4^ A TREATISE MATERIA MEDICA s?eisemottos. JOHN EBERLE, M.D. Member of the American Philosophical Society; of the Academy of Natural Sciences of Philadelphia; Corresponding Member of the Medico-Chirurgical Society of Berlin, &c. &c. CO IN TWO VOLUMES. VOL. I. SECOND EDITION, WITH CORRECTIONS, PUBLISHED BY S. & W. MEETEER, BALTIMORE: AND JAMES WEBSTER, PHILADELPHIA. William Brown, Printer. 1825. t 15^ /or Eastern District of Pennsylvania, to -wit .- ,♦»»,„ BE IT REMEMBERED, That on the twelfth day of February, £ seal. * in the forty-ninth year of the Independence of the United States ******* of America, A. D. 1825, James Webster, of the said District, hath deposited in this office the title of a book, the right whereof he claims as proprietor, in the words following, to wit: " A Treatise of the Materia Medica and Therapeutics. By John Eberle, M>.1). Member of the American Philosophical Society; of the Academy of Natural Sciences of Philadelphia; Corresponding Alemberof the Medi- co-Chirurgical Society of Berlin, &c. &c. In Two Volumes. Vol. I. Se- cond edition, with corrections." In conformity to the act of the Congress of the United States, entitled, " An act for the encouragement of learning, by securing the copies of maps, charts, and books, to the authors and proprietors of such copies, during the times therein mentioned." And also to the act, entitled, " An act supple- mentary to an act, entitled, • An act for the encouragement of learning, by securing the copies of maps, charts, and books, to the authors and proprie- tors of such copies during the timts therein mentioned,' and extending the benefits thereof to the arts of designing, engraving, and etching historical and other prints." D. CALDWELL, Clerk of the Eastern District of Pennsylvania. 3^i?®W sulp. alum. 31. pulv.coccinel. gr. iii. aquae bulentis tfei- Mix these in a mortar, until the solution is cold and the sediment deposited, then pour it oft'. Dose, a table spoonful for an adttlt. n EMETICS. tines, as the infusion of simarouba, if there Be an ei- cess of alum. It is extremely difficult to adapt the proper quantity of alum to the astringent effect requir- ed; when it produces constipation, the morbid secre- tions, tormina, &c. are increased, and sometimes in- duce an actual relapse, and when the excess of sulphas zinci maintains a free discharge of natural faeces, the morbid secretions are diminished."* In the treatment of diarrhoea, this remedy appears to be more decidedly advantageous, and is certainly less hazardous than in dysentery. Dr. Moseley speaks also in favour of the employment of the zinc solution, in colica pictonum. After the bowels are evacuated by suitable purgatives, a table- spoonful of the solution is to be taken every five or six hours, until the pain ceases. Of this practice I can say nothing from my own experience, nor does it appear to have gained much credit with the profession. To relieve hooping-cough, the sulphate of zinc is, undoubtedly, a remedy of very considerable powers. For this purpose I have prescribed it with unequivocal advantage. I think it decidedly superior to the antimo- nial emetics, in cases where there is much pulmonic oppression, or difficult respiration. The only objec- tion to its use is its very disagreeable taste, a circum- stance, indeed, which renders its employment by chil- dren, extremely difficult, and often altogether impracti- cable. As an expectorant, in chronic catarrhal affections, attended with oppressed breathing and a tough mucous expectoration, the same writer who I have already so often mentioned, speaks in exalted terms of his " vitri- olic solution." He directs it to be taken in slightly nauseating doses, three or four times a day. In phthisis* * Practical Treatise on Tropiral and Scorbutic Dysentery, p, 193. London, 1819. EMETICS. 73 attended with bloody expectoration, he declares this remedy to be often of signal service. In all these af- fections I have occasionally employed it, but never with any decided advantage. Dr. Paris, however, adds his testimony in favour of the use of this remedy in pectoral complaints.' " In affections of the chest," says he, " at- tended with inordinate secretion, I have witnessed much benefit from its exhibition, particularly when presented in the form of lozenge." Under the head of astringents this remedy will be again noticed, to which the reader is referred for an account of the various other uses to which it has been applied in medical practice. "The white vitriol of commerce," says Dr. Paris, u ought never to be used in medicine, since it generally contains the sulphates of copper and iron." SULPHAS CUPRI.—SULPHATE OF COPPER.—BLUE VITRIOL.--BLUE COPPERAS. This salt occurs in the form of rhomboidal prisms of a deep blue colour, having an exceedingly harsh and styptic taste. It consists of one portion of peroxide, with two portions of sulphuric acid, constituting there- fore, an oxy-sulphate. It dissolves in four parts of water, at the temperature of 60°, and in less than two, at the boiling point. It is not soluble in alcohol. The operation of blue vitriol, as an emetic, is ex- ceedingly prompt, but its impressions upon the general system appear to be much less powerful and extensive than those of the other articles of this class. When taken into the stomach it very speedily excites' strong efforts at vomiting: and though the agitation of the body which it creates is very considerable, yet its impressions seem to be a good deal confined to the stomach, since, vol. i.—K 74 EMETICS. neither during the operation, nor after it is over, does the patient experience that distressing relaxation, and general prostration of the system which is occasioned by the other emetics. As an emetic, this remedy has been very little em- ployed, except in the cure of phthisis puhnonalis. Dr. Marryatt* appears to have been the first who employed the sulphate of copper in this way. He recommends it to be given with tart, emetic, in doses of little more than two grains of each, two or three times a week. Nothing is to be drank during its operation, and hence he calls it the dry vomit. When diarrhoea attends, he gives one grain of the sulphate of copper with five grains of ipecacuanha. In a paper on phthisis puhnonalis, published in the first volume of the Transactions of the College of Plry- sicians of Philadelphia, Dr. Senter declares, that he " has restored more persons labouring under hectic fever from glandular suppuration, by vomiting every second or third day with the sulphate of copper, and giving in the intervals as much as the stomach would bear of Dr. Griffith's myrrh mixture, than by all other methods he has ever tried." He considers this prepa- ration of copper, when united with ipecacuanha, as one of the safest and most efficacious emetics we possess. Dr. Thomas,f aig0 adds his testimony in favour of the good effects of this practice. He says that he has adopted it in the treatment of many cases of incipient phthisis " with infinite advantage." Dr. Samuel Fort Simmons,| likewise speaks very favourably of this re- medy in consumption. When this preparation is taken into the stomach in excessive doses, it acts as a strong poison, producing • Therapeutics; or, the Art of Healing, 21stedition, 1806. t Modern Practice. \ Practical Observations on the Treatment of Consumption. London, 1780. EMETICS. 7o pain in the throat, stomach, and intestines, accompa- nied with violent vomitings, "foetideructations; hiccup. difficulty of respiration, and almost suffocation; the pulse becomes small, hard, and accelerated, and in certain cases it may be said to vibrate under the finger like catgut. An inextinguishable thirst, difficulty of making water, cramps, the extremities of an icy cold- ness, horrible convulsions, general decay of strength, the features of the face changed, delirium—death." Tocounteiact these effects it has been found that the white of eggs, beat up with water, is the best remedy we possess. Sugar is also useful, and by many has been highly praised as an antidote to this poison. Orfila ad- mits the propriety of its employment, but he says it is not a counter poison. " Liver of sulphur, the alkalies, gall-nuts, Peruvian bark, charcoal, &c. considered as counter poisons, are useless, often dangerous, and ought, therefore, to be banished."* The alkalies and their carbonates, sub-borate of soda, acetate of ammonia, tartrate of potass, muriate of lime, nitrate of silver, sub-acetate and acetate of lead, oxymuriate of mercury, all astringent vegetable v infusions and tinctures, decompose it and alter or de- stroy its effects.] In the dose of from two grains to fifteen, this article acts as a prompt emetic; from one-eighth to one-fourth of a grain, it operates as a tonic. MERCURIAL PREPARATIONS. The subsulphas hydrargyri flavus, or turpith mineral, is the most active and prompt emetic of the mercurial preparations. It was, atone time, a good deal employed * Orfila. t Paris's Pharmacologia. 76 EMETICS. for this purpose, but it is now almost entirely neglected, on account of the violence of its operation, and its apt- ness sometimes to excite salivation. It has been recom- mended for the cure of virulent gonorrhoea, and hernia humoralis, in which affections it has been said to act be- neficially, both as a mercurial and an emetic. In leprous diseases, it has also been employed with advantage, par- ticularly when it affects robust constitutions. It has like- wise been administered with good effects in putrid sore- throat, croup, and in peripneumony. It is given in the dose of from two grains to six or eight. Given in smaller doses, it acts as an alterative and diaphoretic. Dr Hope, senior, states that it forms an excellent errhine by mixing it with powdered liquorice- root. The corrosive sublimate has also been employed with a view to its emetic effects. Its use, however, for this purpose, has been properly abandoned, as violent and dangerous. CHAPTER III Cathartics. Cathartics are medicines which evacuate the contents of the intestines downwards,'or which, when given in proper doses, produce purging. As, in many parts of the intestinal tube, its contents are carried forwards in a direction contrary to their gra- vity, a very considerable force, it is evident, must be pretty constantly exerted from above downwards, in order that the alvine evacuations may be regularly effect- ed. This force consists in that regular series of con- tractions of the muscular fibres of the intestinal canal from above downwards called peristaltic motion. Con- stipation must therefore depend either upon a cessation, or an inadequate force of this peristaltic action, or upon some mechanical resistance to its natural propulsive power, or upon both these causes combined. Whatever, therefore, increases the alvine discharges, acts either by increasing the peristaltic action of the bowels; or, by removing the impediments to its regular powers; or by producing both these effects. It is in this latter way that cathartics produce their evacuant effects. For, while they excite the peristaltic or propulsive action of the intestinal canal, they also augment its natural secretions. They thus at once in- crease the force of the propelling power, and diminish the resistance of the substances propelled, by lubrica- ting the internal surface of the bowels and attenuating their contents by the increased secretions they produce. Independent of the different degrees of evacuant power which these remedies possess, they differ also essentially 78 CATHARTICS. from each other in relation to the particular parts of the intestinal tube upon which they more immediately exert their actions, as well as in the nature and appearances of the discharges which they, produce. Thus gamboge, calomel, and a few others direct their action more par- ticularly upon the upper portion of the intestines; whilst aloes acts almost entirely upon the lower portion of the bowels. With regard to the particular character of the evacuations, produced by the articles of this class, the diversity is equally remarkable. Jalap and the saline pur- gatives for instance produce copious watery discharges; castor oil, rhubarb, &c. merely evacuate the contents of the bowels; whilst others, as calomel, increase the secre- tion of bile, and carry off this fluid in augmented quan- tities. It is not improbable, as Dr. Paris observes, that the diversity which exists in relation to the part of the intestinal tube upon which different purgatives act, is owing to the different degrees of" the solubility of the active elements" of these remedies. " It is, for instance, easy to conceive," says this writer, " that a medicine may act more immediately and especially upon the sto- mach, small or large intestines, according to the relative facility with which its principles of activity enter into solution; that those which are dissolved before they pass the pylorus are quick and violent in their effects, and liable to affect the stomach, as is exemplified by the ac- tion of gamboge, &c. whilst some resinous purgatives, on the other hand, as they contain principles less soluble, seldom act until they have reached the colon. Colocynth has a wider range of operation, since its principles of ac- tivity reside both in soluble and insoluble elements. Aloes again, being still further insoluble, pass through the whole alimentary canal before they are sufficiently dissolved, and act, therefore, more particularly upon the rectum." A knowledge of these circumstances is of very great con- sequence, both in a therapeutic and pharmaceutical point of view. For it will not only enable the practitioner to CATHARTICS. 79 modify the peculiar action of these remedies, by chang- ing the degree of their solubility, but also to select those articles which are peculiarly adapted to the particular circumstances of the diseases for which they are prescrib- ed. Thus, in ascites, we would be naturally led to employ those purgatives that have a more especial ten- dency to evacuate serum from the intestines, as the saline cathartics; whilst in cases attended with redundancy or vitiated bile, we would resort to such as act particularly upon the upper portion of the bowels, and at the same time influence the functions of the biliary system. Again, if, in addition to the mere effect of unloading the con- tents of the bowels, we wish also to produce a determi- nation to the pelvic viscera, to the uterus, for instance, in amenorrhoea, we select aloes as the appropriate purga- tive, because of its more particular action on the rectum. Besides the more immediate operation of evacuating the contents of the bowels, cathartics produce other ef- fects on the animal economy, to which no small part of their remediate powers may, with reason, be ascribed. 1. They diminish the action of the heart and arteries, and are therefore of more or less advantage in all dis- eases of a sthenic character. They produce this effect not only by evacuating the vitiated or accumulated con- tents of the bowels, and thereby removing a source of general irritation, but also, by abstracting from the con- tents of the blood-vessels themselves, by the increased secretion of serum they produce in the alimentary ca- nal. In this respect the operation of these remedies resembles, in some degree, those of blisters; which, though acting primarily as stimulants upon the sangui- ferous system, reduce its action as a secondary effect, by the evacuation of serum which they occasion. 2. They promote the absorption of fluids, from the internal cavities. This effect they produce by a two- fold operation; namely, by depriving the blood-vessels of a portion of their serous contents, and by augmenting, 80 CATHARTICS. as a consequence of this, the reabsorption of serum, from those cavities in which it may exist in a state of mor- bid accumulation. To render this explanation intelligi- ble, it will be necessary to enter into a more particular exposition of the grounds upon which it rests. It ap- pears to be conclusively established, both by direct ex- periment* and pathological observations, that absorp- tion is accelerated in proportion as the quantity of fluid circulating in the blood-vessels is diminished. It would appear too, that there is a constant effort in the system to preserve the regular proportion of serum in the blood, and that its inordinate loss by one emunctory, is counterbalanced either by a greater absorption from some of the internal cavities, in which it may be accu- mulated, or by the diminished action of one or more of the other serous emunctories. Thus when the exha- lants of the peritoneum effuse a preternatural portion of serum into the cavity of the abdomen, producing ascites, the morbid diminution of this fluid in the blood- vessels is, in some degree, counteracted by the dimi- nished action of the cutaneous exhalants, and of the kidneys. The moment, however, that the kidneys are excited into a more perfect performance of their func- tions, then (this check to the morbid diminution of the serum of the blood being removed) some new supplying power is requisite to keep up the necessary proportion of serous fluid in the blood-vessels; hence the absorbents are called into action, and the dropsical fluid is reab- sorbed into the circulation, and thence eliminated by the regular emunctories. From these facts, we readily perceive the way by which active cathartics promote the absorption of dropsical effusions. By irritating the ex- halants of the internal surface of the intestines, a very greatly increased secretion of serum is suddenly pro- duced by the action of these remedies. As a conse- * Journal of Experimental Physiology, by M. Magendie, 182! CATHARTICS. 81 quence of this, not only is the further effusion of drop- sical fluid diminished by deriving the blood from the ex- halants of the cavities to those of the intestines, but its existing bulk is also directly lessened, by the absorbents assuming a more vigorous action, in order to supply the deficiency which the purging has suddenly induced in the serous portion of the blood. This view of the sub- ject will aid us, I think, in accounting for the fact men- tioned by Dr. Paris, and others, that cathartics often in- crease the effects of diuretics. If, for instance, we give a diuretic to a dropsical patient, a slight, but insuffici- ent increase of urinary secretion, for the most part, follows; the absorption is, of course, proportionally small. Let a cathartic be now administered. This will excite a sudden and considerable increase of serous evacuation by the bowels; hence, an unusual demand for a restitution of this constituent portion of the blood is created; and hy consequence, a new impulse given to the supplying or absorbing vessels; which, continuing after the operation of the cathartic has ceased, will have the effect of supplying the kidneys with a larger portion of the elements of their secretion, and, therefore, ena- ble those medicaments which are calculated to increase their action, to operate more effectually. 3. Cathartics tend to remove the torpor which some- times prevails in the portal circulation, and thereby to promote the biliary secretion. This they do by exciting "a brisk peristaltic motion of the intestines, whereby the blood which is accumulated, and, as it were stag- nated in the portal circle, is propelled forwards."* 4. They produce a powerful derivation of the circu- lation from the superior to the inferior parts of the body, on the principle of ubi irritatio ibi fluxus; and hence their utility in cephalic diseases. It may be observed, that, under particular circum- * Johnson on the Diseases of Tropical Climates. VOL. I.--L 82 CATHARTICS. stances, bleeding has a decided effect in increasing the susceptibility of the intestinal canal to the operation of cathartic medicines. " I have often noticed this fact," says Dr. Paris, "in contending with a plethoric dia- thesis; whenever the bleeding preceded the purgative, the effects of the latter have been uniformly more speedy and considerable; in obstinate constipation the same fact has been observed, and mild remedies have been known to act more powerfully, when preceded by blood letting, than potent ones have when exhibited antecedent to it." Having premised these general observations, I shall now pass on to a more particular account of the prac- tical application of this class of remedies. There is no class of articles belonging to the materia medica, whose application is more extensive, or whose aid is more essential to the medical practitioner, than this one. In almost every variety of febrile disease, cathar- tics are among the most indispensable and important curative means we possess. The alimentary canal has been, not unaptly, called the " store-house of diseases." Whatever may be the original febrile cause; whether seated in the bowels or elsewhere, it is certain that the secretions which are poured into.the alimentary canal are, perhaps in almost every instance of fever, changed from their natural or healthy condition, to a state which renders them additional causes of irritation, to the al- ready preternaturally excited system. Hence, simply with a view to remove these additional supporters of febrile action, cathartics are important and indispensa- ble throughout the whole course of nearly all acute dis- eases. But it is not merely by evacuating the vitiated and irritating contents of the bowels, but also by their direct depletory effects on the sanguiferous system, and their consequent power of reducing arterial excitement that cathartics are beneficial in febrile diseases. In fevers of high vascular excitement, or in the first CATHARTICS. 83 stage of febrile diseases, of a low grade of action, we should, therefore, always select such cathartics as ajre calculated at once to evacuate completely the contents of the bowels, and to occasion an abundant effusion of serous fluid from the intestinal exhalants. It is on this account that the saline cathartics, in the ordinary sy- nochous fevers, are decidedly the most advantageous. In fevers, however, that are attended by functional derange- ment of the biliary system, as is the case commonly in re- mittent and intermittent fevers, it will be necessary to employ such cathartics as have a tendency, in addition to the effects just mentioned, to correct the disordered hepatic secretions. For this purpose calomel forms the most effectual medicine, in union with other appropriate cathartics. But, upon this point, I shall speak more particularly when I come to the consideration of the particular articles of this class of remedies. Typhus fever, having been long considered as essen- tially characterized, ab initio, by debility, cathartics were, of course, almost universally held as improper in its treatment, until Dr. Hamilton, of Edinburgh, pointed out their utility, in his inestimable work on purgatives. That they are, in fact, not only safe, but eminently useful, in the management of this form of fever, is now sufficiently established by the concurrent testimony of the ablest practical writers of the present day. Dr. Rush has, long since, observed, that purgatives are often found to remove, in a sudden and remarkable manner, the apparent debility which frequently exists in the latter stages of acute diseases. In the yellow fever he often saw the prostrated strength of a patient suddenly renovated by the operation of a single purga- tive. That debility is conspicuously produced by the impression of irritating matters on the intestinal nerves, is a fact too frequently witnessed to admit of a moment's doubt. Who has not seen the impression of indigesti- ble food, in persons of debilitated digestive organs. 84 CATHARTICS. bring on the most alarming prostration? Why do we so strenuously restrict our debilitated convalescents from taking food, which, in health, would be deemed alto- gether insufficient to sustain the natural powers? It is because' we fear, and justly too, lest it either prostrate the already debilitated vital energies, or raise a tumult in the system dangerous to life. If the natural ingesta are thus able to affect the animal economy, when not fortified by strong digestive powers, is it not reasonable to expect similar pernicious consequences from the re- tention and irritation of the vitiated matters, on the in- testinal nerves of the debilitated typhous patient? That the contents of the intestines are more or less vitiated in all febrile diseases, and especially in the low typhus fever, is certain, I think, not only from the actual ap- pearance of the discharges themselves, but also from the necessary results of the suspended digestion and morbid intestinal secretions which occur in these fevers. From this view of the subject, therefore, we can readi- ly perceive the utility of employing mild purgatives in the latter stage of typhus fevers; since we thereby free the system from a powerful cause of irritation, and at once renovate the vital powers, and enable the intesti- nal emunctories to recover their natural functions. " 1 have directed a strict attention," says Dr. Hamilton, 46 to this practice for a long time, and 1 am now tho- roughly persuaded that the full and regular evacuation of the bowels relieves the oppression of the stomach, cleans the loaded and parched tongue, and mitigates thirst, restlessness, and heat of surface; and that thus the latter and more formidable impression on the ner- vous system is prevented; recovery more certainly and speedily promoted, and the danger of relapsing into the fever much diminished."* These observations apply particularly to the latter stages of typhus, for, in the * Hamilton on Purgatives. CATHARTICS. 85 commencement of this pMsease, when vascular excite- ment is pretty active, brisk purgatives will be beneficial, both by unloading the bowels of their irritating contents, and by their direct depletory effects on the blood ves- sels. In relation to the modus operandi of purgatives in typhus, Dr. Armstrong* makes the following re- marks, which, though correct, do not, as this respect- able writer would seem to think, invalidate the forego- ing remarks concerning the mode in which these medi- cines produce their good effects in typhus. " Purgatives seem beneficial by unloading the intestines of faeces and excrementitious matters, which, when retained, excite and keep up much general irritation. But is it not ex- ceedingly probable, that they have another and far more salutary effect, in restoring healthy secretion, and in re- moving irregular distributions of blood from the head, liver, and other parts? The full operation of aperients sometimes reduces the morbid heat of the skin and the morbid force of the pulse, almost as effectually as the affusion of cold water or venesection; consequences which surely indicate, that their action extends further than the mere removal of fecal matter from the intesti- nal canal." It cannot, indeed, be denied, that the consequences here mentioned do sometimes follow the operation of cathartics; but when we reflect that the very circumstances of a hot and dry skin, an irritated pulse, morbid function of the intestinal exhalants, and irregular, distributions to the head, liver, and other vital parts, are in reality, often produced by irritating matters lodged in the intestines; it will appear evident, that these symptoms may be mitigated by purgatives, not by any operation independent of their mere evacuant effects, but solely, by removing those irritating matters from the bowels, upon which the morbid phenomena just mentioned depend. * Treatise on Typhus Fever, p. 102. First Am. edit 86 CATHARTICS. Dr. Armstrong makes another observation on this subject, to the reasonableness of which I readily sub- scribe. " I believe," says he, " that purgatives are also beneficial by preventing, through their operation, the absorption of the morbid secretions and excrementitious matter of the intestines; for when these have been allowed to be retained in typhus, I have generally observed a con- siderable increase of, irritation, with an offensive odour from the lungs and from the skin^and, on the contrary, when the morbid secretions and excrementitious matter have been regularly evacuated, there has mostly been a diminution of irritation, with an absence of this peculiar odour" I have already said that some purgatives excite the in- testinal exhalants to a copious evacuation of serous fluid, and thereby occasion a very considerable reduction of vascular action, whilst others appear to do little more than merely to evacuate the contents of the bowels. This circumstance should be always kept in mind when pre- scribing purgatives in typhus. For while cathartics of the former kind are best adapted to the first stage of the disease, when it may be necessary to reduce the general excitement, they are, undoubtedly, less proper in its ad- vanced stages than purgatives of a milder character, when our object is, in general, merely to unload the irritating contents of the bowels, with as little reduction of the vi- tal powers as is possible. In all the exanthematous fevers cathartics are very im- portant remedies. Their beneficial operation in these diseases would seem, I think, to depend chiefly on their power of determining the circulation from the cutaneous to the intestinal capillaries. That the exanthemata are peculiarly characterized by strong morbid excitement in the cutaneous vessels, is perfectly obvious from the manifest character of these diseases. It would, therefore, appear reasonable, a priori, to suppose that whatever is calculated to moderate the action of the vessels of the CATHARTICS. 