohol of the tincture may act as a corrigent; whilst the tincture itself is unquest- ionably an adjuvant. In like manner, tincture of senna is added to infusion of senna; tincture of catechu to infusion of catechu ; tinc- ture of Peruvian bark to infusion or decoction of Peruvian bark, &c. &c. In the generality of cases, however, the prescriber combines different agents, which are possessed — as he conceives — of similar powers, in order that he may induce a more potent effect than the basis alone might be capable of inducing. Combinations of this kind require great judgment and accurate observatioti; the want of which is a great cause of that confusion, which is observed in many,, extemporaneous formulae, and from which certain officinal prepara- tions are not altogether free : — take, for example, the Electuarmm opiatum polypharmacum of the Parisian ' Codex,' which is retained as the lineal descendant of the ancient Theriac, with even an additional number of ingredients : it contains acrid substances, 5 ; astringent, 5 ; bitter, 22 ; indigenous aromatics, 10 ; umbelliferous aromatics, 7 ; bal- sams and resinous substances, 8 ; fetid ingredients, 6 ; nacrotics, 1 ; earthy substances, 1; gummy or amylaceous, 4; saccharine, 3; total, 72; and one of these the flesh of the viper !—a little more than a grain of opium, wdiich may be regarded as a principal effective ingredient, being contained in a drachm of the compound. Yet, when the question arose in the London College of Physicians, as to what should be the fate of this " many-headed monster," and when it was proposed to eject it from the Pharmacopoeia, it was found that the college was divided, and that fourteen members were for the mea- sure, and thirteen against it; so that it wras discarded by a majority of one only. (See the Preface to the author's JVew Remedies, 4th edit. Philad. 1843.) Its place in the Pharmacopoeias is now taken by the CONFECTIO OPII, which as elsewhere shown, (Vol. i., p. 353,) consists of opium, a narcotic,—with cinnamon, ginger, cardamom, nutmeg,.— as aromatic excitants, and clarified honey,— as the ex- cipient. Of the combination of agents that are possessed of similar powers, we have examples in common purgative mixtures, as where sulphate of magnesia, infusion of senna, and tincture of senna are associated in the same prescription ;—in the ordinary emetic com- bination of tartrate of antimony and potassa and ipecacuanha ; — in • the officinal preparations, EXTRACTUM COLOCYNTHYDIS COMPOSITUM, COMBINATION OF THERAPEUTICAL AGENTS. 445 (Vol. i., p. 194,) which is composed of colocynth, aloes, and scam- raony, cathartic ingredients ; in the CONFECTIO SEM, (Vol. i., p. 177,) composed of senna, liquorice root, figs, pulp of prunes, pulp of tama- rinds, pulp of purging cassia, &c, as mild cathartics; and in the FILM CATHARTICS COMPOSITE, (Vol. i., p. 194,) composed of com- pound extract of colocynth, extract of jalap, mild chloride of mer- cury, and gamboge ; — all cathartics. The action of the basis or principal ingredient is often, also, aided by the addition of some agent, which may not possess the same pro- perties as the basis, and yet may make its operation more certain. The addition of tartrate of antimony and potassa, for example, to a cathartic, renders the intestinal canal more impressible to the action of the latter ; and the addition of a tonic has frequently a similar effect. In selecting his agents with the view of correcting the action of the basis or principal remedy, it is necessary for the prescriber to be well acquainted with its ordinary qualities and effects. Many cathartics, for example, cause tormina or nausea, which may be prevented by the addition of some aromatic, or of a small quantity of opium. The same corrigents are demanded when tonics, as cinchona in powder, or the ferri subcarbonas, disagree, from quantity, with the stomach. The mild chloride of mercury, or the mercurial pill, when admi- nistered with the view of causing the peculiar effects of mercurials on the system, is apt to pass off by the bowels, and thus defeat the wishes of the prescriber. He adds, therefore, a small quantity of opium to each dose to prevent this. Often, too, a disagreeable me- dicine, which might, otherwise, cause nausea and vomiting may be retained by combining it with substances that mask those ; and at the same time induce a different impression on the stomach. Tur- pentine, for example, is often rejected when merely dropped on sugar, or mixed with molasses ; but it may be retained if made into an emulsion with yolk of egg, or mucilage as the intermedium ; and peppermint water, which is an aromatic excitant, as the excipient or constituent. The same remarks apply to copaiba, which, at times, resists all the ingenuity of the physician, and is invariably rejected. The discovery of the mode of enveloping it in gelatin capsules (Vol. i., p. 489,) was therefore, valuable ; for in many cases, doubt- less, it is the disagreeable and enduring taste of the copaiba, that occasions its rejection. In an early part of this work, the author has dwelt upon the im- portance of laying down proper indications for the treatment of every case ; and has dwelt at some length upon the extensive information in every department of his profession that is required of the compe- tent therapeutist. If his indications be erroneous, and his informa- tion defective, so must be his practice. Especially liable to error is he, when the case seems to require separate and distinct indications, and he feels it, in consequence, necessary to combine substances which, individually, may seem adapted for the fulfilment of an indi- vol. n.—38 446 ART OF PRESCRIBING. cation ; and yet, when combined, may not answer for any. Cases repeatedly arise, where the indication may he first, to evacuate the bowels, and secondly, to produce a tonic effect upon the digestive organs and upon the system generally: hence, tonics and cathartics are associated with much propriety: cathartics, again, may require an association with opiates, as in cases of colic, and enteritis of the peritoneal coat; - a full dose of an opiate, acting as a sedative and relieving spasm of the muscular coat, whilst the cathartic acts upon the mucous coat, and augments the secretion from it. On this prin- ciple, calomel and opium are so often combined in the same formula In the combination of substances that act chemically upon each other, care is required, that the resulting compound may not defeat the intentions of the prescriber. Not many years ago the author read a series of cases, in which dilute sulphuric acid had been suc- cessfully prescribed with acetate of lead in haemoptysis ! yet the merest tyro in chemistry knows, that however appropriate either of these astringents might be, when taken singly, they must neces- sarily be inert when taken in combination : — the sulphuric acid would lay hold of the oxide of lead of the acetate of lead, and form an inert and insoluble compound; whilst the acetic acid would be separated, and could alone exert any dynamic action. In all the published cases, therefore, the fortunate issue must have been owing to the general treatment adopted along with these agents, or perhaps to the natural or instinctive actions unmodified by therapeutical ma- nagement. . . It is important, consequently, for the physician to be acquainted with the therapeutical agents, that are incompatible in the same prescription, before he can combine his medicines with thorough un- derstanding. He may then escape the application of the satire of the late Professor James Gregory, of Edinburgh, that " it is easier to pre- scribe than to think." The following table of ' Incompatible*}' was prepared with considerable care by Dr. James Hamilton, of Baltimore, now of the United States Navy, and was kindly placed, some time ago, at the author's disposal. It has the advantage of the incompatible substances being in alphabetical order. TABLE OF INCOMPATIBLES. 447 TABLE OF CHEMICAL INCOMPATIBLES Absinthium, Wormwood. Acacia, Gum Arabic. Acidum Arseniosum, Arsenious Acid. Acidum Citricum, Citric Acid. Acidum Hydrocyanicum, Hydrocyanic Acid. Acidum Muriaticum, Muriatic Acid. Acidum Nitricum, JV itric Acid. ' Iron, sulphate of. Lead, acetate of. Ziuc, sulphate of. Acids. Alcohol. Ammonia. Ether, sulphuric. Iron, tincture of chloride of. Lead, Acetate of. ^_ Soda, borate of. r Bark, decoction of. j Copper, sulphate of. I Lime water. } Silver, nitrate of. I Potassium, iodide of. \_ Potassa, sulpho-hydrate of. f Acetates, alkaline. I metallic. Acid, nitric. J sulphuric- Carbonates, alkaline. earthy, metallic. Potassa, tartrate of. Sulphurete, alkaline. earthy. ' u Soaps. C Acids, mineral. } Antimony, oxides of. j Chlorine. J Iron, salts of. Y Mercury, oxides of. J Oxides generally. Silver, nitrate of. (_ Sulphurets. Alkalies. Carbonates. Earths. ILead, acetate of. Oxides. Potassa, sulphate of. tartrate of. V_ Silver, nitrate of. C Alcohol. Alkalies. Carbonates. Earths. Iron, protosulphate of. ■^ Lead, acetate of. Oils, essential. Oxides. Potassa, acetate of. Sulphurets. Zinc, sulphate o£ 448 TABLE OF INCOMPATIBLES. Acidum Oxalicum, Oxalic Acid. Acidum Sulphuricum, Sulphuric AcicL Acidum TartarictiEa, Tartaric Acid. Adeps, Lard. Jiltheris Nitrici Spiritas> Spirit of Nitric Ether. Aloe, Aloes* Aloes, Decoctum Compositum, Compound Decoction of Aloes. Alume% Alum. Ammoniae Acetatis Liquor, Solution of Acetate of Ammonia. < Lime, salts of. f Alcohol. Barium, chloride of. Calcium, chloride of. Carbonates. Chlorohydrates. ■^ Nitrates. I Oils, essential. Organic substances. 1 Oxides. Sulphohydrates. l_ Vegetable astringent infusions. f Alkalies. I Carbonates, alkaline. earthy. Earths. Lead, salts of. Lime, salts of. water. Mercury, salts of. Potassa, salts of. t. Vegetable astringents: f Alcoholic preparations. ! Decoctions. ) Infusions. ^_ Tinctures. < Guaiac, tincture of. I Iron, sulphate of. r Mercury, nitrate of. < Silver, nitrate of, (_ Tin, protochloride of. C Acids, strong. Antimony and potassa, tartrate o£ ■^ Lead, acetate of. j Mercury, chloride of. ^ Zinc, sulphate of. r Alkalies. Alkaline salts. Ammonia, carbonate of. Ammonia, chlorohydrate o£ Galls. ^ Kino. Lead, acetate o£ Lime water. Magnesia, carbonate o£ Mercury, salts of. ^ Potassa, tartrate of. r Acids. Alkalies. Alum. Copper, sulphate of. Iron, sulphate of. ■^ Lime water. I Lead, acetate of. Magnesia, sulphate of. j Mercury, bichloride o£ I Silver, nitrate of. l^ Zinc, sulphate o£ TABLE OF INCOMPATIBLES. 449 Ammonias Liquor, Solution of Ammonia, Ammonia? Carbonas, Carbonate of Ammonia. Ammonia? Murias. Muriate of Ammonia. Ammoniae Spiritus Aromaticus, Aromatic Spirit of Ammonia. Amygdala? Oleum, Oil of Almonds. Angustura, Angustura Bark. 38' C Acids. < Alum. ( Salts, metallic. f Acids. Alkalies, fixed. Alum. Carbonates, alkaline. Iron, sulphate of. Lead, acetate of. Lime. chloride of. Magnesia. sulphate of. Mercury, acetate of. bichloride of. protochloride of. Potassa, bitartrate of Salts, acidulous. _ Zinc, sulphate of. " Acid, sulphuric. nitric. Alkalies, fixed. Carbonates, alkaline. Iron, sulphate of. Lead, acetate of. J Lime. * Magnesia. sulphate of. Potassa. carbonate of. Salts, metallic. Silver, nitrate of. L Zinc, sulphate of. C Acids. Lime water. Salts, earthy. metallic, ,_ with excess of acid. " Acids. Mercury, bichloride of. Oxymel. Poppies, Syrup of. Potassa, bisulphate of. bitartrate of. tartrate of. I Resins. Squill, syrup of. V. Water, hard. Acids, mineral. Antimony and potassa, tartrate of. Cinchona, infusion of. Copper, sulphate of. Galls, infusion of. Iron, sulphate of. Lead, acetate of. triacetate of. Mercury, bichloride of. Potassa. L. Silver, nitrate of. 450 TABLE OF INCOMPATIBLES. Antimonii et Potassae Tartras, Tartrate of Antimony and Potassa, Antimonii Sulphuretum Auratura. Golden Sulphuret of Antimony. < r Acids, Mineral. " Alkalies. Carbonates, alkaline. Decoctions, bitter. Earths. Sulphohydrates. I Infusions, bitter. } Metals. ^ Soaps. C Acids. I Salts, acidulous. An them is, Chamomile. " Cinchona, infusion of. Iron, preparations of. Isinglass, solution of. Lead, acetate of. triacetate of. Mercury, bichloride of. Silver, nitrate of. Argenti Nitras. Nitrate of Silver^ f Acid, arsenious. chlorohydric and salts. sulphuric and salts. tartaric and salts. Alkalies, fixed. Earths, alkaline. Sulphohydrates. Soaps. Vegetable astringent infusions. l_ Water, common. Armoracia, Horseradish. f Carbonates, alkaline. j Cinchona, infusion of. ^ Galls, infusion of. I Mercury bichloride of. l_ Silver, nitrate of. Arnica, Leopard's Bane, r Acids, mineral. J Iron, sulphate of. | Lead, acetate of. l_ Zinc, sulphate of. Aurantii Cortex, Orange-peel. Auri Chloridum, Chloride of Gold. Cinchona, infusion of. Iron, sulphate of. Lime water. Alkalies. Vegetable juices. Barii Chloridum, Chloride of Barium, Bistorta. Bistort. Calamus, Sweet Flag. {Carbonates, Nitrates. Phosphates, Sulphates. Gelatin. Iron, sulphate of. < Lead, acetate of. TABLE OF INCOMPATIBLES. 451 Calcis Liquor, Lime Water. Calx Chlorinata, Chlorinated Lime. Capsicum, Cayenne Pepper. Cardamomum, Cardamom. Caryophyllus, Cloves. Cascarilla, Cascarilla. Catechu, Catechu. Centaurea Benedicta, Blessed Thistle, Cinchona, Peruvian Bark. " Acids. Borates. Citrates. Infusions, astringent. Salts, alkaline. I metallic. Sulphur. Tartrates. l„ Tinctures. C Acid, sulphuric. Alkalies, fixed. \ Ammonia, carbonate of. Carbonates, alkaline. l_ Sulphates. "~ Alum. Ammonia. Carbonates, alkaline. Copper, sulphate of. Galls, infusion of. J Iron, sesquisulphate of. » Lead, acetate of. Mercury, bichloride of. nitrate of. Potassa, carbonate of. Silver, nitrate of. c Zinc, sulphate of. C Acids. < Iron, sulphate of. (_ Mercury, chlorides of. f~ Cinchona. J Antimony and potassa, tartrate of. Iron, sulphate of. Lead, acetate of. I Lime water. Silver, nitrate of. l_ Zinc, sulphate of. i Same as the preceding. C Acid chlorohydric. sulphohydric. Albumen. Alkalies, Baryta, solutions of. Gelatin. Lime water, and salts of lime. Salts, alkaline. l_ Salts, metallic. < Lead, acetate of. { Silver, nitrate of. r Antimony and potassa, nitrate of. Carbonates, alkaline. Catechu, ") Chamomile, C Infusion Columbo, j Iron, salts of. Lime water. Mercury, bichloride of. Rhubarb, infusion of. Silver, nitrate of. V. Zinc, sulphate of. < 452 TABLE OF INCOMPATIBLES. Coccus, Cochineal, Colchicum, Colchicum, Colocynthis, Colocynth. Conium, Hemlock, Cupri Sulphas, Sulphate of Copper. Cuprum Ammoniatum. Ammoniated Copper: Digitalis, Foxglove. Diosma, Buchu, Ferri Chloridi Tinctura, Tincture of Chloride of Iron. Ferri et Potassa? Tartras, Tartrate of Iron and Potassa. Ferri Sulphas, Sulphate of Iron, Iron, sulphate of. Lead, acetate of. Zinc, sulphate of. Acids. " Alkalies, fixed. Iron, sulphate of. Lead, acetate of. triacetate of. Lime water. Mercury, bichloride of. c Silver, nitrate of. > Vegetable acids. (" Alkalies, Ammonia, acetate of. Calcium, chloride of. Carbonates, alkaline. Lead, acetate of. triacetate of. ^ Lime water. Mercury, bichloride of. Potassa, tartrate of. Silver, nitrate of. Soda, biborate of. Vegetable astringent infusions. l_ tinctures. C Acids, < Alkalies, fixed. C Lime water. T Cinchona, infusion of. < Iron, sulphate of. (_ Lead, acetate of. C Galls, infusion of. £ Iron, sulphate of. C Alkalies. ! Carbonates, alkaline. j Mucilage. l_ Vegetable astringent infusions. C Acids. J Lime water. "S Potassa, sulpho-hydrate of. (_ Vegetable astringent infusions. Alkalies. Ammonia, acetate of. chlorohydrate of. Carbonates, alkaline. Earths. Lead, acetate of. triacetate of. Potassa, nitrate of. and soda, tartrate of. Salts, with base forming insoluble sul- phates. Silver, nitrate of. Soap. Soda, biborate of. ^ Vegetable astringent infusions. TABLE OF INCOMPATIBLES. 453 Ferrum Ammoniatum, Ammoniated Iron. Galla, Galls. Guaiaci Resinar Guaiac. Gentiana, Gentian. Haematoxylon,, Logwood. Humulus, Hops. Hydrargyri Chloridum, Corrosivum, Corrosive Chloride of Mercury. Alkalies. Carbonates, alkaline. Lime water. Vegetable astringents. Acid chlorohydric. sulphuric. Antimony and potassa, tartrate of. Copper, sulphate of. Gelatin. Iron, salts of. Lead, acetate of. Lime water. Mercury, bichloride of. nitrate of. Potassa, carbonate of. Salts, generally. Silver, nitrate of. Soda, carbonate of. Zinc, sulphate of. Acids, mineral. Iron, sulphate of. Lead, acetate of. " Acid, acetic. chlorohydric nitric. sulphuric. Antimony and potassa, tartrate of. Copper sulphate of. Iron, sulphate of. . Lead, acetate of. Acids, mineral. Iron, "\ L/ad, v Salts of< Mercury. Silver. J Almond mixture. Alkalies fixed. Ammonia. Antimony and Potasa, tartrate of. Bismuth. Carbonates, alkaline. Copper. Iron. Lead. acetate of Lime water. Mercury. Oils, volatile. Potassium, sulphuret of. Silver, nitrate of. Soap. Sulphur. Zinc. Chamomile, Cinchona, Columbo, Horseradish, Oakbark, Senna, Simaruba, L Tea. >■ Infusions of. 454 TABLE OF INCOMPATIBLES. Hydrargyri Chloridum Mite. Mild Chloride of Mercury. Hyoscyamus, Henbane. Ipecacuanha, Ipecacuanha, Kermes Mineralis, Kermes Mineral. Kino, Kino. Krameria, Rhatany. Lavandula, Lavender, Limonis Cortex, Lemon Peel. Lupulina, Lupulin. Magnesias Carbonas. Carbonate of Magnesia: Magnesia? Sulphas, Sulphate of Magnesia. Marrubium, Horehound, " Acid, nitric. Alkalies. Antimony, goldsn sulphuret of Carbonates, alkaline. Chlorine. J Copper. Iron. Lead. Lime water. Potassium, sulphuret of. ^ Soaps. f Acids, vegetable. (Iron, sulphate of. Lead, acetate of. Silver, nitrate of. C Acids, vegetable, £ Galls, infusion of. > Acids. See Galla. Acids, mineral. Gelatin. Iron, salts of. Iron, sulphate of. Acid, nitric. oxalic. sulphuric. tartaric. Lime water. C Iron. J Mercury, | Platinum, I Tin, Salts of. f Acids. Alkalies. Alum. Copper, sulphate of. Iron, sulphate of. Lead, acetate of. «^ Mercury, acetate of. bichloride of. Potassa, bitartrate of. Salts, acidulous. neutral. Silver, nitrate of. L Zinc, sulphate of. f Alkalies, fixed. Ammonia, muriate of. Barium, chloride of. Calcium, chloride of. Carbonates, alkaline. Lead, acetates of. L Silver, nitrate of. > Iron, sulphate of. TABLE OF INCOMPATIBLES. 4oo Melissa, Balm. Morphia, Morphia. Morphia, Salts of. \ Moschus, Musk. Mucilago. Mucilage. Opium, (solid,) Opium. Opium, (Infusion of, &c.) Pimenta, Pimento. Piper, Black Pepper. Plumbi Acetas, Acetate of Lead. Iron, sulphate of. Lead, acetate of. Silver, nitrate of. Oxides, metallic. r Alkalies. Carbonates, alkaline. Decoctions of vegetable astringents. *{ Infusions of vegetable astringents. Lime. Magnesia. ^ Silver, nitrate of. f Cinchona, infusion of. J Iron, sulphate of. "^ Mercury, bichloride of. l_ Silver, nitrate of. C Alcohol. | Ammonia. J Acids, strong. ] Ether, sulphuric, compound spirit of. Iron, chloride of, tincture of. \_ Salts metallic. f Alkalies. | Cinchona. <> Galls. Lead, acetate of. i_ Mercury, bichloride of. C Ammonia. Carbonates, alkaline. Copper, sulphate of. Galls, infusion of. J Iron, sulphate of. Lead, acetate of. Mercury, bichloride of. Silver, nitrate of. l_ Zinc, sulphate of. r Cinchona, infusion of. ? Iron, nitrate of. (_ sulphate of. I Galls, infusion of. Acids. Alkalies. Alum. Ammonia, solution of, acetate of. Antimony and potassa, tartrate of. Carbonates, alkaline. Earths, alkaline. Chlorohydrates. Iron, ammoniated. Iron and potassa, tartrate of. Soaps. Soda, biborate of. Sulphates. Sulphurets. Water, common. 456 TABLE OF INCOMPATIBLES. Plumbi Subacetatis Liquor, Solution of Subacetate of Lead. Potassa? Acetas, Acetate of Potassa. Potassa? Arsenitis Liquor, Solution of Arsenite of Potassa. Potassa? Carbonas, Carbonate of Potassa. Potassa? Bicarbonas, Bicarbonate of Potassa. Potassa? Nitrag. Nitrate of Potassat Potassa? Sulphas, Sulphate of Potassat f Alkalies. j Carbonates, alkaline. J Mucilage. ] Soap liniment. | Sulphates, alkaline. t Sulphurets of alkaline metals. f Fruits, acid. | Acids, mineral. ! Tamarinds. ] Salts, acid. [ Salts, alkaline. l^ Salts, metallic. C Cinchona, infusion of. | Copper, salts of. -^ Lime water. | Potassa, sulphohydrate of l_ Silver, nitrate of. > See Potassa? bicarbonas. Acids. Alum. Ammonia, acetate of. carbonate of. muriate of. Antimony and potassa, tartrate of. Copper, acetate of. sulphate of. Iron, chloride of. and potassa, tartrate of. i sulphate of. I Lead, acetate of. Lime water. j Magnesia, sulphate of. I Mercury, bichloride of. protochloride of. I Silver, nitrate of. j Salts, acidulous. I Soda, biborate of. L Zinc, sulphate of. f Acid, sulphuric. I Alum. Copper, sulphate of. ^ Iron, sulphate of. Magnesia, sulphate of. Soda, sulphate of. l^ Zinc, sulphate of. f Acid, chlorohydric. nitric. J Lead, acetate of. 1 Lime and compounds. I Mercury, bichloride of. L. Silver, nitrate of. TABLE OF INCOMPATIBLES. Potassa? Tartras. Tartrate of Potassa. Potassa Bitartras, Bitartrate of Potassa. Potassii Sulphuretum, Sulphuret of Potassium. Quassia, Quassia. Quercus, Oak Bark. Quinia? Sulphas, Sulphate of Quinia. Rheum, Rhubarb. Rosa Gallica, Red Roses. Salix, Willow. Saliva, Sage. vol. ii.—39 r Acids. Barium, chloride of. Lead, acetates of. Lime. J Magnesia. Salts, acidulous. Silver, nitrate of. Tamarinds. 1^ Vegetables, acid. C Acids, mineral. < Alkalies. £ Earths, alkaline. < Salts, metallic. { Water. C Lead, acetate of. £ Silver, nitrate of. f Alkalies. Carbonates, alkalies. Cinchona, Infusion of. Iron, salts of. ^ Isinglass, solution of. Lead, acetates of. Lime water. Mercury, bichloride of. _ Zinc, sulphate of. C Alkalies. | Earths, alkaline. J Infusion of orange peel, compound. ^j Infusion of roses. j Solutions, astringent. ^_ Tincture of cinchona. ["Acids, strong. Antimony and potassa, tartrate of. Angustura, ""| Catechu, ' T _ . . Cinchona, f Infusions of. Galls. J Iron, sulphate of. Lead, acetate of. Mercury, bichloride of. Silver, nitrate of. ^ Zinc, sulphate of. r Gelatin. J Iron, sulphate of. "S Lime water. l^ Zinc, sulphate of. f Ammonia, carbonate of. j Gelatin. j Iron, sulphate of. j Lime water. j Potassa, carbonate of. i_ Zinc, sulphate of. > Iron, salts of. 458 TABLE OF INCOMPATIBLES. Sapo, Soap Sarsaparilla, Sarsaparilla. Scammonium, Scammony. Scilla, Squill. Senna, Senna. Serpentaria, Virginia Snake root. Simaruba, Simaruba. Soda? Boras, Borate of Soda. Soda? Carbonas, Carbonate of Soda. < f Acids. Alum. Antimony and Potassa, tartrate of. Calcium, chloride of. Copper, ammoniated. Copper, sulphate of. Iron, ammoniated. and potassa, tartrate of. sulphate of. Lead, acetate of. Magnesia, sulphate of. Mercury, acetate of. bichloride of. protochloride of. Salts, acidulous. Silver, nitrate of. Vegetable astringent infusions. l_ Zinc, sulphate of. C Lead, acetate of. < Lime water. C Mercury, nitrate of. £ Acids. < Alkalies. ^ Acids, strong. Antimony and potassa, tartrate of. Cinchona, infusion of. ■i Lead, acetate of. Lime water. Mercury, bichloride of. V_ Silver, nitrate of. > Lead, acetate of. f Carbonates, alkaline. I Catechu. Cinchona. , Galls. * Lead, acetate of. Lime water. Mercury, bichloride of. ^ Silver, nitrate of. f Acids. j Ammonia, chlorohydrate of. J sulphate of. ", Chlorohydrates, earthy. j Potassa. L Sulphates, earthy. £ See Potassa? Carbonas. TABLE OF INCOMPATIBLES. 459 Sodse et Potassae Tartras, Tartrate of Soda and Potassa. Soda? Phosphas, Phosphate of soda. Sods? Sulphas, Sulphate of Soda. Stramonium, Stramonium, Tamarindus, Tamarinds. Taraxacum, Dandelion. Tormentilla, Tormentil. Valeriana, Valerian. Zinci Sulphas, Sulphate of Zinc. < Salts of. r Acids. Ammonia, muriate of. Baryta, salts of. Lead, acetates of. Lime, salts of. Magnesia, sulphate of. Potassa, sulphate of. Salts, acidulous. Soda, sulphate of. ^ Tamarinds. f" Acid, chlorohydric. | Acid, nitric. J Acid, sulphuric. \ Barium, chloride of. LLime. Magnesia. > See Magnesia? Sulphas. f Acids, mineral. j Iron, ") tLead, Mercury, Silver. J f Antimony and potassa, tartrate of. I Carbonates, alkaline. Lime water. l_ Potassa, salts of. f~ Galls, infusion of. j Iron, sulphate of. ■^ Lead, acetate of. j Mercury, bichloride of. \_ Silver, nitrate of. C Alkalies. J Earths, alkaline. Y Iron, salts of. (_ Isinglass, solution of. £ Iron, salts of. r Alkalies. j Earths. <( Milk. | Sulphohydrates. V. Vegetable astringent infusions. i 460 ART OF PRESCRIBING. The prescriber — who is well acquainted with chemistry — may, however, throw together in the same prescription substances that are really incompatible or that act upon each other; but then he does this understanding^, and with the view of obtaining a new compound. Thus, the Pharmacopoeia of the United States contains formula? for various preparations produced by double decomposition. The MISTURA FERRI COMPOSITA has been considered an unchemical compound, because carbonate of potassa and sulphate of iron are in- gredients ; and it would be objectionable, were the prescriber to be- lieve, that each of these agents exerts its own powers when the com- pound is taken. Such is not, however, his belief. He is desirous of administering an oxide of iron, and he knows that this must be the result of the mutual decomposition of those salts. Hence, the formula is chemical and philosophical. The same remarks apply to the PILM FERRI COMPOSITE of the pharmacopoeias; and to the black wash, (Vol. ii. p. 301,) and the yellow wash, (Vol. ii. p. 302 ;) the former made by the admixture of lime ^ water and mild chloride of mercury, and the latter of lime water and the corrosive chloride of the same metal. In all these cases, the physician is desirous of producing, by chemical decompo- sition, a resulting agent, which he knows by experience, to be ca- pable of exerting definite powers. The above are the chief points for the guidance of the young prac- titioner in the " art of prescribing." In works on therapeutics, the whole subject is so clogged with difficulties and cautions, that he is apt to regard it as a hopeless task; and if he were to take those works as his regulators, it would not be easy for him to proceed. The matter is really, however, more simple. At the outset of his career, when he has examined fully into the history and nature of any case that presents itself to his notice, — laid down his indica- tions ; and taken into consideration all the circumstances, that modify the indications, which have been detailed at the commencement of this work, he decides upon the agent or agents which he considers best adapted for fulfilling those indications, and upon the dose in which he thinks it ought to be exhibited. He then reflects, whether it require the addition of any other agent that may add to its powers, and whether there be any unpleasant action apt to be indued by it, which may demand an addition to the prescription to obviate it. In making these additions he must be careful, that there is no resulting incompatibility — therapeutical or chemical—unless he is desirous of producing a third substance from the action of the other ingre- dients upon each other, which may possess different properties than either article taken singly. Throughout the preceding pages, it has been seen that the form in which a therapeutical agent is prescribed is not always a matter of indifference. In many cases, powders disagree ; — at times, in con- sequence of the unpleasant impression made by them on the nerves COMBINATION OF THERAPEUTICAL AGENTS. 461 of taste ; at others, owing to their exciting nausea or vomiting, or both, by the impression they make on the stomach. Hence, in cases of atony of that organ, owing either to convalescence from acute diseases, or to chronic diseases, — as chronic dyspepsia, — the phy- sician prefers to administer tonics in the form of infusion, by which he gets rid of the insoluble woody matter. Where, however, he is desirous of making a powerful impression on the stomach, and through it on the organism — as in a case of intermittent fever, to break in upon the chain of associated actions, that give occasion to the recurrence of the paroxysms — he prefers to administer cinchona in powder, and often finds that it succeeds, when other forms of preparation, and the sulphate of quinia had failed. The pilular form is generally chosen, where the article is of nau- seous taste, and — in the case of cathartics — where it is not desired that the operation should be speedy. There are substances too, which, like the mild chloride of mercury, are so heavy that they could not be taken in any ordinary thin vehicle ; but even these may be administered in thick fluids, as molasses or syrup. Where it is desirable, that the medicine should produce its effects soon ; and ci fortiori, if it be desirable to impress powerfully the gustatory nerves as well, the form of mixture is always chosen. Many cathartics are accordingly given in the form of mixture; nauseous antispasmodics are prescribed in the same form ; and — as has been remarked under the appropriate head — sulphate of quinia acts more satisfactorily in solution than in substance. Throughout this wTork, the doses of medicines have been given as they apply to the adult male ; but various circumstances modify these materially, and in modes that have been referred to under the differ- ent classes, or under individual articles. Those circumstances, too, which have been described as modifying the therapeutical indications, — for example, age, sex, original conformation, habit, climate, mental affections, way of life, causes, seat, period, &c. of the disease, — may equally modify the doses of medicines. (See Vol. i. p. 37.) The greatest difficulty with the young practitioner is to appor- tion the dose to the age. As a general rule, the dose diminishes in an inverse ratio with the age ; children requiring a much smaller quantity of most medicines. In old age, again, the doses may usually be smaller; yet, owing to the blunted sensibility, certain agents re^ quire to be administered in larger quantities. The following tables of doses by Gaubius and Dr. Thomas Young may be regarded as approximations, which may serve to a certain extent as guides. The estimate of Gaubius wrere made from the results of observation. Those of Dr. Young are based upon a for-. mula, the results of which correspond closely with those of Gaubius. " The doses of most medicines for children under twelve years of age," he observes, " must be diminished in the proportion of the 39* 462 ART OF PRESCRIBING. Gaubius. Young. 5j or gr. 60. £j or gr. 60. 1-15 to 1-12 gr. 4 to 5. 1-13 gr-4§ 1-8 gr. 7£ 1-7 gr- 8$ 1-6 gr. 10. 1-5 gr. 12. 1-4 gr. 15. 1-4 gr. 15. 1-3 gr. 20. gr. 22. 1-2 gr. 30. gr. 32. 2-3 gr. 40. gr. 37i age to the age increased by 12; thus, for example, at two years _J___I Dose for an adult, from 20 to 60 years of age, For a child under one year, " two years old, " three years, " four years, " seven years, " fourteen years, For a man twenty years old, Yet numerous exceptions occur to any rule of this kind. For example, children are not very susceptible to the action of mercury under two years of age. It is, indeed, exceedingly difficult to sali- vate them at this age, even when large doses of calomel are given ; yet, at the age of three or four, they are very readily influenced by mercurials. The ordinary dose of calomel, too, for a child of the age last mentioned, is generally enough to operate on the adult. In infancy, on the other hand, the susceptibility to the action of narco- tics is very great, so that the dose has to be reduced below the ordi- nary average as applicable to other remedies ; — but these are points that have been referred to elsewhere. In the different formulae, and in apportioning the doses of medi- cines, the weights and measures used, are those of the Pharmaco- poeia of the United States of America ; but it is not uncommon to direct modes of apportionment that are liable to vary in consequence of the want of uniformity in the size of the instruments, that are em- ployed for the purpose. Still, they are presumed to average as fol- lows : —a cupful (Cyathus,) contains f. givss ; a winfglass (Cya- thus vinarius), from f. ^iss to f. ^ij; a table-spoonful (Cochleare amplum,) f. ^ss ; a dessert-spoonful (Cochleare medium;) about f. 3ij ; a teaspoonful (Cochleare parvum,) about f. 5J. None of these measures can, however, be used, where great exactitude is re- quired. Many teacups, for example, contain six fluidounces ; and the breakfast cups twelve. Wine-glasses, too, are of various sizes, as well as spoons. When great nicety is not required, the physician often directs important articles to be given by drops; but this is an unsatisfactory method compared with that of dispensing them by the minim measure. A fluidrachm is divided into 60 portons, and each of these is termed a minim. The minim must, therefore, always be of the same size, whatever may be the character of the fluid; but this cannot be the case with the drop, which differs materially ac- cording to the lip of the vessel, the nature of the fluid, &c. The great difference between the size of the minim and of the drop of various fluid preparations is exhibited in the following table : the results were obtained by Mr. Durand, a skilful Pharmacien of Philadelphia, under circumstances, as regards the different articles, as nearly identical as possible. COMBINATION OF THERAPEUTICAL AGENTS. 463 One fluidrachm of Acid, acetic (crystallisable,) ----hydrocyanic, (medicinal,) ----muriatic, ----nitric, ----------diluted, (1 to 7,) -----sulphuric, ------------aromatic, - ------------diluted, (1 to 7,) - Alcohol, (rectified spirit,) ------- diluted (proof spirit,) Arsenite of potassa, solution of, Ether, sulphuric, Oils of aniseed, cinnamon, cloves, peppermint, sweet almonds and olives, Solution of ammonia, (strong,) -------------------(weak,) Tinctures of assafetida, foxglove, guaiac and opium, ------- of muriate of iron, Vinegar, distilled, - ------- of colchicum, - ------- of opium, (black drop,) ------- of squill, - Water, distilled, ... Wine, (Teneriffe,) ... ---- antimonial, ... ---- of colchicum, ---- of opium, - Drops. contains 120 a 45 a 54 a 84 a 51 a 90 a 120 a 51 a 138 a 120 a 57 a 150 it 120 tt 54 it 45 a 120 a 132 it 78 a 78 a 73 t. 78 a 45 a 78 n 72 a 75 a 78 INDEX. ABLUTION, ii. 207 Absinthium, ii. 43 Acacia, i, 235, ii. "388 Acetone, i. 234 Acetum, i. 250 colchici,i. 286, ii. 192 destillatum, i. 251 opii, i. 354 scillae, i. 123, 272 Acid, acetic, i. 251, ii.259, 271 diluted, i. 251 gallic, ii. 216 arsenious, ii. 83, 278, 326 benzoic, i. 230 boracic, ii. 216 hydrocyanic, ii. 180 hydrosulphuric, ii. 199 muriatic, i. 294, ii. 278, 377 diluted ii. 384 nitric i. 294, ii. 71, 259, 277, 377 dilute, ii. 71 nitro-muriatic, ii. 331 pyroligneous. ii. 133, 381 succinic, i. 483 sulphuric, i. 294, ii. 70, 139, 260, 278 aromatic, ii. 70, 139 diluted, ii. 70, 139 sulphurous, ii. 378 tannic, ii. 115 Acida mineralia, i. 294, ii. 267, 271, 277 330 Acids, mineral, i. 294,ii. 267,271, 277,330 vegetable, i. 295 Acidum aceticum,i. 251, ii. 259, 271 dilutum, i. 251 empyreumaticum, ii. 133 arseniosum, ii. 83, 278, 326 benzoicum, i. 230 gallicum, ii. 116 hydrocyanicum, ii. 180 hydrosulphuricum, ii. 199 muriaticum, ii. 377, 380 dilutum, ii. 380 nitricum, i. 294, ii. 71 dilutum, ii. 259, 277, 377 nitro-muriaticum, ii. 331 sulphuricum, i. 294, ii. 70,139 260, 278 aromaticum, ii. 70, 139 Acidum sulphuricum dilutum, 70, 139 sulphurosum, ii. 378 tannicum, ii. 115 Aconite, i. 371 Aconitia, i. 371, 373 Aconitum, i. 371, 373 Acqua Binelli, ii. HO Acupuncture, i. 502, ii. 260, 355 Adeps, ii. 401 .Ether sulphuricus, i. 402,489 .Etherea, i. 402 Affusions, ii. 207 Alcohol, i. 484 dilutum, i. 484 Alder, black, ii. 49 Aletris, ii. 39 Alkalia.ii. 295,330 Alkalies, ii. 295, 330 Allium, i. 232, ii. 253 cepa, ii. 253 porrum, ii. 253 Allopathy, i. 84 Almonds, i, 237, ii. 398 Aloe, i. 169, 409 Aloes, i. 169,409 Althaea, i. 236, ii. 389 Alum, ii. 134 dried, ii. 271 root, ii. 130 Alumen, ii. 134 exsiccatum,ii. 271 Alumina, sulphate of, ii. 378 Aluminas sulphas, ii. 378 Amber, i. 404, 482 Ammonia, i. 297, 492 arseniate of, ii. 326 carbonate of, i. 297, 313,494 ii. 366 citrate of, i. 314, muriate of, i. 495 preparations of, i. 402, ii. 253, 263 Ammoniac, i. 224 Ammoniacum, i. 224 Ammoniated lotions, ii. 253 Ammoniae arsenias, ii. 326 carbonas, i. 297, 313, 494, ii. 366 citras, i. 314 murias, i. 495 praparata, i. 402, ii. 253, 263 Ammonium, iodide of, ii. 319 466 INDEX. Amygdala, i. 237, ii. 398 Amylum, ii. 398 Angelica, ii. 44 tree bark, i. 323 Angustura, ii. 41 Anise, i. 441. Anisum, i. 441 Antacids, ii. 358 modus operandi of, ii. 359 special, ii. 363 Antalkalies, ii. 367 special, ii. 363 Anthelmintics, i. 204 cathartic, i. 206 mechanical, i. 206, 216 preventive, i. 207 special, i. 208 true, i. 205, 208 Anthemis, i. 125, ii. 40 Anthrakokali, ii. 336 sulphuretted, ii. 337 Antidotes, ii. 408 table of, ii. 441 Antilithics, i. 287 acid, i. 294 alkaline, i. 295 special, i. 294 therapeutics of, i. 290 tonic, i. 297 Antimonials, i. 308 Antimonii et potassa? tartras, i. 115, 309 ii. 265 murias, ii. 277 sulphuretum pracipitatum, i. 310 Antimony, muriate of, ii. 277 and potassa, tartrate of, i. 115,309 ii. 265 sulphuret of, precipitated, i. 310 Antiparasitics, ii. 408, 421 special, ii. 421 Antipathy, i. 79 Antiperiodic tonics, ii. 71 Antissplics, ii. 373, 378 Antispasmodics, i. 338 excitant, i. 396 modus operandi of, i. 391 special, i. 396 therapeutics of, i. 393 Apocynum androsaemifolium, i. 131 cannabinum, i. 203 Aqua acidi carbonici, ii. 435 Binelli, ii. 110 camphora, i. 461 chlorini,ii. 252, 332, 376, 379 cinnamomi, i. 441 fceniculi, i. 446 menthae viridis, i. 447 menthae piperita, i. 447 picis liquids, ii. 133 Araiia racemosa, ii. 348 nudicauiis, ii. 347 Araiia spinosa, i. 332 Argeuti chloridum ii. 68 nitras, ii. 66, 140, 263, 270, 276 oxidum, ii. 67 praparata, ii. 329 Argil, pure, ii. 146 Argilla pura, ii. 146 Aristolochics, i. 417 Armoracia, i. 263, 472 Arnica, i. 387 Arrowroot, ii. 391 Brazilian, ii. 393 East Indian, ii. 393 English, ii. 394 Florida, ii. 393 Portland, ii. 393 Tahiti, ii. 393 West Indian, ii. 391 Arsenic, iodide of, ii. 278, 318, 326 preparations of, ii. 325 Arsenici praeparata, ii. 325 Artemisia vulgaris, ii. 44 Arum, i. 323 Asarabacca, i. 259 Asarum, ii. 45 Europaeum, i. 259 Asclepias, flesh coloured, i. 131 incarnata, i. 131 Syriaca, i. 381 tuberosa, i. 321 Ash, prickly, j, 322 Assafetida, i. 232, 396, 412 Assafetida, i. 232, 396, 412 Astringents, ii. 91,382 in blennorrhoea, ii. 108 in diabetes, ii. 109 in ephidrosis, ii. 109 in fever, ii. 97 in hemorrhage, ii. 99 in inflammation, ii. 98 of the stomach, &c ii. 106 in leucorrhoea, ii. 109 mineral, ii. 134 modus operandi of, ii. 93 in phthisis, ii. 110 in relaxation of parts, ii. 110 special, ii. 115 therapeutics of, ii. 97 in topical diseases, ii. 110 vegetable, ii. 115 Atropia, i. 361, 366 Aurantii cortex, i. 457 Auri chloridum, ii. 328 cyanuretum, ii. 329 iodidum, ii. 329 oxidum, ii. 329 preeparata, ii. 327 et sodii chloridum, ii. 329 Aurum metallicum, ii. 327 A venae farina, ii. 397, 404 INDEX. 467 Avens, water, ii. 48, 130 Azedarach, i. 214 Azote, protoxide of, i. 504 Ballota Janata, i. 273 Balm, i. 321 tea, i. 322 Balsam of Peru, i. 226 of Tolu, i. 227 Barii chloridum, ii. 325 Barium, iodide of, ii. 318 chloride of, ii. 325 Bark, pale, ii. 74 Peruvian, ii. 72 red, ii. 74 Winter's, i. 463 yellow, ii. 73 Barley, ii. 390 Bath, air, hot, i. 497 air, warm, i. 325 airpump, ii. 258 airpump vapour, ii. 258 arm, i. 329 . foot, i. 328 hand, i. 329 hip, i. 32.3 shower, ii. 207 vapour hot, i. 497 vapour, warm, i. 325 warm, partial, i. 326 water, hot, i. 498 water, warm, i. 326 Bathing, cold, ii. 26 Bearberry, i. 300 Bear's whortleberry, i. 300 Bebeerina, ii. 91 Bebeerine, ii. 91 Belladonna, i. 361 Benne, i. 245, ii. 389, 403 Benzoin, i. 229, 249 Benzoinum, i. 229, 249 Bismuth, subnitrate of, ii. 68 Bismuthi, subnitras, ii. 68 Bittersweet, ii. 349 Blackberry root, ii. 131 Bleeding, revulsive, ii. 245 Blood-letting, ii. 149 local, ii. 171 Bloodroot, i. 128 Borax, ii. 216 Bromide of iron, ii. 321 Bromidum potassii, ii. 321 Bromine, ii. 320 Brominum, ii. 320 Bran, ii. 403 Broom, i. 271 Brucia, i 386 Buchu, i. 297 Bugleweed, i. 38l Butterfly Weed, i. 321 Butter nut, i. ] 78 Cabbage, skunk, i. 401 Cainca root, i. 272 Caincee radix, i. 272 Cajeput oil, i. 481, ii. 255 Calamus, i. 263, 463 Calcii chloridum, ii. 324 Calcium, chloride of, ii. 324 Caloric, i. 324, 497, ii. 257, 264, 272, 378 Calx chlorinata, ii. 333, 376, 379 Camphor, i. 316, 458 Camphora, i. 316,458 Canella, i. 462 Cannabis indica, i. 377 Cantharis, i. 276, ii. 254, 260, 268, 338 atrata, i. 279 cinerea, &c. i. 279 marginata, i. 279 vittata, i. 279, ii. 263 Carthamus, i. 324 Capsicum, i. 466, ii. 253 Caraway, i. 442 Carbo animalis, ii. 323 ligni, ii. 49, 381 purificatus, ii. 323 Carbon, sesqui-iodide of, ii. 318 Carbonic acid gas, ii. 202 Carburetted hydrogen, ii. 201 Cardamom, i. 443 Cardamomum, i. 443 Carminatives, i. 426 Carota, i. 281 Carrot seed, i. 281 Carum, i. 442 Caryophyllus, i. 444 Cascarilla, ii. 40 Cassia fistula, i. 160 Marilandica, i. 177 purging, i. 160 Cassiae fistulas pulpa, i. 160 Castor, i. 378, 412 Castor oil, i. 163 Castoreum, i. 398. 412 Cataplasm, emollient, ii. 403 yeast, ii. 202 Cataplasma, fermentis, ii. 202 Cataria, i. 483 Catechu, ii. 117 Cathartics, i. 132. in abdominal inflammation, i. 149 brisk, i. 163 in colic, i. 150 in constipation, i. 150 defined, i. 132 drastic, i. 191 in dropsies, i. 154 in dyspepsia, i. 150 in eruptive fevers, i. 148 in fever, i. 146 in head affections, i. 152 in hemorrhage, i. 151 in hemorrhoids, i, 152 468 INDEX. Cathartics, in hepatic diseases, i. 120 in intermittents, i. 148 mild, i. 155 modus operandi of, i. 141 in the neuroses, i. 153 in pregnancy, i. 152 saline, i. 184 special, i. 155 therapeutics of, i. 146 in thoracic inflammation, i. 149 in worms, i. 154 Catnep, i. 483 Cauterants, ii. 222 actual, ii. 272 potential, ii. 275 Cayenne pepper, ii. 466 Cedar, red, i. 412 Centaury, American, ii. 38 Cera alba, ii. 399 flava, ii, 399 Cerate of arsenic, ii. 278 carbonate of lead, ii. 352 subacetate of lead, ii. 353 resin, i. 477 compound, i. 477 savine, ii. 269 simple, ii. 401 soap, ii. 354 of Spanish flies, ii. 261 spermacetti, ii. 402 of carbonate of zinc, ii. 352 Ceratum arsenici, ii. 278 cantharidis, ii. 261 cetacei, ii. 402 plumbi carbonatis, ii. 352 subacetatis, ii. 353 resinae, i. 477, ii. 351 compositum, i. 477, ii. 351 sabinae, ii. 269, 351 saponis, ii. 354 simplex, ii. 401 zinci carbonatis, ii. 352 Cerevisiae fermentum, ii. 382 Cetaceum, i. 240, ii. 398, 402 Cetraria, i. 246, ii. 390 Cetrarin, ii. 90 Cetrarina, ii. 90 Chalk, ii. 144, 367 prepared, ii. 367 Chalybeates, ii. 52 Chamomile, i. 129, ii. 40 German, ii. 48 Charcoal, ii. 49, 381 animal, ii. 323 Chemical agents, ii. 356 Chenopodium, i. 209 Cherry bark, wild, ii. 36 Chestnut, horse, ii. 87 Chimaphila, i. 272 Chirayita, ii. 34 Chloride of gold, ii. 328 Chloride of gold and sodium, ii. 329 Chloridum auri, ii. 328 barii, ii. 325 calcii, ii. 324 Chlorine, i. 251, ii. 331, 375, 379 Chlorinum, i. 251, ii. 331, 375, 379 Chondrus, i. 247, ii. 390 Cimicifuga, ii. 196 Cinchona, ii. 72, 382 flava, ii. 73 pallida, ii. 74 rubra, ii. 74 Cinchonia, ii. 82 iodide of, ii. 83,318 sulphate of, ii. 82 Cinnamomum, i. 439 Cinnamon, i. 439 Classification, author's, i. 92 Barbier's, i. 90 A. T. Thomson's, i. 90 Cloves, i. 444 Cocculus, ii. 422 Codeia, i. 348 Colchici radix, i. 286, ii. 189 semen, i. 286, ii. 189 Colchicum root, i. 286, ii. 189 seed, i. 286, ii. 189 Colocynth, i. 193 Colocynthis, i. 193 Colomba, ii. 30 Columbo, ii. 30 American, ii. 37 Combination, art of, ii. 436 Compression, methodical, ii. 289, 353 Confectio aromatica, i. 441 aurantii, i. 459 opii, i. 353 rosae, ii. 127 sennae, i. 177 Confection, aromatic, i. 441 of opium, i. 353 of orange peel, i. 458 of roses, ii. 127 of senna, i. 177 Confidence, ii. 28 Conium, i. 367 Contra-stimulants, ii. 177 Contrastimulus, doctrine of, ii. 177 Contrayeroa, ii. 45 Convolvulus, panduratus, i. 203 Coontie, ii. 393 Copaiba, i. 230, 281, 478 Copper, ammoniated, ii. 69 salts of, ii. 68 subacetate of, ii. 68, 270 sulphate of, i. 114, ii. 69, 141, 270 Coptis, ii. 38 Coriander, i. 443 Coriandrum, i. 443 Cornine, ii. 87 Cornus circinati, ii. 88 IND1 Cornus florida, ii. 87 sericea, ii. 88 Corylus rostrata, i. 217 Cotula, ii. 46 Cowhage, i. 216 Cranesbill, ii. 125 Creasote, i. 216,234,255, 404,490, ii. 132, 279, 381 Creasotum, i. 216, 234, 255, 404, 490, ii. 132,229, 381 Creta, ii. 144, 367 praeparata, ii. 132, 144, 367 Crocus, i. 324 Crowfoot, ii. 263 Cubeba, i. 281,468 Cubebs, i. 281,468 Cupping, ii. 171 dry, ii. 258 Cupri sales, ii. 68 subacetas, ii. 68, 270 sulphas, i. 114, ii. 69, 141,270 Cuprum ammoniatum, ii. 69 Cusparia, ii. 