87 surface, is by this effect, equally calculated to moderate the characteristic symptoms of these diseases. It is upon this principle that cold air and tepid ablutions act so be- neficially in affections of this kind. Experience has taught us the fact, that an increased action of the ves- sels of the intestines, or an afflux of blood to these organs, is almost invariably attended by a simultaneous diminu- tion in the action of the extreme vessels of the cuticular surface, or, in other words, by a partial desertion of the blood from these vessels, and vice versa. Hence, sudori- fics are useful in checking intestinal fluxes; and hence too, cathartics, by exciting intestinal exhalation, act be- neficially in the exanthematous fever. Undoubtedly, however, something is also to be ascribed to the mere removal of the irritating contents of the intestines, and to the general reduction of arterial excitement, which these remedies occasion. In the early stage of scarlatina simplex and anginosa, purgatives are of essential service. Their utility in this disease has been particularly dwelt on by Dr. Hamilton, in his work on purgatives; and Dr. Armstrong adds his testimony in favour of this practice—a practice which is, indeed, pretty universally recommended at the present day. In order to derive the full advantage of purgatives, it is necessary to produce brisk and copious evacuations. For, if the views just given of the modus operandi of pur- gatives, in affections of this kind, be correct, it is evident that such cathartics as act briskly upon the bowels, must be most efficacious in this disease. Dr. Armstrong re- commends the employment of sulphate of magnesia with tartrate of antimony, with the view of exciting rapid purging and vomiting. The same observations apply to the use of purgatives in erysipelas. In no disease are cathartics more decidedly beneficial than in dysentery. Such is the tenderness of the in- flamed intestinal canal in this disease, that even its ordinary contents become a source of great and painful 88 CATHARTICS irritation. One of the first steps, therefore, in its treat- ment, is to remove these irritating matters by the em- ployment of such purgatives as produce a speedy and full action on the bowels; and, as the secretions which are poured into them are, perhaps, in all instances in a vitiated state, these remedies must be occasionally em- ployed throughout the whole disease. As our principal object is, however, to remove those substances from the bowels which have a tendency to irritate, it is obvious that our purpose will be best answered by such means, as will evacuate them with the least possible irritation. It is, therefore, of considerable consequence to select such cathartics as are least harsh in their operation, though sufficiently active to induce copious evacuations. Cathartics are exceedingly useful in puerperal fever and peritonitis. Active purging in the onset of these diseases, is, indeed, often sufficient effectually to arrest their future progress. Used in conjunction with de- cisive venesection, cathartics constitute the only re- mediate measures upon which any reliance deserves to be placed. There is generally much difficulty in moving the bowels in these affections, and we must, therefore, employ strong doses of the most active of these remedies. 1 am decidedly of opinion, both from theoretical con- siderations and practical observation, that the benefit resulting from purgatives in these diseases will, in gen- eral, be proportionate to the activity of their operation. Drs. Abercrombie* and Broussais are of opinion that purgative medicines are injurious in peritoneal inflamma- tions. The latter writer observes, that these remedies are hurtful, " because the vermicular contractions which they excite in the intestines, must increase the morbid sensibility of the peritoneum." The following observa- tions of Dr. James Johnson upon this subject, appear to * Researches on the Pathology of the Intestinal Canal, in the 63d number of the Edinburgh Medical and Surgical Journal CATHARTICS. 89 me to be highly judicious. " In abdominal inflammation, provided the mucous tissues are not inflamed, purgative medicines excite the secreting vessels, not only ol the whole internal surface of the intestines themselves, but of the glandular organs whose excretory ducts open into the prima3 via?, and thus powerfully deplete locally the vascular system of the abdominal viscera. When the portion of peritoneum reflected over the intestines is inflamed, but where the villous coat is unaffected, 1 hesi- tate not to assert, from personal experience, that consti- pation of the bowels will, in nine cases out of ten, be a feature of the disease; and in such cases we maintain that to excite the natural action of the mucous mem- brane, immediately after proper vascular depletion, is a powerful mean of checking the peritoneal inflammation ; in the same way that a free expectoration from the mu- cous membrane of the lungs, relieves the vascular turg s- cence and inflammation of the parenchimatous structure or pleural covering of the same organ."* Dr. Marshall Hall, gives an account of a disease pe- culiar to puerperal women, resembling very closely gen- uinepuerperal fever, in which purgative medicines would appear to be the only remedies offering any prospect of success; and in which bleeding, according to his expe- rience, is almost certainly fatal. Dr. Hall's description of this disease, as distinguishable from puerperal tt^er, properly so called, is, however, by no means satisfactory. He has pointed out no marks by which it may be discri- minated from this latter disease; there can, however, be no doubt, that great prostration of the vital powers, pain and arterial excitement, may sometimes arise from intestinal irritation in puerperal women, without the ex- istence of any local abdominal inflammatian; and under such circumstances we can readily perceive, that bleecl- * Medico-Chirurgical Review, No. 2, Analytical series*. VOL. I.—M 90 CATHARTICS. ing, especially if copious, would be improper, since it would create additional debility without removing the cause of irritation, which would, indeed, by this very practice, become more pernicious in its effects. From the general antiphlogistic operation of cathar- tics, it is evident that they are not inapplicable in the treatment of acute rheumatism. They are, in fact, much recommended in this disease by writers of great respec- tability. "The advantage," says Dr. Scudamore, " of making a detraction from the general circulation by the channel of the alimentary canal, is no less remarkable in rheumatism, than in every other inflammatory disease. In proportion as we pursue this practice upon a continu- ed principle from day to day, do we obtain its good ef- fects in acute rheumatism ; the circulation becomes moderated; the inflammatory diathesis subdued, and the absorbent system is excited to increased action. Hence, we powerfully promote the removal of those excessive secretions of the synovial membranes, which have been already described as causing the distention and imped- ing the motion of the affected parls. A saline purgative, administered in small doses, and at repeated intervals, is the most advantageous."* Drastic purges are, how- ever, as a general rule, not to be employed in the treat- ment of this disease. These are, in some degree, in- compatible with that regular action of the cutaneous exhalants which seem to be indispensable in the removal of this painful affection. Laxatives, on the contrary, are of unquestionable service; they remove the sources of intestinal irritation; tend gently to equalize the circulation, and lessen the action.of the heart and arte- ries, by their evacuant effects upon the extreme vessels of the intestines. As an auxiliary to other antiphlogis- tic measures, they can seldom be neglected with pro- * A Treatise on the Nature and Cure of Gout and Rheumatism, p.299. CATHARTICS. 91 priety in the cure of acute rheumatism. Nearly the same thing may be said in relation to the use of ca- thartics in the treatment of gout. Whatever be the real nature of this disease, it seems certain that there is, perhaps, always functional derangement of the se- cretory organs of the alimentary canal, and especially" of the liver and portal system of vessels.* There is no difficulty, therefore, in accounting for the beneficial op- eration of purgatives in gout; since they not only remove the vitiated and irritating contents of the bowels, but tend also to correct the action of those glands whose products are poured into the alimentary canal, and, by detracting from the general circulation, to moderate the febrile excitement, and especially to promote and invigorate the portal circulation, which, according to Scudamore, is in a morbidly engorged condition.! Dr. Sutton, m his Tracts on Gout, &c. speaks strongly in favour of the employment of cathartics in this dis- ease. Dr. Scudamore states, that " he has invariably employed, with the greatest advantage, purgative and diuretic medicines conjointly, so that the exhalant ves- sels of the alimentary canal, and the secreting function of the kidneys are stimulated to increased action at the same time." Such a union of purgatives and diuretics is particularly serviceable in those cases that are attend- ed with dropsical effusions in the extremities. There is no acute disease in which purgative medi- cines are more indispensable than in hydrocephalus in- ternus. The pathology of this complaint has, of late years, been much elucidated. It appears to be now pretty generally admitted, that it very often depends on gastric irritation. The alvine discharges, in this dis- ease, afford unequivocal proof of great functional dis- order of the liver. They very commonly consist of large quantities of black, or green and glary bile, and seldom, if ever, exhibit the appearance of natural and * Dr. Scudamore on Gout, p. 74. t Ibid. p. 100. 92 CATHARTICS. healthy evacuations. Tn post mortem examinations of hydrocephalic children, Dr. Cheyne " found in the liver the remains of great inflammatory action, and also proofs that undue irritation had existed in the alimen- tary canal."* And Mr. Abernethyf states, that on dis- secting the body of a child that had died of ''unequivo- cal symptoms of hydrocephalus,1' he found the brain perfectly healthy, Ike ouly diseased appearance being in the bowels. Dr. Cheyne also mentions the case of a girl, who, complaining in the evening of headacb, was put to bed by her mother, and soon asleep; next day, at noon, she was still sleeping profoundly, respiring fully and slowly, with now and then a heavy sigh; the eyes were fixed, the pupils large and immovable. She had been very costive for some days previous, and was languid; she was ordered an enema, and this roused her so far as to swallow a bolus of jalap and calomel. This operated powerfully; and brought away "two chamber-potfuls of the most extraordinary collection of feces" the doctor ever saw. The patient recovered im- mediately. This case shows, in a striking manner, the powerful influence which intestinal irritation, from the presence of. acrid or vitiated matters, may have upon the brain. We have a further confirmation of the cor- rectness of this pathology of hydrocephalus, in the fact, that cholera infantum very often terminates in unequi- vocal symptoms of hydrocephalus. Nor is it an uncom- mon thing to see children who have long been harassed with indigestion and diarrhoea, die with symptoms of hydrocephalus acutus. Indeed, proofs of the morbid influence of visceral irritations on the brain are so vari- ous and palpable, that the most careless observer must have often noticed them.| * Cheyne on Hydrocephalus. t Surgical Obvjrvatioiis, part ii. p. 190. t This pathology of hydrocephalus is particularly advocated by CATHARTICS. 93 But, whether the disease be an idiopathic, or only a secondary affection of the encephalon, purgative medi- cines are amongst the most important of our remediate resources. It is evident, however, that where the dis- ease is dependent on a primary irritation in the bowels, cathartics are more especially iudicated, since they tend, at once, to remove the remote cause of the dis- ease, and, by determing an afflux to the intestines, to lessen the flow of blood to the brain. The bowels should, therefore, be actively moved, in every instance where hydrocephalic symptoms supervene, whatever other measures be adopted. They have a more power- ful effect in lessening the action of the circulation in the head, than any other internal remedies we can employ. "Should we ascertain," says Dr. Cheyne, "that the alimentary canal is torpid, and imperfectly performing its functions, admitting an accumulation of feculent matter, or thai the secretions flowing into it are vitiated or diminished in quantity, which we discover by the pe- culiarity in the appearance, or the pungent fcetor of the stools, we must, by steadily pursuing the purgative plan, endeavour to effect a change; for while this is produced in the appearance of the stools, by the stimulating qua- lity of our medicines, we are effecting a most important change in the hepatic system, alimentary canal, and all the parts, including every organ essential to life, which is connected with them."* For the same reason that cathartics are prescribed in hydrocephalus; namely, to determine the circulation from the head, and to remove the causes of intestinal irritation, are they useful in apoplexy. Whatever be the speculative notions entertained in relation to the pathological character of this disease, all experience Drs. Cheyne and Yates. Spurzheim thinks that it is sometimes dependent on primary gastric irritation, but generally, an idio- patheiic cerebral affection. * Essays on the Diseases of Children, by John Cheyne, M.Q: 1)4 CATHARTICS. would seem to testify in favour of the employment of active cathartics in its cure. As the advantages deriv- ed from these remedies, in the present disease, arise probably more from the strong tendency they have to diminish the afflux of blood to the encephalon, and di- recting it upon the intestines and other gastric viscera, it is evident that the more rapidly they purge the more beneficial will be their operation. Hypochondriasis is, in general, obviously connected with and often preceded by a deranged state of the chylopoietic viscera. We may frequently trace the suc- cessive grades of dyspepsia up to the full formation of this deeply distressing complaint. It is almost invaria- bly preceded by disorder of the digestive organs. The appetite is either morbidly increased, or depressed; a distressing sense of fulness is experienced in the sto- mach, and there are foetid eructations, with a white tongue, obstinate constipation, and headach. Yet in this disease active purging does not appear to be proper; for, as the gastric symptoms just mentioned, and upon which those of the mental affection would seem to de- pend, arise from a debility of the digestive organs, it is easy to understand why drastic purgatives rather do harm than good. For, although they might effectually remove the vitiated contents of the intestines, yet, as their operation would have a tendency to weaken still more the already debilitated chylopoietic organs, it is evident that they cannot be employed with propriety in this affection. The same objection does not, however, stand against the use of laxatives in this disease. These, on the contrary, are indispensable auxiliaries in its treat- ment. By gently exciting the action of the bowels, they tend to restore the natural intestinal and hepatic secre- tions, and to remove the torpor which, in this disease, prevails in the portal circulation. Purgatives ought to be united with mild bitter tonics, and given in such a way as to procure one, or at most but two good evacu- CATHARTICS. 9o ations every twenty-four hours. There is often an amazing quantity of faecal matter impacted in the lower bowels of hypochondriacs, which has a strong influence in keeping up the disease, and which it is almost im- possible to remove by purgatives. When there is rea- son to suspect the presence of such accumulated con- tents, there is no way by which we can so conveniently, and at the same time so effectually and beneficially re- move them, as by the daily employment of mild and copious laxative injections. These, indeed, should never be neglected in the treatment of this and other chronic diseases, dependent on gastric derangement and accompanied with intestinal torpor, Hysteria is a disease closely allied to the preceding; and its intimate connection with disorder of the diges- tive viscera, is demonstrated by the symptoms of wan- dering pains in the abdomen, flatulence, acid and foetid eructations and constipation, which characterize the hysteric constitution.* " in my opinion," says Dr. Ha- milton, " these symptoms afford conclusive evidence, that this gastric affection is primary, and that the other multifarious symptoms of hysteria depend on it. I have, therefore, thought it reasonable to attend particu- larly to the state of the stomach and intestines, and to employ, in the first place, purgative medicines, to re- move the constipation of the body which most common- ly prevails in hysteria/' I have been much in the habit of employing purgative medicines in hysteria. In some cases I have succeeded in putting a stop to the paroxysm by means of a brisk cathartic, after all the ordinary re- medies for cases of this kind had been tried with little or no advantage. Purgatives will, however, produce very little benefit in this disease, unless they be admi- nistered in doses sufficient to occasion full and active * Dr. Hamilton. 96 CATHARTICS. purging. They may be very advantageouslv united with the foetid gums, particularly asafcetida. Dr. Hamilton observes, what, indeed, I have myself repeatedly no- ticed, that " the first purgatives seem, on some occa- sions, to aggravate the symptoms; but the practice must not be deserted on this account. The additional irri- tation which purgatives may give in the first instance, soon passes away; and perseverance in the use of them removes that irritation which gave rise to the disease, which, of course, disappears in proportion as the bowels are relieved of the oppressive mass of accumu- lated faeces." It is evident, however, that in a disease, which, like this one, is so intimately connected with disordered digestive powers, ihe employment of tonic and gently stimulating remedies will often be found ne- cessary along with purgatives. Chorea is another of the neuroses in which the em- ployment of purgatives has been especially recommend- ed. That it is often dependent on gastric irritation, and connected with great faecal accumulations in the lower intestines, I have not the least doubt: and that, in such cases, purgatives will be useful is at once obvious. Dr. Hamilton is the first who directed the attention of ihe profession fo the purgative plan of treating this disease. It appears, however that the exhibition of purgatives in the present disease, is countenanced by the practice of Sydenham, De Haen, and Dr. Stoll. " Chorea," says Dr. Hamilton, " consists of two sta- ges. In the first, while the intestines yet retain their sen- sibility, and before the accumulation of faeces is great, gentle purgitives, repeated as occasion may require, will readily effect a cure, or rather prevent the full formation of the disease. In the confirmed stage, more sedulous attention is necessary. Powerful purgatives must be given, in successive doses, in such a manner that the latter doses may support the effect of the former, till the movement and expulsion of the accumulated matter arc CATHARTICS. 97 effected." It is absolutely indispensable to pursue this treatment in a firm and decided way, in order to derive permanent advantages from its employment. "Half measures, in instances of this kind, will prove unsuccess- ful." ^ It must be confessed, however, that, although cho- rea may frequently, perhaps generally, have its origin in the alimentary canal, yet we sometimes meet with cases which do not seem to depend upon causes seated in the abdominal viscera, or which, at least, do not yield to the most complete and efficient course of purgative remedies. I have seen two cases in which purging was practised copiously and regularly for a reasonable length of time, with no alleviation, but, on the contrary, with a manifest aggravation of the convulsive motions of the patients. One of these patients was finally cured by tonics and antispasmodics; the other did not recover. I have, how- ever, seen five other cases, two in my own practice and three in the practice of other physicians, which were effectually cured on the plan recommended by Dr. Ham- ilton. I am, therefore, fully persuaded, that, although, this mode of treating the disease will not always succeed, it holds out a more certain and rational prospect of suc- cess than any other treatment with which we are at present acquainted. Respecting the employment of purgatives in the treat- ment of tetanus, no very satisfactory recommendations have been advanced. When this disease arises from general causes, or, more properly speaking, when it does not depend on any local mechanical injury, it would seem, from the reports of Drs. Hamilton and Burns, to be occasionally reme- diable by the vigorous employment of purgatives. In the treatment of trismus nascentium, or the locked-jaw of in- fants, purging has also been successfully employed. Dr. Chalmers says, " I have cured one case of the jaw-falling of infants, by purging with an infusin of rhubarb, to VOL. I. n 98 CATHARTICS. which a few grains of musk and a little ol. tart. per. deliq. were added."* When once formed, however, this disease of infants is but very rarely cured. I know of no authority for the assertion made by Dr. Chapman, that " the utility of purging is indisputably established in trismus nascentium." A very few solitary cases appear on record, in which these remedies were employed with seeming success; but their utility is far, I am sorry to say, very far, from being " indisputably established/' in this fatal variety of spasmodic disease.f ' In the treatment of marasmus, a disease unequivocally and essentially connected with morbid derangement of the digestive organs, purgatives constitute our most im- portant remediate resources. In the first stage of this disease, which, according, to Hamilton, extends from its commencement to the ac- cession of the febrile symptoms, and in which " the bowels are not altogether torpid, neither are they over- * London Medical Observat. and Inquiries, vol. i. p. 109. t The following observations on spasmodic diseases are quoted by Dr. Hamilton from Camper's Anatomico-Pathological Demon- strations. " Nervis descriptis ad symptomata accedo, quae ex eorum union- ibus facile explanatur; Ordiar autem a pedum tremor, qui hys- tericis familiaris est. In antecessam vere monere debeo, omnia terribilia hysterica symptomata, quae turn in singulis, turn in uni- versi corporis locis quotidie videmus, ab acrimonia putrida pri- mas viasoccupante omnino dependere; excrementorum enim foetor intolerabilis, fauces, et alia qua prseter naturam sunt, rigorum et convulsionum accessum annuntiant. Res igitur ita se habere videtur; plexu mesenterico inferiori affecto, nervi omnes cum eo conjuncti, Iumbales scilicet, et proinde crurales, atque ob- turatores nervi afficiunUir. Si acrimonia tanta est ut etiam rectum intestinum irritare queat, nervi Ischadici in concensum trahentur, rigebitque pes integer, concucietur, et per vices quiescet, donee animi deliquium tumultum sedet. " Infantum inferiorum extremorum convulsiones, ex ascaridi- bus rectum intestinum occupantibus, hanc theoriam confirmant. " Purgantia, etiam drasticalicet imprudenturabhibita, propterea forsan, epilepsia spurias, choream sancti viti,aliosque spasmodicos sanarunt morbos qui desperati a medicis habebantur." CATHARTICS. 99 loaded with accumulated faeces, mild purgatives will, in general, effect a cure." When, however, the disease has advanced into the second, or febrile stage, more ac- tive aperients must be regularly and perseveringly em- ployed. For this purpose, Dr Hamilton recommends the exibition of small, but frequently repeated doses of the purgative medicines; " so that the latter dose may support the effects of the preceding ones. When the bowels are once opened, stronger purgatives, given at longer intervals, will accomplish the cure." In my own practice I have obtained the happiest results from the con- tinued employment of purgatives, together with a light but nourishing food, in the treatment of this disease. Dr. Hamilton speaks favourably of the use of purga- tives in the treatment of chlorosis. " The slightest at- tention to the history of the disease," says he, " evinces that costiveness proceeds and accompanies the other symptoms. Costiveness induces the feculent odour of the breath, disordered stomach, depraved appetite, and impaired digestion. These preclude a sufficient supply of nourishment, at a period of growth, when it is most wanted; hence paleness, laxity, flaccidity, the nervous symptoms, wasting of the muscular flesh, languor, debili- ty, the retention of the menses, the suspension of other excretions, serous effusions, dropsy, and death." He accordingly recommends purgative medicines, until the bowels are well emptied, after which he has recourse to tonics. I have never used purgatives in this disease, nor am I disposed to employ them to the extent recommend- ed by Dr. Hamilton. The costiveness, as well as the amenorrhoea, is, I think, in some instances at least, the consequence and not the cause of the general debility and torpor of the system. There can be no doubt, how- ever, that these effects may, of themselves, contribute to keep up that state of the general system which in the first place produced them. And hence, although pur- gatives will be proper, to remove at least one of these 100 CATHARTICS. symptoms, namely, constipation, still, our main depend- ence ought to be placed on the employment of tonics, nourishing diet, and exercise. The same author speaks in very high terms of the employment of purgative me- dicines, in that variety of vomiting of blood which " at- tacks females who are from eighteen to thirty years of age." The attack of this variety of haemorrhagy " is pre- ceded by great languor and oppression, both about the chest and the praecordia; and by a sense of fulness of the praecordia; by cough, dyspnoea, and sometimes by pain of the breast; by loss of appetite, headach, vertigo, and disturbed sleep; the eye is dull, the countenance is ex- pressive of much distress, the pulse is feeble, and the bowels are constipated." "In this state of impaired health, a particular fit of sickness and nausea is the immediate forerunner of the attack of the vomiting of blood/' I have never had a case of this kind to treat, and can, therefore, say nothing in relation to the utility of purg- ing in its treatment. Dr. Hamilton, however, speaks strongly in favour of this practice. " My success," says he, " has been so uniform, that I now lay it down as a certain position, that the proper exhibition of purgative remedies affords sure and effectual means of removing the vomiting of blood which I speak of." Cathartics have long been considered as important remedies in the cure of dropsies. As I shall, however, have occasion to speak more particularly on this sub- ject when I come to treat of cremor tartar and elate- rium, it will be unnecessary to dwell particularly on this point in the present place. I shall now, therefore, proceed to an account of the particular articles belonging to this class of remedies. CATHARTICS. 101 Of ilie Particular Cathartics. RADIX JALAPiE.