41 Dandelion, i. 279 Decoction of barley, ii. 391 of bittersweet, ii. 350 of dogwood, ii. 88 of guaiacum, ii. 347 of Iceland moss, i. 247 of logwood, ii. 124 of white oak bark, ii. 123 of Peruvian bark, ii. 78 of pipsissewa, i. 272 of sarsaparilla, compound, ii. 345 of seneka, i. 223 of uva ursi, i. 301 Decoctum cetrarise, i. 247 chimaphilae, i 272 cinchonae, ii. 78 cornus floridae, ii. 88 dulcamara?, ii. 350 guaiaci, ii. 347 haematoxyli, ii. 124 hordei. ii. 391 quercus albae, ii- 123 sarsaparillae compositum, ii. 345. scoparii compositum, i. 271 senegae, i. 223 uvae ursi, i. 301, ii. 125 Delphinium, i. 281 Demulcents, ii. 383 external, ii. 401 internal, ii. 388 special, ii. 388 Deobstruents, ii. 408 Dewberry root, ii. 131 Diaphoretics, i. 301 excitant, i. 313 modus operandi of, i. 302 sedative, i. 308 40 ex. 469 Diaphoretics, special, i. 308 topical, i. 324 Digitalin, i. 286, ii. 188 Digitalis, i. 282, ii. 185 Diluents, ii. 404 in dropsy, ii. 406 modus operandi of, ii. 405 Diosma, i. 297 Diospyros, ii. 129 Discutients, ii. 354 Disinfectants, ii. 370 special, ii. 375 Diuretics, i. 264 in dropsies, i. 268 excitant, i. 270 modus operandi of, i. 267 in rheumatic affections, i. 269 sedative, i. 282 special i. 269 therapeutics of, i. 268 Dock, bluntleaved, ii. 131 water, ii. 131 Dog's bane, ii. 131 Dogmatists, i. 27 Dogwood, ii. 87 roundleaved, ii. 88 swamp, ii. 88 Doses, mode of estimating, ii. 471 vary according to age, &c. &c,ii..47l Douche, ii. 207 Dracontium, i. 401 Dragon root, i. 323 Drastics, i. 137 Drop, black, i. 354 Dulcamara, ii. 349 Eau medicinale d'Husson, ii. 190 Efforts of nature, i. 18 Elaterium, i. 199 Elder flowers, i. 324 Elecampane, i. 233 Electricity, i- 415, 498, ii. 260, 355 Electro-magnetic apparatus, i. 502, ii. 355 Electro-puncture, i. 503, ii. 260 Elixir of opium, McMunn's i. 358 of vitriol, ii. 70, 139 Elm, slippery, i. 246, ii. 389, 404 Emetia, i. 120 Emetic Tartar, i. 115 Emetics, i. 94 in diseases of the alimentary canal, i. 109 in amaurosis, i. 109 in bubo, i. 109 direct, i. 114 in dropsy, i. 113 indirect, i. 115 in diseases of the chest, i- 108 in diseases of the encephalon, i. 108 in fevers in general, i. 106 in gout, i 111 470 INDEX. Emetics in hemorrhages, i. 111 in inflammations i. 107 in intermittent fevers, i. 105 in jaundice, i. 112 in the neuroses, i. 112 in orchitis, i. 109 in phthisis, i. 109 in remittent fevers, i. 106 in rheumatism, i. 111 special, i. 114 therapeutics of, 105 Emmenagogues, i. 405 cathartic, i. 409 excitant, i. 411 modus operandi of, i. 407 special, i. 409 Emollients, ii. 386, 401 Empirics, i. 27 Emplastrum ammoniaci, ii. 353 assafcetidee, i. 398 belladonnae, i. 364 ferri, ii 354 galbani compositum, i. 401, ii. 354 hydrargyri, ii. 300, 354 opii, i. 355 picis cum cantharide, ii. 237 plumbi, ii. 353 resinae, ii. 353 saponis, ii. 354 Enantiopathy, i. 84 Enemata, i 143 Epispastics, ii. 216,219 Ergot, i.415, 417, ii. 198 Ergota, i. 515, 417, ii. 198 Erigeron Canadense, i. 281 heterophyllum, i. 282 Philadelphicum, i. 287 Erodents, ii. 220, 270 Errhines, i. 256 special, i. 258 therapeutics of, u 257 Eryngium, ii. 46 Erythronium, i. 131 Escharotic revellents, ii. 270 Escharotics, ii. 222 Essence of peppermint, i. 447 of spearmint, i. 447 Ether, preparations of, i. 402 sulphuric, i. 402, 489 Eupatorium, i. 314 teucrifolium, i. 315 Euphorbia corollata, i. 131 ipecacuanha, i. 132 Euphorbium, i. 260 Eutrophic liniments, ii. 354 Eutrophics, ii. 279 compressing, ii. 353 modus operandi of, ii. 280 special, ii. 290 therapeutics of, ii. 286 topical, ii. 351 Excitants, i. 423 in constipation, i, 431 in fever, i. 431 in gastric affections, i. 429 in hypertrophy of the heart i. 434 in inflammation, i. 433 in local inflammation, i. 436 mental, i. 437 in the neuroses, i. 434 in paralysis, i. 435 special, i. 439 in surgical affections, i. 437 therapeutics of, i. 429 Exercise, ii. 26 Expectorants, i. 218 demulcent, i. 235 emetic and nauseant, i. 249 excitant, i. 222 special, i. 222 topical, i. 249 Extract of aconite, alcoholic, i. 373 ammoniated, i. 373 of belladonna, i. 364 alcoholic, i. 364 of butternut, i. 178 of colocynth, compound, i. 194 of dandelion, i. 281 of gentian, ii. 33 of hellebore, black, i. 411 of hemlock, i. 370 alcoholic, i, 371 of henbane, i. 360 alcoholic, i. 361 of jalap, i. 193 of krameria, ii. 122 of liquorice, i. 242 of logwood, ii. 144 of may apple, i. 179 of nux vomica, alcoholic, i. 383 of Peruvian bark. ii. 79 of quassia, ii. 35 of rhatany, ii. 122 of sarsaparilla, ii. 346 of stramonium leaves, i. 366 seed, i. 366 Extractum aconiti alcoholicum, ii. 373 belladonnae, i. 364 alcoholicum, i. 364 cinchonae, ii. 79 eolocynthidis compositum, i. 194 conii, i. 370 alcoholicum, i. 371 gentians, ii. 33 glycyrrhizse, i. 242, ii. 390 haematoxyli, ii. 124 hellebori, i. 410 * hyoscyami, i. 360 alcoholicum, i. 361 jalaps, i. 193 ju gland is, i. 178 pareirs, i. 304 INDEX. 471 Extractum podophylli, i. 179 quassia ii. 35 sarsaparillse, ii. 346. ■partii scoparii, i. 271 stramonii foliorum, i. 366 seminis, i. 366 taraxaci, i, 280 Fennelseed, i. 445 Fern, male, i. 212 Ferri arsenias, ii. 278, 326 chloridum, ii. 54 citras, ii. 63 et potassae tartras, ii. 55 et quinia? citras, ii. 63 ferrocyanuretum, ii. 56 filum, ii. 63 iodidum, ii. 61,317 lactas, ii. 62 nitras, ii. 142 oxidum hydratum, ii. 54 phosphas, ii. 57 praeparata, ii. 330 protocarbonas, ii. 59 ramenta, ii. 63 sales, ii. 52 snbcarbonas, ii. 53 sulphas, ii. 58, 143 Ferruginous preparations, ii. 52 Ferrum ammoniatum, ii. 55 Fever root, i. 203 Ficus, i. 159 Figs, i. 159 Filixmas, i. 212 Flag, sweet, i. 263, 463 blue, i. 203 Flaxseed, i. 243, ii. 389, 402 Fleabane, Canada, i. 282 Philadelphia, i. 282 various leaved, i. 282 Flies, potato, i. 279, ii. 262 Spanish, i. 276, ii. 254, 260, 338 Flour, wheat, ii. 408 Foeniculum, i. 445 Foxglove, i. 282, ii. 185 Fomentations, warm, i. 329 Frasera, ii. 37 Friction, i. 329, ii. 257, 290 Fucus amylaceus, i. 248, ii. 390 helminthocorton, i. 215 Fuligo, ii. 133 Fuligokali, ii. 337 Fuligokali, sulphuretted, ii. 337 Galbanum, i. 232, 400, 412 Galla, ii. 120 Galls, ii. 120 Galvanism, i. 501, ii. 260, 355 Galvano-puncture, i. 503, ii. 355 Gamboge, i. 194 Gambogia, i. 294 Garlick, i. 232, ii. 253 Gas, acidum carbonicum, ii. 202 hydrogenium, ii. 201 carburetum, ii. 201 nitrous oxide, i. 504 oxygen, i. 503 Gases, excitant, i. 503 sedative, ii. 201 Gaultheria, i. 454 Gentian, ii. 31 blue, ii. 33 Gentiana, ii. 31 Catesbaei, ii. 33 chirayita, ii. 34 Geranium, ii. 125 Geum, ii. 48, ISO Gillenia, i. 121 Ginger, i. 264, 470 Glycyrrhiza, i. 242, ii. 390 Glysters, ii. 143 Gold, chloride of, ii. 328 cyanuret of, ii. 328 iodide of, ii. 328 metallic, ii. 328 nitro-muriate of, ii. 279 oxide of, ii. 329 and sodium, chloiide of, ii- 328 powder, ii. 327 preparations of, ii. 327 Golden rod, i. 484 Goldthread, ii. 38 Granati fructus cortex, ii. 126 radicis cortex, i. 212 Grass, star, ii. 39 Guaiac, i. 317, 318 Guaiaci lignum, i. 317, ii. 347 resina, i. 318 Guaiacum, i. 317 wood, i. 317, ii. 347 Gum Arabic, i. 235, ii. 388 !, Hsmatoxylon, ii. 123 Hardhack, ii. 131 Hartshorn and oil, ii. 254 Hazel, beaked, i. 217 Heated metal, ii. 288 Hedeoma, i. 412, 448 Hellebore, American, ii. 195 black, i. 410 white, i. 258, ii. 194 Helleborus, i. 410 Hematology, i. 34 Hemidesmus Indicus, ii. 351 Hemlock, i. 367 gum, ii. 257 Hemp, Indian, i. 203, 377 Henbane, i. 359 Hepatica, ii. 49 Heracleum, i. 483 Hermodactyl, ii. 190 472 INDEX. Heteropathy, i. 84 Heuchera, ii. 130 Hilarity, i. 438 Hindesmus [misprinted for Hemidesmus] Indicus, ii. 351 Hippocastanum, ii. 88 Hive syrup, Coxe's, i. 124 Homoeopathy, i. 84 Honey of borax, ii. 216 of roses, ii. 129 Hope, ii. 28 Hops, i. 376 Hordeum, ii. 390 Horehound, ii. 48 wild, i. 215 Horse-chestnut, ii. 88 mint, i. 447 radish, i. 263, 472 Hot iron, ii. 272 Humulus, i. 376 Hydrargyri et arsenici iodidum, ii. 318,226 bromidum, ii. 321 chloridum corrosivum, ii. 278, 304 mite, i. 180, ii. 302, 421 cyanuretum, ii. 308 iodidum, ii. 279, 305 rubrum, ii. 278, 306 oxidum nigrum, i. 183, ii. 301 rubrum, ii. 279, 301 praeparata, ii. 290 sulphas flavus, i. 130, 259, ii. 310 sulphuretum nigrum, ii. 307 rubrum, ii. 308 Hydrargyrum, ii. 296 ammoniatum, ii. 305 eum creta, ii. 298 cum magnesia, ii. 299 Hydriatria, ii. 214 Hydrogen gas, ii. 201 Hydropathy, ii. 213 Hydrosudopathy, ii. 213 Hydrosudotherapeia, ii. 213 Hydrotherapeia, ii. 213 Hyoscyamus, i. 359 Iceland moss, i. 246, ii. 390 Immersion, ii. 207 Impetuosity, i. 438 Indian physic, i. 121 tobacco, i. 124 Indications modified by age, i. 37 by climate, i. 53. by conformation, i. 42 by causes, &c, of disease, i. 67 by habit, i. 50 by idiosyncrasy, i. 47 by mental affections, i. 57 by professions, &c, i. 65 by sex, i. 39 Indications modified by temperament, i. 45 therapeutical, i. 37 Indigo, ii. 51 Indigum, ii. 51 Infusion of angustura bark, ii. 42 of buchu, i. 298 of cascarilla, ii. 41 of catechu, compound, ii. 119 of chamomile, i. 130 of wild cherry bark, ii. 36 of cloves, i. 445 of columbo, ii. 31 of flaxseed, i. 244 of foxglove, i. 285, ii. 185 of gentian, compound, ii. 32 of hops, i. 377 of horseradish, i. 472 of Peruvian bark, ii. 78 compound, ii. 78 of pink root, i. 211 of quassia, ii. 35 of rhatany, ii. 122 of rhubarb, i. 168 of roses, compound, ii. 126 of sarsaparilla, ii. 345 of senna, i. 176 of slippery elm bark, 246 of snakeroot, Virginia, ii. 43 of thoroughwort, i. 314 of tobacco, i. 127 e>f valerian, i. 400 Infusum angusturs, ii. 42 an them id is, i. 130 armoraciae, i. 472 caryopbylli, I 445 cascarills, ii. 41 catechu compositum, ii. 119 cinchons, ii. 78 compositum, ii. 78 colombse, ii. 31 digitalis, i. 285, ii. 188 diosmae, i. 298 eupatorii, i. 315 gentians compositum, ii. 3S humuli, i. 377 krameris, ii. 122 lini, i. 244, ii. 389 pareirs, i. 304 pruni Virginians, ii. 36 quassis, ii. 35 rhei, i. 168 ross compositum, ii. 121 sarsaparills, ii. 345 scoparii, i. 271 senns, i. 176 serpentaris, ii. 43 spigelis, i. 211 tabaci, i. 127 ulmi, i. 246 valerians, i. 400 Inhalations, i. 221, 249 excitant, i, 249 INDEX. 473 Inhalation, sedative, i. 255 Injections of warm water, i. 329 Instinctive actions, i. 14 Inula, i. 233 Iodide of ammonium, ii. 319 of arsenic, ii. 217,318, 326 of barium, ii. 318 of gold, ii. 329 of iron, ii. 61, 317 of lead, ii. 318 of mercury, ii. 305, 320 red, ii. 278, 306 and arsenic, ii. 318 of potassium, ii. 316 of quinia, ii. 83, 319 of starch, ii. 319 of sulphur, ii. 319 Iodidum auri, ii. 329 ferri, ii. 61, 317 hydrargyri, ii. 305 rubrum, ii. 278, 306 plumbi, ii. 318 potassii, ii. 316 sulphuris, ii. 319 Iodine, i. 253, 415, ii. 310 preparations of, ii. 310 Iodini prsparata, ii. 310 Iodinum, i. 253, ii. 310 Ipecacuanha, i. 116, 311, ii. 266 American, i. 132 spurge, i. 132 Iris Florentina, i. 261 versicolor, i. 203 Irish moss, i. 246, ii. 390 Iron, ammoniated, ii. 55 arseniate of, ii. 278, 326 bromide of, ii. 321 chloride of, ii. 54 citrate of, ii 63 and quinia, citrate of, ii. 63 ferrocyanuret of, ii. 56 filings, ii. 63 hot, ii. 272 iodide of, ii. 61, 317 lactate of, ii. 62 nitrate of, ii. 142 oxide of, hydrated, ii. 54 phosphate of, ii. 57 and potassa, tartrate of, ii. 55 preparations of, ii. 331 protocarbonate of, ii. 59 salts of, ii. 52 subcarbonate of, ii. 53 sulphate of, ii. 58, 143 wire, ii. 63 Issues, ii. 267 Jalap, i. 191 Jalapa, i. 191 Joy, i. 438 Juglans, i. 178 40* Juglans cinerea, ii. 350 Juniper, i. 270, 455 Juniperus, i. 270,455 Virginiana, i. 41 Kino, ii. 119 Krameria, ii. 121 Kyapootie oil, i. 405 Lac sulphuris, i. 158 Lactucarium, i. 374 Lactuca, i. 374 Lard, ii. 401 Larkspur, i. 281 Laughter, i. 438 Lavandula, i. 261,402,452 Lavender, i. 261,402, 452 Lavemens, i. 143 Laxatives, i. 136, 155 Lead, acetate of, ii. 137 iodide of, ii. 318 water, ii. 139 Leeching, ii. 171 Leek, ii. 253 Lemon peel, i. 456 Leopard's bane, i. 387 Lettuce, i. 375 Lime, chlorinated, ii. 333, 376, 379 water, i. 297, ii. 145, 367 Limonis cortex, i. 456 Liniment of ammonia, ii. 254 camphor, i. 462, ii. 355 of lime water, ii. 145 of mercury, ii. 350 soap, camphorated, i. 462, ii. 355 of Spanish flies, ii. 255 of turpentine, i. 477, ii. 255 Liniments, eutrophic, ii. 354 Linimentum ammonis, ii. 254 calcis, ii. 145, 407 camphors, i. 462, ii. 355 cantharidis, ii. 255 hydrargyri compositum, ii. 300 saponis camphoratum, i. 462, ii. 355 terebinthins i. 477, ii. 255 Linum, i. 243, ii. 389, 402 Liquefacients, ii. 414 Liquor ammonis, i. 314,492, ii. 279, 366 fortior, i. 493 acetatis, i. 313 hydrosulphatis, ii. 200 anodyne, Hoffman's, i. 380, 402,490 barii chloridi, ii. 325 calcii chloridi, ii. 324 calcis, ii. 145, 367 ferri iodidi, ii. 62, 317 persesquinitratis, ii. 142 iodini compositus, ii. 317 morphia citratis, i. 357 sulphatis, i. 357 opii sedativus, i, 358 474 INDEX. Liquor plumbi subacetatis, ii. 138 dilutus, ii. 139 potasss, i. 296, ii. 365 arsenitis, ii. 85, 328 carbonatis, ii. 365 citras, i. 316 sods chlorinats, ii. 334, 376, 380 Liquors, malt, i. 487 Liquorice root, i. 242, ii. 390 Liriodendron, ii. 88 Lithonthryptics, i. 293 Liverwort, ii. 49 Lobelia, i. 124, ii. 199 Logwood, ii. 123 Lotions, ammoniated, ii. 253 Granville's, i. 493 Lupulina, i. 376 Lycopus, i. 381 Madder, i. 414 Magnesia, i. 158, 297, ii. 366 carbonate of, i. 159, 297, ii. 366 fluid, i 297 muriate of, i. 184 sulphate of, i. 184 Magnesis carbonas, i. 159, ii. 367 Malambo, ii. 129 murias, i. 185 sulphas, i. 184 Magnesii chloridum, i. 185 Magnesium chloride of, i. 184 Magnolia, ii. 46 Malt liquors, i. 489 Manna, i. 155 Mannite, i. 156 Manganese, sulphate of,i. 191 Manganesii sulphas, i. 191 Maranta, ii. 391 Marjoram, sweet, i. 261 Marrubium, ii. 47 Marshmallow, i. 236, ii. 389 Masterwort, i. 483 Matias, ii. 129 Matico, ii. 128 Matricaria, ii. 48 May apple, i. 179 Mayweed, ii. 46 Meal, Indian, ii. 408 Mechanical agents, ii. 382 Medicines, i. 70 classification of, i. 88 defined, i. 70 modus operandi of, i. 70 Mel boracis, ii. 216 ross, ii. 127 Melissa, i. 321 Mentha piperita, i. 446 viridis, i. 447 Mercury, ii. 296 ammoniated, ii. 305, 421 chloride of, corrosive, ii. 278, 304 Mercury, chloride of, mild, i. 180, ii. 302 cyanuret of, ii. 308 deutobromide of, ii. 321 iodide of, ii. 279, 305, 318 red, ii. 278, 306, 318 oxide of, black, ii. 301 red, ii. 301, 421 preparations of, ii. 290 protobromide of, ii. 321 sulphate of, yellow, i. 130, 259, ii. 310 sulphuret of, black, ii. 307 red, ii. 308 and arsenic, iodide of, ii. 318, 326 with chalk, ii. 298 Mezereon, i. 263, 318, ii. 269, 347 Mezereum, i. 263, 3,18, ii. 269, 347 Milkweed, i. 131,381 Mineral waters, ii. 423 table of, ii. 423 Mint horse, i. 448 pepper, i. 446 spear, i. 446 Mistura ammoniaci, i. 225 amygdalae, i. 238, ii. 398 assafcetidae, i. 232, 398 crets, ii. 144 ferri composita, ii. 60 Mixture, almond, i. 238 ammoniac, i. 225 assafetida, i. 232, 398 chalk, ii. 144 frigorific, ii. 218 Hope's, i. 357 of iron, compound, ii. 60 neutral, i. 316 saline, i. 316 Modus operandi of medicines, i. 71 Monarda, i. 447 Monesia, ii. 127 Morbus pedicularis, ii. 427 Morphia, i. 355 acetate of, 356 bimeconate of, i. 358 muriate of, i. 357 nitrate of, i. 357 sulphate of, i. 357 tartrate of, i. 358 Morphine acetas, i. 356 murias, i. 357 nitras, i. 357 sulphas, i. 357 Moschus, i. 403 Moss, Ceylon, i. 248, ii. 390 Iceland, i. 246, ii. 390 Irish, i. 247, ii. 390 Marine, i. 248 Moxa, ii. 273 Mucilage of gum arabic, i. 236. of tragacanth, i. 245 Mucilago acaciae, i. 236 tragacanthae, i. 240 INDEX. 475 Mucuna, i. 216 Mudar, ii. 450 Mugwort, ii. 44 Musk, i. 403 Mustard, i. 125, 162, 470, ii. 251, 264 Myristica, i. 450 Myrrh, i. 231 Myrrha, i. 231 Myroxylon. i. 226 Naphtha, i. 234 Naphthaline, i. 234 Narcotics, i. 330 in fevers, i. 342 in inflammation, i. 343 in intermittents, i. 342 modus operandi of, i. 337 in spasmodic diseases, i. 343 special, i. 344 therapeutics of, i. 342 Narcotin, i. 348, ii. 89 Narcotina, i. 34cf, ii. 89 Nature, efforts of, i. 18 Nauseants, i. 95, 97 in constipation, i. 96 in internal inflammation, i. 96 in obstetrical cases, i. 97 in surgical cases, i. 97 therapeutics of, i. 96 Nightshade, deadly, i. 361 Nutmeg, i. 450 Nux vomica, i. 382 Oak, bark, black, ii. 123 white, ii. 123 poison, i. 387 Oatmeal, ii. 397, 404 Oil of almonds, i. 162, 238, ii. 402 of amber, i. 483 of amber, rectified, i. 404, 483 animal, i. 209 of anise, i. 441 benne, i. 245, ii. 403 of bergamot, i. 457 cajeput, i. 481, ii. 255 of caper spurge, i. 199 of caraway, i. 442 Carron, ii. 145 castor, i. 163 of cinnamon, i. 440 codliver, ii. 322 croton, i. 197, ii. 266 Dippel's, i. 405 of ergot, i. 418 empyreumatic, of Chabert, i. 209 flaxseed, ii. 402 of garlic, ii. 253 of horsemint, i. 448 of juniper, i. 456 kyapootie, 405 of lavender, i. 453 Oil of lemons, i. 456 of marjoram, i. 449 of mustard, volatile, ii. 252 neatsfoot, ii. 404 olive, i. 162, 239 of origanum, i. 449 of peppermint, i. 447 of pimento, i. 464 of rosemary, i. 454 of sassafras, i. 321, 452 of savine, i. 413 of spearmint, i. 447 of spurge, i. 177 of tar, ii. 351 of thyme, i. 449 of turpentine, i. 208, 280, 474, ii, 255 of wormseed, i. 210 Ointment, antimonial, ii. 265 of subacetate of eopper, ii. 271 of creasote, i. 492 of galls, ii. 121 of hellebore, white, ii. 352 of iodine, ii. 316 compound, ii. 316 of carbonate of lead, ii. 352 mercurial, ii. 299 of mercury, ammoniated, ii. 305 nitrate of, ii. 309 red oxide of, ii. 302 of mezereon, ii. 269 nitric acid, ii. 277 of rosewater, ii. 402 simple, ii. 401 of Spanish flies, ii. 268 of stramonium, i. 366 of sulphur, ii. 335 compound, ii. 335 tar, ii. 651 tobacco, ii. 351 of zinc, oxide of, ii. 352 Ointments, eutrophic, ii. 321 Oleum amygdalae, i. 162, 238, ii. 398, 402 Oleum animale, i. 209, 405 anisi, i. 441 bergamii, i. 457 bubulum, ii. 404 cajuputi, i. 405, 481, ii. 255 cari, i. 442 caryophylli, i. 445 chenopodii, i. 210 cinnamomi, i. 440 copaibs, i. 481 cubebs, i. 468, 469 euphorbis lathyridis, i. 199 foeniculi, i. 445 gaultheris, i. 455 hedeoms, i. 499 jecoris aselli, ii. 322 juniperi, i. 270, 456 lavanduls, i. 453 limonis, i. 456 476 INDEX. Oleum lini, ii. 402 menthae piperits, i. 447 menthae viridis, i. 447 monards, i. 448 myristics, i. 451 olivs, i. 162, 239, ii. 398 origani, i. 449 piments, i. 464 ricini, i. 163 rosmarini, i. 454 sabins, i. 413 sassafras, i. 321, 452 sesami, i. 245, ii. 403 sinapis, i. 470, ii. 252, 483 succini, i. 404, 483 rectificatum, 404, 483 terebinthins, i. 208, 280, 405, 474, ii. 255 tiglii, i. 197, ii. 266 Onion, ii, 253 Opium, i. 312, 344 Orange peel, i. 457 Origanum, i. 449 majorana, i. 261 Orris, Florentine, i. 261 Oxygen gas, i. 503 Oxymel scills, i. 123 of squill, i. 123 Oystershells, prepared, ii. 144 Papaver, i. 358 Palliative treatment, i. 84 Pareira, i. 299 brava, i. 299 Parsley, i. 282 Partridge berry, i. 454 Parturifacients, i. 416 special, i. 417 Paullinia, ii. 49 Pellitory, i. 262 Pennyroyal, i. 412, 448 Pepper, black, i. 465 Cayenne, i. 446, ii. 253 mint, i. 446 Persimmon, ii. 129 Perkinism, i. 61 Petroselinum, i. 282 Phloridzin, ii. 90 Phloridzina, ii. 90 Phosphorus, i, 496 Phytolaccs radix, i. 132 Picrotoxine, ii. 429 Pills of aloes and assafetida, i. 173, 398 and myrrh, i. 173, 410 aloe tic, i. 172 Asiatic, ii. 326 assafetida, i. 398 Blaud's, ii. 60 cathartic, compound, i. 194 of copaiba, i. 481 galbanum, compound, i. 401 Pills of carbonate of iron, ii. 69 of iron, compound, ii. 60 of mild chloride of mercury, i. 182 mercurial, i. 183, ii. 299 of opium, i. 343 of sulphate of quinia, ii. 82 of rhubarb, i. 168 of rhubarb, compound, i. 168 of soap, compound, i. 353 of squill, compound, i. 224 Vallet's ii. 59 Pilulie aloes, i. 172 aloes et assafstidae, i. 173, 398 myrrhs, i. 173, 410 Asiatics, ii. 326 assafoetidae, i. 398 cathartics composit i. 194 copaibce, i. 481 ferri carbonatis, ii. 59 ferri composits, ii. 60 galbani composits, i. 401 hydrargyri, i. 183, ii. 299 hydargyri chloridi mitis, i. 182 hydrargyri iodidi, ii.305 opii, 353 quinis sulphatis, ii. 82 rhei, i. 168 rhei composits, i. 168 saponis composits, i. 353 scills composits, i. 224 Pimenta, i. 464 Pimento, i. 464 Pink root, i. 210 Piper, i. 465 Piperin, ii. 86 Piperina, ii. 86 Pipsissewa, i. 272 Pitch, Burgundy, ii. 255 Canada, ii. 257 hemlock, ii. 257 Pix abietis, ii. 255 Canadensis, ii. 257 Plaster, ammoniac, ii. 353 of ammoniacum with mercury, ii. 300 of assafetida, i. 398 of belladonna, i. 364 galbanum, compound, i. 401 iron, ii. 354 lead, ii. 353 mercurial, ii. 300 opium, i. 355 resin, ii. 353 of pitch with Spanish flies, ii. 257 soap, ii. 354 Platinum, preparations of, ii. 330 Pleurisy root, i. 321 Plumbi acetas, ii. 137 iodidum, ii. 318 Podophyllum, i. 179 Poison oak, i. 387 Poisons, ncro-narcotics, ii. 416,420 INDEX. 477 Poisons, animal, ii. 419 corrosive, ii. 410 inorganic, ii. 412, 413 irritant, ii. 417, 420 narcotic, ii. 418,4420 narcotico-acrid, ii, 410, 416 organic, ii. 410, 416 table of, ii. 412 vegetable, ii. 416 Poke root, i. 132 Polygala, bitter, ii. 48 rubella, ii. 48 Pomegranate rind, ii. 126 root, bark of, i. 213 Pommade ammoniacale, jj. 253 Poppyheads, i. 358 Potassa, ii. 275 acetate of, 190, 276 bicarbonate of, ii. 364 bisulphate of, 189 bitartrate of, 188,274 carbonate of, ii. 296, 365 impure, ii. 365 pure, ii. 365 chlorate of, ii. 337 citrate of, i. 315 cum calce, ii. 275 with lime, ii. 275 nitrate of, i. 275, ii. 215 sulphate of, i. 189 salts of, i. 274 supersulphate of, i. 189 tartrate of, i. 187 and soda, tartrate of, i. 186 Potasss acetas, i. 190, 276 bicarbonatis, ii. 364 bisulphas, i. 189 bitartras, i. 188,274 carbonas, ii. 365 impurus, ii. 365 chloras, ii. 337 citras, i. 315 nitras, i. 275, ii. 215, sulphas, i. 189 tartras, i. 187 Potassii bromidum, ii. 320 cyanuretum, ii. 184 ferrocyanuretum, ii. 184 iodidum, ii, 316 iodohydrargyras, ii. 307 sulphocyanuretum, ii. 185 sulphuretum, ii. 336 Potassium, cyanuret of, ii. 184 bromide of, ii. 320 ferrocyanuret of, ii. 184 iodide of, ii. 316 iodohydrargyrate of, ii. 307 sulphocyanuret of, ii. 185 sulphuret of, ii. 336 Potato, wild, i. 203 Poultices, warm, i. 329 VOL. II.—41 Powder of aloes and canella, i. 173 410 antimonial, i. 310 aromatic, i. 441 of ipecacuanha and opium, i. 311 of jalap, compound, i. 192 of tin, i. 217 Powders, Castillon, ii. 397 Prescribing, art of, ii. 446 Pressure, ii. 289 Prinos, ii. 49 Prunes, i. 161 Pruni pulpa, 161 Prunum, i. 161 Prunus Virginiana, ii. 36 Prussian blue, pure, ii. 56 Pthiriasis, ii. 421 Pulp of prunes, i. 161 of purging cassia, i. 160 of tamarinds, i. 161 Pulvis antimonialis, i. 310 aromaticus, i. 441 aloes et canells, i. 173, 410 auri, ii, 327 ipecacuanhs et opii, i. 311 jalaps compositus, i. 192 stanni, i. 217 Purgatives, i. 136 Pyrethrum, i. 262 Quassia, ii. 34 Quercus alba, ii. 123 tinctoria, ii. 123 Quinia, ii. 79 iodide of, ii. 83, 319 salts of, ii. 82 sulphate of, ii. 79, 382 valerianate of, ii. 82 Quinis sulphas, ii. 79 Ranunculus, ii. 263 Rationalists, i. 27 Refrigerants, ii. 203 in fevers, ii. 210 in hemorrhage, ii. 212 in inflammation, ii. 212 modus operandi of, ii. 208 in pulmonary affections, ii. 213 saline, ii. 214 special, ii. 214 therapeutics of, ii. 209 topical, ii. 217 Resin, ii. 477 vapour of, i. 254 Resina, i. 477 Resolvents, ii. 409 Revellents, ii. 218 in arthritis, ii. 245 in dropsy, ii. 250 escharotic, ii. 270 in fevers, ii. 227, 257 in hemorrhage, ii. 246 in hypertrophy, ii. 250 478 INDEX. Revellents in inflammation, ii. 239 in intermittents, ii. 235 in nervous diseases, ii. 247 in the changeable phlegmasia, it. 229 rubefacient, ii. 251 special, i.. 251 suppurant, ii. 265 therapeutics of, ii. 235 vesicant, ii. 260 where to be applied, ii. 233 Revulsion, i. 83 permanent and intermittent, ii. 225 Rhatany, ii. 121 Rheum, i. 165 Rhubarb, i. 165 syrup of, aromatic, i. 168 Rhus glabrum, ii. 130 Root, yellow, ii. 39 Rosa Gallica, ii. 126 Rosemary, i. 261, 453 marsh, ii. 131 Roses, red, ii. 126 Rosin, i. 477 Rosmarinus, i. 261, 453 Rubbing, dry, ii. 290 Rubefacients, ii. 220 Rubia, i. 414 Rubus trivialis, ii. 131 villosus, ii. 131 Rue, i. 413 Rurrifex Britannica, ii. 131 obtusifolius, ii. 131 crispus, ii. 131 Ruta, i. 413 Sabbatia, ii. 38 Sabina, i. 412, ii. 269, 271 Saccharum, i. 241, ii. 271, 338 Saffron, i. 324 Dyer's, i. 324 Sago, ii. 395 Portland, ii. 393 Salep, ii. 396 Salicin, ii. 85 Salix, ii. 85 Sambucus, i. 324 Sanguinaria, i. 128 Sarsaparilla, ii. 441 country, ii. 351 false, ii. 347 Sassafras, medulla, i. 245, 389 pith, i. 245, ii. 389 radicis cortex, i. 320, 452, ii. 348 root, bark of, i. 320, 452, ii. 348 Savine, i.412, ii. 269,271 Scammonium, i. 195 Scammony, i. 195 Scilla, i. 122, 223, 271 Scoparius, i. 271 Sedatives, ii. 146, 180 modus operandi of, ii. 147 special, ii. 180 Senna, i. 174 American, i. 178 Senega, i. 222 Seneka, i. 222 Serpentaria, ii. 42 Sesamum, i. 245, ii. 389, 403 Setons, ii. 267 Setaceum, ii. 268 Sevum, ii. 399 Sialogogues, i. 261 special, i. 262 therapeutics of, i. 261 Silkweed, common, i. 381 Silver, chloride of, ii. 141 nitrate of, ii. 66, 140, 263, 270, 276 oxide of, ii. 67 preparations of, ii. 329 Simaruba, ii. 35 Sinapis, i. 125, 162, 470, ii 251,264 Skunk cabbage, i. 401 Snakeroot, black, ii. 196 button, ii. 46 Canada, ii. 45 Virginia, ii. 42 Soda, arseniate of, ii. 327 bicarbonate of, i. 276, ii. 363 borate of, i. 276, 422, ii. 215 carbonate of, i. 276, 296, ii. 364 dried, ii. 364 muriate of, i. 130, 190, 215 nitrate of, ii. 215 phosphate of, i. 187 sulphate of, i. 185 salts of, i. 276 Sods bicarbonas, i. 276, ii. 363 boras i. 276, 422, ii. 215 carbonas, i. 276, ii. 364 exsiccatus, ii. 364 phosphas, i. 187 and potassa, tartrate of, i. 187 sulphas, i. 185 et potasss tartras, i. 186 Sodii chloridum, i. 130, 190, 215 Sodium, chloride of, i. 130, 190, 215 Solidago, i. 484 Solution of acetate of ammonia, i. 313 of ammonia, i. 314, 492, ii. 366 strong, i. 493 of arsenite of potassa, ii. 85 of hydrosulphate of ammonis, ii. 200 of chloride of barium, ii. 325 of calcium, ii. 324 of chlorinated lime, ii. 333 soda, ii. 377, 380 of chlorine, ii. 332 of iodide of iron, ii. 62 of iodine, compound, ii. 317 of lead, subacetate of, ii. 138 diluted, ii. 139 of sulphate of morphia, i. 357 of potassa, i. 296, ii. 365 of carbonate of potassa, ii. 365 INDEX. 479* Solution of citrate of potassa, i. 316 Plenck's, ii. 299 Soot, wood, ii. 133 Sorbefacients, modus operandi of, ii. 280 Spanish flies, i. 276 Spearmint, i. 441 Specific, Reynolds's, ii. 190 Spermaceti, i. 240, ii. 399, 402 Spigelia, i. 210 Spikenard, American, ii. 348 Spirea, ii. 131 Spirit of ammonia, i. 494 of ammonia, aromatic, i. 402, 494 of ether, compound, i. 380, 402, 490 of ether, nitric, i. 273 of juniper, compound, i. 270 of lavender, i. 453 compound, i. 403, 453 of nitric ether, i. 273, 315, 402, 490 of nutmeg, i. 451 of pimento, i. 465 of rosemary, i. 454 of sulphuric ether, compound, i. 380, 402, 490 Spirits, ardent, i. 484 Spiritus ammonis, i. 494 ammonis aromaticus, i. 402, 494 stheris nitrici, i. 273, 315, 402, 490 sulphurici compositus, i. 380, 402, 490 juniperi compositus, i. 270 lavanduls, i. 453 lavanduls compositus, i. 403, 453 myristics, i. 451 piments, i. 465 rosmarini, i. 454 Sponge, burnt, ii. 321 Spongia usta, ii. 321 Spurge, blooming or large flowering, i. 131 ipecacuanha, i. 132 Squill, i. 122,223,271 Staphisagria, ii. 423 Starch, ii. 398 iodide of, ii. 319 Stargrass, ii. 39 Statice, ii. 131 Statistics, medical, i. 29 Stavesacre, ii. 429 Stimulants, i. 423 Storax, i. 227 Stramonium, i. 255, 364 Strychnia, i. 384,415 Sty rax, i. 227 purificata, i. 228 Succinum, i. 404, 482 Suet, ii. 399 Sugar, i. 241, ii. 271,338 Sulphur, i. 156, ii. 334 iodide of, ii. 319 precipitated, i. 158, ii. 334 prscipitatum, i. 158, ii. 334 Sulphurus iodidum, ii. 319 Sumach, ii. 130 Suppositories, i. 145 Suppurant revellents, ii. 265 Suppuiants, ii. 220 Sympathetic powder, i. 15 Sympathy, i. 76 of contiguity, i. 76 of continuity, i. 76 Syrup, i. 223 hive, Coxe's, i. 124 of almonds, i. 238 of garlic, i. 233 of ginger, i. 471 of ipecacuanha, i. 120 of orange peel, i. 458 of rhatany, ii. 122 of rhubarb, i. 168 aromatic, i. 168 of sarsaparilla, compound, ii. 346 of seneka, i. 223 of senna, i. 177 of squill, i. 123 of squill, compound, i. 123 oftolu, i. 227 Syrupus, i. 242 allii, i. 233 amygdalae, i. 238 aurantii corticis, i. 458 ipecacuanhs, i. 120 krameris, ii. 122 rhei, i. 168 rhei aromaticus, i. 168 sarsaparills compositus, ii. 346 scills, i. 124 compositus, i. 124 senegse, i. 223 senns, i. 177 tolutani, i. 227 zingiberis, i. 471 Tabacum, i. 126, 255, 260, 264 Tamarindi pulpa, i. 161 Tamarinds, i. 161 Tamarindus, i. 161 Tanacetum, i. 215, 415 Tannin, ii. 115 Tansey, i. 215, 415 Tapioca, ii. 395 Tar, boiling, vapour of, i. 254 oil of, ii. 351 Tartar emetic, i. 115 Taraxacum, i. 279 Terebinthina, i. 472 canadensis, i. 473 Testa prsparata, ii. 144 Tetanies, i. 382 special, i. 382 Therapeutics, defined, i. 13 general considerations on, i. 13 Thornapple, i. 364 480 INDEX. Thoroughwort, i. 314 Thridace, i. 374 Tin, powder of, i. 217 Tinctura aconiti, i. 372 aloes, i. 173 et myrrhs, i. 173, 410 assafcetids, i. 398 belladonns, i. 364 benzoini composita, i. 230 camphors, i. 461 cantharidis, i. 272 capsici, i. 468 cardamom, i. 444 castorei, i. 398 catechu, ii. 119 cinchons, ii. 79 composita, ii. 79 cinnamomi, i. 441 composita, i. 441 colchici seminis, ii. 191 colombs, ii. 31 conii, i. 371 cubebs, i. 469 digitalis, i. 285, ii. 188 diosms, i. 298 ferri chloridi, ii. 54, 142 galls, ii. 121 gentians composita, ii. 32 guaiaci, i. 319 ammoniata, i. 319 hellebori, i. 410 humuli, i. 377 hyoscyami, i. 361 iodini, ii. 315 composita, ii. 316 jalaps, i. 193 krameris, ii. 122 lobelia?, i. 124 lupulins, i. 377 myrrhs, i. 232 olei menths piperits, i. 447 viridis, i. 447 opii, i. 353 acetata, i. 354 camphorata, i. 354 quassis, ii. 35 rhei, i. 168 et aloes, i, 169 et gentians, i. 169 et senns, i. 169 sanguinaris, i. 129 saponis camphorata, i. 462, ii. 355 scills, i. 123, 272 senns et jalaps, i. 176 serpentaris, ii. 43 stramonii, i. 366 tolutani, i. 227 valerians, i. 400 ammoniata, i. 400 zingiberis, i. 470 Tincture of aconite, i. 372 Tincture of aloes, i. 173 and myrrh, i. 173,410 of assafetida, i. 398 of belladonna, i. 364 of benzoin, compound, i. 230 of bloodroot, i. 129 of camphor, i. 461 of cardamom, i. 444 of castor, i. 398 of catechu, ii. 119 of cayenne pepper, i. 468 of chloride of iron, ii. 54, 142 of cinnamon, i. 441 compound, i. 441 of colchicum seed, ii. 191 of columbo, ii. 31 of cubebs, i. 469 of digitalis, ii. 188 of diosma, i. 298 of foxglove, i. 285 of galls, ii. 121 of gentian, compound, ii. 32 of ginger, i. 470 of guaiac, i. 319 ammoniated, i. 319 of hellebore, black, i. 410 of hemlock, i. 371 of henbane, i. 361 of hops, i. 377 of iodine, ii. 315 compound, ii. 316 of jalap, i. 193 of lobelia, i. 124 of lupulin, i. 377 of myrrh, i. 232 of oil of peppermint, i. 447 spearmint, i. 447 of opium, i. 353 acetated, i. 354 camphorated, i. 354 of Peruvian bark, ii. 79 compound, ii. 79 of quassia, ii. 35 of rhatany, ii. 122 of rhubarb, i. 168 and aloes, i. 169 and gentian, i. 169 and senna, i. 169 of senna and jalap, i. 176 of snakeroot, Virginia, ii. 43 of soap, camphorated, i. 462, ii. 355 of Spanish flies, i. 278 of squill, i. 123 of stramonium, i. 366 of tolu, i. 227 of valerian, i. 400 of valerian, ammoniated, i. 400 Tobacco, i. 126, 255, 260, 264, ii. 199 indian, i. 124 Tolu, i. 226 Tolutanum, i. 226, 251 Tonics, ii. 13, 382 antiperiodic, ii. 71 bitter, ii. 30 aromatic, ii. 40 astringent, ii. 48 in chronic cutaneous diseases, ii. in fever, ii. 20 in hemorrhage, ii. 23 in inflammation, ii. 22 in local diseases, ii. 25 mechanical, ii. 50 mental, ii. 29 mineral, ii. 52 modus operandi of, ii. 15 in the neuroses, ii. 24 simple, ii. 31 special, ii. 30 therapeutics of, ii. 20 in worms, ii. 24 L'ormentil, ii. 124 ^ormentilla, ii. 124 I'ous-les-mois, ii. 394 Toxicodendron, i. 387 Tragacanth, i. 244, ii. 390 Tragacantha, i. 244, ii. 390 Triosteum, i. 203 Tritici farina, ii. 403 Troches of chalk, ii. 367 of ipecachuanha, i. 249 of liquorice and opium, i. 249 of magnesia, ii. 366 of peppermint, i. 447 Trochisci crets, ii. 367 glycyrrhizs et opii, i. 243 ipecacuanhs, i. 249 magnesis, ii. 366 menths piperits, i. 447 Tulip tree bark, ii. 88 Turnip, Indian, i. 323 Turpentine, i.472 Canada, i. 473 Ulmus, i. 246, ii. 389, 404 Unguentum acidi nitrici, ii. 259, 277 sulphurici, ii. 260 antimonii, ii. 365 aqus ross, ii. 402 cantharidis, ii. 268, 351 creasoti, i. 492, ii. 351 cupri subacetatis, ii. 271, 351 galls, ii. 121, 351 hydrargyri, ii. 299, 351, ammoniati, ii. 305, 351 biniodidi, ii. 307 iodidi, ii. 306 nitratis, ii. 309, 351 oxidi rubri, ii. 302, 351, iodini, ii. 316, 351 compositum, ii. 316, 351 mezerei, ii. 269, 351 picis liquids, ii. 351 INDEX. 481 Unguentum plumbi carbonatis, ii. 352 iodidi, ii. 318 simplex, ii. 401 stramonii, i. 366 sulphuris, ii. 335, 351 compositum, ii. 335, 351 tabaci, ii. 351 veratri albi, ii. 352, 421 zinci oxidi, ii. 352 Uva ursi, i. 300, ii. 125 Valerian, i. 399 Valeriana, i. 399 Valerianate of zinc, i. 400 Veratria, i. 259, 286, ii. 193 sulphate of, ii. 194 Veratrum album, i. 258, ii. 194 viride, ii. 195 Vesicant revellents, ii. 260 Vesicants, ii. 220 Vinegar, i. 250 of colchicum, i. 286, ii. 292 distilled, i. 251 of opium, i. 354 of squill, i. 123 Vinum, i. 486 aloes, i. 173, 410 antimonii, i. 116, 309 colchici radicis, ii. 192 seminis, ii. 192 ergots, i. 422 ipecacuanhs, i. 120, 312 opii, i. 354 rhei, i. 169 tabaci, i. 128 veratri albi, ii. 195 Viola, i. 248 Violet, i. 248 dog's tooth, i. 131 Vis niedicatrix naturae, i. 14 Walnut, ii. 350 Wassercur, ii. 213, 425 Water, acidulous, simple, i. 294 of ammonia, i. 492 of bitter almonds, ii. 181 boiling, ii. 264 camphor, i. 461 carbonic acid, ii. 435 cherrylaural, ii. 181 cinnamon, i. 441 fennel, i. 446 lead, ii. 139 lime, i. 295, ii. 367 peppermint, i. 447 spearmint, i. 447 tar, ii. 133 Vichy, i. 297 Watercure, ii. 214 Waters, mineral, ii. 430 table of, ii. 423 482 INDEX. Wax, myrtle, ii. 400 white, ii. 399 yellow, ii. 399 Wheat flour, ii. 403 Whortleberry, bear's, i. 300 Willow, ii. 85 Wine of aloes, i. 173, 410 antimonial, i. 116, 309 of colchicum seed, ii. 192 root, ii. 192 of ergot, i. 422 ipecacuanha, i. 120, 312 of opium, i. 354 of rhubarb, i. 169 of tobacco, i. 128 of white hellebore, ii. 195 Wines, i. 485 Wintera, i. 463 Winter's Bark, i. 463 Wool, burning, i. 254 Wormseed, i. 209 Corsican, i. 215 Wormwood, ii. 43 Xanthorrhiza, ii. 39 Xanthoxylum, i. 322 Yeast, ii. 382 Yellowroot, ii. 39 Zinc, acetate of, ii. 65 carbonate of, ii. 352 prepared, ii. 352 chloride of, ii. 65, 276 cyanuret of, ii. 65 ferrocyanuret of, ii. 65 oxide of, ii. 64 salts of, ii. 64 sulphate of, i. 114, ii. 64, 143 valerianate of, i. 400, ii. 66 Zinci acetas, ii. 65 carbonas, ii. 352 prsparatus, ii. 352 chloridum, ii. 65, 276 cyanuretum, ii. 65 ferrocyanuretum, ii. 65 oxidum, ii. 64 sales, ii. 05 sulphas, i. 114, ii. 64, 143 Zingiber, i. 264, 470 TO THE MEDICAL PROFESSION. 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Carpenter's General and Comparative Physiology, 1 vol. 8vo, preparing. Carpenter's Vegetable Physiology, 1 vol. 12mo, with cuts, 300 pages. Carpenter's Manual of Physiology, preparing. Carpenter's Animal Physiology, to be. published. Cooper, Sir Astley on Hernia, imp. 8vo, plates, 428 pp. Cooper on Dislocations, 1 vol. 8vo, with cuts, 500 pp. Cooper on the Testis and Thymus Gland, 1 vol. impe- rial Svo, many plates. Cooper on the Anatomy and Diseases of the Breast, &c. &c, 1 vol. imperial 8vo, splendid lithographic plates. Condie on Diseases of Children, 1 vol. Svo, 652 pages. Churchill on Females, 3d edition, 1 vol. 8vo, 572 pp Churchill's Midwifery, 1 vol. 8vo, 520 pp. with cuts. Cyclopaedia of Practical Medicine, by Forbes, &c. Edited by Dunglison, in 4 large super-royal vols., 3154 double columned pages. Carson's Medical Formulary, in preparation. Dewees' Midwifery, with plates, 10th edit., 660 pages. Dewees on Children, 8th edition, 548 pages. 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Manual of Ophthalmic Medicine and Surgery, to be published hereafter. Medical News and Library, published monthly. Meigs' Translation of Colombat de l'Isere on the Dis- eases of Females, 1 vol Svo, 720 pages. Prout on the Stomach and Renal Diseases, 1 vol. Svo, with coloured plates. 466 pages. Popular Medicine, by Coates, 1 vol. 8vo, 614 pages. Philip on Protracted Indigestion, 1 vol., 240 pages. Pereira'3 Materia Medica, 2 vols. 8vo. 15K) very large and closely printed pages. Second Edition. Royle's Materia Medica, with illustrations, preparing. Roget's Animal and Vegetable Physiology, with many cuts, 2 vols. Svo, 872 pages. Roget's Outlines of Physiology, 1 vol. 8vo, 516 pages. Rigby's System of Midwifery, 1 vol. 8vo, 492 pages. Ricord on Venereal, new edition, 1 vol. Svo. 256 pages. Ricord's large work on Venereal Diseases, with nu- merous plates, preparing. Ramsbotham on Parturition, with many plates. 1 vol. imperial Svo, a new and improved edition. 520 pp. Robertson on the Teeth, 1 vol. 8vo, 230 pages. Stanley on the Bones, 1 vol. Svo, preparing. Simon's Chemistry of Man, 1 vol. Svo. Select Medical Essays by Chapman and others, 2 vols, Svo, 1150 pages, double columns. Taylor's New \Vork on Medical Jurisprudence, by Griffith, 1 vol. Svo, 540 pages. Traill's Medical Jurisprudence, 1 vol. Svo, 234 pages. Trimmer's Geology and Mineralogy, 1 vol. Svo. 528pp. Todd's Cyclopaedia of Anatomy and Physiology, to be published hereafter. Thomson on the Sick Room, 1 vol. 12mo, 360 large pages, with cuts. Walshe's Diagnosis of the Diseases of the Lungs, 1 vol. 12mo, 310 pages. Watson's Principles anil Practice of Physic, by Con- die, 1 vol. Svo, 1060 pages, large type. Wilson's Human Anatomy, with cuts, 1 vol. Svo, a new and improved edition, 60S pages. Wilson's Dissector, or Practical and Surgical Anato- my, by Goddard, with cuts. 1 vol. 12mo, 444 pages. Wilson on the Skin, 1 vol. Svo, 370 pages. Youatton the Horse, by Skinner, cuts, 448pp. 1 vl.8vo. Youatt and Clater's Cattle Doctor, 1 vol. 12mo, with cuts. 282 pages. Williams' Pathology, or Principles of Medicine, 1 vol. Svo, 3*1 pages. Williams' Lectures on Stomach, &c. preparing. Williams on Respiratory Organs, by Clymer, 1 vol Svo, 500 pages. %* They have other works in preparation not included in this list 4 LEA & BLANCHARD'S PUBLICATIONS. THE eBE&T USEOSOAL LIBRARY. NOW READY. THE CYCLOPEDIA OF PRACTICAL MEDICINE, » COMPRISING TREATISES ON THE NATURE AND TREATMENT OF DISEASES, MATERIA JVIEDSCA AND THERAPEUTICS, DISEASES OF WOMEN AND CHILDREN, MEDICAL JURISPRUDENCE, &C. &C. EDITED BY JOHN FORBES, M.D., F.R.S., ALEXANDER TWEEDIE, M.D., F.R. S., AND JOHN CONOLLY, M.D. REVISED, WITH ADDITIONS, By ROBLEY DUNGLISON, M. D. This work is now complete, and forms FOUR LARGE SUPER.ROYAL OCTAVO VOLUMES, CONTAINING THIRTY-TWO HUNDRED AND FIFTY-FOUR UNUSUALLY URGE PAGES IN DOUBLE COLUMNS, printed on good paper, with a new and clear type. The whole well and strongly bound, WITH RAISED BANDS AND DOUBLE TITLES. Or, to be had, in twenty-four parts, at Fifty cents each. This excellent work has now been before the profession for a short time, and has met with universal approbation as containing a vast body of information on all points connected with Practical Medicine. To physi- cians residing at a distance from Medical libraries, or the means of procu- ring works of reference, it will prove almost invaluable, as a work to be constantly consulted. That the extent of it may be properly understood, the publishers append a list of the contents. It will be seen that one of the peculiar advantages of this work is that every subject has been treated by an author whose attention has been directed peculiarly to that branch, the most eminent physicians of Great Britain having joined in the production of the whole; while the numerous additions of Dr. Dunglison have brought the work up to the very day of publication and with reference particularly to American practice. LEA & BLANCHARD'S PUBLICATIONS. 5 Cyclopaedia of Practical Medicine, continued. CONTENTS OF VOLUME I, Abdomen, Exploration of the, Dr. Forbes. Abortion, Dr. Lee. Abscess. Internal, Dr. Tweedie. Abstinence, Dr. Marshall Hall. Achor, Dr. Todd. Acne, Dr. Todd. Acrodynia, Dr. Dunglison. Acupuncture, Dr. Elliotson. Age, Dr. Boget. Air, Change of, Sir James Clarke. Alopecia, Dr. Todd. Alteratives, Dr. Conolly. Amaurosis, Dr. Jacob. Amenorrheas, Dr. Locock. Anaemia, Dr. Marshall Hall. Anasarca, Dr. Darwall. Angina Pectoris, Dr. Forbes. Anodynes, Dr. Whiting. Anthelmintics, Dr. A. T. Thomson. Anthracion, Dr. Dunglison. Antiphlogistic- Regimen, Dr. Barlow. Antispasmodics, Dr. A. T. Thomson. Aorta, Aneurism of, Dr. Hope. Apoplexy, Cerebral, Dr. Clutterbuck. " Pulmonary, Dr. Town- send. Arteritis, Dr. Hope. Ascites, Dr. Darwall. Artisans, Diseases of, Dr. Darwall. Asphyxia, Dr. Roget. " of the New Born, Dr. Dun- glison. Asthma, Dr. Forbes. Astringents. Dr. A. T. Thomson. Atrophy, Dr. Townsend. Auscultation, Dr. Forbes. Barbiers, Dr. Scott. Bathing, Dr. Forbes. Beriberi, Dr. Scott Blood, Determination of. Dr. Barlow.. " Morbid Mates of, Dr. Marshall Hall. Blood-letting, Dr. Marshall Hall. Brant, Inflammation of the, Meningitis, Dr. Quain. Cerebritis, Dr. Adair Craw- ford. Bronchial Glands, Diseases of the, Dr. Dunglison. Bronchitis, Acute and Chronic, Dr. Williams. " Summer, Dr. Dunglison. Bronchoeele, Dr. And. Crawford. Bulte, Dr,Todd. Cachexia, Dr. Dunglison. Calculi, Dr. T. Thomson. Calculous Diseases, Dr. Cumin. Catalepsy. Dr. Joy. Catarrh, Dr. Williams. Cathartics, Dr. A. T. Thomson. Chest, Exploration of the, Dr. Forbes Chicken Pox, Dr. Gregory. Chlorosis, Dr. Marshall Hall. Cholera, Common and Epidemic, Dr Brown. " Infantum, Dr. Dunglison* Chorea, Dr. And. Crawford. Cirrhosis of the Lung, Dr. Dunglison Climate, Dr. Clark. Cold, Dr. Whiting. Colic, Drs. Whiting and Tweedie. Colica Pictonumi, Dr. Whiting. Colon, Torpor of the, Dr. Dunglisoni Coma, Dr. Adair Crawford. Combustion, Spontaneous, Dr. Ap- john. Congestion of Blood. Dr. Barlow. Constipation, Drs. Hastings and Sireeten. Contagion. Dr. Brown. Convalescence. Dr Tweedie. Convulsions, Dr. Ailair Crawford. '• Infantile, Dr. Locock. " Puerperal, Dr. Loeock. Coryza, Dr. "Williams. Counter Irritation. Dr. Williams. Croup, Dr. Cheyne. Cyanosis. Dr Crampton. Cystitis,.Dr. Cumin. Dead, Persons found, Dr. Beatty. Delirium, Dr. Pritchard. " Tremens, Drs. Carter and Dunglison. Dengue, Dr Dunglison. Dentition, Disorders of, Dr. Joy. Derivation. Dr. Stokes. Diabetes, Dr. Bardsley. Diagnosis, Dr. Marshall Hall. Diaphoretics. Dr. A. T. Thomson. Diarrhoea, Drs. Cramplon and Forbes. '• Adipous, Dr. Dunglison. Dietetics, Dr. Paris. Disease, Dr. Conolly. , Disinfectants, Dr. Dunglison. Disinfection. Dr. Brown. Diuretics, Dr. A. T.Thomson. Dropsy, Dr. Darwall. , Dysentery, Dr. Brown. Dysmenorrhoea, Dr. Locock. Dysphagia. Dr. Stokes. Dyspncea, Dr. Williams. Dysuria, Dr. Cumin. Ecthyma, Dr. Todd. Eczema. Dr. Joy. Education, Physical. Dr. Eaoriow. Electricity. Dr. Apjohn. Elephantiasis, Dr, Joy. Emetics, Dr. A. T. Thomson. Emmenagogues, Dr. A. T. Thomson _ Emphysema, Dr. R. Townsencl. " of the Lungs, Dr. R Townsend. Empyema, Dr. R. Townsend. Endemic diseases, Dr. Hancock CONTENTS OF VOLUME II. Fever, Infantile, Dr. Joy. " Hectic, Dr Brown. " Puerperal, Dr. Lee. " Yellow, Dr. Gilkrest. Fungus Haematodes, Dr Kerr. Enteritis, Drs. Stokes and Dunglison. Galvanism, Drs. Apjohn and DungH- Hiccup, Dr. Ash. Hemorrhage, Dr. Watson. Haemorrhoids, Dr. Burne. Hereditary Transmission of Disease, Dr. Brown. Herpes, Dr. A. T.Thomson. Ephelis, br. Todd. son. Epidemics. Dr. Hancock. Gastritis, Dr. Stokes. Epilepsy, Dr. Cheyne. Gastrodynia, Dr Barlow, Epistaxis. Dr. Kerr. Gastro-Enteritis, Dr. Stokes. Erethismus MercuriaMs, Dr. Burder. Glanders, Dr. Dunglison. Erysipelas, Dr. Tweedie. Glossitis, Dr. Kerr. Erythema, Dr. Joy. Glottis, Spasm of the, Dr. Joy, Eutrophic, Dr. Dunglison. Gout, Dr. Barlow. Exanthemata, Dr. Tweedie. Hrematemesis. Dr. Goldie. Expectorants, Dr. A. T. Thomson. Hajmoptysis, Dr. Law. Expectoration. Dr. Williams. Favus, Dr. A. T. Thomson. Feigned diseases, Drs. Scott, Forbes and Marshall. Fever, general doctrine of, Dr. Twee- die. . " Continued, and its modifica- tions, Dr. Tweedie. " Typhus, Dr. Tweedie. " Epidemic Gastric,iDr. Cheyne. " Intermittent, Dr. Brown. " Remittent, Dr Brown. " Malignant Remittent, Dr. Dun- glison. Hooping Cough Dr. Johnson. Hydatids. Dr. Kerr. Hydrocephalus, Dr. Joy. Hydropericardium, Dr. Darwall. Hydrophobia. Dr. Bardsley. Hydrothorax, Dr. DarwaJI. Hyperesthesia. Dr. Dunglison. Hypertrophy, Dr. Townsend. Hypochondriasis. Dr. Pritchard. Hysteria, Dr. Conolly. Headache, Dr. Burder. Ichthyosis. Dr. Thomson. Heart, Diseases of the, Dr. Hope. Identity, Dr. Montgomery. " Dilatation of the, Dr. Hope. Impetigo, Dr. A. T. Thomson. " Displacement of the, Dr. Impotence, Dr. Beatty. Townsend. Incubus, Dr. Williams. " Fatly and greasy degenera- Indigestion. Dr. Todd. tion of the, Dr. Hope. Induration, Dr. Carswell. " Hypertrophy of the. Dr. Hope. Infanticide, Dr. Arrowsmith. " Malformations of the, Dr. Wil- Infection, Dr. Brown. Hams Inflammation, Drs. Adair Crawford Polypus of the, Dr. Dunglison. Rupture of the, Dr. Townsend. Diseases of the Valves of the, Dr. Hope. and Tweedie. CONTENTS OF VOLUME III. Influenza, Dr. Hancock. Insanity, Dr. Pritchard. Intussusception, Dr. Dunglison. Irritation, Dr. Williams. Jaundice, Dr. Burder. •' of the Infant, Dr. Dunglison Kidneys, diseases of, Dr. Carter. Lactation, Dr. Locock. Laryngitis, Dr. Cheyne. " Chronic, Dr. Dunglison. Latent diseases, Dr. Christison. Lepra. Dr. Houghton. Medicine, State of in the 19th Cen- Leucorrhoea. Dr. Locock. tury, Dr. Alison. Lichen, Dr. Houghton. " Practical, Principles of, Liver, Diseases of the, Dr. Stokes. Dr. Conolly. Liver, Diseases of the, Dr. Venables. Metena. Dr. Goldie. " Inflammation of the, Dr. Melanosis, Dr. Carswell. Stokes. Menorrhagia, Dr. Locock. Malaria and Miasma, Dr. Brown. Menstruation, Pathology of, Dr. Lo- Medicine, History of, Dr. Bostock. cock. " American, before the Re- Miliaria, Dr. Tweedie. volution, Dr. J. B. Beck. Milk Sickness, Dr. Dunglison. 