—JALAP. Jalap is the root of the Convolvulus Jalapa, a peren- nial plant, indigenous to the southern parts of the United States, Mexico, and some of the West India Islands. It is brought to us, either in transverse slices or in pieces of a pyriform shape; these are compact, solid and heavy; rugous and blackish externally, and of an obscure grey colour internally* ,When powdered, it has a peculiar and somewhat nauseous odour, and a slightly acrid and sweetish taste. It contains a large proportion of resin, upon which its purgative powers seem entirely to depend. It contains also a gum, which, though almost wholly destitute of laxative properties, is extremely active as a diuretic, and some extractive matter, with fecula and salts, enter into its composition. It appears that a combination of the resinous, gummy, and extractive principles of this root, " is requisite for the production of its full cathartic effect;" and hence, proof spirit is its proper menstruum.f The officinal preparations of this substance are: The, pulvis jalapce compositus; extract jalapce; tinctura jalapce; tinctu- ra sennce composita. The Prussian Pharmacopoeia contains a formula for preparing the sapo jalapinus, which is said to operate mildly and promptly.J * Jalap is sometimes mixed with briony root; but this may be readily distinguished from jalap by its pale colour, its spongy tex- ture, and its greater lightness and bitterness, and by its not burn- ing so readily when held to the flame of a candle.—Burdach. t Paris. \ This is made by taking equal parts of castile soap and of 102 CATHARTICS. The resin acts powerfully, but is apt to produce vio- lent griping pains. Its dose is from gr. x. to 9i. It should be well rubbed up with sugar or vitriolated tar- tar, in order to obviate its griping effects. Jalap is commonly given in the form of powder. From twenty to forty grains may be given at a dose, ac- cording to circumstances. In combination with calo- mel it fonns one of the mildest and most effective purges with which we are acquainted. This combination is particularly applicable, when we wish to emulge the biliary organs, to excite the healthy functions of the liver, and to produce prompt and copious alvine evacua- tions. Hence calomel and jalap are very generally pre- ferred to the other purgatives in the treatment of bilious fevers, jaundice, hepatitis, &c. The proportion in which these two substances may be combined varies considerably. About ten grains of the former with fif- teen of the latter, forms a very suitable mixture. A combination of jalap and cremor tartar, in the proportion of about twenty-five graius of the former, with forty to sixty of the latter, forms an exceedingly useful cathartic in dropsical cases. It powerfully ex- cites the intestinal exhalants, causing them to pour out large quantities of serous fluid, in consequence of which it produces very copious watery evacuations. It is on this account too, that this combination forms a peculiar- ly efficacious cathartic for reducing local inflammations; such as that of the hip disease, ophthalmia, &c.; for it not only abstracts copiously from the general circula- tion, but also excites a strong afflux to the intestinal ex- halants, and thereby diminishes the determination of the circulation to the parts affected. Dr. Aiken asserts that " fifteen grains of jalap, with resin of jalap, and digesting them in a sufficient quantity of al- cohol, with a moderate degree of heat, and evaporating to the consistence of a conserve. CATHARTICS. 103 two or three grains of ipecacuanha, purge more than twice the quantity of jalap by itself." RADIX RHEI.—RHUBARB. There are two sorts of rhubarb met with in the shops; the rheum palmatum, and the rheum undulatum. The former is brought from Russia and Turkey, and is considered the better sort. It consists of round rather compact and heavy pieces, with perforations through the middle. Externally it is of a yellow colour, and, on being cut, exhibits a variegated appearance, from a number of reddish or white streaks which pass through it. Its taste is slightly styptic, subacrid and bitterish. That which is imported from China consists of long and somewhat flat pieces. It is heavier and more compact than the Turkey rhubarb, and is seldom perforated with holes. It is also more nauseous to the taste, and its powder has a deeper shade of red than the other sort. Rhubarb contains "gum, resin, extractive, tannin, gallic acid, and a peculiar colouring matter, with traces of alumina and silex." The white or reddish streaks which run through it, consist almost entirely of sulphate and oxalate of lime. It was supposed to contain a pe- culiar acid, to which the name of rheumic acid was given, but it has been satisfactorily ascertained, that this supposed new acid is nothing more than the oxalic acid. The Chinese rhubarb contains less tannin, resin, and oxalate of lime, but a greater proportion of extractive and gallic acid, than that which comes from Turkey. Out of sixty parts of Turkey rhubarb, twenty-four are taken up by water at the temperature of 212°. }}y long boiling it loses its cathartic properties, but becomes more astringent and bitter. Alcohol extracts 2.7 parts 101 CATHARTICS. out of ten. That which comes from China is, however, more soluble. One half of its weight is taken up by boiling water; and alcohol extracts four out of ten parts. " Its habitudes with acids, alkalies, and neutral salts differ likewise from those of the Russian va- riety."* With its cathartic properties rhubarb possesses a very considerable degree of astringency. Given in small doses, as from four to ten grains, it acts as a stomachic, and gentle tonic. In the dose of from twenty to forty grains, it operates as a mild and pretty active cathartic; but, from its astringency, it is apt to leave the bowels in a costive condition after its operation. From this union of properties, it is evident that it is not well suited to the treatment of inflammatory diseases, nor, indeed, to that of any other complaint in which we wish at once to evacuate the contents of the bowels, and to abstract from the general circulation by means of the intestinal exhalants. It has been much recommended in dysen- tery, and there can be no doubt of its peculiar utility in the advanced stages of this complaint; but in the com- mencement of the disease, before the inflammation has been considerably moderated by more decisive antiphlo- gistic measures, rhubarb is unquestionably an improper cathartic. On the contrary, however, the very astringency which rhubarb possesses in common with its cathartic properties, renders it particularly useful in the treat- ment of diarrhoea, and other diseases connected with a laxity or debility of the intestinal canal. It is evident, that much advantage is to be derived in affections of this kind, from a remedy, which, like the present one, at once evacuates the bowels of their vitiated contents, and acts upon them as a gentle tonic. In the treatment of indigestion, rhubarb is decidedly * Paris's Pharmacologia. CATHARTICS. 105 the most useful purgative we possess. Where, from debility of the digestive organs, much acid is generated in the primse viae, rhubarb may be very advantageously exhibited in union with magnesia. In the diseasesof infants this medicine has been long regarded as peculi- arly beneficial. It is especially useful, when combined with magnesia, in the griping bowel complaints of very young infants. From one to two grains of rhubarb with three or four grains of magnesia, rubbed up with a little cinnamon water and sugar, forms a most excel- lent medicine in cases of this kind. United with aromatics, rhubarb forms a highly use- ful aperient in atonic gout, attended with uneasy sen- sation and debility of the stomach. For this purpose it is generally admitted that Warner's cordial is an exceed- ingly useful preparation.* Externally the powdered rhubarb is sometimes em- ployed as an application to ulcers, for the purpose of promoting granulations. When taken internally its co- louring matter passes rapidly through the circulation, and is soon conspicuously manifested in the urine. Its purgative effects are considerably enhanced by uniting it with neutral salts; "the super-sulphate of potass forms a very useful adjunct, and its acidulous taste com- pletely covers that of the rhubarb.f * Rhubarb bruised §i. senna §ss. saffron Ji. powdered liquorice 3iv. raisins pounded fti. brandy Ibiii. Digest for a week and strain. f Incompatible substances. " The stronger acids; the sulphates of iron and zinc; nitrate of silver; tartarized antimony; acetate of lead; oxymuriate of mercury ; and the infusions of cusparia; cinchona, catechu, galls, and of some other astringent vegeta- bles ; the alkalies deepen the colour, but produce no decomposi- tion." VOL I.—0 106 CATHARTICS FOLIA SENN.E.--SENNA LEAVES. The senna of the shops, according to the observations of Nectoux, is furnished by three different plants : the cassia senna, the cassia lanceolata, and the cynanchum olecefolium. The leaflets of the cassia senna (known in Egypt by the name of senna bellidy,) are obtuse, oval, unequal at the base, somewhat thick, and supported on footstalks destitute of glands. The pods of this species are compressed oval, sickle-shaped, and marked on each side with small longitudinal elevations, corresponding in situation with the seeds they contain. The leaflets of the senna lanceolata of Lamarck, which is known to the inhabitants of Egypt by the name of senna quebelly^ may be distinguished from those of the former by being more acuminate, or lance-shaped, and having a small elevation or gland at the base of the footstalk. The pod of this species is very flat, oval, oblong, and not curved. The leaves of cynanchum olecefolium, (arguel,) known in commerce by the name of senna Mekki, are very often found mixed with those of the two species of senna just described. They may, however, be detected by their greater length, and especially by being covered with a long down.* Of these the cassia lanceolata, or as it is commonly called, the Alexandrian senna, is re- garded as the most valuable. It does not appear, how- ever, that the leaves of the cynanchum olecefolium, are in any degree inferior as a cathartic to the best senna. Mr. Nectoux observes that the arguel (cynanchum oleaefol.) possesses properties equal to those of good senna; he even holds it as being preferable to either of * The senna of the shops is sometimes adulterated by the leaves of coluta arborescens. These are, however, easily distin- guished by being conspicuously cordate, and notched at the points. CATHARTICS. 107 the species of cassia; an opinion which he predicates upon the experiments made with it by Dr. Pugnet, as well as upon the testimony of the inhabitants of those parts of Egypt from which it is brought. According to an interesting analysis of senna, made by M. Bouillon Lagrange, it appears: 1. that the watery extract of senna is almost entirely soluble in alcohol, and that the part thus soluble is not a resin, as has been supposed, but a substance which requires simply the addition of a certain portion of oxygen to convert it into a matter which has all the characteristics of resin. 2. That the part soluble in water contains sulphate of potass, potass, carbonate of lime, magnesia, silex, &c. together with that substance, which, I have just said, is connected with a matter possessing the character of resin by uniting with a portion of oxygen, and to which senna seems to owe its purgative qualities. It appears also that this peculiar substance has a very strong affi- nity for oxygen; and hence we see the propriety of the caution given by Dr. Paris, that the infusion of senna should never be suffered to stand long before it is taken, "since, by simple exposure to the air, for only a few hours, in consequence of the powerful affinity of its extractive matter for oxygen, a yellow precipitate takes place, and the infusion loses its purgative quality." " In preparing it, therefore," he adds, " we see the neces- sity of conducting the process in covered vessels, and of making only such a portion as may be required for im- mediate use."* * M. M. Lassaigne and Fenuelle, have lately succeeded in se- parating the active principle of senna in a pure state, and to which they have given the name of Cathartine. This principle does not crystallize; it is of a reddish yellow colour, and has a peculiar smell and a bitter and somewhat nauseous taste. It is soluble in alcohol and water in all proportions, out insoluble in ether. The extract attracts the humidity of the atmosphere and becomes moist when exposed. It is powerfully cathartic 108 CATHARTCS. Senna is hardly ever employed as a cathartic, except in the form of an infusion. In order to divest it of its griping quality, which it possesses to a very consider- able degree, it is commonly mixed with other substances, such as manna, coriander, fennel or anise seeds. For this purpose, however, the best adjuncts are soluble tartar and alkaline salts, which have the power " of in- creasing the solubility of its oxidized extractive." A decoction of guaiacum is said to increase its powers and to render its operation milder.#f It is observed by Alibert, on the authority of M. Bouillon Lagrange, that the powdered senna is very apt to undergo alteration or decomposition, from being suffered to remain exposed to a humid atmosphere. In such a situation it becomes covered with a kind of pel- licle, or mouldiness, which contains a small portion of potass. The powder, however, is but very seldom em- ployed, except in the form of an electuary in combina- tion with other purgatives. "The infusion is disturbed by strong acids, lime water, nitrate of silver, oxymu- riate of mercury, acetate of lead, tartarized antimony, and by the infusion of yellow cinchona," * Paris's Pharmacologia. f The infusum senna limoniatum, is a very convenient mode of exhibiting this medicine to children. It is made by pouring six ounces of boiling water upon 5ss. of fol. senna, %\\. lemon peal, and 3ii. lemon juice. The ivfusum laxativum uqennense, is also an excellent prepa- ration. It is made thus: folior. sennae 3U- cremor tart. 3iss. pulv. rhei. $\. sem. coriander 3iss. mannae §i. aquse ferventis §vi. Digere per 4t# horas. Selivay's prepared essence of senna.—" This is a concentrated infusion of senna in combination with an alkali. It is admirably adapted for domestic use."-^-PARts. CATHARTICS. 109 CASSIA MARILANDICA. This species of cassia is exceedingly abundant in many parts of the United States. Its leaves differ but little in appearance and properties Jrom the senna of the shops. The predominant constituents of the leaves of this plant are resin and a volatile substance. " The tincture is of a dark brown colour, and is rendered ex- tremely turbid by water."* I have very frequently em- ployed it instead of the officinal senna, and have always found it a certain and safe purgative. It seems to be more apt to gripe than the common senna, " a quality which may, however, in a great measure, be correct- ed, by infusing with the leaves a small quantity of ihe root of glycyrrhiza, or anise, and employing a large quantity of water." The cassia marilandica is not so powerful as the senna of the shops. It requires about one third more than the latter to produce an ordinary cathartic effect. For a particular description, and very accurate figures of this plant, the reader is referred to Dr. Barton's Vegetable Materia Medica of the United States, vol. i. and to Dr. Bigelow's American Medical Botany, vol. ii. PODOPHYLLUM PELTATUM.—MAY APPLE. This is an exceedingly common plant in the United States; and every where well known, on account of its esculent, and, to some, delicious yellow fruit. Its root possesses valuable cathartic properties; but the turiones, or young shoots of this plant are said to be highly poi- sonous. Dr. Barton, the present professor of botanv * Bigelow's American Medical Botany, vol. ii. p. 168. 110 CATHARTICS. in the University of Pennsylvania, has shown me a letter from the Rev. F. Heckewelder, of Bethlehem, in which it is stated, that the Indians of this country have been known to use these shoots as a poison, to destroy themselves. According to Dr. Bigelow, the root con- tains a resin, a bitter extract, faecula, and a small pro- portion of gum. As a cathartic, the powdered root is pretty extensively employed in some parts of this coun- try. I have myself given it very frequently instead of jalap, and have always found it active and safe in its operation. It is, however, more drastic and apt to gripe than jalap, nor does it appear to be so prompt in its effects as this cathartic. " Its operation," says Dr. Burzon, " in all cases in which I have administered it, is slower than that of jalap, but it leaves the bowels longer in a lax and soluble condition. I once took twenty grains at four o'clock, P. M. which gave me no disturbance till the next morning, when its operation commenced, and produced continual motions all that day and part of the next night, together with severe tormina; this was the first dose of podophyllum I had ever administered; and its effects being so decided, I have since prescribed it in a multitude of cases, and, for the most part, with similar results. It is more dis- agreeable to the stomach than common purgatives, and will often occasion emesis."* Calomel renders its operation milder. In combina- tion with crem. tart, it forms an exceedingly good ca- thartic for the cure of anasarca and ascites. It has also been particularly recommended in bilious fevers. It certainly is entitled to considerable attention from the American practitioner, as a useful indigenous cathartic. " The medical properties of the podophyllum peltatum," says Dr. Bigelow, " are those of a sure and active ca- thartic, in which character it deserves a high rank * American Medical Recorder, vol. iii. p. 332. CATHARTICS. Ill among our indigenous productions We have hardly any native plant which answers better the common pur- pose of jalap, aloes and rhubarb." The best time for taking up the root is in autumn, when the leaves are turning yellow. The extract of it is said to operate mildly and freely. For excellent figures of this plant see Bigelow's American Medical Botany, vol. ii. and Barton's Vegetable Materia Medica of the United States, vol. i. JUGLANS CATHARTICA.--WHITE WALNUT.—BUTTERNUT. The white walnut grows in considerable abundance throughout the United States, and furnishes us with the most important of our indigenous cathartics. Dur- ing the American revolution, it was much employed in our military hospitals, and was esteemed as a most excellent substitute for the ordinary officinal cathartics. The extract made from the inner bark of this tree is alone employed for medicinal purposes. Given in doses of from fifteen to thirty grains, it operates as an active cathartic, without " occasioning heat or irritation." It is thought to be particularly applicable as an aperient in habitual costiveness, as it is less apt, than most other cathartics, to leave the bowels in a state of languor or costiveness. Calomel increases its activity, and, com- bined with this article, it is said to be especially useful in bilious fevers. The bark of the root will blister the skin. The extract should be made from the bark in the month of May or June. CAMBOGIA.--GAMBOGE. This gummy-resinous substance is furnished by the 112 CATHARTICS staligmitis cambogioides, a tree of middling size, indi- genous to the kingdom of Siam and Ceylon. It con- sists of small, irregular, solid lumps, of saffron yellow colour, breaking with a shining or vitreous fracture. WThen moistened it assumes a beautiful bright yellow colour. It is destitute of odour, but has a slightly acrid taste. It consists of one portion of gum, and four of a very brittle resinous matter. Gamboge acts very powerfully both as a cathartic and an emetic, and is, in consequence, condemned by some, as apt to excite violent and dangerous hypercatharsis and vomiting. Others, on the contrary, speak strongly in its favour, and represent it as a mild, certain, and safe cathartic. Dr. Ferriar, especially, recommends it as one of the gentlest and most certain of our purgative remedies. " After a long and extensive experience," says he, " of the qualities of gamboge, I can recom- mend it as one of the gentlest, most certain, and least nauseous laxatives in the materia medica. Being nearly free from either smell or taste, it is particularly well adapted to the management of children, with whom its anthelmintic power is likewise valuable.* It seems; however, to be generally allowed, that its action is too powerful for the ordinary purposes of purgative reme- dies; and, unless as an adjunct to other substances of this class, it is, at present, but seldom employed in practice. Gamboge has been a good deal employed in dropsy. By proper management, it is undoubtedly a medicine of considerable value, in this disease. For this purpose it is commonly given in union with cremor tartar, in the proportion of about two grains of the former to half an ounce of the latter for a dose. Large watery stools and an increase of urine are generally produced by the opera- tion of such a dose. Dr. Ferriar relates several remark- * Medical Histories, p. 270. Philad. edit. L816. CATHARTICS. 113 able instances of the efficacy of gamboge in dropsy, given in union with the nitrous or vitriolic ether. He directed five grains of gamboge with two drachms of spiritus setheris vitriolici, in a draught two or three times a week. This composition acted as a gentle purgative, and considerably increased the urine. " When there is imminent danger of suffocation," says Dr. Ferriar," from the quantity of water effused, in hydrothorax, I have frequently given immediate relief, by the following pur- gative draught* A draught of this kind may be given twice or thrice a week, in such cases, while the crem. tartar and diuretic dropsf are employed in the interme- diate days." Gamboge has also been frequently employed with ad- vantage for the expulsion of intestinal worms. It has been especially recommended against the tape-worm; and as an active cathartic, either after the exhibition of more direct anthelmintics, or independent of such reme- dies, there can be no doubt of its occasional beneficial operation in such cases. Given in minute doses, such as do not produce either vomiting or purging, this remedy is said to be service- able, as a stimulant, in chronic rheumatism, asthma, and particularly in exciting the activity of the portal circula- tion,:}: Its great solubility increases its tendency to act upon the stomach and to excite vomiting. This effect is ac- * R. Cambog. - - gr. iv. Sp. sether nitros. 31. Tinct. senn. - 3U- Syrup rhamni. Ag. menth. aa 5ss. Misce. tR. Oxymel. colchi. scill. Tinct. nicotian. Sp. aether, nitros. aa p. as. M. Capiat cochleare parvulum, ex aquae pauxillo, quate r indie, \ Burdach's Arzneymittellehre, band. iii. s. 66. VOL. I.—P 114 CATHARTICS. cordingly much diminished by giving it in combination with other substances, which lessen its solubility, and hence, the addition of a portion of aloes to it (as in the pil. cambogice compos.) renders it a very mild and un- irritating purgative. To obviate its tendency to produce vomiting Dr. Cul- len prescribed it in small doses, and repeated at short intervals until purging was produced. Dr. Ferriar, in his Medical Histories, says: "a very commodious form for exhibiting gamboge, is a solution in distilled water, in the proportion of half a grain to half an ounce of water. A table-spoonful may be given to an adult, every hour, till it operates. A tea-spoonful of this solution, given in the same way, is a dose for a child under twelve years of age. When given in this manner, doses of seven or eight grains have been found necessary to move the bowels, and it has proved strongly diuretic." ALOES EXTRACTUM.—ALOES. We meet with three varieties of aloes in the shops. 1. The aloes spicata or socotorina. 2. aloes vulgaris, or hepatica. 3. aloes caballina, or horse aloes. The aloes socotorina is imported in small pieces from the island of Socotora, in the Indian ocean, and is much purer than the other two varieties. It is of a reddish brown colour, with a faint purple cast; and when pulverized becomes of a lively yellow colour. The hepatic, or Barbadoes aloes, is the product of the aloe vulgaris, a plant, which, Dr. Sibthorpe states, in his Flora Grasca, to be the true aloe described by Dioscorides. This variety of aloes is brought from the East Indies, but chiefly from Barba- does. It comes in large lumps, of a brighter brown co- lour, and a much stronger and more disagreeable odour than the former variety. Its taste, too, is almost entirely CATHARTICS. 115 destitute of the aromatic flavour which accompanies the bitterness of the socotorine aloes. The caballine or horse aloes, is the most impure of the three species, and may be easily distinguished by its peculiar rank smell. In other respects, however, it differs but little from the hepatic aloes. According to the analysis of Tromsdorff, socotorine aloes consists of twenty-five parts of resin and seventy- five of a saponaceous extractive matter, soluble both in alcohol and in water; a slight trace of gallic acid may also be detected in it. This saponaceous extract is in- tensely bitter, and possesses a faint odour resembling, in some degree, that of saffron. The resinous matter is not very bitter,, and possesses but feeble powers as a purgative. Mr. Braconnot, " conceives aloes to be a substance sui generis/' which he terms, " bitter resin." Aloes is but very slowly and sparingly dissolved by cold water. Boiling water dissolves it readily, " but, on cooling, a precipitation ensues." Long boiling deprives it entirely of its purgative properties. Its appropriate solvent is proof spirit. The solubility of aloes is increas- ed " by alkaline salts and soaps, but by such a combina- tion aloes undergoes a material change in its medicinal properties-, the bitterness is diminished, its purgative effects impaired, and it ceases to operate specifically up- on the large intestines, a fact so far valuable as it en- ables us in certain cases to obviate its irritating action upon the rectum."* Aloes is a slow, stimulating cathartic, exciting a sen- sation of warmth in the stomach and bowels, and direct- ing its operation more especially upon the lower portion of the intestinal canal. This latter circumstance depends on its great insolubility, in consequence of which it passes through the stomach and small intestines before it has had time to dissolve, and, therefore, to act upon them. * Paris's Pharmacologja, 116 CATHARTICS. Being, however, at Inst dissolved in its progress through the large intestines, it acts upon them with considerable force, and produces free evacuations. Dr Cullen ob- serves, that aloes evacuates the bowels simply by excit- ing the peristaltic action of the intestines, without increasing materially the intestinal secretions, as is evi- dent from the state of the evacuations, which are hardly ever liquid. In consequence of Jts tendency to act more particular- ly on the rectum, and thereby to create an afflux of the circulation to the pelvic viscera, aloes is a good deal employed to promote the secretion of the menses; for which, indeed, it seems to be well adapted in cold, phleg- matic and costive habits. This very tendency, however, renders aloes an improper aperient in persons subject to haemorrhoidal tumours, or affected with any other dis- ease of the rectum. From its acting in small doses as a slow aperient, it is well suited to obviate habitual costiveness. When em- ployed with this intention, it is necessary to avoid a strong operation, as it is apt, when it acts fully, to leave the bowels in a dry and costive condition. Given in small doses, as from two "to four grains, it seems, like bile, to keep up the regular peristaltic action of the intestines, and it is only when it produces this slow but natural action of the bowels, that it can be employed with pro- priety in constitutional costiveness. Its aperient opera- tion is not proportionate to the size of the dose given; four or five grains will produce nearly the same opening, effect that ten or fifteen grains will do. In an uncom- bined state, indeed, it hardly ever produces large evac- uations, whether it be given in a small or large dose. In union with other articles, however, it furnishes us with several very useful preparations.* Viz. pulv. aloes * Dinner pills—Lady Webster's, or Lady Crespigny's pills.— These popular pills are the "flilula stomachichef vulgoflilult ante CATHARTICS. 