6 LEA & BLANCHARD'S PUBLICATIONS. Cyclopaedia of Practical Medicine, continued. CONTENTS OF VOLUME III— Continued. Mind, Soundness and Unsoundness Pancreas, diseases of the, Dr. Carter.Pneumothorax. Dr. Houghton. of, Drs. Pritchard andDunglison. Paralysis, Dr. Todd. Porrigo, Dr. A. T. Thomson. Molluscum, Dr. Dunglison. Parotitis, Dr. Kerr. Pregnancy and Delivery, signs Of, Mortification, Dr. Carswell, Parturients, Dr. Dunglison. Dr. Montgomery. Narcotics, Dr. A. T. Thomson. Pellagra, Dr. Kerr. Prognosis, Dr. Ash. Nauseants, Dr. Dunglison. Pemphigus, Dr. Corrigan. Prurigo, Dr. A. T. Thomson. Nephralgia and Nephritis, Dr. Carter. Perforation of the Hollow Viscera, Pseudo-Morbid Appearances, Dr. Neuralgia, Dr. Elliotson. Dr. Carswell. Todd. Noli-Me-Tangere or Lupus, Dr. Pericarditis, Dr. Hope. Psoriasis, Dr. Cumin. Houghton. Peritonitis, Drs. Mc Adam and Stokes. Ptyalism, Dr. Dunglison. Nyctalopia, Dr Grant. Phlegmasia Dolens, Dr. Lee. Puerperal Diseases, Dr. Marshall Obesity, Dr. Williams. Pityriasis, Dr. Cumin. Hall. CEdema, Dr. Darwall. Plague, Dr. Brown. Pulse, Dr. Bostock. Ophthalmia, Drs. Jacobs and Dungli-Plethora, Dr. Barlow."' Purpura, Dr. Goldie. son. Pleurisy. Dr. Law. Pus, Dr. Tweedie. Otalgia and Otitis, Dr. Burne. Plica Polonica, Dr. Corrigan. Pyrosis, Dr. Kerr. Ovaria, Diseases of the, Dr. Lee. Pneumonia, Dr. Williams. Rape, Dr. Beatty. Palpitation, Drs. Hope andDunglison. CONTENTS OF VOLUME IV. Refrigerants, Dr. A. T. Thomson. Statistics, Medical, Drs. Hawkins Toxicology, Drs. Apjohn and Dungli- Kheumatism, Drs. Barlow and Dun- and Dunglison. son. glison. Stethoscope/Dr. Williams. Transformations, Dr. Due&bury. Rickets, Dr. Cumin. Stimulants, Dr. A. T. Thomson. Transfusion. Dr. Kay. Roseola, Dr. Tweedie. Stomach, Organic Diseases of, Dr. Tubercle, Dr. Carswell. Rubeola, Dr. Montgomery. Houghton and Dunglison. Tubercular Phthisis, Sir James Clark. Kupia, Dr. Corrigan. Stomatitis, Dr. Dunglison. Tympanitis, Dr. Kerr. Scabies, Dr. Houghton. Strophulus, Dr. Dunglison. Urine, Incontinence of, Dr. Cumin. Scarlatina, Dr. Tweedie. Succession of Inheritance, Legitima- Urine, Suppression of, Dr. Carter. fecirrhus, Dr. Carswell. cy, Dr. Montgomery, Urine, Morbid States of, Dr. Bostock. Scorbutus, Dr. Kerr. Suppuration, Dr. Todd. Urine, Bloody, Dr. Goldie. bcrofula, Dr. Cumin. Survivorship, Dr. Beatty. Urticaria, Dr. Houghton. Sedatives, Drs. A. T. Thomson and Sycosis, Dr. Cumin. Uterus, Pathology of, Dr. Lee. Dunglison. Symptomatology, Dr. Marshall Hall. Vaccination, Dr. Gregory. It^'iPp"?. £!' ^' ^,eatty- Sr7ncop,e,' Dr- Ash- Varicella, Dr. Gregory. *)r. Joy. Veins, Diseases of, Dr. Lee. itchard. Ventilation, Dr. Brown. s—on. Wakefulness, Dr. Cheyne. asm, Dr. Pritchard Tetanus, Dr. Symonds. Waters Mineral, Dr. T.Thompson. Spermatorrhoea, Dr. Dunglison. Throat, Diseasesof the, Dr. Tweedie. Worms, Dr. Joy. Spinal Marrow, Diseases of the, Dr. Tissue Adventitious. Yaws Dr Kerr 1 c,Todi- *, „ Tonics, Dr. A. T.Thomson. Index! &c. Spleen, Diseases of the, Drs. Bigsby, Toothache, Dr. Dunglison. and Dunglison. The Publishers wish it to be particularly understood that this work not only embraces all the subjects properly belonging to PRACTICAL MEDICINE, but includes all the diseases and treatment of WOMEN AND CHILDREN, as well as all of particular importance on MATERIA MEDICA, THERAPEUTICS, AND MEDICAL JURISPRUDENCE, Thus presenting important claims on the profession from the greater extent of subjects .embraced in this than in other works on the mere practice ofr Medicine ; while, notwithstanding its BEAUTIFUL ■£■ J? UTJ°N> its REMARKABLE CHEAPNESS places it within the reach of all. LEA & BLANCHARD'3 PUBLICATIONS. Cyclopaedia of Practical Medicine, continued. The Publishers present a few of the notices which the work has received from the press in this country and in England. We rejoice that this work is to be placed within great extent and usefulness."—Dr. Barlow's Address the reach of the profession in this country, it being to the Med. and Sur. Association. unquestionably one of very great value to the practi- " For reference, it is above all price to every practi- tioner. This estimate of it has not been formed from tioner."— The Western Lancet. a hasty examination, but after an intimate acquaint- "This Cyclopedia is pronounced on all hands to be ance derived from frequent consultation of it during one of the most valuable medical publications of the the past nine or ten years. The editors are practition- day. It is meantto be a library of Practical Medicine. era of established reputation, and the list of contribu- As a work of reference it is invaluable. Among the tors embraces many of the most eminent professors contributors to its pages, it numbers many of the most and teachers of London, Edinburgh, Dublin and Glas- experienced and learned physicians of the age, and as gow. It is, indeed, the great merit of this work that a whole it forms a compendium of medical science the principal articles have been furnished by practi- and practice from which practitioners and students tioners who have not only devoted especial attention may draw the richest instruction.''— Western Journ. to the diseases about which they have written, but of Med. and Surgery. have also enjoyed opportunities for an extensive prac- "The contributors are very numerous, including tical acquaintance with them, and whose reputation the most distinguished physicians in the kingdom. carries the assurance of their competency justly to The design of the work embraces practical articles of appreciate the opinions of others, while it stamps their judicious length in Medicine, Therapeutics, Hygiene, own doctrines with high and just authority."—Ameri- &c, so that, within a small compass, and of easy re- con Medical Journal. ference, the student possesses a complete library, "Do young physicians generally know what a trea- composed of the highest authorities. To the country sure is offered to them in Dr. Dunglison's revised edi- practitioner, especially, a publication of this kind is tion? Without wishing to be thought importunate, we of inestimable value."— U. S. Gazette. cannot very well refrain from urging upon them the "When it is considered that this great work em- claims of this highly meritorious undertaking."—Bos- braces three hundred original essays, from sources of ton Medical and Surgical Journal. the highest authority, we cannot but hope that our " It has been to us, both as learner and teacher, a medical friends will offer all the requisite encourage- work for ready and frequent reference, one in which ment to the publishers."—Boston Medical and Sur- modern English medicine is exhibited in the most gical Journal. advantageous light, and with adaptations to various "In our last number we noticed the publication of tastes and expectations."—Medical Examiner. this splendid work by Lea & Blanchard. We have " Such a work as this has long been wanting in this since received three additional parts, an examination country. British medicine ought to have set itself of which has confirmed us in our first impression, that forth in this way much sooner. We have often won- as a work of reference for the practitioner—as a Cyclo- dered that the medical profession and the enterprising psedia of Practical Medicine—it is admirably adapted publishers of Great Britain did not, long ere this, to the wants of the American profession. In fact, it enter upon such an undertaking as a Cyclopedia of might advantageously find a place in the library of Practical Medicine."—London Medical Gazette. any gentleman, who has leisure and taste for looking "It is what it claims to be, a Cyclopedia, in which somewhat into the nature, causes, and cure of dis- Practical Medicine is posted up to the present day, eases."— Western Journal of Med. and Surgery. and as such constitutes a storehouse of medical know- "The favourable opinion which we expressed on ledge upon which the student and practitioner may former occasions from the specimens then before us, draw with equal advantage."—The Western Journal is in no degree lessened by a further acquaintance of Medicine and Surgery. with its scope and execution."— Medical Examiner. "The Cyclopedia of Practical Medicine, a work "The Cyclopedia must be regarded as the most which does honour to our country, and to which one complete work of Practical Medicine extant; or, at is proud to see the names of so many provincial phy- least in our language. The amount of information on sicians attached."—Dr. Hastings' Address to Pro- every topic which it embraces, is posted up to the vincial Medical and Surgical Association. present time; and so far as we are able to judge, it is " Of the medical publications of the past year, one generally more free from natural exclusiveness and may be more particularly noticed, as partaking, from prejudices, than is usually the case with British pub- its extent and the number of contributors, somewhat lications. The getting up of the American edition is of the nature of a national undertaking, namely, the very creditableto the Publishers. It will compare very 'Cyclopedia of Practical Medicine.' It accomplishes favourably with the English edition. In some re- what has been noticed as most desirable, by present- spects.it is much to be preferred. During the original ing, on several important topics of medical inquiry, publication, many of the articles not being in readi- full, comprehensive, and well-digested expositions, ness to be printed in proper alphabetical order, it be- showing the present state of our knowledge on each, came necessary to include them together in a single In this country, a work of this kind was much wanted: volume, as a supplement to the work. This difficulty and that now supplied cannot but be deemed an im- is obviated in the American edition. On the whole, portant acquisition. The difficulties of the undertak- we advise those who desire a compendious collection ing were not slight, and it required great energies to of the latest and most important information in the surmount them. These energies, however, were pos- various departments of Practical Medicine, including sessed by the able and distinguished editors, who, Midwifery, Materia Medica, Medical Jurisprudence, with diligence and labour such as few can know or &c, to possess themselves of this work."—The Bvf- appreciate, have succeeded in concentrating in a work falo Medical Journal. of moderate size, a body of practical knowledge of * * In reply to the numerous inquiries made to them respecting Tweedie's Library of Practical Medicine, the Publishers beg leave to state that its place is supplied, in a great measure, by the Cyclopaedia of Practical Medicine, a work much more extended in its plan and execution. The works are entirely distinct and by different authors. The " Library"consists of essays on diseases, systematically arranged. The " Cyclopaedia" embraces these subjects treated in a more extended manner, together with numerous interesting essays on all important points of Medical Jurispru- dence, Materia Medica, Therapeutics, Diseases of Women and Children, History of Medicine, &c, fc»» hv thn first Dhvsicians of England, the whole arranged alphabetically for easier reference. LEA & BLANCHARD'S PUBLICATIONS. WATSON'S PRACTICE NEW AND IMPROVED EDITION. Now Beady, LECTURES PHYSIC, DELIVERED AT KING'S COLLEGE, LONDON. By THOMAS WATSON, M. D., &c. &c. SECOND AMERICAN, FROM THE SECOND LONDON EDITION. REVISED, WITH ADDITIONS, By D. FRANCIS CONDIE, M. D., Author of a work on the "Diseases of Children," &c. In one Octavo Volume. Of nearly eleven hundred large pages, strongly bound with raised bands. The rapid sale of the first edition of this work is an evidence of its merits, and of its general favour with the American practitioner. To commend it still more strongly to the profession, the publishers have gone to a great expense in preparing this edition with larger type, finer paper, and stronger binding, with raised bands. It is edited with reference par- ticularly to American practice, by Dr. Condie; and with these numerous improvements, the price is still kept so low as to be within the reach of all, and to render it among tne cheapest works offered to the profession. It has been received with the utmost favour by the medical press, both of this country and of England, a few of the notices of which, together with a letter from Professor Chapman, are submitted. " We know of no work better calculated for being " We find that, from the great length we have gone placed in the hands of the student, and for a text book, in our analysis of this work, we must close our notice and as such we are sure it will be very expensively of it here for the present—not, however, without ex- adopted. On eveTy important point the author seems pressing our unqualified approbation of the manner in i£eJ?08}er Up ■ knowledg« lo the day."—Anuri- which the author has performed his task. But it is as Ca?^„.l'c t - r ^ „r a book of elementary instruction that we admire Dr. in tne lectures of Dr. Watson, now republished .Watson's work.''—Medico-Chirurgical Review. TuL a large and c osely-prmted volume, we have " One of the most practically useful books that ever *ffi| cl?cln»e.a<>.d Practice of medicine well cal- was presented to the student-indeed a more admira- -Rullitin nf M.j;,„i cr ■ "----—~« «. ^.v,.j age, m aa.y uus uui uppeareu lor very many years, int -\vTrJ{rT^TlT,nCe- , , lecturer proceeds through the whole classification of r .uli, 21 , Lectures as the best exposition human ills, a capite ad calcem, showing at every step •k» oni w f. anJ We rememher «o have read, an extensive knowledge of his subject, with the ability i „ };<■ r f^uredly master of his art. His has of communicating his precise ideas in a style remark- l)een a lite ot observation and study, and in this work able for its clearness and simplicity." -2V . Journal he has given us the matured results of these mental of Medicine and Surgery. ' efforts."—^Vew Orleans Medical Journal. LEA & BLANCHARD'S PUBLICATIONS. 9 WATSON'S PRACTICE—Continued. Philadelphia, September 21th, 1S44. Watson's Practice of Physic, in my opinion, is among the most com- prehensive works on the subject extant, replete with curious and important matter, and written with great perspicuity and felicity of manner. As calculated to do much good, I cordially recommend it to that portion of the profession in this co-untry who may be influenced by my judgment. N. CHAPMAN, M.D. Professor of the Practice and Theory of Medicine in the University of Pennsylvan ia. " We know not, indeed, of any work of the same " We are free to state that a careful examination of size that contains a greater amount of interesting and this volume has satisfied us that it merits all the corn- useful matter The author is evidently well acquainted mendation bestowed on it in this country and at with everything appertaining to the principles and home. It is a work adapted to the wants of yoi-ng practice of medicine, and has incorporated the stores practitioners, combining, as it does, sound princip es of his well stocked mind, in the work before us. so and substantial practice. It is not too much 10 say ably and agreeably, that it is impossible for the inte- that it is a representative of the actual slate of medi- rest of the reader to flag for a moment. That they are cine as taught and practised by the most eminent phy- well adapted for such a purpose all must admit; but sicians of the present day, and as such we would their sphere of usefulness may extend much beyond advise every one about embarking in the practice of this. We are satisfied, indeed, that no physician, well physic to provide himself with a copy of it."—Western read and observant as he may be,can rise from their Journal of Medicine and Surgery. perusal without having aaded largely to his stock of "It is the production of a physician of undoubted valuable information."—Medical Examiner. talent and great learning, and whose industry in per- "The medical literature of this country has been forming the most laborious duties of this profession enriched by a work of standard excellence, which we has been well known for a long series of years. * * can proudly hold up to our brethren of other countries Let us not forget to add that the style and general as a representative of the natural state of British me- character of the work are peculiarly practical; and dicine, as professed and practised by our most en- the cases which Dr. Watson has from time to time lightened physicians. And, for our own parts, we are introduced to illustrate his views, are highly appro- notonly willing that our characters as scientific phy- priate and interesting, and add much to the value of sicians and skilful practitioners may be deduced irom the work; and this certainly must be admitted to be the doctrines contained in this book, but we hesitate one of the great advantages of casting this work in not to declare our belief that for sound, trustworthy the shape of lectures, in which these cases assuredly principles, and substantial good practice, it cannot be appear more fitly, and in which-they are introduced paralleled by any similar production in any other more easily and naturally than they could have been country. * * * * VV'e would advise no one to set had the form of the work been different. Lastly, we himself down in practice unprovided with a copy."— are well pleased to observe that a strong vein of British and Foreign Medical Review. common sense, as well as good tuste, runs through "We cannot refrain from calling the attention of the whole treatise, and sustains both the interest and our younger brethren, as soon as possible, to Dr. Wat- the confidence of the reader throughout."—Edinburgh son's Lectures, if they want a safe and comprehensive Medical and Surgical Journal. guide to the study of practical medicine. " In calling the attention of the profession lo the ele- "In fact, to any of our more advanced brethren who gant volume recently published by Lea & Blanehard wish to possess a commodious book of reference on —the lectures delivered at King's College. London, by any of the topics usually treated of in a course of lee- Dr. Watson—we do not suppose, any one at all con- tures on the practice of physic, or who wish to have versant with the medical literature of the day to be a simple enunciation of any facts or doctrines which, unacquainted with its general character. Dr. VV. de- from their novelty or their difficulty, the busy practi- livered these now celebrated lectures during the me- tioner may not have made himself master of amidst dical session of J836-7. They have been revised by the all-absorbing toils of his professional career, we the author, and those who now study these erudite can recommend these lectures most cordially. Here productions will have them divested of any objecu'on- we meet with none of those brilliant theories which able matter that might have formerly crept in through are so seductive to young men, because they are made inadvertence. There are ninety lectures, fully written, to explain every phenomenon, and save all the trouble embracing the whole domain of human maladies, with of observation and reflection; here are no exclusive their treatment, besides an appendix particularly re- doctrines; none of those markable for its richness in important practical infor- mation. We could not give even a tolerable svnopsis 'Bubbles that glitter as they rise and break 0f ,ne subjects discussed in this gre»t undertaking On vain Philosophy's all babbling spring.' without materially entrenching on the limits assigned But we have the sterling production of a liberal, well- to other matter. * * * Open this huge, well-finished stored arid truly honest mind, possessed of all that is volume wherever we may, the eye immediately rests currently known and established of professional know- on something that carries value on its front. We are ledge, and capable of pronouncing a trustworthy and impressed at once with the strength and depih of the impartial judgment on those numerous points in which lecturer's views; he gains on our admiration in pro- Truth is yet obscured with false facts or false hypo- portion to the extent of our acquaintance with Ins tl,eses "—Provincial Medical Journal. profound researches. Whoever owns this book will "The style is correct and pleasing, and the matter have an acknowledged treasure, if the combined wis- worthy the attention of all practitioners, young and dom of the highest authorities is appreciated."— Baton Old."— Western Lancet. Medical and Surgical Jou mal. HORNER'S^NATOMIT. SPECIAL ANATOMY AND HISTOLOGY. BY WILLIAM E. HORNER, M.D., Professor of Anatomy in the University of Pennsylvania, Member of the Imperial Medico-Chirurgical Academy of St. Petersburg, of the Am. Philosophical Society, &c., &c. Sixth Edition, in two Volumes, 8to. "Another edition of this standard work of Professor Horner has made its appearance to which many additions have been made, and upon which much labour has been bestowed by the author.— The additions are chiefly in the department of Histology, or Elementary Anatomy, and so import- ant are they that the Professor has added the term to the title of his work. Every part of this edition seems to have undergone the most careful revision, and its readers may rest assured of hav- ing the science of Anatomy fully brought up to the present day."—Am. Med. Journal. A X&AGOTFXCENT AND CHEAP WORK. SMITH & HORNER'S ANATOMICAL ATLAS. Just Published, Price Five Dollars in Parts. AN ANATOMICAL ATLAS ILLUSTRATIVE OF THE STRUCTURE OF THE HUMAN BODY. BY HENRY H. SMITH, M.D., Fellow of the College cf Physicians, %c UNDER THE SUPERVISION OF WILLIAM E. HORNER, M.D., Professor of Anatomy in the University of Pennsylvania. In One large Volume, Imperial Octavo. This work is but just completed, having been delayed over the time intended by the great difficulty in giving to the illustrations the desired finish and perfection. It consists of five parts, whose contents are as follows: Part I. The Bones and Ligaments, with one hundred and thirty engravings. Part II. The Muscular and Dermoid Systems, with ninety-one engravings. Part III. The Organs of Digestion and Generation, with one hundred and ninety-one engravings. Part IV. The Organs of Respiration and Circulation, with ninety-eight engravings. Part V. The Nervous System and the Senses, with one hundred and twenty-six engravings. Forming altogether a complete System of Anatomical Plates, of nearly SIX HUNDRED AND FIFTY FIGURES, executed in the best style of art, and making one large imperial octavo volume. Those who do not want it in parts can have the work bound in extra cloth or sheep at an extra cost. This work possesses novelty both in the design and the execution. It is the first attempt to apply engraving on wood, on a large scale, to the illustration of human anatomy, and the beauty of the parts issued induces the publishers to flatter themselves with the hope of the perfect success of their undertaking. The plan of the work is at once novel and convenient. Each page is perfect in itself, the references being immediately under the figures, so that the eye takes in the whole at a glance, and obviates the necessity of continual reference backwards and forwards. The cuts are selected from the best and most accurate sources; and, where neces- sary, original drawings have been made from the admirable Anatomical Collection of the University of Penn- sylvania. It embraces all the late beautiful discoveries arising from the use of the microscope in the investi- gation of the minute structure of the tissues. In the getting up of this very complete work, the publishers have spared neither pains nor expense, and they now present it to the profession, with the full confidence that it will be deemed all that is wanted in a scientific and artistical point of view, while, at the same time, its very low price places it within the reach of all. It is particularly adapted to supply the place of skeletons or subjects, as the profession will see by examining Hie list of plates now annexed. "These figures are well selected, and present a complete and accurate representation of that wonderful fabric, the human body. The plan of this Atlas, which renders it so peculiarly convenient for the student, and its superb artistical execution, have been already pointed out. We must congratulate the student upon the completion of this atlas, as it is the most convenient work of the kind that has yet appeared; and, we must add, the very beautiful manner in which it is 'got up' is so creditable to the country as to be flattering to our national pride."—American Medical Journal. "This is an exquisite volume, and a beautiful specimen of art. We have numerous Anatomical Atlases, but we will venture to say that none equal it in cheapness, and none surpass it in faithfulness and spirit- We strongly recommend to our friends, both urban and suburban, the purchase of this excellent work, for which both editor and publisher deserve the thanks of the profession."—Medical Examiner. " We would strongly recommend it, not only to the student, but also to the working practitioner, who, although grown rusty in the toils of his harness, still has the desire, and often the necessity, of refreshing his knowledge in this fundamental part of the science of medicine.^'—New York Journal of Medicine and Surg. " The plan of this Atlas is admirable, and its execution superior to any thing of the kind before published in this country. It is a real labour-saving affair, and we regard its publication as the greatest boon that could be conferred on the student of anatomy. It will be equally valuable to the practitioner, by affording him an easy means of recalling the details learned in the dissecting room, and which are soon forgotten."—American Medi- cal Journal. " It is a beautiful as well as particularly useful design, which should be extensively patronized by physicians, surgeons and medical students."—Boston Med. and Surg. Journal. '• It has been the aim of the author of the Atlas to comprise in it the valuable points of all previous works to embrace the latest microscopical observations on the anatomy of the tissues, and by placing it at a moderate price to enable all to acquire it who may need its assistance in the dissecting or operating room or other field of practice."— Western Journal of Med. and Surgery. ' "These numbers complete the series of this beautiful work, which fully merits the praise bestowed upon the earlier numbers. We regard all the engravings as possessing an accuracy only equalled by their beautv and Sur™ lly recommend th* work to all engaged in the study of anatomy."—New York Journal of Medici, * l,-^„H^»le^n!W°r7k,han,tlVe,?nJe- Kore)lsc.c°»l°' n« easily be placed by a physician upon the table of Ins student."—Western Journal of Medicine and Surgery. ." ™f,™er5 !IJuch,plea.s^1wito Part I but the Second Part gratifies us still more, both as regards the attract- ive nature of the subject, (The Dermoid and Muscular Systems,) and the beautiful artistical execution of the .(lustrations. We have here delineated the most accurate microscopic views of some of the tissues, as for instance, the cellular and adipose tissues, the epidermis, rete mucosum and cutis vera, the sebaceous anri perspiratory organs of the skin, the perspiratory glands and hairs of the skin, and the hair and nails Then .ollows the general anatomy of the muscles, and, lastly, their separate delineations. We would recomm.'n I this Anatomical Atlas to our readers in the very strongest terras."—New York Journal of Medicine and Sur LIST OF THE ILLUSTRATIONS EMBRACING SIX HUNDRED AND THIRTY-SIX FIGURES IN SMITH AND HORNER'S ATLAS. A HlGHLY-riNISHED VlEW OF THE BoNES OF THE HEAD, View of Cuvier's Anatomical Theatre,..... facing the title-page . . . . vignette Fig. I Front view of adult skeleton. 2 Back view of adult skeleton. S Foetal skeleton. 4 Cellular structure of femur. 5 Cellular and compound structure of tibia. 6 Fibres of compact matter of bone. 7 Concentric lamella? of bone. 8 Compact matter under the microscope. 9 Haversian canals and lacuna? of bone. 10 Vessels of compact matter. 11 Minute structure of bones. 12 Ossification in cartilage. 13 Ossification in the scapula. 14 Puncta ossificationis in femur. 15 Side view of the spinal column. 16 Epiphyses and diaphysis of bone. 17 External periosteum. 18 Punctum ossificationis in the head. 19 A cervical vertebra. 20 The atlas. 21 The dentata. 22 Side view of the cervical vertebrae. 23 Side, view of the dorsal vertebras. 24 A dorsal vertebra. 25 Side view of the lumbar vertebra. 26 Side view of one of the lumbar vertebra. 27 Perpendicular view of the lumbar vertebrae. 28 Anterior view of sacrum. 29 Posterior view of sacrum. 30 The bones of the coccyx. 31 Outside view of the innominatum. 32 Inside view of the innominatum. S3 Anterior view of the male pelvis. 34 Anterior view of the female pelvis. 35 Front of the thorax. 36 The first rib. 37 General characters of a rib. 38 Front view of the sternum. 39 Head of a Peruvian Indian. 40 Head of a Choctaw Indian. 41 Front view of the os frontis. 42 Under surface of the os frontis. 4S Internal surface of the os frontis. 44 External surface of the parietal bone.s 45 Internal surface of the parietal bone. 46 External surface of the os occipitis. 47 Internal surface of the os occipitis. 48 External surface of the temporal bone. 49 Internal surface of the temporal bone. 50 Internal surface of the sphenoid bone. 51 Anterior surface of the sphenoid bone. 52 Posterior surface of the ethmoid bone. 53 Front view of the bones of the lace. 54 Outside of the upper maxilla. 55 Inside of the upper maxilla. 56 Posterior surface of the palate bone. 57 The nasal bones. ■ 58 The os unguis. 59 Inferior spongy bone. 60 Right malar bone. 61 The vomer. 62 Inferior maxillary bone PART I.—BONES AND LIGAMENTS. Fig. 64 Sutures of the posterior of the cranium. 65 Diploe of the cranium. 66 Inside of the base of the cranium. 67 Outside of the base of the cranium. 68 The facial angle. 69 The fontanels. 70 The os hyoides. 71 Posterior of the scapula. 72 Axillary margin of the scapula. 73 The clavicle. 74 The humerus. 75 The ulna. 76 The radius. 77 The bones of the carpus. 78 The bones of the hand. 79 Articulation of the carpal bones. 80 Anterior view of the femur. 81 Posterior view of the femur. 82 The tibia. 83 The fibula. 84 Anterior view of the patella. 85 Posterior view of the patella. 86 The os calcis. 87 The astragalus. 88 The naviculare. 89 The cuboid bone. 90 The three cuneiform bones. 91 Top of the foot. 92 The sole of the foot. 93 Cells in cartilage. 94 Articular cartilage under the microscope. 95 Costal cartilage under the microscope. 96 Magnified section of cartilage. 97 Magnified view of fibro-cartilage. 98 White fibrous tissue. 99 Yellow fibrous tissue. 100 Ligaments of the jaw. 101 Internal view of the same. 102 Vertical section of the same. 103 Anterior vertebral ligaments. 104 Posterior vertebral ligaments. 105 Yellow ligaments. 106 Costo-vertebral ligaments. 107 Occipito-altoidien ligaments. 108 Posterior view of the same. 109 Upper part of the same. 110 Moderator ligaments. Ill Anterior pelvic ligaments. 112 Posterior pelvic ligaments. 113 Sterno-clavicular ligaments. 114 Scapulo-humeral articulation. 115 External view of elbow joint. 116 Internal view of elbow joint 117 Ligaments of the wrist. 118 Diagram of the carpal synovial membrane 119 Ligaments of the hip joint. 120 Anterior view of the knee joint 121 Posterior view of the knee joint. 122 Section of the right knee joint 123 Section of the left knee joint. 124 Internal side of the ankle joint. 125 External side of the ankle joint 126 Posterior view of the ankle joint 127 Ligaments of the sole of the foot 128 Vertical section of the foot 63 Sutures of the vault of the cranium. PART II.—DERMOID AND MUSCULAR SYSTEMS. 129 Muscles on the front of the body, full length. ISl Muscles on theback of the body,/«« length. 130 The cellular tissue. 132 Fat vesioles. 133 Blood-vessels of fat 134 Cell membrane of fat vesicles. 135 Magnified view of the epidermis. Illustrations to Smith and Horner's Alias, continued. Fig. 130 Cellular tissue of the skin. 137 Rete mucosum, &c, of foot. 138 Epidermis and rete mucosum. 139 Cutis vera, magnified. 140 Cutaneous papillae. 141 Internal face of cutis vera. 142 Integuments of foot un"t 513 Posterior view of the spinal marrow, Sic. 514 Decussation of Mitischelli. 515 Origins of the spinal nerves. 516 Anterior view of spinal marrow and nerves. 517 Posterior view of spinal marrow and nerves. 518 Anterior spinal commissure. 519 Posterior spinal commissure. 520 Transverse section of the spinal marrow. 521 Dura mater and sinuses. 522 Sinuses laid open. 523 Sinuses at the base of the cranium. 524 Pons Varolii, cerebellum, Sec. 525 Superior face of the cerebellum. 526 Inferior face of the cerebellum. 527 Another view of the cerebellum. 528 View of the arbor vita, Sic. 529 Posterior view of the medulla oblongata. 530 A vertical section of the cerebellum. 531 Another section of the cerebellum. 532 Convolutions of the cerebrum. 533 The cerebrum entire. 534 A section of its base. 535 The corpus callosum entire. 536 Diverging fibres of the cerebrum, &c. 537 Vertical section of the head. 538 Section of the corpus callosum. 539 Longitudinal section of the brain. 540 View of a dissection by Gall. 541 The commissures of the brain. 542 Lateral ventricles. 543 Corpora striata-fornix, Sic. 544 Fifth ventricle and lyra. 545 Anotherjjview of the lateral ventricles. 546 Another view of the ventricles. 547 Origins of the 4th and 5th pairs of nerves. 548 The circle of Willis. 549 A side view of the nose. 550 The nasal cartilages. 551 Bones and cartilages of the nose. 552 Oval cartilages, Sic. 553 Schneiderian membrane. 554 External parietes of the left nostril. 555 Arteries of the nose. 556 Pituitary membrane injected. 557 Posterior ewes. 558 Front view of the eye. 559 Side view of the eye. 560 Posterior view of the eyelids, Sic. 561 Glandula palpebrarum. 562 Lachrymal canals. 563 Muscles of the eyeball. 564 Side view of the eyeball. 565 Longitudinal section of the eyeball. 566 Horizontal section of the eyeball. 567 Anterior view of a transverse section. 568 Posterior view of a transverse section. 569 Choroid coat injected. 570 Veins of the choroid coat. 571 The iris. 572 Theiref'ia and lens. 573 External view of the same. 574 Vessels in the conjunctiva. 575 Retina, injected and magnified. 576 Iris, highly magnified. 577 Vitreous humour and lens. 578 Crystalline adult lens. 579 Lens of the foetus, magnified. 580 Side view of the lens. 581 Membrana pupillaris. 582 Another view of the same. 583 Posterior view of the same. 584 A view of the left ear. 585 Its sebaceous follicles. 586 Cartilages of the ear. 587 The same with its muscles. 588 The cranial side of the ear. 589 Meatus auditorius externus, &c. 590 Labyrinth and bones of the ear. 591 Full view of the malleus. 592 The incus. 593 Another view of the malleus. 594 A front view of the stapes. 595 Magnified view of the stapes. 596 Magnified view of the incus. 597 Cellular structure of the malleus. 598 Magnified view of the labyrinth. 599 Natural size of the labyrinth. 600 Labyrinth laid open and magnified. 601 Labyrinth, natural size. 602 Labyrinth of a foetus. 603 Another view of the same. 604 Nerves of the labyrinth. 605 A view of the vestibule, Sec. 606 Its soft parts, Sic. 607 An ampulla and nerve. 608 Plan of the cochlea. 609 Lamina spiralis, Sec. 610 The auditory nerve. 611 Nerve on the lamina spiralis. 612 Arrangement of the cochlea. 613 Veins of the cochlea, highly magnified. 614 Opening of the Eustachian tube in the throat 615 Portio mollis of the seventh pair of nerves. 616 The olfactory nerves. 617 The optic and seven other pairs of nerves. 618 Third, fourth and sixth pairs of nerves. 619 Distribution of the fifth pair. 620 The facial nerve. 621 The hypo-glossal nerves. 622 A plan of the eighth pair of nerves. 623 The distribution of the eighth pair. 624 The great sympathetic nerve. 625 The brachial plexus. 626 Nerves of the front of the arm. 627 Nerves of the back of the arm. 628 Lumbar and ischiatic nerves. 629 Posterior branches to the hip, Sec. 630 Anterior crural nerve. 631 Anterior tibial nerve. 632 Branches of the popliteal nerve. 633 Posterior tibial nerve on the leg. 634 Posterior tibial nerve on the foot, LEA & BLANCHARD'S PUBLICATIONS. 15 ____________• _________^__^______________________ PROFESSOR DUNGLISON'S WORK?. The Workq of Professor Dunglison on various departments of Medicine are here presented.— Nearly all of them are extensively used as text books in the branches of science to which they re- late, and the profession and students may rely upon the great care and accuracy of the author in foavmg each new edition of his works posted up to the day of publication. A MEW EDITION OP THE STANDARD MEDICAL DICTIONARY. A DICTIONARY OF "MEDICAL SCIENCE; CONTAINING A CONCISE ACCOUNT OF THE VARIOUS SUBJECTS AND TERMS, WITH THE FRENCH AND OTHER SYNONYMES, NOTICES OF CLIMATES AND OF CELE- BRATED MINERAL WATERS, FORMULA FOR VARIOUS OFFICINAL AND EMPIRI- CAL PREPARATIONS, &c. Fifth Edition, Extensively Modified and Improved over former Editions. BY ROBLEY DUNGLISON, M.D. ProfessoTof the Institutes of Medicine, &c., in Jefferson Medical College, Philada.; Secretary to the American Philosophical Society, &c., &c. In one large royal octavo volume of nearly 800 double columned pages, and bound with raised bands. The author's object has not been to make the work a mere Lexicon, or Dictionary of terms, but to afford, under each, a condensed view of its various medical relations, and thus to render the worka complete epitome of the existing condition of medical science. This he hasbeenln a great measure enabled to do, as the work is not stereotyped, by adding in each successive edition all new and interesting matters or whatever of importance had been formerly omitted. To show the advantage of this, it need only be remarked that in the present work will be found at least two thousand subjects and terms not embraced in the third edition. " To execute such a work requires great erudition, unwearied industry, and extensive research; and we know no one who could bring to the task higher qualifications of this description than Pro- fessor Dunglison."—American Medical Journal. DUNGLISON'S PRACTICE, A NEW EDITION, THE PRACTICE OF MEDICINE. OR A TREATISE ON SPECIAL PATHOLOGY AND THERAPEUTICS. BY ROBLEY DUNGLISON, M.D., Second Edition, carefully Revised and with Additions. In Two Large Octavo Volumes of over thirteen hundred pages. The Publishers annex a condensed statement of the Contents:—Diseases of the Mouth, Tongue, Teeth, Gums, Velum Palati and Uvula, Pharynx and (Esophagus, Stomach, Intestines, Peritoneum, Morbid Productions in the Peritoneum, and Intestines.—Diseases of the Larynx and Trachea, Bron- chia and Lungs, Pleura, Asphyxia.—Morbid conditions of the Blood, Diseases of the Heart and Membranes, Arteries, Veins, Intermediate or Capillary Vessels,—Spleen, Thyroid Gland, Thymus Gland, and Supra Renal Capsules, Mesenteric Glands,—Salivary Glands, Pancreas, Biliary Appara- tus, Kidney, Ureter, Urinary Bladder.—Diseases of the Skin, Exanthematous, Vesicular, Bullar, Pustular, Papular, Squamous, Tuberculous, Maculae, Syphilides.—Organic Diseases of the Nervous Centres, Neuroses, Diseases of the Nerves.—Diseases of the Eye, Ear, Nose.—Diseases of the Male and Female Organs of Reproduction. Fever,—Intermittent, Remittent, Continued, Eruptive, Arthritic.—Cachexies, Scrofulous, Scorbutic, Chlorotic, Rhachitic, Hydropic and Cancerous. This work has been introduced as a text-book in many of the Medical Colleges, and the general favour with which it has been received, is a guarantee of its value to the practitioner and student. " In the volumes before us, Dr. Dunglison has proved that his acquaintance with the present facts and doctrines, wheresoever originating, is most extensive and intimate, and the judgment, skill, and impartiality with which the materials of the work have been collected, weighed, arranged, and exposed, are strikingly manifested in every chapter. Great care is everywhere taken to indicate the source of information, and under the head of treatment, formula? of the most appropriate reme- dies are everywhere introduced. We congratulate the students and junior practitioners of Ame- rica on possessing in the present volumes, a work of standard merit, to which they may confidently refer in their doubts and difficulties."—British and Foreign Medical Review, for July, 1842. " Since the foregoing observations were written, we have received a second edition of Dungli- son's work, a sufficient indication of the high character it has already attained in America, and justly attained."—British and Foreign Medical Review, for October, 1844. " We hail the appearance of this work, which has just been issued from the prolific press of Messrs. Lea & Blanchard of Philadelphia, with no ordinary degree of pleasure. Comprised in two large and closely printed volumes, it exhibits a more full, accurate, and comprehensive digest of the existing state of medicine than any other treatise with which we are acquainted in the English language. It discusses many topics—some of them of great practical importance, which are en- tirely omitted in the writings of Eberle, Dewees, Hosack, Graves, Stokes, Mcintosh, and Gregory ; and it cannot fail, therefore, to be of great value, not only to the student, but to the practitioner, as it affords him ready access to information of which he stands in daily need in the exercise of his profession."—Louisville Journal. 16 LEA & BLANCHARD'S PUBLICATIONS. PROFESSOR DUNGLISON'S WORKS—Continued. GENERAL THERAPEUTICS km MATERIA MEDICA, ADAPTED FOR A MEDICAL TEXT-BOOK. BY ROBLEY DUNGLISON, M.D., In two Volumes, 8vo. " The subject of Materia Medica has been handled by our author with more than usual judgment. The greater part of treatises on that subject are, in effect expositions of the natural and chemical history of the substances used in medicine, with very brief notices at all of the indications they are capable of fulfilling, and the general principles of Therapeutics. Dr. Dunglison, very wisely, in our opinion, has reversed all this, and given his principal attention to the articles of the Materia Medica as medicines.....In conclusion, we strongly recommend these volumes to our readers.— No medica] student on either side of the Atlantic should be without them."—Forbes' British and Foreign Medical Review. " Our junior brethren in America will find in these volumes of Professor Dunglison a ' Thesau- rus Medicaminum,' more valuable than a large purse of gold."