117 compos. L. pil. aloes cum myrrha. L. E. D. pil. aloes compos, pil. aloes cum asafcetid. E. pil. aloes cum co- locynth. E. pil. scammon. cum aloe. D. extract, colo- cynth. compos. L. D. tinct. aloes comp. L. E. D. tinct. aloes aetherea E. SCAMMONIA.--SCAMMON V. This substance is the inspissated juice of the root of the convolvulus scammonia, a perennial plant, growing abundantly in the mountainous parts of western Asia. It qornes to us from Smyrna and Aleppo, in blackish gray cakes. That which is imported from the latter place, is purer and better than the Smyrna scammony. It has a bitter, subacrid taste, and a peculiar disagree- able odour. When rubbed with water, it forms a milky fluid. Aleppo scammony, according to the ana- lysis of Buillon Lagrange, contains sixty parts of re- sin, two of extractive, three of gum, and thirty-five of insoluble matter. That which comes from Smyrna con- tains less resin but more gum and extractive. Proof spirits is its best menstruum ; it dissolves all except its impurities. Water takes up about one-fourth and alcohol two-thirds. Scammony was one of the purgatives employed by the ancients. A decoction of the root of the plant which yields it was used by Hippocrates; and it is said to be an exceedingly good purgative when given in this way, cibum," of the Codex Medicatnentarius Parisiensis, edito quinto, A. D. 1758. Viz. R. Aloes optimae ^iv. Mastiches et rosarum rubrarum, aa $\\. syrupi de absinthio q. s. ut fiat massa; the mass is to be divided into pills of three grains each. The operation of this pill is to produce a copious and bulky evacuation, and in this. respect experience has fully established its value.—Paris's Phar- macologic. 118 CATHARTICS. procuring free evacuations, without occasioning griping pains or any manner of sickness.* Scammony is a powerful stimulating purgative. The accounts which are given of its effects by different wri- ters, are, however, very discrepant; some representing it as mild and perfectly safe, and others as a violent and dangerous cathartic. Orfila found ulcers in the stomachs of animals that had been killed by scammony. These differences in the action of this remedy, are, however, supposed " to be entirely owing to the different circumstances of the pa- tient, and not to any hurtful quality, or irregularity of operation of the medicine; where the intestines are lined with an excessive load of mucus the scammony passes through without acting upon them; but where the natural mucus is deficient, a small dose of this or any other resin- ous cathartic, irritates and inflames, "f Scammony enters into the composition of many of the purgative remedies that have been recommended against worms. It enters also into several useful offici- nal preparations; such as the confect. scammon. L. D. pulv. scammon. comp. L. E. extract colocynth. com. L. pulv. sennas comp. L. A very good mode of exhibiting scammony, is totri- tHrate it with sulphate of potass, sugar, or almonds. Given in this way, it operates mildly and with consi- derable promptness. It may also be very conveniently exhibited by being dissolved in a strong infusion of liquorice, and poured off from the faeces. The dose is from three to fifteen grains.J Much was formerly said * Dr. Alexander Russel, in a letter to Dr. Fothergill. See Medical Observations and Inquiries, vol. i. p. 13. t Dr. Andrew Duncan's Dispensatory. JDr. Paris says, that " there is a compound bearing the name of scammony to be met with in the market which is altogether factitious, consisting of jalap, senna, manna, gamboge, and ivory- black. Good scammony ought to be friable, and when wetted with the finger, it should lactify or become milky; and the powder CATHARTICS. 119 of a preparation into which scammony enters as a chief ingredient, and known by the name of Count War- wicks powder, or pulv. detritius. It consists of a mix- ture of sulphuretted scammony, diaphoretic antimony, and cremor tartar. Kamazzini, Baglivi, Van Swieten, Werlhoff, recommend it as a peculiarly efficacious pur- gative in intermittent fevers. COLOCVNTH^DIS FULPA. This is the medullary or pulpy part of the fruit of the cucumis colocynthis, an annual cucurbitaceous plant, growing in abundance in Syria, Arabia, and also in some parts of Spain. It is intensely bitter, and contains a soponaceous extractive, a bitter resin, gum, and ve- getable fibrous matter. This is one of the most ancient purgatives employed in practice at the present day. The Greek and Arabian physicians mention it in their writings as a powerful and valuable cathartic. It is now but seldom administered in an uncombined form, on account of the great violence of its operation. As a hydragogue, however, it is still occasionally given in dropsical cases; in one instance of which, I have myself prescribed it with great advantage. Bang re- commends a decoction of it as an exceedingly good re- medy in dropsy; and Hufeland considers it as the most effectual diuretic we possess, in persons of a cold and sluggish habit of body. His mode of prescribing it for this purpose is, to boil two drachms of the colocynth, in a quart of beer, down to a pint, of which one or two table-spoonfuls are to be taken every day. should manifest its characteristic odour, which has been compar- ed to that of old ewe milk cheese.—Pharmacologia. \20 CATHARTICS. This substance has also been recommended in small doses, in paralysis of the lower extremities and in her- petic eruptions. Heim, a German writer, speaks a great deal in favour of the tincture of colocyth, in union with tinctura antimonii saponata, in the proportion of twenty drops of the former to sixty of the latter every three hours, in cutaneous affections* Colocynth has been a good deal employed in coma and apoplexy; and, as the beneficial effects of cathar- tics in these diseases depend, perhaps, entirely on the afflux which they occasion from the head to the intesti- nal canal, there can be no doubt that a remedy which produces such prompt and strong impressions on the bowels, and which, therefore, procures such copious watery evacuations as the present one, is well calculated to prove beneficial in affections of this kind. The compound extract of colocynth is a very useful preparation. In combination with calomel this extract forms one of the most effectual, and at the same time, mild purgatives with which I am acquainted. In cases where we wish at once to evacuate the bowels gently, but copiously, and to correct the functions of the biliary organs, I have found the pill recommended by Dr. James Johnson,f a most valuable medicine. The dose of the compound extract of colocynth is from ten to fifteen grains. The colocynth, in substance, is given in doses of from five to ten grains. The subacetate and acetate of lead, the nitrate of silver, sulphate of iron, and the fixed alkalies, disturb its infusion.^ * Kolpin liber die Wiirkung der Tinctura Colocynthidis.—-See Hufeland's Jour, of Pract. Medicine, vol. ii. No. iii. p. 4. t U. Extract, colocynth. comp. - 3'1, Submuriat. hydrarg. - - gr. xv. Antim. tart. - - - gr. i. Olei carui - gr. v. M. In pilulas, 24 divid. Take 1, 2, or 3 every night. \ Dr. Paris observes, that " when the fruit is larger than a St. Michael's orange, and has black, acute pointed seeds, it is not good." CATHARTICS. 121 ELATERIUM. This substance is obtained from the fruit of the momordica elaterium, a cucurbitaceous plant, growing wild in the southern parts of Europe. The fruit of this plant bears a very strong resemblance to the com- mon garden cucumber; differing from it merely in point of size. " When full grown it is from an inch to an inch and a half in length, and of proportionate* thick- ness. The seeds, which, when fully ripe are of a black colour, are lodged in a light green pulp, the interstices of which contain from half a drachm to a drachm of nearly limpid fluid." This juice, when first collected, is perfectly limpid. On standing a few hours, it first becomes turbid, and then gradually lets fall a sediment, which, when slowly dried, without being exposed to a strong light, has a yellowish white colour, with a faint shade of green. This is the pure elaterium; a sub- stance which is decidedly the most powerful cathartic we possess. Its taste is acrid and slightly bitter. It appears to be entirely insoluble in water, whether hot or cold. That which is obtained from the spontaneous deposition of the juice, is almost wholly soluble in alcohol; whilst, of that which is commonly met with in the shops, not more than one half, and sometimes not above a fourth part is dissolved by alcohol. That part of it which is left undissolved, appears to possess no medicinal powers whatever. According to the experiments of Dr. Paris, elaterium consists of water A, extractive, 2.6, fecula 2.8, gluten .5, woody matter 2.5, elatin and bitter prin- ciple 1.2. According to the experiments of Dr. Clutterbuck, elaterium is almost entirely, if not wholly confined to the limpid fluid contained in the centre of the cucum- VOL. i.—Q m CATHARTICS. ber; for no other part of the plant has been found to possess active properties. It is evident, therefore, that the common mode of preparing this substance, namely, by pressing the fruit and collecting its ordinary juice together with that which is lodged in the centre, and afterwards evaporating it, must yield an article of infe- rior and .uncertain powers. Dr. Clutterbuck recom- mends the following method for preparing this medicine, and its superiority over the modes usually adopted is manifest. " The cucumbers should be gathered when as nearly ripe as possible, and without violence, that might en- danger their bursting. They should then be wetted by the affusion of cold water, that less of the juice, when they are cut, may adhere to the external surface. In this state they should be cut through longitudinally, and the juice allowed to strain through a fine sieve placed in a large earthen vessel. The seeds and surrounding pulp should be scooped out upon the sieve, and washed with repeated affusions of cold water, by which they will be freed from all adhering juice. Something will be saved also by afterwards rinsing the split cucumbers themselves in cold water, from which a portion of ela- terium may be collected. After standing a few hours a sediment is formed, from which the clear liquor is to be poured off; it is then to be thinly spread on fine linen, and exposed to the air to dry; a gentle warmth may be employed without injury; but the access of sun- shine destroys the fine green colour which the substance otherwise acquires."* Elaterium is a very ancient remedy, and was, for a long time, much esteemed as a hydragogue in hydropic diseases. In modern times it had, however, almost sunk into entire neglect, in consequence of its occasional harsh and violent operation, until it was again brought * London Medical and Physical Journal, July, 1819. v CATHARTICS. 123 into notice as a remedy.for dropsy, by Dr. Ferriar. It cer- tainly is a medicine of exceedingly active powers, and may readily do mischief if improperly administered. Ela- terium, says Dr. Clutterbuck, is, with the exception of arsenic, perhaps, and the hydro-cyanic acid, the most active article of the materia medica; and Dr. Ferriar observes, that " on its first exhibition to a patient, it is nearly as active and as dangerous, if incautiously given, as arsenic." It is, nevertheless, susceptible of such management in its administration, as to render it, not only a safe, but a most important remedy. " Its powers," says this latter writer, " in removing se- rous accumulations in the cavities of the human body, surpass those of any other medicine; and the astonishing relief which it affords in the dyspnoea occasioned by hy- drothorax or ascites, even in persons of the most advanc- ed age, must place it in the first class of hydragogues." Dr. Clutterbuck also, speaks in the highest terms of this remedy. " I know of no medicine," says he, " from which I have derived greater benefit, on various occa- sions, nor one in which greater confidence may be placed. Whatever can be accomplished in the cure of diseases, by active purging, may be effected certainly by this me- dicine." The sensible effects of this substance are, excessive nausea, copious and frequent watery stools; and if the dose be very large, vomiting, violent pains in the stom- ach and bowels, inflammation of these organs, spasms, and death. Along with its cathartic effects, it excites the action of the heart and arteries, even when given in moderate doses. When prepared according to the method of Clutter- buck, one-eighth of a grain will be sufficient to produce violent purging. As it is met with in the shops, its dose is from one to two grains. It should, however, always be commenced with in a small dose, as, for instance, half a grain, and repeated every hour until the desired effects 124 CATHARTICS. be produced. Dr. Ferriar states,'that he generally gave it in union with some diuretic, when employed in drop- sy, and commencing with a very small dose, sometimes carried to the extent of six grains a day.* HELLEBORUS NIGER.--BLACK HELLEBORE. This article will be particularly described under the head of Emmeuagogues, and I shall, therefore, in this place, speak of it only as a cathartic. Of all the articles of the materia medica, this has held the greatest reputation among the ancients for its reme- diate powers, and especially for its virtues as a cathartic. It was particularly esteemed in the treatment of mania, melancholia, and gout. For the cure of this latter dis- ease it is mentioned, by Aretaeus, as being superior to every other remedy then known. Black hellebore is an exceedingly active cathartic, and, when given in an over-dose, is apt to produce the most alarming effects. It occasions very copious watery evacuations, and hence it has been a good deal employed in dropsical affections. Dr. Ferriar reports several cases of this kind, in which the good effects of this remedy were conspicuously evinced. He prescribed it in the form of Bacher's tonic pills;f a preparation which, on various accounts, deserves much more attention than it appears to receive at the present day. Dr. Ferriar ob^ serves, that when these pills have succeeded in his prac- tice, their operation was in general soon manifested, * He usually gave it in the following prescription : R Extract, elaterii gr. i. sp. aether, nitros 5ii. tinct. scill. ox- ymel colchic. sing. 5ss. syrup rhamni Si. M. ft- solutio. cap 3'i< ex equae pauxillo ter, quater-ve in die. t The formula for preparing these pills is given under the art- icle helleborus niger, in the class of Emmenagogues. CATHARTICS. 125 producing, very early, copious watery evacuations. Their action, he says, is easy, but in protracted cases, contra- ry to Mr. Bacher's assertion, they evidently weaken the patient, however cautiously given.* From two to six of these pills may be given three times every day, accord- ing to the effects they produce. The black hellebore is now but seldom if ever em- ployed by itself, or in substance, with a view to its cathar- tic effects. From twenty to thirty grains of the powdered root are said to be a proper dose for this purpose. CROTON TIGLIUM. The oil which is obtained from the seeds of this plant, has been recently introduced to the notice of the pro- fession, as one of the most active purgatives known. It is generally supposed to be a new remedy, but this is a mistake; both the seeds and oil were very early noticed and employed in medicine. Serapion the younger, mentions this plant and its seeds. (De Simplicibus, c. 261.) M. Pomet, chief druggist to Louis XIV. in his General History of Drugs, speaking of the seeds of Tig- lium, says, " the use of these kernels is to purge, and it is indeed one of the greatest purgatives we have." M. Lemary speaks of the oil of these seeds ;t as being ca- pable of exciting purging, simply by rubbing the stomach and belly with it."f Rumphius, also, speaking of this plant says, " Olim grana (Tiglii) per totam Indiam Ori- entalem crebro in usu fuerat ad lympham hydropicum per alvum praeprimis eliminandam, in iis vero, quorum ventriculus debjlis simul emesis subsequuta. Fortioribus 'Medical Histories, vol. i. p. 46. t Vide Mr. Iliff's Paper, in the 97th No. of the London Med. Repos. 126 CATHARTICS. bina grana sufficerunt, aliis granum unum cum semisse. Variis aliis in morbis in quibus purgantia fortiora oppor- tuna videntur, ista in India adhibent. Et hanc quidem acrimoniam oles ipsi seminis inesse, tarn ex dictis quam inde apparet, quod olei ex siccis granis expressi gutta una cum canariensi vino capta vulgare apud chirurgos in India degentes purgans constituent."* The seeds are also mentioned by Dr. Fleming in the 11th vol. of the Asiatic Researches, as having been formerly well known and employed in Europe as hydragogue purga- tives. Bergius, Lour, Linnaeus, and Burdach speak of the grana Tiglii as powerfully purgative. According to the experiments of Dr. Nimmo, alcohol of sp. gr. 825, dissolves only a portion of the oil. The part which remains undissolved, is destitute of the charac- teristic acrimony of the oil, " this property being entirely transferred to the alcoholic solution, which answers the medicinal properties of the entire oil in a more certain manner, and unattended by several inconveniences for- merly experienced from its use." The oil contains forty- five parts of acrid principle, and fifty-five of fixed oil. The acrid principle is united with a resinous substance, which is dissolved by alcohol, sulphuric aether, volatile and fixed oils.f The oil itself is converted into a sapo- naceous mass by means of an alkali. This oil is powerfully purgative. Given in the dose of from one-half to one drop, it produces copious evacua- tions, and generally with very little or no griping or other inconvenience. Mr. Iliff, apothecary to the South Lon- don Dispensary, whose experience with this remedy has been very extensive, thinks, however, that it produces nausea and griping more frequently than has been sup- posed; nor does it appear to be uniformly certain in its * Vide Medico-Chirurgical Review for Sept. 1821. Rumphius Herb Amboininu, torn. iv. p. 98. t London Medical Repository, vol. xvii. CATHARTICS. 127 operation. Mr. Iliff states that he gave nine drops in a case of apoplexy, in three drop doses, without any ope- ration whatever; whereas ten grains of calomel, which was afterwards resorted to, acted briskly.* We have also the testimony of Dr. Carter, one of the physicians of the Kent and Canterbury Hospital, in fa- vour of the employment of this article as an active pur- gative. He says that he employed it in seventeen cases, in one of which only did it fail to operate. Croton oil has been successfully used in maniacal cases. Sir George Tuthill, one of the physicians to Bethlem Hospital, has found it beneficial in affections of this kind. It has also been used with advantage by Dr. Pearson;! and it is said to be an excellent hydragogue, and to have proved very serviceable in hydropic cases. Professor Francis of New-York states in a letter to me, that " he is induced to pronounce the oil of croton a powerful and certain and speedy purgative, and free in its action from griping. In a case of most obstinate and very long continued cos- tiveness, he says it effected what neither the elaterium, nor the other vegetable drastics, nor mercury could ac- complish." He thinks it will be found peculiarly ser- viceable in habitual torpor of the intestinal canal. This oil appears to make a very powerful and prompt impression on the nerves. The editor of the London Medico-Chirurgical Review J says, that " cases of tic doloureux have been lately relieved, and even removed, by a drop or two of oil of croton applied to the tongue. The effect on the nerve was almost instantaneous." Mr. Frost says that he has seen instances in which the ap- plication of this oil to the tips of the fingers " produced a sense of numbness in the fingers, hand, and arm, (but no local inflammation) dryness in the throat and head- * London Medical Repository, vol. xvii. t A Sketch of the Botanical Literature, Sec. of Croton Tiglium, By John Frost, Esq. See London Med. Repos. July. 1822. \ No. 6. p. 428. New Series. 128 CATHARTICS. ach, which continued for several hours." It generally, however, produces a very considerable degree of local inflammation when applied externally. It may be conveniently given in the form of pills, made with the oil and crumbs of bread. The violence of the action of this oil may be lessened by giving it in union with some aromatic, and particu- larly with any of the volatile oils: viz. oleum, caryophil- lorum, cinnamoni, &c. Roasting, or baking the seeds, previous to extracting the oil, is said also to lessen the violence of its action. The vegetable acids are likewise said to moderate its action.* Dr. Frost recommends the following formula for exhibiting this oil.! CALOMEL, OR SUBMURIATE OF MERCURY. Calomel is unquestionably one of the most import- ant articles of the materia medica, whether we consider it in relation to its purgative virtues, or to its more ex- tensive and specific influence upon the animal economy. Under the head of mercury, I shall consider the reme- diate powers of this article, so far as they depend on its constitutional or specific effects, and confine myself, in this place, merely to a consideration of its. virtues as a purgative. Given in proper doses, either by itself or in combina- tion with other articles of this class, it produces copious evacuations, without any harsh or drastic effects. Along with its cathartic virtue calomel has the peculiar power of exciting the biliary organs, and it is, therefore, parti- *Lond. Med Repos. June, 1822. t §> Ol. Expressi Sem. Crotonis gtti. Olei Caryophillorum, gui. * Confectionis Rosae Gallicae, gr. ir Misce et sit pilula. CATHARTICS. 129 I'.ularly adapted as a purgative to all diseases attended with functional derangement of the hepatic system. A combination of calomel and jalap, forms one of our most useful and common purgatives in bilious diseases, as well as for the ordinary purposes to which remedies of this kind are usually applied. Where we wish to procure easy, but copious alvine evacuations, we in general, find our intentions fully answered by giving three or four grains of calomel in the evening, and exhibiting on the following morning an ordinary dose of any of the milder cathartics. Calomel, from its possessing very little taste, is well suited as a cathartic for children. In my own practice I seldom employ any other purgative in the diseases of children. It evacuates more freely, and, at the same time, more mildly, than, perhaps, any other article of this class, the intestinal mucus which is often morbidly accumulated in the bowels of children. Of late it has been much recommended as a cathartic in dysentery. Dr. James Johnson speaks strongly in favour of large and frequently repeated doses of calomel in this disease, as it occurs in tropical climates.—He gave scruple doses three or four times a day, and he affirms that it was gen- erally followed by great alleviation of all the distressing symptoms which attend this complaint. When calomel is given in very minute doses it has a direct anti-cathartic effect, by lessening the morbid irri- tability of the intestinal canal. It is, indeed, one of our most valuable remedies for excessive purging. Dr. Ayre, of Hull, in his very valuable work on bilious affections, adduces satisfactory testimony of the utility of small doses of this remedy in cholera, diarrhoea, &c. From an eighth to one-fourth of a grain, given every half hour or hour, very often puts a speedy stop to the most violent vomiting and purging. I have employed it in this way with much advantage in cholera infantum, and especi- ally in chronic diarrhoea, in which latter affection, I re- vol. i.—R 130 CATHARTICS. gard it as decidedly the most important remedy we possess. In affections of this kind it is, perhaps, most effectually administered in union with prepared chalk; or, as I have sometimes given it, with small doses of some astringent vegetable powder, as, for instance, the powdered root of geranium maculatum. Calomel is also frequently employed as a vermifuge; but as I have occasion to mention it again in relation to its powers in this way, in the chapter on Anthelmintics, I shall dispense with any further remarks on it in this place. The usual dose of calomel, as a cathartic, is from eight to twenty grains; ten grains may be considered as a me- dium dose. If given in too large a dose it is apt to ex- cite vomiting. OLEUM RICINI.--CASTOR OIL. This oil is obtained by expression, or decoction, from the seeds of the ricinus communis, a plant which grows wild in the East and West Indies, and in some parts of South America, and which is now cultivated in this country. It is a yellowish or colourless oil, possessing a faint peculiar sweetish taste, and scarcely any odour. On being swallowed it excites an unpleasant acrid burning in the throat and fauces, which, however, is but very slight when the oil is fresh and entirely free from ran- cidity. It is wholly soluble in alcohol and sulphuric aether; and mixes more readily with caustic ley than any other oil. These circumstances distinguish it from the other fat oils, and enable us without difficulty to detect its adulterations. Castor oil is a very mild, uuirritating, but certain and prompt cathartic, procuring copious faecal evacuations. CATHARTICS. 131 without appearing to excite the intestinal emunctories, since it hardly ever occasions any very liquid or watery discharges. Where we wish simply to evacuate the con- tents of the bowels, or avoid costiveness, there is no ar- ticle belonging to this class of remedies, so well adapted as castor oil to answer our intentions. Independent of the mildness and completeness of its operation, it is less apt than any other cathartic to leave the bowels in a dry or costive condition. In cases of obstinate constipation, castor oil, though often insufficient, by itself, to procure adequate evacua- tions, acts, in general, with much advantage when given some hours after the exibition of a full dose of calomel, or calomel and jalap. No laxative is more commonly employed in the treat- ment of dysentery than this one; and when the stomach can bear it, it is, without doubt, a very important reme- dy. " Oleum ricini," says Dr. Bampfield," is, perhaps, better calculated to afford relief m dysentery than any other aperient or cathartic; for its action is not only mild and generally effectual, but I have observed, that some of it passes undecomposed, in its oily form, through the in- testines, and appears on the surface of the excrement, and hence may serve as a sort of sheather or defence to the diseased intestines, from the stimulus of faeces and morbid secretions." A common mode of prescribing it in this disease. when there is much tenesmus and griping, is in union with a full dose of laudanum. Given in this way it is much less apt to be rejected by the stomach, and it more- over mitigates directly the sufferings of the patient, and loses but very little of its aperient effects * * The following is an excellent mode of exhibiting castor oil in cases of this kind : 01. ricini |i. vitelli ovi. q. s. tere simul et adde syrupi papaveris 3H. tinct opii g" x. aquae distillatae §iss; fiat haustus. 132 CATHARTICS. Castor oil has also been much recommended in the treatment of colica piclonum. It is particularly useful in this disease to put the bowels in motion, after large doses of calomel and opium have been administered. In the form of an emulsion* it is a very excellent ape- rient for children. Castor oil has also been highly recommended as a remedy for the expulsion of the tape worm. Dr. Odier, of Geneva, and Dunant, employed it with much success in expelling the unarmed tcenia,\ and Brera states that " it sometimes serves wonderfully well to expel also the armed taenia."J After having previously administered three drachms of powdered male fern, Odier gave the ol. ricini, by table-spoonful? every half hour until full purging is induced. Brera, however, recommends it to be given to the extent of three ounces for a dose. " In my journal," says he, " I have two caeca of armed taeniae expelled by three ounces of this oil, taken by a patient during three successive days, and by another taken twice a day for a week." The celebrated S. G. Vogel§ has introduced a com- position which strongly resembles castor oil, and which forms an excellent substitute for it when it is rancid. It consists of nine grains of resin of jalap, three grains of Venetian soap, to be triturated in a mortar with an ounce and a half of oil of olives. The dose is a table-spoon- ful. Dr. Schmitman speaks very highly of this mix- ture in dysentery. He says it always allays the pain and severe excitement of the intestines, but at the * R Ol. ricini ^i. sacch. alb. 3i. album, ovi. q. s. tere simul et adde, gradatim aq. menthae ^ss. aq. fontanae % ii. Dose for a child one year old, a tea-spoonful every hour. t Manuel de Medicine-Pratique, par. L. Odier, p. 225. \ A Treatise on Verminous Diseases, by V. L. Brera, profes- sor of clinical medicine at Pavia, p. 234. § Summa Observationum Medicarum, &c. CATHARTICS. 133 same time gently and completely evacuates their con- tents. OLEUM OLIViE—OLIVE OIL. Olive oil is of a pale yellowish colour, without odour, and of a pleasant bland taste. When perfectly pure it congeals at a temperature of 38? of Fahrenheit. With the exception of the oil of almonds, it is the light- est of the fat oils, having a specific gravity of no more than 0.915. It is composed of forty-nine parts of car- bon, thirty oxygen, and twenty-one hydrogen. It pos- sesses less activity as a laxative than the oleum ricini; it is, nevertheless, in many cases, a very useful aperient and is much employed for this and other purposes in medicine. This oil was very extensively used by the Roman phy- sicians as an external application in the cure of diseases. Celsus, Galen, and Aetius were much in the habit of employing oily frictions; and have left us some excel- lent observations in relation to the cases in which they are applicable. A good deal has been said of the utility of frictions with this oil in dropsy. Cases of ascites are said to have been cured, by such frictions assiduously applied to the abdomen.* Dr. Donald Monro informs us that, al- though unsuccessful in his attempts to cure ascites in this way, he found it effectual in some cases of ana- sarca.! It is probable, however, that very little, if any thing, is to be ascribed to the oil in such cases. It is well known that frictions, whether with or without any inter- * Oiver, Stork, Burdach, &c. t Alibert. Nouveaux Elemens de Therapeutique, vol. ii. p, 252. 131 CATHARTICS. mediate substance, have a considerable tendency to ex- cite the activity of the absorbents; and it is not unlikely that all the good that has ever been done in this disease by oily frictions might have been obtained by frictions with the dry and bare hand. This oil has also been much recommended, both as an internal and an external remedy against the effects of the bites of venomous snakes and insects.* It does not, however, appear to be entitled to any attention for its supposed remediate virtues in cases of this kind. The external application of warm olive oil has been much employed as a remedy against the plague. Bald- win especially speaks in the highest terms of this prac- tice. According to this writer the patient is to be briskly rubbed all over with the warm oil, which is to be repeat- ed every day, and assisted by warm drinks and the heat of a bed, until a copious perspiration is excited. This practice is only effectual when early employed-! To blunt the activity of certain poisonous substances brought into the stomach, olive oil is of unquestionable utility. Its powers, in common with other oily or fat substances, to prevent the deleterious effects of lead upon the system are well known to those who are much exposed to the influence of this poison, it being a com- mon practice among such persons to fortify themselves against its effects, by the daily use of olive oil, or some other fat or oily substance. Burdach says,| that it should never be given where narcotic poisons have been swallowed, since, as he ob- * Abr. Vater diss, de antidoto novo adversus viperarum mor- sum praestantissimo. Viteb. 1763. Ejusdem. Progr. pro olei oli- varum efficaciam et virtutem adversus morsum animalium vene- natorum confirmat. 1751. t Osservazioni circa un nuovo specifico, contra la peste, ritro- vato e fatto sperimentare, da 9. Baldwin. 1800. t Arzneymittellehre, B. ii. S. 118. CATHARTICS'. 135 serves, it is not only useless but absolutely injurious in cases of this kind. Olive oil may be advantageously employed as an ape- rient in cases of habitual costiveness, and in colica pic- tonum. It operates, commonly, with considerable promptness and certainty, and may be conveniently exhi- bited with other articles of this class, as manna, the re- sin of jalap, &c. In ileus it is said to be an exceedingly good remedy given either alone or in combination with opiates. Gal- lesky recommends it to be given in the dose of a table- spoonful every hour until the bowels are moved and the pains abate. Malacarne* has published a memoir on the internal employment of olive oil in wandering arthritic pains. He gave from one to two pounds of the oil, having pre- viously added a portion of culinary salt to it, in the course of two or three days. He speaks very favourably of this practice. This oil has also been recommended as a vermifuge; its powers in this way are, however, of no consequence. Olive oil is often adulterated by the oil of poppy seeds. This fraud may be readily detected " by exposing the oil to a freezing temperature; when the olive oil will congeal, while that of poppies will remain fluid; and since those oils which freeze with most difficulty are most susceptibile of rancidity, the admixture of poppy oil must be regarded as injurious; it also deserves no- tice, that the piculiar habitudes of oil of olives w'Uhper- nitrate of mercury, offer a distinguishing character, by which the adulteration of the oil may be satisfactorily detected; for if the per-nilrate (made by dissolving six parts of the metal in 1.5 of nitric acid of sp. grav. 1.36, at a common temperature,) be mixed with olive oil, the mixture, if kept cold, will, in the course of a few hours, * Samlung Auserlesener Alhandl. Bd. xii. St. iv. S. 579. 130 ( AlllAttTIC1- become solid, whereas if it has any admixture of the oil of grains, it will not undergo such a change. The con- tamination derived from lead, which is frequently im- mersed in the oil for the purpose of removing its rancidity, may be detected by shaking one part of the suspected sample with three parts of water, impregnated with sul- phuretted hydrogen, in a stopped vial."* SULPHUR SUBLIMATUM. The sulphur of commerce is extracted from pyrites by sublimation. In volcanic districts, it is occasionally found in a perfectly pure and crystallized state; and it exists in a combined state in some animal and vegetable substances. It is insoluble in water and alcohol, but per- fectly soluble in both the essential and fixed oils. Lin- seed oil is one of its most powerful solvents. Sulphur was much esteemed for its medicinal powers by the ancients, and continues to this day to hold a very important rank among the articles of the materia medica. When taken in the dose of from one to two drachms, it acts as a mild and pretty certain laxative, producing one or two copious evacuations, without either heating the system or griping the bowels. " These circumstances/' says Dr. Cullen, " render it a most proper and conve- nient laxative; and were it not for the fcetor that some- times attends its operation, and is ready to be diffused in the air around, sulphur would be one of the most agreeable laxatives that could be employed." It appears to pass with facility into the circulation as is evinced by the sulphureous odour which the breath and cutaneous exhalation of those who take sulphur soon acquire; and also by the black colour which polished * Paris'S Pharmacologia. CATHARTICS. ' 137 metals carried in the pockets of such persons often con- tract. It seems to direct its action more especially upon the lower portion of the bowels, and to excite the activity of the circulation in the portal system of vessels. It has been accordingly much recommended in haemorrhoidal affections, more, however, with a view of obviating, than of removing them when they already exist. The most important medicinal powers of this sub- stance are, however, those which it possesses against various obstinate diseases of the skin. Alibert considers it as the most efficacious article we possess in affections of this kind. " I have used sulphur a great deal in my practice," says he, 'c and have removed cutaneous erup- tions with it, that had resisted all the other means known." It is observed by the same author, that per- sons whose employment exposes them much to the fumes of sulphur, are never affected with chronic cutaneous eruptious. He considers it as particularly efficacious in the cure of herpetic diseases. For the cure of tinea capitis, too, he thinks that there is no remedy superior to the unguentum sulphuris. I have, however, employ- ed the kali sulphuratum, according to the prescription of Barlow,* with much better effect than the simple sul- phur ointment. For the cure of psora, it is a very common remedy. I have found Jasser's ointment, as it is altered in the Prussian Pharmacopoeia, an exceedingly useful remedy in this disagreeable affection.! For the cure of psora in children, Dr. Clark, of Dub- lin, recommends a lotion, made by pouring a quart of boiling water on an ounce of broken sulphur, and suf- * R Kali sulph. (recens. preperat.) 3iii. sapo Hispan. 3L aq. calc §viii. spir. vin. rect. 3"- M. fiat lotio. Wash the head morning and evening. t R Flor. sulp.fii. sulp. zinci. £ii. ol. lauri. auxung. porcin. q. s. ut fiat unguent. VOL. I.—S 138 CATHARTICS. fering it to infuse for twelve hours. In this process, says Dr. Paris, the water probably takes up a small portion of sulphurous acid. Sulphur has also been much praised as a remedy in gout and rheumatism. Barthez, in particular, com- mends its powers in the former of these diseases; in the chronic form of the latter, I have, in several instances, derived great advantage from the employment of sul- phur, in combination with guaiacum. Its beneficial ope- ration in these diseases is, no doubt, mainly dependent on its tendency to excite the cutaneous exhalants, and to equalize the general circulation. Wedekind, a German physician of celebrity, speaks very favourably of the employment of sulphur, in the dose of twenty grains, with double the portion of gum arabic, in the cure of dysentery. " The bloody dis- charges," he says, " together with tormina and tenes- mus, often cease as soon as a few doses of this medicine have been administered."* Werlhof recommends the internal employment of sul- phur as a valuable remedy for the anasarca, which is sometimes the consequence of scarlet fever. Sulphur is, by many, supposed to have the property of diminishing the salivant effects of mercury, and it is accordingly a good deal prescribed for the purpose of moderating ptyalism. I do not believe, from what I have observed in my own practice, that it possesses any vir- tues in this respect beyond what may be ascribed to its diaphoretic operation. MAGNESIA. Nature no where presents us with this substance in a pure state. It is commonly found in combination with * Burdach, Arzneymittellehre, Band. ii. S. 14. CATHARTICS. 139 sulphuric acid, from which it is separated by precipitat- ing it from its solution by potash. Magnesia is a white and very light earthy substance having a specific gravity of 2.3. It converts very deli- cate blue vegetable colours to a green; is very sparingly soluble, requiring two thousand times its-weight of water to hold it in solution. The solutions of alkaline carbon- ates dissolve it; but those of the caustic alkalies have no action on it. It increases the solubility of camphor, opium,' and resins, in water.* It combines with sulphur. This substance was, for a long time, sold in Italy as a secret remedy, under the name of magnesia alba, or Count Palma's powder. It was not until about the mid- dle of the last century that it was introduced into prac- tice as a regular remedy. At present it is much employ- ed as a mild aperient, both in its pure state and in that of a carbonate. As a laxative it is particularly serviceable where an acid exists in the primae viae. It unites with the acid, andj acquiring, thus, the character of a neutral salt, acts with greater energy as a purgative. If the carbonate of mag- nesia be employed under such circumstances, the acid in the stomach, uniting with the magnesia, evolves a con- siderable portion of carbonic gas, and may thus create painful flatulent distentions. This effect is obviated by using the pure magnesia, instead of the carbonate. Magnesia has been n tch commendel for its good effects in gout. Dr. Scudamore,! however, states his conviction, that its use in this disease is derived solely from its qualities as an antacid and purgative; and that in no other way than by such influence on the stomach and alimentary canal can he consider it as having any claim to our regard."J * Paris's Pharmacologia. t Treatise on the Nature and Cure of Gout, Sec. p. 278. tin conjunction with laxatives, the same respectable writer 140 CATHARTICS. In cases of dyspepsia, attended with an acid in the stomach, magnesia may be advantageously united with aromatics and some of the milder tonics. In this way we not only remove the morbid contents of the stomach, but at the same time also, invigorate this organ, and thereby counteract the new formation of the acid. Used simply as an absorbent or neutralizer, magnesia is highly useful in all affections attended with morbid acidity of the stomach. In the griping bowel complaints of children, attended with green or sour stools, magne- sia is much employed, in which it is indeed a very useful remedy. For this purpose, the prescription given below is a very convenient form of exhibiting it.* Magnesia has of late, been recommended as a very use- ful remedy to prevent the too copious secretion of uric acid by the kidneys, and consequently to obviate the for- mation of those urinary calculi that are chiefly or wholly composed of this acid-! Mr. Brande has published some very interesting ex- periments and observations on the comparative value of magnesia and alkalies in calculous affections. Sir £. Home had suggested the superiority of the former over the latter remedy, on the ground of its possessing less solubility, and, being therefore, more apt to remain long- est on the stomach, and to counteract the formation of uric acid. The correctness of this suggestion, so far as regards the fact, was confirmed by the experiments of Mr. Brande. Dr. Scudamore admits the fact of its supe- states, that heobtained the most remarkable success in gout "from a draught composed of magnesia, gr. xv. ad xx. magnes. sulphat. 3'i. ad 3n. aceti colchici $i. ad 3"- whh a sufficient quantity of sweetened water. It should be repeated every four, six, or eight hours. * §> Magnes. calc. 3ss. pulv. rhei. gr. viii. sacch. alb 3i- pulv. G. Arab. 3ss. aq. menth. |ss. aq. fontanae 3i. Misce. Dose, a tea- spoonful. t Brande, on Calculous Disorders, in the Philos. Trans 1810, P. i. CATHARTICS. 141 riority over the alkalies; but he ascribes it chiefly to its purgative qualities, by which the acid of the stomach is not only neutralized, but also carried out of the body. Magnesia may be conveniently given in union with other purgatives. It is frequently united with lac sul- phuris; in which combination it is said to be particularly useful in bilious complaints. The dose of the carbo- nate, for an adult, is from twenty to sixty grains. Infants may take from two to five grains. It ought to be observed, that from a considerable num- ber of authentic cases reported in the journals within the last ten or twelve years, it would appear that the long use of magnesia produces sometimes enormous and dan- gerous accumulations of this substance in the large in- testines. In the Journal of Science and the Arts, No. xi. Mr. Brande has given an account of two cases, " in which the long continued use of magnesia was productive of a concretion of this earth in the bowels, in an immense quantity," and which " gave rise to many of the worst symptoms attendant on an obstruction of the intestinal canal." In the second case, it is stated that " not only large quantities of a concretion of a similar description were voided, but upon examination after death, which took place perhaps six months after any magnesia had been taken, a collection, supposed to be from four to six pounds, was found imbedded in the head of the colon, which was, of course, much distended." Cases similar to these have since been published by other physicians. Carbonate of magnesia has been much recommended by some late writers as an antidote. Mr. Marshal* men- tions this article as one of the most valuable remedies, in cases of poisoning from arsenic. Mr. Hume alsof speaks highly of its effects in this way. He relates a * Remarks on Arsenic. t London Medical and Physical Journal, Nov. 1821, p. 466 ] 42 CATHARTICS. ease of poisoning by arsenic, of a very hopeless cha- racter, which was cured by the compositon given be- low.* Neutral Salts. SULPHAS SODJE.—GLAUBER^S SALTS. This salt is one of the most common and useful pur- gatives we possess. It consists of 24.64 parts of sul- phuric acid, 19.36 of soda, and 56 of water. It crys- tallizes in transparent six-sided prisms, terminated by dihedral summits. When exposed to the air it efflores- ces. It possesses a saline and disagreeable bitter taste. One ounce of water at 60° dissolves 3iiiss. of the salt; boiling water dissolves it in much greater proportion, in alcohol it is quite insoluble. It is decomposed by the muriates of ammonia, baryta, and lime; nitrate of silver; sub-acetate and acetate of lead. The dose is from |ss. to |ii; when administered in lemonade, or with the addition of a small portion of cremor tartar, it is much less disagreeable to the taste. SULPHAS MAGNESIA—EPSOM SALTS. This is also a very common and useful purgative. It consists of small, needle-like, tetrahedral prisms; pos- sesses a bitter taste, and is soluble in its own weight of water at 60°. WThen pure, it effloresces on being ex- posed to the open air. It is decomposed by "baryta, * R Magnes. carbonatis 3ji. aquae distillatae §xv. vini opii 3iss. spiritus lavand. comp. 3hi. sacchari albi 5ss. M. Capiat aeger cochlearia duo magna frequenter, phiala. assidue agitati. CATHARTICS. 143 strontia, the alkalies, and all the salts formed by these salifiable bases, excepting the alkaline muriates; and by the nitrate, muriate, and carbonate of lime." The ad- dition of a little common salt is said to increase its pur- gative powers, and a small portion of tart, antimony quickens its operation. The dose is from |ss. to f,ii. The sulphates of magnesia and soda differ but little in their effects. Being less apt to heat the system than the other active articles of this class, they are more particu- larly applicable to the treatment of febrile diseases. Given with a minute portion of antimony, according to the directions of Sir Gilbert Blane and Dr. Chisholm, they are exceedingly useful in the beginning of bilious fever. A solution of §ii. of either of these salts, with gr. ii. of tart, antimony, in a pint of water may be very usefully given in the begining of such fevers, in doses of a wine-glass full every hour, until vomiting and full purg- ing is produced. The sulphate of magnesia is in general, less apt to be rejected by the stomaoh than the sulphate of soda, and it is on this account best suited to cases attended with morbid irritability of the stomach. It has been said that epsom salt has a peculiar power of moderating gastric pain, independent of its cathartic effects. Exhibited in small and frequently repeated doses its effects have been particularly extolled in ileus and colica pictonum. A so- lution of this salt in lemonade is a very convenient and efficacious laxative in the diseases of very young children. SULPHAS POTASS.E.--VITRIOLATED TARTAR. This salt crystallizes in small transparent, hard six- sided prisms, terminated by six-sided pyramids. It is bitter, and dissolves slowly in water, requiring |i. of water at 60° to dissolve twenty-four grains of the salt; 144 CATHAHTJCS. in alcohol it is quite insoluble. It consists of 32.8 asid, 67.2 of potass and water. The barytic salts, the nitrates and muriates of strontia, and lime decompose this salt; it is partially decomposed by the tartrates and the salts of mercury, silver and lead. Sulphate of potass acts as a gentle aperient, when given in doses of about twenty or thirty grains. In the dose of from 3v. to 3vi. it acts as a mild cathartic, though, on account of its difficulty of solution it acts much slower than the preceding two salts. It is, however, very rarely employed with a view to its purgative effects. " It forms a component part of the pulvis ipecac, compositus." SUPER-TARTRASS POTASSiE.--CREMOR TARTAR. This is a bi-tartrate, having two proportionals of acid and one proportional of potass. It is but sparingly so- luble, requiring for its solution one hundred and twenty parts of water at 60° and thirty parts at 212°. By long keeping the watery solution of cremor tartar undergoes decomposition, depositing a mucous matter, and leaving " a solution of carbonate of potass, coloured with a little oik"* The solubility of cremor tartar is greatly increas- ed, " by combining it with boracic acid."! The alka- lies, alkaline earths, and mineral acids decompose it. v Paris's Pharmacologia. t " The following formula is introduced into the Codex Medi- camentarius of Paris, for preparing a ' tartarus acidulus potass* solubilis admixto acido Boracico?' Let thirty parts of boracic acid and twenty parts of distilled water be heated together in a silver dish ; as soon as this has been affected, add in divided por- tions one hundred and twenty parts of super-tartrate of potass, taking care to shake the mixture continually, the whole will soon liquefy, and by continuing the heat a pulverulent mass will re- sult." CATHARTICS. 145 Cremor tartar is, for many purposes, an exceedingly useful purgative. It is a mild, cooling, and certain laxa- tive, exciting the intestinal exhalants, to a copious effu- sion of serous fluid, and producing at the same time pretty strong diuretic effects. From these properties it is mani- festly a very appropriate remedy in dropsy, a disease in which, indeed, it has been much employed, and very frequently with the happiest effect. Dr. Ferriar gives an account of forty-three cases of dropsy treated by cream of tartar, of which thirty-three were effectually cured. He says: "I think we may fairly rank this medi- cine in the first class of hydragogues."* Dr. Home also, speaks much in favour of its effects in dropsical dis- eases.! In my own practice, I have often derived the most decided advantage from this remedy in the treat- ment of ascites. It may be very advantageously united with gamboge, and digitalis. In several cases of this disease, I derived very great benefit from the prescrip- tion given below.J Cream of tartar has been a good deal extolled for its power in removing obstinate constipation. In union with jalap, it will often excite the action of the intestines, after the most powerful cathartics have been given in vain. In the dose of 3iv. or 3vi. it acts as a hydragogue ca- thartic; in smaller doses it produces diuretic effects. A very pleasent aperient beverage may be made by dissolv- ing about 3i. of this salt in a pint of hot water, and fla- vouring it with lemon peal and sugar. * Medical Histories and Reflections, p. 46. t Clinical Observ. Exper. &c. p. 349. f: R Crem. tart. ^iss. sulph. potassae 5ss. pulv. scillae 3h\ tart. antimonii grs. ii. M. Dose, four or five tea-spoonfuls every day. This formula was originally recommended by Langhans, a Ger- man writer." VOL. I.—T 146 CATHARTICS. TARTRAS POTASSiE.—SOLUBLE TARTAR. This salt consists of one atom of acid and one of potass. It is soluble in its own weight of water when in a crystallized state; but when it is in the form of small grains, as it is commonly met with in the shops, it re- quires four times its weight of water for its solution. Alcohol dissolves it very readily. It is decomposed by magnesia, baryta, lime, and strontia; the sulphates of potass, soda, and magnesia, and the muriate of ammonia decompose it partially. It is also entirely or partially de- composed by all acids;4' and hence it is improper to join it with tamarinds or other acid fruits, as is too often done in the extemporaneous practice of those physicians who are fond of mixing different cathartics together, and know little of chemistry."* Soluble tartar, given in the dose of from thirty to sixty grains, acts as a mild and unirritating aperient. In the dose of 3vi. or 3vii. it acts pretty strongly as a cathar- tic. It is commonly employed in conjunction with senna or the other resinous cathartics, with a view of correct- ing their griping qualities. Soluble tartar has been much recommended as an aperient in maniacal affections. It has also been recommended in dropsy and jaundice. * Dr. A. Duncan, CHAPTER IV. II. MEDICINES CALCULATED TO DESTROY OR COUN- TERACT THE INFLUENCE OF MORBIFIC SUBSTANCES LODGED IN THE ALIMENTARY CANAL. Anthelmintics. Anthelmfntics are such medicines as have the power of dislodging and expelling worms situated in the in- testinal canal. The operation of these remedies is not difficult to understand. Some of them act in the man- ner of a poison on these animals ; others destroy them by a mechanical action on them; others again simply ex- pel them from the bowels, by producing strong purging; and some increase the tone of the digestive organs, and thereby obviate that condition of the stomach and bowels which appears to favour the generation and nourishment of these animals. There are four species of worms generated in the human intestinal canal. The taenia, the tricocephalus or trichuris, the ascaris vermicularis, and the lumbri- coides. The tcenia, or tape-worm, is a long tape-like worm, "formed of a chain of flat articulations, united to- gether by means of a border or edge varying in breadth and thickness." These links or articulations are possessed of independent vitality, and capable of be- coming distinct worms, when left in the intestinal canal. The taenia occasionally grows to an amazing length. Brera speaks of one, preserved in the cabinet of the uni- 148 ANTHELMINTICS. versity of Pavia, which exceeds two hundred and thirty feet. There are two species of taenia : the taenia cur- cubitina, or armed tape-worm, and the taenia lata, or un- armed tape-worm. The former of these species is found exclusively in the human subject. It is very difficult to dislodge it from the bowels, in consequence of the power it has of insinuating itself into the mucous membrane of the intestines, by means of two small fangs or crotchets with which its head is armed, and from which it derives its specific name. This species of taenia is rarely dis- charged entire ; it usually comes away in small pieces, or in single joints, resembling the seeds of the gourd. The taenia lata is not furnished with the fangs which characterize the other species, and is, therefore, much more easily expelled than the armed one. The trichocephalus or trichuris.—This worm is but very seldom found in the human intestines. It was first described by Dr. Wagler, a German writer, about the middle of the last century, who found it in the caecum of some French soldiers who had died of a contagious epidemic at Gcettingen.* It is a very thin spiral worm, from an inch and a quarter to two inches in length. The external surface is marked by a great number of transverse lines, like rings. " One part of the body ter- minates in a filamentous elongation, as fine as a hair, and coiled round in a very surprising manner; the other part, turning in a spiral form, most commonly terminates in a hook, broad and obtuse, and similar to the pistil of the liliaceous flowers. From this extremity the worm can put forth a sort of tube enveloped in a sheath." It is commonly found in the caecum or ileum. The ascaris vermicularis or ascarides, are an exceed- ingly common worm, and are often discharged in aston- ishing numbers. They are round, thread-like, very slender, and not more than from a quarter of an inch to * Brera's Treatise on Verminous Diseases, p. 44. ANTHELMINTICS. 