—Medico-Chirurgical Review, for January, 1845. WITH UPWARDS OF THREE HUNDRED ILLUSTRATIONS, BY ROBLEY DUNGLISON, M.D., Fifth Edition, Greatly Modified and Improved, in 2 Vols, of 1304 Large Octavo Pages. " We have on two former occasions, brought this excellent work under the notice of our readers, and we have now only to say that, instead of falling behind in the rapid march of physiological science, each edition brings it nearer to the van. Without increasing the bulk of the treatise, the author has contrived to introduce a large quantity of new matter into this edition from the works of Valentin, BischofF, Henle, Wildebrand, Muller, Wagner, Mandl, Gerber, Liebig, Carpenter, Todd and Bowman, as well as from various monographs which have appeared in the Cyclopaedias, Trans- actions of learned societies and journals. The large mass of references which it contains renders it a most valuable bibliographical record, and bears the highest testimony to the zeal and industry of the author."—British and Foreign Medical Review. " Many will be surprised to see a fifth edition of this admirable treatise so rapidly succeeding the fourth. But such has been the rapid progress of physiology within a short period that to make his work a fair reflection of the present state of the science, no less than an account of its extensive popularity, Dr. Dunglison has found it necessary to put forth a new edition with material modifica- tions and additions. To those who may be unacquainted with the work, we may say that, Dr. D. does not belong to the mechanical, chemical, or vital school exclusively ; but that, with a discri- minating hand he culls from each and all, making his treatise a very excellent and complete digest of the vast subject."—Western Journal of Medicine and Surgery, NEW REMEDIES, PHARMACEUTIGAllY AND THERAPEUTICALLY CONSIDERED, BY ROBLEY DUNGLISON, M.D., In One Volume, Octavo, over 600 pages, the Fourth Edition. Or, the Influence of Atmosphere and Locality, Change of Air and Climate, Seasons, Food, Clothing, Bathing and Mineral Springs, Exercise, Sleep, Corporeal and Intellectual Pursuits, &a, &c, on Healthy Man: Constituting x ELEMENTS OF HYGIENE. BY ROBLEY DUNGLISON, M.D. A New Edition with many Modifications and Additions. In One Volume, Svo. "We have just received the new edition of this learned work on the « Elements of Hygiene.'— Dr. Dunglison is one of the most industrious and voluminous authors of the day. How°he finds time to amass and arrange the immense amount of matter contained in his various works, is almost above the comprehension of men possessing but ordinary talents and industry. Such labour de- serves immortality."—St. Louis Med. and Surg. Journal. A NEW EDITION OF THE MEDICAL STUDENT, OR AIDS TO THE STUDY OF MEDICINE. A REVISED AND MODIFIED EDITION. BY ROBLEY DUNGLISON, M.D., In One neat 12mo. Volume. LEA & BLANLHARD'S PUBLICATIONS. ir CHAPMAN'S WORKS ON THE PRACTICE OF MEDICINE. CHAPMAN ON FEVERS, ETC. LECTURES ON THE MORE IMPORTANT ERUPTIVE FEVERS, HEMORRHAGES AND DROPSIES, AND ON GOUT AND RHEUMATISM, DELIVERED IN THE UNIVERSITY OF PENNSYLVANIA. By N. CHAPMAN, M.D., Professor of the Theory and Practice of Medicine, ice. &c. In one neat Octavo Volume. This volume contains Lectures on the following subjects: EXANTHEMATOUS FEVERS. Variola, or Small Pox; Inoculated Small Pox; Varicella, or Chicken Pox; Vanolae Vaccinise, or Vaccinia, or Cow-pock; Varioloid Disease; Rubeola, Morbilli, or Measles; Scarlatina vel Febris Rubra—Scarlet Fever. HAEMORRHAGES. Haemoptysis, Spitting of Blood; Hsemorrhagia Narium, or Hajmorrhage from the Nose; Haematemesis, or Vomiting of Blood ; Haematuria, or Voiding of Bloody Urine; Hremorrhagia Uterina, or Uterine Haemorrhage; Hasmorrliois or Haemorrhoids; Cutaneous Haemorrhage; Purpura Hasmorrhagica. DROPSIES. Ascites; Encysted Dropsy; Hydrothorax; Hydrops Pericardii; Hydrocephalus Internus, acute, subacute, and chronic : Anasarca; with a Disquisition on tlie Management of the whole. GOUT, RHEUMATISM, &c. &c. "The name of Chapman stands deservedly high in the annals of American medical science. Ateacheranda lecturer for nearly forty years, in the oldest and, we believe, the first medical school on this side of the Atlantic, the intimate friend and companion of Rush, Kuhn, Physick, Wistar, Woodhouse, Dewees, and a host of others scarcely Ii'ss renowned, Professor Chapman reflects upon the profession of this generation something of the genius aud wisdom of that which has passed; he stands out the able and eloquent champion of the doctrines and principles of other limes, when Cullen's "first lines" formed the rule of faith for all the Doctors in Medicine throughout Christendom. In him is embodied the experience of three score and ten, strengthened by reading, and enlightened by a familiar intercourse with many of the ablest medical men in the New and Old World. " In conclusion, we must declare our belief that the name of Chapman will survive when that of many of his cotemporaries shall have been forgotten; when other generations shall tread the great theatre of human affairs, and when other discoveries yet undisclosed, shall shed a brighter light upon the path of medical scieuce. The various lectures which he has been publishing, containing, as they do, the doctrines that he has so long and so eloquently taught to large and admiring classes, we doubt not will be welcomed with delight by his nu- merous pupils throughout the Union."—New Orleans Medical Journal. CHAPMAN ON THORACIC VISCERA, ETC. LECTURES ON THE MORE IMPORTANT DISEASES OK THE THORACIC AND ABDOMINAL VISCERA, DELIVERED IN THE UNIVERSITY OF PENNSYLVANIA. By N. CHAPMAN, M.D. Professor of the Theory and Practice of Medicine, &c. In one Volume, Octavo. WILLIAMS AND CLYMER ON THE RESPIRATORY ORGANS, ETC. A TREATISE ON THE DISEASES OE THE RESPIRATORY ORGANS, INCLUDING THE TRACHEA, LARYNX, LUNGS, AND PLEURA. By CHARLES J. B. WILLIAMS, M.D., Consulting Physician to the Hospital for Consumption and Diseases of the Chest; Author of " Principles of Medicine," &c. &c. WITH NUMEROUS ADDITIONS AND NOTES. By MEREDITH CLYMER, M.D., Physician to the Philadelphia Hospital. In one neat 8vo. Volume, with Cuts. This work recommends itself to the notice of the profession as containing a more particu- lar and detailed account of the affections of which it treats than perhaps any other volume before the public. J- '• The wood cuts illustrating the physical examination of the chest, are admirably executed, and the whole mechanical execution of the work, does much credit to the publishers. This work is undoubtedly destined to take precedence of all others yet published on the "Respiratory Organs," and as a text book for teachers and Btudents no better in the present state of the science is to be expected "—New York Journal of Medicine. LEA & BLANCHARD'S PUBLICATIONS. NOW READY, A NEW AND IMPROVED EDITION OP RAMSBOTHAM'S STANDARD WORK ON PARTURITION. THE PRINCIPLES AND PRACTICE OF OBSTETRIC MEDICINE AND SURGERY, IN REFERENCE TO THE PROCESS OE PARTURITION. ILLUSTRATED BY One hundred and forty-eight Large Figures on 85 Lithographic Plates. By FRANCIS H. RAMSBOTHAM, M. D., &c. A NEW EDITION, FROM THE ENLARGED AND REVISED LONDON EDITION. In one large imperial octavo volume, well bound. The present edition of this standard work will be found to contain numerous and important improvements over the last. Besides much additional matter, there are several more plates and wood-cuts, and those which were before used have been re-drawn. This book has long been known to the profession, by whom it has been most flatteringly received. The publishers take great pleasure in submitting the following testimony to its value from Professor Hodge, of the Pennsylvania University. Philadelphia, August 6th, 1845. Gentlemen:—I have looked over the proofs of Ramsbotham on Human Parturition, with its important improvements, from the new London edition. This Work needs no commendation from me, receiving, as it does, the unanimous recommendation of the British periodical press, as the standard work on Midwifery ; " chaste in language, classical in composition) happy in point of arrangement, and abounding in most interesting illustrations."* To the American public, therefore, it is most valuable—from its intrinsic undoubted excellence, and as being the best authorized exponent of British Midwifery. Its circulation will, I trust, be extensive through- out our country. There is, however, a portion of Obstetric Science to which sufficient attention, it appears to me, has not been paid. Through you, I have promised to the public a work on this subject, and although the continued occupation of my time and thoughts in the duties of a teacher and practitioner have as yet prevented the ful- filment of the promise, the day, I trust, is not distant, when, under the hope of being useful, I shall prepare an account of the Mechanism of Labour, illustrated by suitable engravings, which may be regarded as an addendum to the standard works of Ramsbotham, and our own Dewees. Very respectfully, yours, HUGH L. HODGE, M. D., Professor of Obstetrics, 4*c. fyc, in the University of Pennsylvania. Messrs. Lea & Blanchard. " This new edition of Dr. Ramsbotham's work forms one of the most complete and thoroughly useful treatises on Midwifery with which we are acquainted. It is not a mere reprint of the first edition; the entire work has undergone a careful revision, with additions. We have already given specimens of the work sufficient to justify our hearty recommendation of it as one of the best guides that the student or young practitioner can follow."—British and Foreign Medical Review, Jan., 1845. " The work of Dr. Ramsbotham may be described as a complete system of the principles and practice of Midwifery; and the author has been at very great pains, indeed, to present a just and useful view of the pre- sent state of obstetrical knowledge. The illustrations are numerous, well selected, and appropriate, and en- graved with great accuracy and ability. In short, we regard this work, between accurate descriptions and useful illustratious, as by far the most able work on the Principles and Practice of Midwifery that has ap- peared for a long time. Dr. Ramsbotham has contrived to infuse a larger proportion of common sense, and plain unpretending practical knowledge into this work, than is commonly found in works on this subject; * Northern Journal of Medicine for July 1845. LEA & BLANCHARD'S PUBLICATIONS. 19 RAftlSBOTHAM ON PARTURITION—Continued. and as suchwe have ereat pleasure in recommending it to the attention of obstetrical practitioners."-JEdm- burgh Medical and Surgical Journal. "This is one of the most beautiful works which have lately issued from the medical press; and is alike creditable to the talents of the author and the enterprise of the publisher. It is a good and thoroughly prac- tical treatise; the different subjects are laid down in a clear and perspicuous form, and whatever is of import ance, is illustrated by first rate engravings. A remarkable feature of this work, which ought to be mentioned, is its extraordinary cheapness. As a work conveying good, sound, practical precepts, and clearly demonstra- ting the doctrines of Obstetrical Science, we can confidently recommend it either to the student or practi- tioner."—Edinburgh Journal of Medical Science. "This work forms a very handsome volume. Dr. Ramsbotham has treated the subject in a manner worthy of the reputation he possesses, and has succeeded in forming a book of reference for practitioners, and a solid and easy guide for students. Looking at the contents of the volume, and its remarkably low price, we have no hesitation in saying that it has no parallel in the history of publishing."—Provincial Medical and Surgi- cal Journal. "It is the book of Midwifery for students; clear, but not too minute in its details, and sound in its practi- cal instructions. It is so completely illustrated by plates (admirably chosen and executed,) that the student must be stupid indeed who does not understand the details of this branch of the science, so far at least as description can make them intelligible."—Dublin Journal of Medical Science. "Our chief object now is to state our decided opinion, that this work is by far the best that has appeared in this country for those who seek practical information upon Midwifery, conveyed in a clear and concise style. The value of the work, too, is strongly enhanced by the numerous and beautiful drawings, which are in the first style of excellence."—London Medical Journal. "We most earnestly recommend this work to the student who wishes to acquire knowledge, and to the practitioner who wishes to refresh his memory, aa a most faithful picture of practical Midwifery ; and we can with justice say, that altogether it is one of the best books we have read on the subject of Obstetric Medi- cine."—Medico-Chirurgical Review. "All the organs concerned in the process of parturition, and every step of this process, in all its different forms, are illustrated with admirable plates.....When we call to mind the toil we underwent in acquiring a knowledge of this subject, we cannot but envy the student of the present day the aid which this work will afford him.....We recommend the student who desires to master this difficult subject with the least possible trouble, to possess himself at once of a copy of this work."—American Journal of the Me- dical Sciences. "It is intended expressly for students and junior practitioners in Midwifery; it is, therefore, as it ought to be, elementary, and will not consequently, admit of an elaborate and extended review. Our chief object now is to state our decided opinion, that this work is by far the best that has appeared in this country, for those who seek practical information upon Midwifery, conveyed in a clear and concise style. The value of the work, too, is strongly enhanced by the numerous and beautiful drawings by Bagg, which are in the first style of excellence. Every point of practical importance is illustrated, that requires the aid of the engraver to fix it upon the mind, and to render it clear to the comprehension of the student."—London Medical Gazette. " We feel much pleasure in recommending to the notice of the profession one of the cheapest and most ele- gant productions of the medical press of the present day. The text is written in a clear, concise, and simple style. We offer our most sincere wishes that the undertaking may enjoy all the success which it so well merits."—Dublin Medical Press. "We strongly recommend the work of Dr. Ramsbotham to all our obstetrical readers, especially to those who are entering upon practice. It is not only one of the cheapest, but one of the most beautiful works in Midwifery."—British and Foreign Medical Review. "Among the many literary undertakings with which the Medical press at present teems, there are few that deserve a warmer recommendation at our hands than the work—we might almost say the obstetrical library, comprised in a single volume—which is now before us. Few works surpass Dr. Ramsbotham's in beauty and elegance of getting up, and in the abundant and excellent engravings with which it is illustrated. We hear- lily wish the volume the success which it merits, and we have no doubt that before long it will occupy a place in every medical library in the kingdom. The illustrations are admirable; they are the joint production of Bagg and Adlard, and comprise within the series the best obstetrical plates of our best obstetrical authors, ancient and modern. Many of the engravings are calculated to fix the eye as much by their excellence of execution and their beauty as works of art, as by their fidelity to nature and anatomical accuracy."— The Lancet. " This is a work of unusual interest and importance to students and physicians. It is from the pen of Dr. Ramsbotham consulting physician in obstetric cases of the London Hospital, and embodies in one volume the Principles and Practice of Obstetric Medicine and Surgery. The treatise is admirably written, and illus- trated by a great variety of engravings: Indeed every thing in the obstetric art, capable of being explained by encravings, is displayed to the eye in these admirably executed prints. A medical correspondent of the New York American, says, that the 'universal voice of the British journals accords in commending this work to the profession, as one of the best elementary treatises in the language,' and we can only say, in addi- tion that the American publishers have, as far as we can judge from the execution of the plates In their edi- tion'done full justice to the original work. We sincerely hope that it may meet with entire success, and we cannot doubt that, when its merits are fully known, it will be found in every medical library in the country.'^ —Saturday Evening Post. so LEA & BLANCHARD'S PUBLICATIONS. Now Ready, CHEMISTRY FOR STUDENTS. ELEMENTARY CHEMISTRY, THEORETICAL AND PRACTICAL By GEORGE FOWNES, Ph. D., Chemical Lecturer in the Middlesex Hospital Medical School, &c. &c. With Numerous Illustrations. Edited, with Additions, By ROBERT BRIDGES, M. D., Professor of General and Pharmaceutical Chemistry in the Philadelphia College of Pharmacy, &c, &c. In one large duodecimo volume, sheep or extra cloth. This is among the cheapest volumes on Chemistry yet presented to the pro- fession. The character of the work is such as should recommend it to all col- leges in want of a text-book as an introduction to the larger and more advanced systems, such as Graham's and others. The great advantage which it possesses over all the other elementary works on the same subject now before the public, is the perfect manner in which it is brought up to the day on every point, em- bracing all the latest investigations and discoveries of importance, in a concise and simple manner, adapted to the time and comprehension of students com- mencing the science. It forms a royal 12mo. volume of 460 large pages, on small type, embellished with over one hundred and sixty wood engravings, which will be found peculiarly instructive as to the practical operations of the labora- tory, and the new and improved methods of experimenting. It has already been adopted as a Text-book by Professor Silliman of Yale Col- lege, and by other Colleges in different parts of the country. Extract fr,om« letter from Professor MiUington, of being omitted, and appears to us extremely well William and Mary College, Va. adapted as a text-book for the pupil attending a course «ti«,„d«o. >»j ,u u i -.v. v. i j of lectures on chemistry. Indeed we have no doubt "1 have perused the book with much pleasure, and ,..,.,. r,„^ it o „„., „^„; „i i„ i j . ■ j u tnat u wl" ultimately become the medical student's und it a most admirable work; and, to my mind, such . . a one as is just aow much needed in schools and col- fa'0Ur,t? manual.»-D^m Medual Press. leges. * * * All the books I have met with on che- Havlng examined II wittt some attention, we feel mistry are either too puerile or too erudite, and I con- an accurate compendium of the state of chemical will profit by using it during the session of lectures. science; which is, moreover, well illustrated by ap- "As a judicious compendium, I think Fownes'Che- propriate and neatly executed wood engravings * * mistry cannot fail to be highly useful to the class of After what we have stated of this work, our "readers reader* for whom it was designed." will not be surprised that it has our hearty commenda- _____ tion, and that, in our opinion, it is calculated, and at a trifling expense, to spread the doctrines of the intricate "Mr. Fownes'work, although consisting of only a science which it so clearly explains."—Medieo-Chi- single thick 12mo. volume, includes a notice of almost rurgical Review. every branch of the *ubject, nothing of any importance LEA & BLANCHARD'S PUBLICATIONS. 21 " This is an unpretending, but decidedly valuable treatise, on the elements of chemistry, theoretical and practical. Dr. Bridges has a perfect idea of what is needed, and the preparation of this excellent guide should have the countenance of all public instructors, and especially those of medical students."—Boston Med. Sfs Surg. Journal. " This is a very excellent manual for the use of stu- dents and junior practitioners, being sufficiently full and complete on the elements of the science, without omitting any necessary information, or extending too far into detail. It is written in a clear and concise style, and illustrated by a sufficient number of well executed wood-cuts and diagrams. The Editor has executed his task in a creditable manner, and we have no doubt the work will prove entirely satisfactory, as an introduction to the science of which it treats."—N. Y. Journal of Med. Sr Surgery. u He has succeeded in comprising the matter of his work in 460 duodecimo pages, which, assuredly, is a recommendation of the volume as a text-book for stu- dents. In this respect it has advantages over any treatise which has yet been offered to American stu- dents. The difficulty in a text-book of chemistry is to treat the subject with sufficient fullness without going too much into detail. For students comparatively ignorant of chemical science, the larger systems are unprofitable companions in their attendance upon lec- tures. They need a work of a more elementary cha- racter, by which they may be inducted into the first principles of the science, and prepared for mastering its more abstruse subjects. Such a treatise is the one whicli we have now the pleasure of introducing to our readers ; no manual of chemistry with which we have met comes so near meeting the wants of the beginner. All the prominent truths of the science, up to the pre- sent time, will be found given in it with the utmost practicable brevity. The style is admirable for its conciseness and clearness. Many wood-cuts are supplied, by which processes are made intelligible- The author expresses regret, that he could not enter more largely into organic chemistry, but his details will be found to embrace the most important facts in that interesting branch of the science. We shall re- commend his manual to our class next winter."—The Western Journal of Medicine and Surgery. " We are presented with a work, not only compre- hensive as regards general principles, but full of prac- tical details of the working processes of the scientific laboratory; and in addition, it contains numerous wood engravings, showing the most useful forms of apparatus, with their adjustments and methods of use. "The qriginal work having been full and complete, as far as the limits of such a volume would permit, and on every point brought up to the date of its publi- cation (in September last,) the task of the editor lias been to add any important matter which appeared since, and to correct such typographical errors as had escaped the author. That this task has been well and ably performed, the known zeal and competency of Dr. Bridges afford a sufficient guarantee."