149 an inch in length. They skip and move with very great vivacity, and when touched contract to nearly half their lengfh. The ascarides reside in the large intestines, and are commonly most abundant in the rectum, just within the anus. They are also occasionally discharg- ed from the stomach. Brera states that he found several masses of ascarides in the oesophagus of a woman who had died of a nervous fever. He states too, that this worm is frequently found in the vagina of women. " The ascarides live longer than any other, in the human body. It can exist an almost incredible space of time. The nature of the aliment which supports this worm has been the subject of various opinion. Bnt it has at length been observed that the mucous matter which lu- bricates the intestines and the vagina of women, is the substance for which it has the strongest predilection. Agreeably to this, it is not wonderful that we find the ascaris vermicularis in other parts of the body, in which the mucous fluid abounds, as those of the bladder, sto- mach, oesophagus, &c."* The lumbricoides bear a strong resemblance in shape to the common earth worm, and they were by Linnaeus, regarded as belonging to the same species. This worm is white, sometimes of a flesh colour, and commonly about the thickness of a goose-quill, and perfectly round. "Thecanal which passes through the abdo- men of the worm is yellow and transparent," which some regard as a characteristic sign of this species. Its length is from four to twelve inches. Worms of this species are generally situated in the small intestines, but not unfrequently in the stomach, and occasionally in the colon and rectum. " When they have once passed the valve of Bauhin," says Brera, "we may consider them as destroyed." They are generally soon evacuated af- ter having passed into the lower intestines. Children \ Brora's Treatise on Verminous Diseases, p. 50. 150 ANTHELMINTICS. are particularly subject to the lumbricoides; and they are often discharged, even by very young subjects, in great numbers. They are sometimes discharged* col- lected together into round balls. Worms are capable of producing great disturbances in the system. Not only do they aggravate ordinary diseases when they are present, but they also give rise to a great variety of very alarming and anomalous affec- tions. The whole train of spasmodic and convulsive diseases may proceed from the irritation of worms in the alimentary canal. Chorea, epilepsy, catalepsy, tetanus, paralysis, mania, convulsions, as well as a variety of other nervous and convulsive affections, are not unfre- quently the immediate effects of this cause. Besides these diseases, worms have also been known to produce pleuritic and rheumatic pains, dysentery, remitting fever, hydrocephalus, consumption, chronic and spasmodic cough, &c. &c. But I must refer the reader to the works on practice, and particularly to Brera's excellent treatise on verminous diseases, for a full account of the morbific effects of intestinal worms. Although we have no unequivocal signs of the pre- sence of intestinal worms, except their actual discharge either from the bowels or stomach; yet there are cer- tain symptoms which enable us to pronounce, with toler- able assurance, on their presence in the alimentary canal. Among these symptoms the following are the most common and striking : a pale, leaden coloured and occasionally flushed countenance ; a bluish streak under the eyes ; these are dull and heavy ; the pupils are di- lated, or very much contracted ; the lower eyelids and upper lip tumefy, especially during the night while sleeping ; great itching in the nostrils, which causes the patient to pick his nose ; foetid breath ; disturbed sleep, during which the patient grinds his teeth, is apt to lie on his belly, to scream out and start up suddenly, as if frightened ; tingling in the ears, giddiness ; interrupted ANTHELMINTICS. 151 Speech ; palpitation of the heart, muscular debility and flaccidity ; pulse frequent, corded, and often intermit- tent; a dry and spasmodic cough ; irregular and deprav- ed appetite, being sometimes entirely suppressed, and at others exceedingly voracious ; abdomen swelled and hard ; diarrhoea or costiveness ; unnatural, slimy, and foetid stools ; pricking and tearing pains in the bowels ; emaciation ; convulsions, paralysis, &c. The above symptoms may be considered as common to all the species of worms that have been mentioned. There are others, however, which are peculiar to some of these species separately, and which it will be proper to advert to in this place. A pricking and rending pain in the umbilical region ; colic, with a rumbling noise in the belly, may be consid- ered as symptoms peculiar to the lumbricoides. This worm is capable of perforating the intestines with the sharp cutting point of its head ; and its efforts to insinu- ate itself into the mucous coat of the intestines are sup- posed to cause the pains just mentioned. The symptoms which are peculiar to the ascarides are : an irritation and intolerable itching and pricking pain in the extremity of the rectum. These worms are usually found in conglobated masses, and although near the ex- tremity of the large intestines they are exceedingly diffi- cult to remove entirely from their place of lodgment. They sometimes produce inflammation of the rectum, with bloody stools and tenesmus. Swelling and pain of the anus is also occasionally observed as the effects of as- carides. The symptoms of taenia, besides those which have already been mentioned as common to the intestinal worms, are : a sense of weight and pain in the abdomen, accompanied with a burning motion of something alive in the bowels. " Occasional prickings, or rather bitings, are felt in the region of the stomach, the abdomen swells at intervals, and then subsides almost by undulation ; a 152 ANTHELMINTICS. sense of cold from time to time pervades the abdominal viscera. The appetite is usually uncommonly great; his complexion is livid, and he is frequently faint ; the pupils are unusually dilated ; vertigo confuses the head of the patient and excites vomiting ; the legs vacillate, and sometimes the whole body seems to be affected with convulsive trembling. Often small substances resem- bling the seeds of lemon or gourd are evacuated with the faeces of the patient, which are portions of the marginal papillae of these worms." It is stated also, by authors, that persons affected with taenia become uneasy and ill whenever they hear music, particularly the music of an organ at church* Particular Anthelmintics. SPIGELIA MARYLANDICA.—PINK ROOT. This plant is indigenous to the southern parts of the United States, where it is found in great abundance. It has a perennial root, consisting of numerous fibrous branches, of a yellowish colour when first dug out of the earth, but becoming black on being dried and long kept. The stalk is herbaceous, and grows to the height of from six inches to two feet. Spigelia possesses a bland but somewhat nauseous taste. It contains a considerable portion of mucilage, which is precipitated from its de- coction by the addition of alcohol. It does not appear to contain any resin. Water extracts its active princi- ples.! ' The pink-root is esteemed as a very valuable vermi- fuge. It was first introduced into regular practice by * Brera's Treatise on Verminous Disease!?, p. 147. t' Bigelows's Medical Botany, vol. i. p. 144. ANTHELMINTICS. 153 Drs. Lining,* Garden, and Chalmers of South Carolina, and it is now more frequently prescribed in this coun- try, for the expulsion of the round worm, than any other anthelmintic we possess. The whole plant possesses anthelmintic properties ; the root, however, is by far the most powerful portion of it. Dr. Garden states, that the spigelia is much more active in its recent state than when old ; by very long keeping it looses nearly all its active qualities. Dr. Thompsonf took large doses of this root, and found it to produce acceleration of the pulse, flushed face, drowsiness, and a sensation of stiffness of the eye- lids. It is now ascertained beyond a doubt, that this plant possesses narcotic powers, capable of producing unpleasant and even alarming symptoms, when taken in very large doses. I once had a little patient, in the commencement of my practice, to whom I administered this medicine in very large and frequent doses, and the effects were such as clearly demonstrated its narcotic powers. The child, a boy about six years old, after having taken three or four gills of a strong decoction of the root, was suddenly affected with complete mental derangement. The derangement was precisely of that kind which is sometimes produced by the seeds of stra- monium, and of which I have seen an example. He dis- torted his countenance into a variety of shapes; Was af- fected by alternate fits of laughing and crying, and run and skipt about the room incessantly, The pupils of his eyes were greatly dilated and his talk was wild and inco- herent. These symptoms went off in the course of about twenty-four hours, and left him quite as well as he had been before he took the pink-root. I have, how- ever, since, prescribed this medicine in a great number * Essays and Observations of Physic and Literature, vol. iii. p. 151. t An Inaugural Dissertation on the Spigelia Marilandica, by Hodge Thompson. Philadelphia, 1802. VOL. I.—U 154 ANTHELMINTICS. of instances, and have not, except in one case, seen any ill effects from it, and in this instance it only produced slight giddiness, with dimness of sight, and dilatation of the pupils. The pink-root may be given either in powder, or in decoction. The latter mode of using it is, however, the preferable one, as the medicine is much more rapidly and equably diffused through the intestinal canal when in a liquid form than when given in a powder. The powder is given to children in doses of from ten to twen- ty grains. A pint of the decoction made from an ounce of the root should be given in the course of four, five, or six hours. It is usual to combine senna with the pink root in order to procure the expulsion of the worms as soon as they have been destroyed or weakened by this anthelmintic. It is better, however, to give the spigelia by itself, and to exhibit a strong mercurial purge immediately after the medicine is taken. Given in this way it will seldom fail to bring away worms, if there are any present. The pink-root possesses purgative pro- perties ; but these are both uncertain and feeble. It is said to be most active when recently dried, and that its efficacy is always impaired by keeping longer than six months.* The root possesses more activity than the other parts of the plant. MELIA AZEDARACK.—THE PRIDE OF CHINA. This beautiful and stately tree was originally brought * from Japan, and is now naturalized to most of the coun- tries of Europe, and to the southern parts of the United States. It appears from the testimony of some of our south- * Bigelow's Amer. Med. Bot. p. 146. ANTHELMINTICS. 155 em physicians, that the fresh bark of the root of this tree possesses very active anthelmintic properties. Dr. L. Kollock, vice-president of the Georgia Medical So- ciety, speaking of the vermifuge powers of this tree, says : " It is a vermifuge of efficacy. Its use is in some mea- sure general among the planters, and with many super- sedes the use of all others. I have given it with success where all others in common use have failed of relieving. But when given in the months of March and April, while the sap is mounting into the tree, it has sometimes been followed by stupor, dilatation of pupil, stertorous breathing, subsultus, &c. But these symptoms, like those sometimes produced by spigelia, pass off without any perceptible injury to the system. This article like the spigelia, is also a useful febrifuge medicine, in those affections usually denominated verminous fevers, but where no worms are voided. The common form is that of decoction. A large handful, say about four ounces, of the bark of the fresh root, is boiled in a quart of water, till it acquire the colour of strong coffee, i. e. to about a pint, of which from half an ounce to an ounce may be given every two or three hours till it operates. Given in this manner its operation is powerful, sometimes producing both vomiting and purging." The late pro- fessor Barton had a very high opinion of the vermifuge powers of this tree. He considered it as the most valu- able anthelmintic with which we are acquainted.* The berries have also been employed with success as an an- thelmintic. Children are suffered to eat them, " with- out any particular regard to the dose," and it is stated by some, that they are quite as efficacious as the bark of the root. The pulp of the fruit made into an ointment with lard, has been employed with success in tinea cap- itis.! * Collections for an Essay towards a Materia Medica of the United States, P. ii. p. 53. \ t Thacher's Dispensatory, p. 283. 156 ANTHELMINTICS CHENOPODIUM ANTHELMINTICUM.—JERUSALEM OAK. This is a native of Buenos Ayres, and of different parts of the United States. It has been much praised for its anthelmintic power, and from no inconsiderable experience with it, I am fully satisfied that it is worthy of very considerable attention as a vermifuge. The leaves and stalks are bitter, and possess an aromatic acri- mony. Every part of the plant is endued with active properties, but the seeds are decidedly the most power- ful. The juice of the fresh leaves are occasionally em- ployed in the dose of a table-spoonful two or three times a day, for children under five years old. Given in this way, however, it is exceedingly unpleasant, and very few children can be induced to take it. I have employed the juice in a few instances with much advantage. The best, and, indeed, usual form for giving this remedy, is the powdered seeds, made into an electuary, with syrup. From twenty to forty grains of the seeds may be thus taken two or three times a day, by a child four or five years old. It is usually directed to be given early in the morning, before eating, and again in the evening, some hours after supper. The seeds of the chenopodium contain an essential oil, which has been lately much recommended, in cases of worms. It is, indeed, an exceedingly active vermi- fuge ; I have, in many instances, succeeded in expelling numbers of lumbrici with it, after various other anthel- mintics had been repeatedly tried in vain. A child two or three years old may take from three to eight drops twice a day, mixed with a good deal of sugar or mucilage. After it has been given for three or four days, some brisk purgative medicine should be administered. The oil, like the expressed juice, is very offensive both to the taste and smell, and this forms a very great obstacle to its employment with children. Where it can be ANTHELMINTICS. 157 regularly given, however, it is unquestionably one of the best anthelmintics of which we have any know- ledge. GEOFFRiEA INERMIS.—CABBAGE-TREE. The bark of this tree, a native of Jamaica and other West India islands, has been lately introduced into no- tice, as a vermifuge of great powers. It is of a grey co- lour externally, and of a dark brown or black and fur- rowed appearance on the inside. It has a sweetish and mucilaginous taste, and a pretty strong unpleasant smell. This article is prescribed either in the form of pow- der, or decoction, or of extract. The docoction is, how- ever, most commonly employed. It is made by boiling one ounce of the bark in a quart of water, till it acquires the colour of Madeira wine. Brera states, that it is more efficacious when it is combined with valerian He says that he has employed it with great efficacy against lumbricoides and the ascarides. When given in full doses, it often produces nausea and occasional vomiting. If the dose is too large its effects are sometimes very violent, producing strong vomiting and purging, delirium and fever. It should, therefore, always be commenced with in small doses : and when carefully administered, it is said by those who have tried it, to be a very powerful vermifuge. It is more particularly useful for the expulsion of the lumbrici. Of the decoction two table-spoonfuls may be given to an adult two or three times a day ; the powdered bark is given in doses of about half a drachm ; of the extract, from three to four grains are considered a full dose. It is said by some that cold water, drank during the em- ployment of this remedy, is apt to occasion very alarming 158 ANTHELMINTICS. effects. When fever, delirium, or other disagreeable effects arise from its use, relief may be obtained by drink- ing warm water, vinegar, or castor oil. DOLICHOS PRURIENS.—COWHAGE. This plant grows in considerable abundance in the East and West Indies. It bears pods, thickly beset on the outside with stiff hairs, which, when applied to the skin, occasion a most intolerable itching. These hairs, by their mechanical action on worms, are a safe and ef- fectual anthelmintic. It appears that this article is equally useful against every species of intestinal worm. When used for the expulsion of the tape worm, it ought, however, to be given in at least double the quantity which is usually directed in cases of lumbricoidcs. In cases of ascarides, I have, in some instances, employed this ar- ticle with much benefit. Against whatever species of worm it be employed, however, it should always be pre- ceded by one or two cathartics, as its efficacy is common- ly much increased by this practice, probably by exposing the worms more to the action of this substance. The proper mode of giving the cowhage is to mix it with mo- lases or syrup, into a thick electuary. Of this a tea- spoonful may be given to a child two or three years old, and repeated in the morning and evening for three or four successive days. The dose for an adult is a table- spoonful of the electuary. It appears to be quite a safe remedy, and I am persuaded from my own experience, that it is often very effectual. Mr. Chamberiain says, that one of his children about five years old, " took, by stealth, three or'four ounces of the syrup of cowhage, without any other inconvenience than a diarrhoea, which did her more good than harm."* * Coffin's translation of Brera's work on Verminous Diseases, ANTHELMINTICS. 159 The root of this plant is said to possess very valuable diuretic properties ; and a vinous infusion of the pods (12 to a quart) is stated to be a certain remedy for the dropsy.* Dr. Collier, of London, in a late number of the London Medical and Physical Journal, proposes scattering some of the pubes dolichi prurientis over the body, for the purpose of rousing the system in cases of poisoning by narcotics. The effects are said to be sud- den and powerful. ARTEMISIA SANTONICA. The seeds of this plant, are an excellent anthelmin- tic. They have a bitter and subacrid taste, and a mo- derately strong and disagreeable odour. They contain a large portion of an essential oil, upon which their ac- tivity appears entirely to depend. They are prescribed in substance, in infusion, in the form of an electuary, and in that of an extract. The dose for children under five years, is from four to eight grains, and for adults from two scruples to a drachm, two or three times a day. The following is an excellent formula for giving these seeds. " Take an ounce of pulverized semen santonicum, and of black sulphur of mercury, resin of jalap, and of powdered cinnamon bark, three scruples, white sugar seven ounces ; dissolve these in water and boil to a consistence, mix the whole, and form the mass into boluses. The dose for a child is from one to two drachms." p. 301. See also Chamberlain's Practical Treatise on the efficS" cy of Cowhage, &c. 1785. * Thacher's Dispensatory 160 ANTHELMINTICS. POLYPODIUM FELIX MAS.—MALE FERN. The root of this fern has been long celebrated as an efficacious anthelmintic Pliny,* Theophrastus, and Galen,! prescribed it against taenia?, and lumbricoides ; and it is still considered by many practitioners as a re- medy of very important vermifuge powers. Its employ- ment is, however, at present almost exclusively confined to cases of taenia ; and there is much testimony extant of its efficacy against this species of worm. The pow- der of this root forms the basis of the celebrated specific of Madame Nouffer.J When administered in substance it is given in doses of from one to three drachms, followed by a full dose of some active cathartic. In this way I have employed it in four or five instances, but never with any advantage. I have, however, known it to be used with perfect suc- cess in the practice of other physicians. The French commissioners who were appointed to examine the re- medy of Madame Nouffer, assert that it will not destroy the armed taenia. Brera and others, however, contradict this statement. " I have had several patients attacked by armed taenia," says Brera, " who were happily cured by this remedy." He states, in a note, that he cured * De Simplici Medicin*, lib. viii. t Opera, lib. xxviii. t The secret of this remedy was purchased by Lewis XV. of France. The following are the directions given for using it: Take three drachms of the root of thefelix mas, reduced to a pow- der, mixed with four or six ounces of water. The whole is to be swallowed by the patient, in the morning, on an empty stomach. For children the dose is lessened to one drachm of the powder. If this produces nausea, the patient must inhale the odour of strong vinegar. Two hours after the powder is taken the patient is to swallow the following bolus: take submuriate of mercury, and dry resin of scammony, of each twelve grains, and five grains of gamboge; let them be finely powdered and formed into a bolus, and taken at one dose. ATHELMINTICS. 161 seven patients affected with armed taenia by Nouffer's method. Herenschwand, a German physician, had em- ployed the male fern before Madam Nouffer's secret was known, in a way very similar to her method. His mode of using this remedy, is to administer two drachms of the male fern root two successive mornings and even- ings, and on the third day a cathartic composed of "twelve grains of gamboge, thirty of carbonate of pot- ass, and two grains of turpentine soap, dissolved together in a cup of water." Three hours after an ounce of ol. ricini is to be given and repeated in an hour; if the worm does not come away, another dose of the castor oil must be given in two hours after. " But, if the worm be still not discharged, a clyster of equal parts of milk and water, and three ounces of oleum ricini must be in- jected towards evening, by which means the worm will come away entire and with ease." This plan of treat- ment has been found very efficacious by some physi- cians. PUNICA GRANATORUM. The bark of the pomegranate tree has been recently introduced to the notice of the profession, as a very effi- cacious remedy for the removal of the tape worm. It was first noticeel, I believe, as a powerful vermifuge, in Dr. Fleming's catalogue of Indian Medicinal Plants and Drugs, published in 1810. Dr. Pollock afterwards pub- lished a case of taenia in an infant, in which this article was employed with complete success* Quite recently, the favourable accounts which had been published of this remedy in taenia, have been amply confirmed by P. Breton, Esq. surgeon to the Rhamgur battalion in the * Edinburgh Med. and Surg. Journ. vol. x. p. 419. VOL. I.--X 162 ANTHELMINTICS. East Indies. He relates eight cases which were prompt- ly and completely relieved by this medicine. In almost every instance the taenia was expeUw, entire and alive, in the course of from three to six hours after first taking the remedy. He employed it both in the form of decoc- tion and of powder. The former he made by boiling two ounces of the bark in a pint and a half of water down to three-fourths of a pint. Of this he gave a wine-glass full every half hour, until four or five doses were taken. Of the powdered bark, he gave twenty grains every hour four or five times repeated. The remedy is apt to occa- sion nausea, and occasionally also, when taken in strong doses, giddiness and faintness. When these effects en- sue, the use of the medicine should be suspended for a time. " The temporary suspension and renewal of the medicine," says Mr. Breton, "may be successfully adopted under such circumstances."* C AMPHORA.--CAMPHOR. Camphor has been a good deal prescribed as an an- thelmintic. Brera and others extol it very highly. " Of all the remedies for the expulsion of the lumbricoides," says Brera, " there is no one, according to my observa- tions, which is more active or more certain than camphor. This substance, administered according -to rule, expels lumbricoides with facility and promptitude, and at the same time strengthens the intestinal tube and the whole body."! Pringle states that he found this remedy ex- ceedingly efficacious in verminous diseases ; and Mos- cate, as we are informed by Brera, generally preferred camphor to other anthelmintics in cases of lumbricoides. * Medico-Chirurgical Transactions, vol. xi. t Treatise on Verminous Diseases, p. 299. ANTHELMINTICS. 163 u The employment of camphor/' says Brera, " is also attended with this precious advantage, that it counter- acts the predisposition to the further development of ver- minous seeds. I have always used it with great success, and I cannot too strongly recommend its use to physi- cians, in worm complaints."* Camphor has also been used with success against taenia. Vogel expelled one of these worms, of great length, by administering camphor in the form of pills and enemata. Camphor is most conveniently given in an emulsion with gum arabic and sugar. By triturating camphor with carbonate of magnesia, we greatly increase its sol- ubility in water. Two or three grains may be thus dis- solved in an ounce of water, and if sugar be added to this solution it forms an elegant and efficacious medicine in the worm affections of children. It is sometimes given in combination with asafcetida, semen santonica, valeri- an, &c. The dose of camphor varies from one grain to thirty, according to the age and strength of the patient OLEUM TEREBINTHINjE. A great deal has lately been said concerning the ver- mifuge powers of the spirits of turpentine. Its efficacy in the expulsion of taenia has been so frequently attest- ed, that we can no longer doubt of its excellence in this respect. On the continent of Europe, the spirit of turpentine has been for many years prescribed in verminous affec- tions. In England and in this country, however, its in- troduction into practice as a vermifuge, is of recent date. It was first noticed in England as a remedy against taenia, in a letter from Dr. John R. Fenwick, of Durham, to * Treatise on Verminous Diseases, p. 199 16-1 ANTHELMINTICS. Dr. M. Bailie, and published in the Medico-Chirurgical Transactions for 1811. Three cases are mentioned by Dr. Fenwick, in which the turpentine was successfully administered. Many other cases have since been related in the periodical journals, which demonstrate the pow- ers of this remedy against taenia. When employed for the* expulsion of this worm it should be given in large doses. From one to three ounces are commonly admin- istered at once. Before the turpentine is taken the bowels should be freely evacuated by some active purga- tive medicine. " Whatever quantity it may be thought proper to give at one trial of the remedy should usually be given in one dose. Three ounces of the spirit of tur- pentine taken at once will be more likely to destroy the worm or worms, than the same quantity taken one third at once repeated after an interval of one, two, or three hours, and will be much less tedious to the patient."* When given in large doses it generally passes through the bowels in a short time, and is consequently less apt to be absorbed, and to affect the urinary organs than when employed in small doses. If it does not move the bowels in three hours after it is taken, a large dose of castor oil should be given. Dr.Coffin says, that as soon as it begins to be discharged per anum, " whether the worm appear or not, the patient should be permitted to drink freely of any bland suitable liquid." The turpentine is also an active remedy against the lumbricoides. When employed for the destruction of these worms, however, it may be given in much smaller doses than is necessary for the expulsion of taenia. Dr. Klapp, of this city, in a paper on worms in the stomach, adduces a number of examples of the value of this remedy as a vermifuge. He gave it in doses of from twelve to fifteen drops every four, five, or six hours, * Coffin's translation of Brera's Treatise on Verminous Dis eases, p. 250. ANTHELMINTICS. 165 occasionally interposing a mercurial cathartic* It acts with peculiar advantage when the worms are situated in the stomach. In several instances of verminous affec- tions, attended with a soreness in the epigastric region, sickness of the stomach after eating, vertigo, a dry short cough, foul breath, and an occasional choking sensation in the throat, I have administered turpentine in doses of from fifteen to twenty drops, and continued for three or four days with the most complete success. The worms are usually discharged in a dissolved state. Under the head of Stimulants I shall again have occasion to speak of this article. Many other vegetable substances have been recom- mended for their vermifuge powers. Of these the fol- lowing are the principal: allium cepa, angelica, asafoetida, juglans regia, tanacetum vulgare, Valeriana officinalis, veratrum sabadilla, caria papaya, pomegranate. According to Schmucker, the veratrum sabadilla, is a very powerful vermifuge ; it is, however, apt to produce violent symptoms, and ought, therefore, to be employed with great caution. Garlic also possesses strong anthel- mintic properties. Taken on an empty stomach, in the morning, in the form of decoction, it seldom fails to ex- pel lumbrici, if any be present. For the expulsion of ascarides, anthelmintics ought to be administered both by the mouth and in the form of injections. Clysters are, indeed, indispensable in cases of this kind. Aloes dissolved in water and thrown into the rectum, is an excellent remedy against these worms. The infusion of semen santonici, is also highly recom- mended for this purpose. Mr. C. M. Clark says, " a strong decoction of the sem. santon. is the most effica- cious of all the injections in use."! A very effectual mode of destroying these worms is to * American Medical Recorder^ vol. iii. p. 155. t Diseases of Females, p. 109. 166 ANTHELMINTICS. introduce a large bougie or tent into the rectum, smear- ed with mercurial ointment. Dr. Coffin says, that a friend of his who suffered violent irritation in the rectum from these worms, obtained complete relief by intro- ducing a bougie, covered with whale oil, into the rectum. STANNUM.—TIN. Tin is a remedy of very considerable powers as an anthelmintic. Of its efficacy against taenia as well as against the lumbricoides, there is abundant evidence ex- tant. Alston, a Scotch physician, was the first who pre- scribed it for the expulsion of taenia.* Dr. J. Fother- gill also speaks in high terms of its powers against this worm. He recommends an ounce of the filings to be given for six days in succession, and a purgative to be taken on the seventh.! Dr. Brera observes, that in cases of old, large armed taenia, he has known the me- thod of Nouffer to be ineffectual, and that in these in- stances the filings of tin regularly administered, produc- ed the desired effect with promptness. Tin appears to be most efficacious when given in the form of filings. These are given in doses of from half a scruple to an ounce, formed into an electuary with honey or syrup. It should be continued for several days, and occasionally suspended for the purpose of interposing a purgative. Brera says, that he has used this metal in the form of Guy's powder of Ethiopia, with great success. J He ob- * Medical Essays and Observations, by a society at Edinburgh vol. v. p. 87. t Med. Obs. 8c Inq. vol. vi. p. 71. \ The following are the directions'given for making this pow- der : " Take seven ounces of pure rasped tin, an ounce of mercu- ry, a drachm of sublimed sulphur, triturate the whole thorough- ANTHELMINTICS. 167 serves also: * The aurum musivum, is one of the most efficacious remedies employed against toenia, particularly the armed taenia. This preparation, more active than the powder of Guy, ought to be thus compounded. Melt ly in a morter to a very fine powder. The dose is from twenty to thirty grains twice a day." Tin forms a principal part of the ver- mifuge of Mathieu. This man received the title of counsellor of the court as well as a large pension for life, from the' king of Prus- sia, for making known his method of expelling taeniae from the bowels. This remedy consists of two electuaries; the first mark- ed A. the second B. " The First Electuary, A. Take an ounce of very fine English tin filings, six drachms of the root of the polypodium filix mas, half an ounce of semen santonicum, a drachm of the resinous root of jalap, and of sulphate of potass, and of honey sufficient to make an electuary. Second Electuary, B. Take two scruples of the pulverized re- sinous root of jalap, and of sulphate of potass, one scruple of scam- mony from Aleppo, ten grains of gamboge, and of honey suffi- cient to form an electuary. Those who may be inclined to adopt this method to expel tae- niae, must observe the four following rules: 1. For some days previous, the patient is to be confined to a suitable diet, that is, he is to eat salted substances,—for example, herrings, light porridges and broths, and leguminous articles. 2, The treatment is begun by administering to the patient, every two hours, a tea-spoonful of the electuary A. This course to be continued two or three days, till the worm is perceived to be in the intestines, and then, 3. The patient is to take electuary B, and of this he also takes, every two hours, a tea-spoonful, till the worm is expelled. The discharge of the worm is facilitated by taking some spoon- fuls of fresh oleum ricini, or by some clysters of the same oil. 4. The age, sex, and temperament of the patient may require a considerable modification of the dose of these remedies; for this reason the treatment ought to be directed and modified by a well informed physician. Finally, It is to be borne in mind that the virtue of the electuary A. depends in great part on the root of the polypodium filix mas; hence this root should be fresh, and its internal hard part only should be reduced to powder. This powder will have a reddish colour; see Hartenkiel^ Mcdi- cmisch-cbirurgische, Zeitung, 1800,-2 Band, p. £93." 168 ANTHELMINTICS. twelve ounces of very pure tin, and add to it three oun- ces of mercury ; let the mixture cool, triturate it in a mortar to a very fine powder ; while triturating the mix- ture, add seven ounces of sublimed sulphur and three ounces of muriate of ammonia. The dose is ten grains twice a day/'* HYDRARGYRIA. Mercury possesses the power of destroyingintestinal worms, and has been much employed by physicians for this purpose. Formerly water boiled on mercury was recommended as a remedy against lumbricoides. Many reports have been made in favour of its vermifuge pow- ers when administered in this way ; but as mercury seems to be entirely insoluble in water, the decoction is now universally neglected as an inert remedy. Calomel, however, is certainly a very useful anthelmintic! Given * Treatise on Verminous Diseases, p. 344. t " Many of the nostrums advertised for the cure of worms, con- tain calomel as their principal ingredient, combined with scammo- ny, jalap, gamboge, or some other purgative: they are uncertain and dangerous medicines; the method of exhibiting them in the form of lozenges {worm cakes,) is also attended with inconveni- ence, for the sugar and the gum generating an acid, by being kept in damp places, may considtrably increase the acrimony of the mercury; besides .vhicli, the calomel is frequently diffused very unequally through the mass, one lozenge may therefore contain a poisonous dose, whilst others may scarcely possess any active matter. Ching's Worm Lozeng/es.—These consist of yellow and brown lozenges, the former are taken in the evening, the latter the suc- ceeding morning. The Yellow Lozenges.—Saffron §ss, of water oj. boil, and strain; add of white panacea of mercury (calomel washed in spirit of wine) ffci. white sugar. 28lb. mucilage of tragacanth as much as maybe sufficient to make a mass, which roll out of an ANTHELMINTICS. 169 in minute and repeated doses, it seldom fails to destroy the lumbrici. Were it not for its tendency to affect the mouth, it would be a very important vermifuge in chil- dren, as it may be more conveniently administered than any other medicine. To children, from one fourth to half a grain may be given night and morning, for three or four days, and a purgative given when the medicine is discontinued. The corrosive sublimate has also been prescribed as a vermi- fuge ; but its extremely unpleasant taste renders it diffi- cult to give to young patients. The ammoniacal muri- ate is said to be a very efficacious form for giving this remedy. The sulphate and sulphur of mercury have also been recommended as useful against worms. The mercurial preparations are frequently given in combina- tion with other vermifuges. There are many other mineral substances recom- mended in books, as possessing useful anthelmintic powers. The principal of these are, arsenic, sulphur, iron, muriate of barytes, muriate of ammonia, and mu- riate of soda. exact thickness, so that each lozenge may contain one grain of panacea. The Brown Lozenges.—Panacea §vii. resin of jalap ffoiiiss. white sugar Jfeix. mucilage of tragacanth q. s. each lozenge should contain gr. $ of panacea. Story's Worm Cakes.—Calomel and jalap made into cakes and coloured by cinnabar."—Paris's Pharmacol. VOL. I.—Y CHAPTER V Antacids. Antacids are substances which obviate acidity in the alimentary canal. The action of these remedies is purely chemical, "as they merely combine with the acid present, and neutralize it."* In a perfectly healthy state of the digestive organs, no acid is, perhaps, ever generated in the alimentary canal. As it, however, frequently happens even in the most temperate, that digestion is retarded or enfeebled, the aliment taken in is often subjected to chemical changes, producing acidity and flatulencies. While these changes go on in a moderate degree only, the system does not, in general, experience any particular inconvenien- ces from them. When, however, the evolution of acid is great, or has become habitual, a train of various and distressing symptoms generally ensue. Acid does not, however, always depend on a chemical change in the substances received into the stomach. It has, in fact, been well ascertained that this acid is usually different from that which is formed by vege- table fermentation. It appears to possess a peculiar character, depending often on a morbid secretion in the stomach. Still, however, as the generation of acid in the primae viae is very often accompanied by the evolution of large quantities of air, it would appear * Murray's Mat. Med. ANTACIDS. 171 io be pretty certain that fermentation does take place in the stomach and bowels, and that the acid depends on this cause. "Acid," says Richter, " in the primae viae, is certainly of two kinds, arising from two differ- ent causes. It is sometimes plainly the consequence of a curruptio spontanea, of acids taken by the mouth, or of meat and drink which have become sour; and in this case it only incommodes the patient when he has taken such meat or drink; it is easily and constantly blunted by alkaline or absorbent medicines, and keeps away as long as the patient carefully uses diceta antacida. Medicines which strengthen the system, with an anta- cid diet, generally cure the patient of this acid. But sometimes the patient is incessantly tormented with acid, eat what he will, even though he only takes ani- mal food. None of the medicines which blunt acidity are of any service, or they only procure him a short mitigation. And in this case the acid is not the pro- duce of a corruptio spontanea, but a secretio perversa liquorum menstruorum. The patient, as Kaempf says, has a brewery of vinegar in his stomach."* The secretion of uric acid by the kidneys, is much influenced by the presence or absence of acidity in the stomach. An accumulation of acid in the primae viae is almost invariably attained with an abundant secre- tion of the uric acid; and hence, we find alkaline re- medies among the most useful for counteracting the lithic acid diathesis. The existence of acid in the stomach, produces, in some, a very troublesome itching in the skin. I have seen several persons who always experienced such an itching in the skin, whenever they were troubled with acid in the stomach; and who invariably obtained re- lief from a dose or two of magnesia. * Medical and Surgical Observations, p. 190. See also the arti- cle Asafcetiday in this work. 172 ANTACIDS. The connection between acidity in the stomach and gout, has often been observed. "Acid/' says Dr. Scudamore, "when much accumulated in the primae viae, will always powerfully concur with the other causes to excite a fit, and will sometimes prove alone sufficient. I have met with several instances, in which the discharge of acrid fluid from the stomach has pro- duced immediate and very sensible relief."* In children, acidity in the bowels is very often the cause of much uneasiness and distress. Whenever we discover the stools to be of a grass-green colour, we may be assured of the existence of acid in the pri- mae viae. The bile in its natural state, is not green, but pale yellow. The green colour which we often observe it to possess in the discharges of infants, depends on the action of the gastric acid upon it. The efficacy of the common practice of giving cretaceous powders, when the stools have this grass-green appearance, depends on their property of obviating acidity. LAPIDES CALCARliE, ET TESTACEA. Calcareous substances are among the most useful articles of this class of remedies. Of these there are a great number, the most important of which are the fol- lowing : Creta prceparata.—This is a very useful antacid, and much employed in diseases of children depending on acidity and relaxation of the alimentary canal. It is, in- deed, particularly serviceable in the chronic bowel com- plaints of infants, whether acid or not be present. The * Scudamore on Gout, p. 57. Philad. edit. ANTACIDS. 173 usual mode of prescribing it is in union with gum arabic, opium, cinnamon, catechu, &c* Teslce Ostrearum.—Pulverized oyster-shells are an excellent antacid and absorbent. They are given with bitter or aromatic articles, in debility of the digestive or- gans, attended with sour eructations and other gastric affections arising from acidity. De Haen states that he cured rachitis, by giving twice a day twenty grains of powdered oyster-shells. This article has also been re- commended as very beneficial in the debility and dys- pepsia, which arises from excessive onanism.! It may be given in doses of from ten grains to two drachms. Oculi Cancrorum.—These are small hemispherical calcareous bodies, found on each side of the stomach of the cancer astacus, during the month of August, They consist of carbonate of lime and animal gelatine. They are slowly soluble .in vinegar. This article has been much used in affections arising from acidity of the first passages. It has been recommended as particularly ser- viceable in disorders of the urinary organs, depending on this cause. I presume, however, that it is not superior, in this respect, to any of the other calcareous articles of this class. Gaubius and others, recommended it as use- ful in leucorrhoea, especially when this complaint is ac- companied with acid in the primae viae.J It has been stated by some German writers, to be apt to excite hae- morrhages, and we are, therefore^ cautioned against em- ploying it where there is much disposition to haemorr- hage. I have no idea, however, that there is any foun- dation for this opinion. This substance is given in doses of from twenty grains to a drachm. * This is a very useful formula for checking diarrhoea de- pending on acidity.—R pulv. cretae. co. cum opio. ^1. pulv. c-atechu extract gr. xv. Sit pulvis, post singulas sedes liquidas sumendus. t Burdach, Arzney. m. 1. vol. ii. p. 504. | Shippers, liber eine besondere wiirkung der krepsaugenbeym weisen flussc—in Sammlg. auserl. Abh. xviii. B. I. 471. 174 ANTACIDS. Aqua calcis.—Lime water is an efficacious corrective of acidity in the first passages. In dyspepsia, attended with acid eructations, and in chronic diarrhoea, this article is often of great service. It is usually given with milk, in doses of from two to four ounces, three or four times a day. Of the various remediate powers of this preparation, and especially of its utility in counteracting the lithic acid diatheses, I shall have occasion to speak when I come to treat of Antilithics. magnesia alba. Magnesia unites readily with the acid generated in the stomach, and is especially serviceable in all cases of acidity attended with a torpid state of the bowels. Where, however, diarrhoea, and a very irritable state of the intestinal canal exists, it is much less useful than the calcareous antacids already mentioned, since it acquires pretty active purgative qualities when united with an acid. In the bowel complaints of infants, attended with green and griping stools, magnesia combined with rhubarb, has long been a favourite remedy with prac- titioners. CARBONAS POTASSJE ET SODJt. The fixed alkaline salts are the most perfect neutral- izes of acids. They have accordingly been much prescribed in affections attended with accumulations of acid in the stomach and bowels ; as they are how- ever, much less pleasant and not more efficacious than magnesia, in the diseases which depend on this ANTACIDS. 175 cause, a preference is generally given to this latter substance. In dysentery, attended with acid eructa- tions, or other symptoms denoting acidity in the ali- mentary canal, the carbonate of potass has been par- ticularly recommended by Causland and Rademay- er. Doctor Mitchill, of New-York, also speaks highly of the alkaline medicines in this disease. The dose of these carbonates is from five to twenty grains. CHAPTER VI. B. MEDICINES WHOSE ACTION IS PRINCIPALLY DIRECTED TO THE MUSCULAR SYSTEM. J. Medicines calculated to correct certain morbid con- ditions of the system, by acting on the tonicity of the muscular fibre. TONICS. These are medicines which impart vigour and tone to the system, without materially increasing either the heat of the body or the frequency of the pulse. Cullen thought that the tonic power of substances is specifically the same principle with that which gives them their bitter taste. That this opinion is, however, with- out foundation, is at once evident from the fact, that some intensely bitter substances do not possess the least tonic virtues, whilst, on the other hand, some very valu- able tonics are destitute of bitterness. Thus opium and digitalis, though very bitter, have no tonic properties ; and some of the metallic-preparations are tonic, though void of bitterness. The action of tonics, unless taken in very large doses, is not manifested by any immediate and obvious excite- ment. The vigour wjiich they impart to the system, is the result of a slow operation on the animal economy, and altogether different in its character from that tern- TONICS. 177 porary augmentation of force which is the immediate consequence of the operation of stimulants, properly so called. When tonic remedies are employed in a debilitated state of the system, their operation is evinced by a gra- dual and permanent increase of the force of the circula- tion ; an invigoration of the digestive powers, and of the general energies of the animal economy. There are three ways in which these remedies may produce their tonic effects on the system. 1. They may increase the strength of the system, by improving di- gestion, and thereby giving rise to a more abundant and healthy formation of chyle. That debility and disease may arise from an imperfection of the chyle, there can- not be the least doubt. Out of this fluid every other fluid and solid part of the system is ultimately formed ; and we may, therefore, conclude that any deviation from its healthy state, must interfere with the regular opera- tions of the animal economy. It is evident, therefore, that whatever substance has the power of restoring the digestive energies of the stomach, and thereby the heal- thy condition of the chyle, will, by this effect alone, give health and vigour to the body. 2. Tonics may also im- part tone to the system, by exciting a peculiar action in the part to which they are immediately applied, and thence propagating a similar action to the other parts of the body, through the medium of the nervous system. The effects of impressions on the stomach are often man- ifested in other parts of the body in an exceedingly vio- lent and sudden manner. Debility, syncope, and even death are sometimes suddenly produced, simply by the action of indigestible food on a weak stomach. Seeing, therefore, such violent affections excited by articles that suddenly resist or prostrate the energies of the stomach, there is reason to believe, on the contrary, that whatever has a tendency to give vigour to this organ, will com- vol. i.—z 178 TONICS. municate a corresponding vigour to the general system.* 3. Finally, tonics may strengthen by being absorbed into the circulation, and by thus acting directly on the whole organization, through the medium of the blood. That remediate substances are carried into the circula- tion, is a fact which is, I trust, established by what has already been said on this head in the first chapter ; and there can be no reason why a tonic substance absorbed into the circulation, should not produce the same invi- gorating impressions on ihe parts with v\hi( h it comes in contact whilst circulating in the blood, as when applied to the surface of the stomach, the rectum, or skin. Tha» tbey do in fact operate in this way, is further ren- dered probable by the new qualities which some of these substances impart to the urine and the other excre- tions. The remediate effects of these medicines are, how- ever, not to be exclusively referred to any one of these modes of influencing the animal economy. Tonics, no doubt, generally act, at once, in all these ways. Although tonics do not produce any very evident ex- citement in the system, yet they have an obvious tenden- cy to increase the inflammatory diathesis, and they are therefore; as a general rule, inadmissible wherever there is any tendency to inflammatory action in the system. It is, indeed, at once obvious, fr m the general effects of these remedies, that the diseases of debility alone are those in which they may be employed with advantage or propriety. As a general axiom this undoubtedly holds good ; yet experience has demonstrated that tonics may sometimes be used beneficially in cases attended with an evident phlogistic condition of the system, as in the declining stage of gout and rheumatism. * Qui stomach am regem totius corporis esse Contendunt, vera niti ratione videntur. Hujus eniir. vAlidus firmat tenor omnia membra :— At contra ejusdem fran^untur cuncta dolore. Serenus Samonicua, De Med. Precept. TONICS. 179 As T shall have occasion to spe?k fully of the thera- peutic application of tonics when treating of the particu- lar articles of this class. \ will not pu sue this subject anv further, but proceed at once to the consideration of the individual tonics. CINCHONA. The cinchona is unquestionably the most important tonic we possess, and justly ranks among the most useful and indispensable articles of the materia medica. Its introduction into regular practice is said to have occurred in the following manner. In 1640. the lady of the Count of Cinchon, viceroy of Peru, was affected with a tertian intermittent, which resisted every mode of treatment that her physicians could devise. Being, at length, nearly exhausted by the disease, she was advised by the governor of Loxa. who had been made acquaint- ed with the febrifuge virtues of this bark by an Indian, to use it as a remedy for her disease. She took it, and the complaint very soon disappeared. The event of this case spread its reputation rapidly throughout S; ain, whence it was carried into Italy by the Jesuits, where it was gratuitiously distributed among the poor sick at Rome, by cardinal de Lugo, and his physician Sebastian Baldo. This latter person has the credit of having written the first work on this valuable remedy* Its fame now rapidly extended itself through France, G. r- many, England, &c. and although much opposed on all sides, the value of ils powers was finally established on the testimony of almost universal experience. The name Cinchona was given to this substance by Lin- * Alibert, 18Q TONICS. naeus, in commemoration of the incident mentioned above. It was also long known by the name of Jesuits' powder, in consequence of its having been first brought into Europe and extensively employed by the Jesuits. The genus cinchona is a very extensive and remark- able family of trees of the natural order rubacece; and of the class pentandria, order monogynia, of Linnaeus. It grows on mountains, and is never found in the plains. Until of late a great deal of confusion and uncertainty existed with regard to the natural history of this family of trees; and indeed, there still exists no inconsiderable perplexity on this subject. The different varieties of bark, as they occur in com- merce, appear to be made up of a considerable number of distinct species, and are assorted into the pale, the red, and the yellow. The pale or grey bark of the shops, is principally de- rived from the cinchona condaminea of Humboldt and Bonpland. This is the cinchona officinalis of Linnaeus, and the cinchona lancifolia of Mutis, which latter is the name adopted in the London Pharmacopoeia. This spe- cies of cinchona is found in abundance in the province of Loxa, and in the neighbourhood of Guancabamba and Ayavaca, in Peru. Bonpland asserts that this is by far the most valuable species of bark, and from its acknowledged superiority the Spaniards have given it the name of cascariila fina. The cinchona condaminea consists of very slender, doubly rolled pieces, not more than a line in thickness, of a brown colour externally, and of a cinnamon colour internally. The epidermis is marked by fine transverse cracks, and readily scales off in small laminae, and is of a much deeper brown than the parts beneath, which are of an orange yellow. Its fracture, when good, is not fibrous or powdery, but even and somewhat shining. It has a faint aromatic odour, and when chewed becomes TONICS. 181 very bitter and astringent. Besides this species, there are others which frequently go to make up the pale bark of commence. Bonpland and Humboldt inform us tiiat the cinchona scrobiculata, a species found very abun- dantly in the province of Jean de Bracemoras, forms a very great portion of the pale bark. There is another species, the cinchona nilida, which is occasionally mixed with c condaminea. The c. nitida is considered as the most valuable of the pale barks, and is now but seldom met with. Indeed, we are informed that the condaminea is daily becoming scarcer, and it would appear from the account given by Humboldt and Bonpland, that the greater part of the pale bark, consists now principally of the c. scrobiculata. Yelloiv bark.—This is the cinchona cordifolia of Mutis; the pubescens of V ahl, and lli^ ovalifotia of Humboldt. This species grows in cold mountainous regions, and is particularly abundant in the provinces of Loxa and Cuenca. This bark comes to us in pieces of about six inches in length, not so much rolled up nor so thin as the pre- ceding kind. Its internal surface is straw-coloured, be- coming of deeper yellow when dipt in water; it is not so heavy and less compact than the pale bark. When chewed it is very bitter, possessing considerable astrin- gency, with little or no odour. " Its decoction, when hot, is redder, but when cold, paler. Its solution strikes a deeper colour with sulphate of iron. It contains more of the active constituents than either of the others, but less gum than the preceding species; according to Mutis, it is the only one which is directly febrifuge, and we are informed by Humboldt, it is that which is most esteem- ed at Loxa." Red bark.—This is the cinchona magnifolia of Ruiz and Pavon, and the c. oblongifolia of Mutis. It is found in considerable abundance in Peru, and at Santa-Fe de Bogata. It is commonly imported in larger, thicker, and 182 TONICS. flatter pieces than the other two kinds. It is compact, friable, and heavy; breaks with a smooth fracture; ex- ternally it is rough, and of a reddish brown colour; the internal surface is redder, of a fibrous woody texture; the central part is resinous, brittle, of a darker red, and compact. This species is more bitter and astringent than the pale bark, and by some is considered the best of the barks in use. Mutis. however, observes, that its febrifuge powers are not equal to those of the yellow bark. It is very frequently found in an adulterated state, being either nothing but pale bark coloured with some other substance, or the red bark mixed with other pow- ders resembling it in colour, &c. Cinchona Caribcea.