—Tht Medical Examiner. GRAHAM'S CHEMISTRX". E ELEMENTS ®F CHEMISTRY. INCLUDING THE APPLICATION OF THE SCIENCE TO THE ARTS. With Numerous Illustrations. BY THOMAS GRAHAM, F. R. S. L. and E. D. Professor of Chemistry in University College, London, &c. &c. WITH NOTES AND ADDITIONS, BY ROBERT BRIDGES, M.D., &c. &c. In One Vol. Octavo. Tlie "Teat advancement recently made in all branches of chemical investigation, ren- ders necessary an enlarged work which shall clearly elucidate the numerous discoveries, especially in the department connected with organic Chemistry and Physiology, in which such gigantic strides have been made during the last few years. The present treatise is considered by eminent judges to fulfil these indications, and to be pecu- liarly adapted to the necessities of the advanced medical student and practitioner. In adaptiii"" it to the wants of the American profession, the editor has endeavoured to render his portion of the work worthy the exalted reputation of the first chemist of England- It is already introduced in many of the Colleges, and has universal approbation. Though so recently published, it has been translated into German, by Dr. F. Julius Otto, the eminent professor at Brunswick, and has already passed to a second edition. 22 LEA & BLANCHARD'S PUBLICATIONS. A NEW MEDICAL DICTIONARY. In one Volume, large 12mo., now ready, at a low price. A DICTIONARY OF THE TERMS USED IN MEDICINE AND THE COLLATERAL SCIENCES; By RICHARD D. HOBLYN, A.M., Oxon. FIRST AMERICAN, FROM THE SECOND LONDON EDITION. REVISED, WITH NUMEROUS ADDITIONS, BY ISAAC HAYS, M.D., EDITOR OF THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES. Believing that a work of this kind would be useful to the profession in this country, the publishers have issued an edition in a neat form for the office table, at a low price. Its object is to serve as an introduction to the larger and more elaborate Dictionaries, and to assist the student commenc- ing the study of Medicine, by presenting in a concise form an explanation of the terms most used in Medicine and the collateral sciences, by giving the etymology and definition in a manner as simple and clear as possible, without going into details; and bringing up the work to the present time by including the numerous terms lately introduced. This design the author has so ably executed as to elicit the highest encomiums of the medical press, a few of the testimonies of which are subjoined. It has been edited with especial reference to the wants of the American practitioner, the native medicinal plants being introduced, with the for- mulae for the various officinal preparations; and the whole being made to conform to the Pharmacopoeia of the United States. It is now ready in one neat royal duodecimo volume of four hundred pages in double co- lumns. ---- Extract from a Letter from Professor Watts of the College of Physicians and Surgeons, N. York. " It is a valuable book for those more advanced in the profession, but especially for students of Medicine, and I shall take pleasure in recommending it to my class during the coming session." OPINIONS OF THE PRESS. ««We hardly remember to have seen so much valuable matter condensed into such a small compass as this little volume presents. The first edition was pub- lished in 1835, and the present may be said to be almost re-written, introducing the most recent terms on each subject. The Etymology, Greek, Latin, &c, is carefully attended to, and the explanations are clear and precise. We cannot too strongly recommend.this small and cheap volume to the library of every student and every practilioner."—Medico-Chirurgical Review. " We gave a very favourable account of this little book on its first appearance, and we have only to repeat the praise with increased emphasis. It is, for its size, decidedly the best book of the kind, and ought to be in the possession of every student. Its plan is sufficiently comprehensive, and it contains an immense mass mlRelskw matI011 in a Very sma11 c°mpass."—British and Foreign Medi- " A work much wanted, and very ably executed."—London Medical Journal. This compendious volume is well adapted for the use of students. It contains ^^ ? g uSary 0i the termS USed in medicine-not only those in common use, but also the more recent and less familiar names introduced by modern wri- ters, lhe introduction of tabular views of different subjects is at once compre- hensive and satisfactory.'"—Medical Gazette. ' "Concise and ingenious."—Johnson's Medico-Chirur. Journal. "It is a very learned, pains-taking, complete, and useful work—a Dictionarv absolutely necessary in a medical library."— Spectator. ' LEA & BLANCHARD'S PUBLICATIONS. 23 LATELY PUBLISHED. A NEW EDITION OF CARPENTER'S HTJMA1T PHYSIOLOGY, REVISED AND MDCH IMPROVED. PRINCIPLES OF HUMAN PHYSIOLOGY. WITH THEIR CHIEF APPLICATIONS TO PATHOLOGY, HYGIENE & FORENSIC MEDICINE. By WILLIAM B. CARPENTER, M.D., F.R.S., &c. SECOND AMERICAN, FROM A NEW AND REVISED LONDON EDITION. WITH NOTES AND ADDITIONS, BY MEREDITH CLYMER, M.D., &c, With Two Hundred and Sixteen Wood-cut and other Illustrations. In one octavo volume, of about 650 closely and beautifully printed pages. The very rapid sale of a large impression of the first edition is an evidence of the merits of this valuable work, and that it has been duly appreciated by the profession of this country. The pub- lishers hope that the present edition will be found still more worthy of approbation, not only from the additions of the author and editor, but also from its superior execution and the abundance of its illustrations. No less than eighty-five wood-cuts and another lithographic plate will be found to have been added, affording the most material assistance to the student. " We have much satisfaction in declaring our opinion that this work is the best systematic treat- ise on physiology in our own language, and the best adapted for the student existing in any lan- guage."—Medic o-Chirurgical Review. NOW READY. A NEW AND IMPROVED EDITION OF FERGTTSSOanS operative stjrgery. A SYSTEM OF PRACTICAL SURGERY. By WILLIAM FERGUSSON, F.R.S.E. Second American Edition, Revised and Improved. WITH TWO HUNDRED AND FIFTY-TWO ILLUSTRATIONS FROM DRAWINGS BY BAGG, ENGRAVED BY GILBERT, WITH NOTES AND ADDITIONAL ILLUSTRATIONS, BY GEORGE W. NORRIS, M.D., &c. In one beautiful octavo volume of six hundred and forty large pages. The publishers commend to the attention of the profession this new and improved edition of Fergusson's standard work, as combining cheapness and elegance, with a clear, sound and practical treatment of every subject in surgical science. Neither pains nor expense have been spared to make it worthy of the reputation which it has already acquired, and of which the rapid exhaustion of the first edition is sufficient evidence. It is extensively used as a text-book in many medical colleges throughout the country. The object and nature of this volume are thus described by the author :—" The present work has not been produced to compete with any already before the Profession r the arrangement, the manner in which the subjects have been treated, and the illustrations, are all different from any of the kind in the English language. It is not intended to be placed in comparison with the elemen- tary systems of Cooper, Burns, Liston, Symes, Lizars, and that excellent epitome of Mr. Druitt.— It may with more propriety be likened to the Operative .Surgery of Sir C. Bell, and that of Mr. Averill, both excellent in their day, or the more modern production of Mr. Hargrave, and the Practical Surgery of Mr. Liston. There are subjects treated of in this volume, however, which none of these gentlemen have noticed ; and the author is sufficiently sanguine to entertain the idea that this work may in some degree assume that relative position in British Surgery, which the dassical volumes of Velpeau and Malgaigne occupy on the Continent." "If we were to say that this volume by Mr. FergussoH,is one excellently adapted to the stu- dent, and the yet ipexperienced practitioner of surgery, we should restrict unduly its range. It ia of the kind which every medical man ought to have by him for ready reference, as a guide to the prompt treatment of many accidents and injuries, which whilst he hesitates, may be followed by incurable defects, and deformities of structure, if not by death itself. In drawing to a close our notice of Mr. Fergusson's Practical Surgery, we cannot refrain from again adverting to the nume- rous and beautiful illustrations by wood-cuts, which contribute so admirably to elucidate the de- scriptions in the text. Dr. Norris has, as usual, acquitted himself judiciously in his office of aonotator. His additions are strictly practical and to the point."—Bulletin of Medical Scienct. 24 LEA & BLANCHARD'S PUBLICATIONS. LATSL1T FUB&ISHBD, A NEW EDITION OF WILSON'S HUMAN ANATOMY, Much Improved. GENERAL AND SPECIAL. B7 ERASMUS WXLSOBT, BI.23., Lecturer on Anatomy, London. SECOND AMERICAN EDITION, EDITED BY PAUL B. GODDARD, A.M., M.D., Lecturer on Anatomy and Demonstrator in the University of Pennsylvania, 8cc WITH OVER TWO HUNDRED ILLUSTRATIONS, Beautifully Printed from the Second London Edition. in one very neat octavo volume. From the Preface to the Second American Edition. " The very rapid sale of the first edition of this work, is evidence of its appreciation by the pro- fession, and is most gratifying to the author and American editor. In preparing the present edition no pains have been spared to render it as complete a manual of Anatomy for the medical student as possible. A chapter on Histology has therefore been prefixed, and a considerable number of new cuts added. Among the latter, are some very fine ones of the nerves which were almost wholly omitted from the original work. Great care has also been taken to have this edition correct, and the cuts carefully and beautifully worked, and it is confidently believed that it will give satisfaction, offering a further inducement to its general use as a Text-book in the various Colleges." " Mr. Wilson, before the publication of this work, was very favourably known to the profession by his treatise on Practical and Surgical Anatomy ; and, as this is the Second American Edition, from the second London Edition, since 1840, any special commendation of the high value of the present work, on our part, would be supererogatory. Besides the work has been translated at Ber- lin, and overtures were repeatedly made to the London publisher for its reproduction in France.— The work is, undoubtedly, a complete system of human anatomy, brought up to the present day.— The illustrations are certainly very beautiful, the originals having been expressly designed and exe- cuted for this work by the celebrated Bagg of London; and, in the American edition they have been copied in a masterly and spirited manner. As a text-book in the various colleges we would commend it in the highest terms."—New York Journal of Medicine. CHURCHILL'S MIDWIFERY- ON THE THEORY AND PRACTICE OF MIDWIFERY, BY FLEETWOOD CHURCHILL, M.D., M.R.I.A., physician to the western lying-in-hospital, etc., etc. WITH NOTES AND ADDITIONS BY ROBERT HUSTON, M.D., Professor in the Jefferson Medical College, &c, &c. And One Hundred and Sixteen Illustrations^ Engraved by Gilbert from Drawings by Bagg and others. In one volume, octavo. This work commends itself .to the notice of the profession from the high reputation of the author and editor, and the number and beauty of its illustrations. Besides accurate directions for THE PRACTICE OF MIDWIFERY, a portion of the work is also devoted to THE PHYSIOLOGY AND PATHOLOGY ee-raeeted with that essential branch of medical knowledge. «It 1« wmoBgibleto eonceire a wore useful or elegant manual: the letter-press contains all that «ne practical man can desire; the illustrations are very numerous, well chosen, and of the most ele- gant description aad the work has been bought out at a moderate Price.»-Pr JnclalMedjZ-. We expected a first rate production, and we have not been in the least disappointed. Although we have many, very many valuable work* on tokology, were we reduced to the necessity of pos- Z7u?sjZn^Pdt**h°°Se' WC W°Uld "^"fr"^* take Churchill.^SLn S. This work is printed, illustrated and bound to match Carpenter's Physiolo^ Fergusson's Surgery and Wdson's Anatomy, and the whole, with Watson's Prfc! 'tee, Pereira's Materia Medica aai J&raham's Chemistry, are extensively used in the various colleges- J u LEA & BLANCHARD'S PUBLICATIONS. 25 PEREIRA'S MATERIA MEDICA. WITH NEAR THREE HUNDRED ENGRAVINGS ON WOOD. A NEW EDITION NOW READY. THE ELEMENTS OF MATERIA~MEDICA AND THERAPEUTICS. COMPREHENDING THE NATURAL HISTORY, PREPARATION, PROPERTIES, COMPO- SITION, EFFECTS, AND USES OF MEDICINES. BY JONATHAN PEREIRA, M.D., F.R.S. and L. S. Member of the Society of Pharmacy of Paris; Examiner in Materia Medica and Pharmacy of the University of London; Lecturer on Materia Medica at the London Hospital, &c, &c. Second American, from the last London Edition, enlarged and improved. With Notes and Additions BY JOSEPH CARSON, M.D., In two volumes, octavo. Part I, contains the General Action and Classification of Medicines and the Mineral Materia Me- dica. Part II, the Vegetable and Animal Kingdoms, and including diagrams explanatory of the Processes of the Pharmacopoeias, a tabular view of the History of the Materia Medica, from the earliest times to the present day, and a very copious index. From the last London Edition, which has been thoroughly revised, with the Introduction of the Processes of the New Edinburgh Phar- macopoeia, and containing additional articles on Mental Remedies, Light, Heat, Cold, Electricity, Magnetism, Exercise, Dietetics and Climate, and many additional Wood-cuts, Illustrative of Phar- maceutical Operations, Crystallography, Shape and Organization of the Feculas of Commerce, and the Natural History of the Materia Medica. The object of the author has been to supply the Medical Student with a Class Book on Materia Medica, containing a faithful outline of this Department of Medicine, which should embrace a con- cise account of the most important discoveries in Natural History, Chemistry, Physiology, and The- rapeutics, in so far as they pertain to Pharmacology, and treat the subjects in the order of their natural historical relations. The opportunity has been embraced in passing this New Edition through the hands of the Editor, Dr. Carson, to make such additions as were required to the day, and to correct such errors as had passed the inspection of the Author and Editor of the first edition. It may now be considered as worthy the entire confidence of the Physician and Pharmaceutist as a standard work. This great Library or Cyclopaedia of Materia Medica has been fully revised, the errors corrected, and numerous additions made by DR. JOSEPH CARSON, Professor of Materia Medica and Phar- macy in the "College of Pharmacy," and forms Two Volumes, octavo, of near 1600 large and closely printed pages. It may be fully relied upon as a permanent and standard work for the coun- try—embodying, as it does, full references to the U. S. Pharmacopoeia and an account of the Medi- cal Plants indigenous to the United States. " An Encyclopaedia of knowledge in that department of medical science—by the common con sent of the profession the most elaborate and scientific Treatise on Materia Medica in our lan- guage."—Western Journal of Medicine and Surgery. "Upon looking over the American edition of the Materia Medica of Dr. Pereira, we have seen no reason to alter the very favourable opinion expressed in former numbers of this Journal. (See Am. Med. Journal, XXIV, 413, and N}S., I. 192.) We are glad to perceive that it has been repub- lished here without curtailment. Independently of the injustice done to an author by putting forth an abbreviated edition of his works, without his superintendence or consent, such a course would in the present instance have been unjust also to the public, as one of the chief recommendations of Dr. Pereira's treatise is its almost encyclopedic copiousness. We turn to its pages with the expectation of finding information upon all points of Materia Medica, and would have good reason to complain were this expectation disappointed by the scissors of an American Editor. Indeed, the main defect of the work, in relation to American practitioners, was the want of sufficient notices of the medicines and preparations peculiar to this country. In the edition before us this defect has been supplied by the Editor, Dr. Joseph Carson, who was, in a high degree qualified for the task, and, so far as we are able to judge from a very partial perusal, has executed it with judgment and fidelity. The nomenclature and preparations of our national standard have been introduced when wanting in the English edition, and many of our medical plants, either briefly noticed or altogether omitted by Dr. Pereira, because unknown in Europe, have been sufficiently described. We must repeat the expression of our opinion that the work will be found an invaluable storehouse of information for the physician and medical teacher, and con- gratulate the profession of this country that it is now placed within their reach."—Am. Med. Journ. " To say that these volumes on Materia Medica and Therapeutics, by Dr. Pereira, are comprehen- sive learned and practical, and adapted to tlie requirements of the practitioner, the advanced stu- dent as well as the apothecary, expresses the opinion, we will venture to assert, of nearly every judge of the subject, but fails to convey to those who are not acquainted with the work, a definite idea of its really distinctive traits, according to our general usage, we shall, therefore, proceed to place these before our readers, so that they may know what it is, and why we praise. Valuable and various as are the contents of the volumes of Dr. Pereira, we have no hesitation in assert- ing despite the adverse cant in some quarters on the subject of the American additions to English works that the value of the present edition is enhanced by the appropriate contributions of Dr. Carson, who has introduced succinct histories of the most important indigenous medicines of the' United States Pharmacopoeia."—Select Med. Library. 26 LEA & BLANCHARD'S PUBLICATIONS. THE SURGICAL WORKSJF SIR ASTLEY COOPER. LEA & BLANCHARD have now completed the last volume of the illustrated works of Sir Astley Cooper. They form an elegant series; the works on Hernia, the Testis, the Thymus Gland and the Breast, being print- ed, illustrated and bound to match, in imperial octavo with numerous LITHOGRAPHIC PLATES, while the Treatise on Dislocations is in a neat medium octavo form, with NUMEROUS WOOD-CUTS similar to the last London Edition. COOPER ON THE ANATOMY AND DISEASES OF THE BREAST, &c. JUST PUBLISHED. This large and beautiful volume contains THE ANATOMY OF THE BREAST; THE COMPARATIVE ANATOMY OF THE MAMMARY GLANDS; ILLUSTRATIONS OF THE DISEASES OF THE BREAST; And Twenty-five Miscellaneous Surgical Papers, now first published in a collected form. By SIR ASTLEY COOPER, Bart., F.R.S.,&c. The whole in one large imperial octavo volume, illustrated with two hundred and fifty-two figures on thirty six Lithographic Plates ; well and strongly bound. SIR ASTLEY COOPER ON HERNIA, With One Hundred and Thirty Figures in Lithography. THE ANATOMY AND SURGICAL TREATMENT OF By Sir ASTLEY COOPER, Bart. Edited by C. Aston Key, Surgeon to Guy's Hospital, &c. This important work of Sir Astley is printed from the authorized second edition, published in London, in large super-royal folio, and edited by his nephew, Professor Key. It contains all the Plates and all the Let- terpress—there are no omissions, interpolations, or modifications—it is the complete work in One large Imperial Octavo Volume. WITH OVER 110 FIGURES ON 26 PLATES, AND OVER 400 LARGE PAGES OF LETTERPRESS. The correctness of the Plates is guaranteed by a revision and close examination under the eye of a distin- guished Surgeon of this city. ANOTHER VOLUME OF THE SERIES CONTAINS HIS TREATISE ON THE STRUCTURE AND DISEASES OF THE TESTIS, Illustrated by 120 Figures. From the Second London Edition. By BRANSBY B. COOPER, Esq. AND ALSO ON THE ANATOMY OF THE THYMUS GLAND, Illustrated by 57 Figures. The two works together in one beautiful imperial octavo volume, illustrated with twenty-nine plates in the best style of lithography, and printed and bound to match. DDOPER ON FRACTURES AND DISI0BATI0NS WITH NUMEROUS WOOD-CUTS. A TREATISE ON DISLOCATIONS AND FRACTURES OF THE JOINTS. By SIR ASTLEY COOPER Bart., F. R. S., Sergeant Surgeon to the King, &c. a»i j.*,* cool ER, A new edition much enlarged; edited by BRANSBY COOPER, F R S Sur,»,;.,„ Ii • . , His nephew, Bransby B. Cooper, from his own experienc^aPadded a umh„ ,!^ P™ct>cal character. Astley left behind him very considerable additions in MS for the exnress ™™I of Z S- ,BTdeS.,thlS' Sir edition. The volume is embellished with ONE HUNDRED AN^THm^ contains the history of no less than three hundred and sixty-one^a«es tZs embonS^hJ^?^f U7^ and practice of the Author and his various editors. There arealso^addhfonarOb^rva^,!s f^m nm °/al,.f« °< by«JA°ftn CtV,Wfiar,re?'„MD-'fhe ?"*»*>'<>.■ Anatomy and SurgeryTn^Harvar?Un7versT ^ "^ fU™shed "After the fiat of the profession, it would be absurd in us to eulogize Sir Astley Cooper's work on P,„ . "aSSS 'S & natl0nal one' and wiU Pr°bably subsist as long as English smgl^-MedZ-Chfr^r LEA & BLANCHARD'S PUBLICATIONS. 27 LATELY PUBLISHED. MEIGS' TRANSLATION N OF GOLOMBAT DE L'ISERE GN THE DISEASES OF FEMALES. A TREATISE ON THE DISEASES OF FEMALES, AND ON THE SPECIAL HYGIENE OF THEIR SEX. WITH NUMEROUS WOOD-CUTS. BY COLOMBAT DE L'ISERE, M.D., Chevalier of the Legion of Honor; late Surgeon to the Hospital of the Rue de Valois, devoted to tlie Diseases of Females, Sec, Sec. TRANSLATED, WITH MANY NOTES AND ADDITIONS, Bi C. D. MEIGS, M.D., Professor of Obstetrics and Diseases of Women and Children in the Jefferson Medical College, fyc,