—This is a native of the Cari- bsean islands, and was first brought to the notice of the profession by Dr. Wright, in an excellent account of it published in the Philosophical Transaclions of London. This bark is imported in pieces from four to six inches in length, rolled into a cylinder, and from a line to two in thickness. Its external surface is brown, and cover- ed with small white lichens. Under the epidermis or thin external covering there is a dark brown and fibrous substance. Its taste is at first sweetish, but on being chewed it becomes bitter and somewhat acrid, not un- like the taste of horseradish. Dr. Wright found it to answer every purpose for which the Peruvian bark is considered useful. This species is not unfrequently con- founded with the cinchona floribunda, which is brought from St. Domingo, and which was first described by Badier, in 1777. This may be distinguished by its grey epidermis, which covers a fibrous parenchyma of a pale brown colour. It is very bitter, and it is said to possess considerable emetic properties. There is, perhaps, no article in the materia medica which has been so frequently the subject of analysis as the cinchona bark. The results, however, have been very various, and in some respects quite contradictory; TOxMICS. 183 so that on this subject there still exists much confusion and perplexity. The cause of this diversity exists, no doubt, in the confusion and uncertainty which has hitherto existed with regard to the different species of the cinchona, and their consequent liability of being mistaken one for the other.* It would be useless and quite uninteresting to give a detailed account of the analyses that have been made of the bark; it will be sufficient to state the most impor- tant results upon this subject. Mr. Descamps, of Lyons, ascertained the existence of lime in cinchona, which he considers as arising from the decomposition of a particular salt residing essentially in the bark. Mr. Vauquelin, who has examined this salt very attentively, thinks that the acid which is united with the lime is a peculiar one, and has, therefore, proposed to call it kinic acid. This acid crystallizes in thin la- mina, unites with earths and alkalies, forming soluble and crystallizable salts, and forms no precipitates with the nitrates of silver, mercury, or lead. According to the very minute analysis of yellow bark, by Marabelli, chemist of Pavia, it appears to contain citric acid, gallic acid, muriate of lime, muriate of mag- nesia, nitrate of potass, sulphate of potass, a resinous ex- tract, a mucous extract, mucus, gum, gluten, a pure re- sin, and woody fibre. Distilled with water on a sand bath a lymph passes over, containing a small portion of acid, some ammoniacal salt, and a volatile oil. Mara- belli observes that the bark should not be given with any of the martial salts, on account of the decomposition that would take place in consequence of the gallic acid of the cinchona. Alibert and Cabal detected a small portion of iron in cinchona. They digested the ashes * Dr. Duncan's Dispensatory. 184 Tonics. of the bark in nitric acid and obtained a fine prussian blue, by the addition of some prussiate of potass* Various opinions have been published in relation to the particular principle of bark in which its tonic vir- tues are supposed to reside. Sequin thought he had demonstrated the existence of gelatine in cinchona, and ascribed its febrifuge powers to this principle. In con- sequence of this supposed discovery some of the French and Italian physicians employed glue in intermittents, and, according to the reports that have been published, with very considerable success. Mr. Westring, a Swe- dish physician of great eminence, was led to conclude from his observations and experiments, that the febri- fuge power of bark resided wholly in the tannin which it contains. " Experience, however, demonstrates, that the virtues of bark must depend upon the combination of all its principles, for no preparation, however care- fully made or scientifically combined, will equal in effi- cacy, bark in the state of powder."f M. Vauquelin, in a second course of experiments on the cinchona, has shown that there are three classes of this bark, differing considerably from each other in their chemical composition. " The first class precipi- tate astringsnts, but not gelatine. The second precipi- tate gelatine, but not astringents. The third precipitate both astringents and gelatine. And lastly, some barks confounded with these, precipitate neither astringents nor gelatine; but these, Vauquelin, viewing the genus chemically, does not consider as cinchonas." Although chemistry may not have afforded us any correct information with regard to the nature of the principle upon which the febrifuge powers of cinchona depend, it nevertheless furnishes us with pretty accurate criteria for ascertaining the relative powers of the differ- * Alibert, Mat. Med. et Therap. vol. i. p. 48. t Paris's Pharmacologia. TONICS. 185 ent species of barks. M. Sequin gives the following di- rections for this purpose: " 1. Good cinchona precipitates the solution of tan- nin, but those of sulphate of iron and gelatine are not precipitated by it. "2. The precipitate which the febrifuge principle forms with the solution of tan, is reddish, slightly floccu- lent and heavy. If the precipitate be considerable, and sink quickly, it is a proof that the febrifuge principle is abundant and of good qualify. If it be not very decid- ed, and remain suspended in the liquor, only disturbing its transparency, it is a proof that it is scanty and of bad quality. " 3. If it does not precipitate the solution of tannin, it is a proof that it does not contain any febrifuge principle. " 4. If it only precipitate the solutions of tannin and of sulphate of iron, it is a proof that it contains an as- tringent substance not capable of tanning, which is fo- reign to it. " 5. If it precipitates solutions of tannin, sulphate of iron, and gelatine, it is a proof that it contains an as- tringent substance analogous to that of the oak." Following these principles, M. Sequin makes six classes of cinchona. "Class 1. Precipitate neither tannin nor gelatine, but form, with sulphate of iron, a precipitate soluble in acids, and insoluble in alkalies; properties common to astringents. This class has no febrifuge property. "Class 2. Precipitate neither tan, gelatine, nor sul- phate of iron. " Class 3. Precipitate neither gelatine nor sulphate of iron, but act slightly on solution of tan. These act only in large and inconvenient doses. " Class 4. Precipitate neither gelatine nor sulphate of iron, but solution of tan abundantly. The best cinchona of commerce are of this class. " Class 5. Precipitate solutions of tan and sulphate vol. i.—a a 186 TONICS. of iron, but not gelatine. The chalybeate precipitate was ferruginous, yellow, and abundant, and soluble in alkalies." He found these properties to belong to a specimen of a bark sold as Angustura. " Class 6. Precipitate tannin and gelatine, but not sulphate of iron." M. Sequin rarely met with this kind of bark, but he thinks favourably of it. Water extracts the virtues of bark; but the infusion very soon under- goes decomposition and loses its medical properties. From an accurate and extensive series of experiments by MM. Pelletier and Caventou, it appears that when cinchona is subjected for a considerable length of time to the action of boiling water, the cinchonine in com- bination with the kinic acid is dissolved, together with some gum, starch, yellow colouring matter, tannin, a portion of red matter, kinate of lime, and generally a portion of fatty matter. By reason of the simultaneous existence of these various substances in the decoction, it soon loses, on becoming cool, its clear colour, in con- sequence of a new compound, insoluble in cold water, formed by the combination which takes place between the tannin and the starch. A part of the red and fatty matter at the same time, falls to the bottom, carrying with it a portion of the cinchonine, by which the active prin- ciple of the preparation is diminished. To obviate these circumstances in some degree. MM. Pelletier and Ca- ventou recommend that a much larger quantity of water than usual be employed in making the decoction, in order to keep the whole of the cinchonine in solution, to filter it when cold, and afterwards to concentrate it by slow evaporation. The extract prepared from the decoction is liable to the same objections that exist against this latter prepara- tion; for that portion of the cinchonine which is com- bined with the kinic acid is insoluble, and is therefore, medicinally inert. Wine and alcohol extract very completely the active TONICS. 187 principles of cinchona. According to MM. Pelletier and Caventou, the alcoholic preparations contain the largest proportion of cinchonine, and constitute therefore the most powerful preparations of this remedy. It is sometimes infused in lime water, and by many this preparation is particularly recommended for children. In the American Pharmacopoeia there is a formula for an infusion of cinchona, in which it is direct- ed to triturate the bark with magnesia, previous to in- fusing it. When prepared in this way it is much stronger than when infused without the magnesia. This sub- stance possesses the remarkable property of increasing, to a very considerable degree, the solubility of resins, balsams, camphor, and oils; and, as it appears that the active principle of cinchona resides chiefly in its resin- oid part, it is upon this principle, no doubt, that the magnesia acts in increasing the strength of the aqueous infusion. MM. Pelletier and Caventou, have shown, that when an alkali is added to an aqueous decoction or infusion of cinchona the cinchonine is precipitated by the alkali, and the liquid, when filtered, is almost entirely inert. As cinchonine is, however, fully soluble in alcohol there can be no objection, as these gentlemen observe, to the practice which has been recommended by some, of ex- hibiting the tincture of bark in combination with an al- kali. It is a singular and important fact that tartar emetic, given in union with bark, loses almost entirely its emetic power. It appears that when these two articles are united a partial decomposition takes place, the oxyde of the antimony uniting with the tannin of the bark, while the cinchonine is set free. It has also been ascertained that the active properties of the bark are weakened by the tartaric acid; the cin- chonine forming an insoluble compound with this acid. Qnite recently a very active and valuable preparation 188 TONICS. of bark has been introduced into practice, which would appear to be superior to every other preparation of this bark previously known. The preparation I allude to is the sulphate of quvna, or quinine, as it is more generally called, and which is now found in most of our shops, and extensively prescribed by the physicians of this country. It consists of white, and when recent, shining needle shaped minute crystals; has an intensely bitter taste, and no perceptible odour; it is soluble in pure al- cohol, but insoluble in water. It is usually prescribed in the form of pills, in doses of from gr. ss. to gr. v. every one, two, or three hours, according to circumstances. Its superior efficacy in intermittents is testified by the ex- perience of almost every physician who has tried it. In my own practice during the preceding summer, I have had very satisfactory evidence of its great usefulness in this disease as well as in other affections requiring a tonic treatment. The salts of iron, sulphate of zinc, nitrate of silver, oxymuriate of mercury, tartarized antimony, solutions of arsenic, form precipitates with the solutions of bark. Mr. Alibert justly observes, that the history of cin- chona is very intimately associated with that of intermit- tent fever, both from the circumstances which attended its introduction into regular practice, and the high cha- racter which it has long held and still sustains, as a re- medy in this disease. Of its very superior efficacy in in- termittents, it would now, indeed, be altogether useless to adduce any evidence. Upon this subject the profes- sion may be considered as unanimous. The only differ- ence of opinion which yet prevails, in relation to the em- ployment of cinchona in these fevers, relates to the mode of administering it; the periods of the intermission, in which it should be given ; the proper doses ; and the utility or inutility of a previous resort to evacuant reme- dies. With regard to the propriety of evacuating the con- TONICS. 189 tents of the stomach and bowels previous to administer- ing the bark, although doubted by some, yet general ex- perience is decidedly in favour of the practice. There can be no doubt that many cases of intermittent fever may be effectually removed by bark given without any previous evacuations whatever. This is more especially the case in those instances which occur in spring or winter, in subjects who have had the disease during the preceding autumn ; and which may, therefore, be con- sidered as relapses of the former attacks. In intermit- tents occuring, however, in summer and autumn, in mi- asmatic districts, and where the biliary secretions are much affected, an emetic, followed by a dose of calomel and jalap, is in general a very useful measure previous to giving the bark. There is too, sometimes, a phlogis- tic tendency in the system which is unfavourable to the febrifuge operation of the bark, and in such cases cathar- tics will act beneficially, by reducing the general excite- ment of the system. Bleeding is also an essential preliminary in some cases of intermittents, before using the bark. I have had many examples of this kind in my own practice. The tendency to inflammatory action in the system is some- times so great, that the fever has not power to develop itself in its genuine character; the intermission is in- complete, attended with restlessness, and an irritated state of the pulse, the cold stage is not marked by strong rigors, but only by creeping and protracted chills; and the hot stage does not go off by a profuse and uni- versal perspiration. In such cases the bark can seldom be employed with any decided advantage, unless it be preceded by venesection, and other evacuants. By one good bleeding and cathartic, in instances of this kind, the fever will commonly assume its genuine character ; the rigors will be strong ; the perspiration which con- cludes the hot stage copious and general, and the inter- mission perfect. The bark will now act beneficially. 190 TONICS. however ineffectually it may have been previously em- ployed. Considerable diversity of opinion has been expressed in relation to the proper time of exhibiting bark in inter- mittents. Dr. Home gave it at the commencement of the hot stage. Heberden gave as much as four ounces immediately before the accession of the paroxysm ; and Drs. Clark, Balfour, and others, recommended it to be given in the hot stage. The proper stage of this dis- ease for administering bark is, however, undoubtedly during the intermission. Upon this point the profession are now, I believe, unanimous. Cinchona should always be given in as large doses as the stomach will bear. In general from one to two drachms of the powder may be taken every hour. Some delicate stomachs will reject the bark when administer- ed even in the smallest quantities. When this is the case, it may be given in the form of decoction or infu- sion, or administered as a clyster. "With children who cannot be prevailed on to take the bark, we may administer it with much efficacy in this way, repeating the, clyster every four hours.v It has also been used effectually in children, by applying it externally, quilted in a shirt or waistcoat. When the bark occasions purging, it must be given with the addition of small doses of opium. This is, in- deed, frequently a very important addition to the cin- chona. It not only prevents the bark from acting on the bowels, but enables the stomach to bear much larger doses of it, and adds, moreover, in many instances, con- siderably to its good effects. The snake root may also sometimes be very usefully combined with the bark. Dr. Thomas says, that this combination is particularly use- ful in intermittents of long continuance, affecting old debilitated persons, living in a damp situation, or when the season is rainy. I have myself occasionally given a combination of bark, opium, and snake-root, in cases of TONICS. 191 ' this kind, and the effects have, in general, been very favourable. Bergius speaks very highly of a combination of bark and mustard in this disease. The late professor Barton recommended a mixture of cinchona and black pepper as an exceedingly efficacious remedy in intermittents. The black pepper, indeed, appears to be a remedy of great powers in this disease, if we are to credit the ac- count given of its effects by Dr. L. Frank. This phy- sician cured intermittents readily, by giving his patients from five to eight grains of pepper twice a day. Doctor Ghigini confirms this statement.* Dr. Alibert, who has published a highly interesting work on malignant intermittents^ observes that the bark is our only remedy when the disease assumes this cha- racter, and that he has known this inestimable remedy arrest, as if by magic, the delirium, convulsions, colliqua- tive sweats, suffocating dyspnoea, lethargy, and excruci- ating pains in the head, which attend this variety of the disease. This writer also observes, that the epidemic constitution of the atmosphere occasionally impresses such a peculiar character on intermittent fevers, as to render them incapable of being cured by the bark. J Hil- lary speaks of an epidemic intermittent at Barbadoes, in which the bark was of no avail, unless combined with saline remedies or some of the tonic bitters. M. Bou- lou, also, mentions an epidemic intermittent, in which the cinchona was found ineffectual. When visceral obstructions accompany intermittents. the bark is a remedy of doubtful efficacy. This is more especially the case where the diathesis is considerab) in- flammatory. When the obstructions occur in weak and phlegmatic habits, I have, however, seldom found any * Journal Complementaire du Dictionaire des Sciences Medi- »ales. t Traite sur le Fievres Pernicieuses Intermittentes. } Klemens de Therapeutique, vol. i. p. 51. 192 TONICS. very particular obstacles to the successful operation of the bark. In cases of this kind, a gentle mercurial im- pression will, in general, either remove the disease, or render it more manageable by the bark. Dr. Barton ob- serves that bark combined with mercury in a small pro- portion, is one of the best medicines for removing the swelling of the spleen, which so often occurs after inter- mittent fevers* In remittents, after the inflammatory excitement has been somewhat moderated, by antiphlogistic measures, bark given during the remission has been recommended by some writers, as not only a safe but a highly useful remedy. Judging from my own experience, however, I am decidedly of opinion, that the practice is, in general, not a safe one, except it be resorted to in the decline of the disease, when the exacerbations are not marked by strong vascular action, and the remissions attended with a cool and moist skin, and a small compressible pulse. It has already been stated, that where the pulse remains irritated and tense, and other symptoms of an inflamma- tory tendency in the system be present, in intermittents, the cinchona will not only frequently fail to remove the disease, but aggravate its symptoms. If this be the case, of which, indeed, there can be no doubt, we can hardly presume that the bark would be often useful in remit- tents, in which there is always some febrile action pre- sent, however complete the remission may be. When the patient has been worn down by the long continuance of the disease, and proper evacuations have been premised, bark may undoubtedly be employed with much advantage in this form of fever. In certain stages of typhus fever, bark is a remedy of considerable utility. During the stage of excitement, it is, however, wholly inadmissible. When the disease is somewhat advanced, and the powers of the system * M.S. notes of Dr. B. S. Barton's Lectures on the Mat. Med. tonics. 193 begin to sink, bark, in conjunction with stimulants, given in moderate quantities, will, in general, produce salu- tary effects. Bergius says, that a combination of bark with mustard, in the proportion of Bii. of the former to gr. viii. of the latter, is peculiarly beneficial in the latter stages of typhus. Where, in the latter stages of the complaint, the tongue and skin are dry, and delirium or coma, with convulsive twitches, attend, the bark is by no means a proper remedy. Here opium is, perhaps, our most valuable remedy. It is in the state of convales- cence, that the cinchona displays its salutary powers; but, in every other period of the disease, where the pow- ers of the system require support, it is decidedly inferior to some of the more diffusible stimulants, such as wine, volatile alkali, opium, musk, &c. The bark has also been highly recommended by some writers, in acute rheumatism and gout. In the former of these diseases, its powers have been particularly ex- tolled by Morton, Fothergill, Saunders, and Haygarth. This latter writer states, that for many years he gave it in this disease in doses of from ,grs. v. to xv. every two, three or four hours, having previously evacuated the sto- mach and bowels by means of antimony; and if this quan- tity proved beneficial he gradually augmented the dose to grs. xx, xxx, xl, taking particular care never to in- crease the dose beyond what agreed with the patient. He observes, that under this treatment, in the great ma- jority of cases, " the pains, swellings, sweats, and other symptoms of inflammatory fever manifestly and speedily cease, till health is perfectly restored." Of the propriety of this practice, however, there is great reason to entertain much doubt. From my own experience I can say nothing either for or against it, having never employed it in this disease; but from the known properties of the bark, we may infer, a priori, that it is a medicine which can be seldom employed in the acute form of rheumatism, whilst the inflammatory vol. i.—b b 194 TONICS. fever continues, without doing injury. After the sympa- thetic fever has been reduced by proper evacuants, and other antiphlogistic measures, the bark may, no doubt, be resorted to with advantage. Dr. Scudamore observes that when the convalescence begins—when the tongue is becoming clean, the urine assuming a light specific gravity, the bowels acting regularly, and the skin relax- ed and soft to the feel, he has found the bark, adminis- tered either as Dr. Haygarth directs, or in decoction with its tincture and sulphuric acid, a valuable medicine. Un- der opposite circumstances, however, he considers its employment of very doubtful efficacy* Acute rheumatism, occurring in autumn, or in mias- matic districts, sometimes assume a remittent, and even an intermittent type; and when this is the case, the bark may be employed with much advantage, after the ali- mentary canal has been well evacuated, by emetics and mercurial purges. Torti, indeed, says that the bark may be usefully given in every form of inflammatory fever, where the disease assumes the form of an inter- mittent. Dr. Tavares,f a Portuguese physician, speaks very highly of the remediate powers of bark in gout. He says in the words of Dr. Held, whom he quotes in fa- vour of this remedy : "Uno verbo, cortex peruvianus in podagra divinum est remedium." It is also recommend- ed by Drs. Small and Saunders, as decidedly useful when administered in large doses during the intermissions of pain and fever, after the local inflammation has been abated.J It does not appear, however, that this practice has ever been much pursued, and very few, I presume, * Scudamore on Gout and Rheumatism, p. 302. t Observationcs et Epicrisis de Corticis Peruviani salutari et proficus usu in Podagra. See Scudamore on Gout, p. 121. Philad. edition. | Scudamore. TONICS. 195 would now be willing to adopt it. In the irregular form of this disease, where great debility attends, bark may be employed with advantage; but in the majority of cases of regular gout, it cannot be resorted to with safe- ty. The late Dr. Barton used to state, in his lectures, that he had observed the bark to be particularly perni- cious in gout, when it evinced a tendency to shift its situation to the stomach, lungs, or brain. According to some British writers the bark is a re- medy of very considerable efficacy in erysipelas. For- dyce gave it in drachm doses every hour, and, as he in- forms us, with the most decided advantage. Sir G. Blane, also, in his Medical Logic observes; " bark is the best remedy in erysipelas," and he adds, that his success with it has equalled Dr. Fordyce's. Instances of the successful employment of the bark in this disease are also related by Dr. Parkman.* It does not however ap- pear to me to be well calculated to do good in the dis- ease as it is commonly met with in this country, it being, so far as I have observed, always attended with much general inflammatory excitement. After the local in- flammation has nearly subsided, and the patient is left in a state of considerable debility, there can be nodoiibt of the usefulness of this remedy. In a late work there is a form of erysipelas described under the name of erysi- pelas phlegmonodes, which is said to be very prevalent in the British navy, and in which bark with mineral acids may be given With much benefit, when it occurs in persons advanced in life, or of a weak habit, and assumes a typhoid character.! The bark was formerly a good deal employed in measles. Dr. Percival describes an epidemic measles of the regular kind, in which, however, it was not usual for violent pulmonic symptoms to occur until five, six * New England Journal of Med. vol. xii. p. 132. t Surgical observations by Mr. Copeland Hutcheson. 196 TONICS. or eight days after the eruption had disappeared. Speak- ing of this epidemic, he says, " I prescribed the bark with great success to many of my patients under the measles, combining it with demulcents and the saline mixture: and premising venesection when the signs of inflammation were urgent." He ascribes the first em- ployment of this remedy in measles to Dr. Cameron, " a very eminent physician at Worcester," and extols the practice very much.* In the putrid measles described by Dr. William Wat- son,! the bark is said to have afforded great relief in the second stage, when great debility was present. He ob- serves, however, that where there was much cough and difficulty of breathing, the bark generally acted pernici- ously, however great the debility of the patient. Not- withstanding these favourable reports of the effects of bark in measles, the present sentiment of the profession appears to be entirely against the practice. In this country, at least, the measles are always too strongly marked by inflammatory symptoms to admit of this re- medy. Venesection, cold and tepid affusions, purgatives and diaphoretics, are the remedies now generally trust- ed to, both in Europe and in this country. In the scarlatina anginosa, the bark has been much recommended by some writers. In the last stage of this complaint, where there is great prostration of strength, with symptoms of malignancy and putrescency, and a tendency to gangrene in the throat, the bark is undoubtedly a medicine calculated to do good. In its simple form of scarlatina, however, the bark is inadmis- sible, except, perhaps, as a tonic during the state of con- valescence; and even here it will seldom be necessary or very useful. Bleeding, purging, emetics, cold and warm affusions, are the remedies to be relied on dur- * Medical Observations and Inquiries, vol. v. p. 284. t Ibid. vol. iv. p. 136. TONICS. 197 ing the stage of excitement, in both the simple and ma- lignant forms of the disease. In the ordinary cases of dysentery, Peruvian bark can, perhaps, never be employed with propriety. It some- times, however, assumes the form of an intermittent, and when this is the case, the bark may generally be given with advantage. This medicine has also been prescrib- ed with success in chronic diarrhoea. In these diseases it is best given in combination with opium. Not much can be said in favour of bark in the cure of epilepsy and tetanus. In the former of these com- plaints it was once a good deal prescribed, but it does not appear to be entitled to any particular attention for its powers in this way. In tetanus, it was employed by Dr. Bush, and he speaks favourably of its effects. Dr. Morrison, in his excellent work on tetanus, observes, what indeed will readily be assented to, that, the disease being conquered, the patient should take wine and bark for many weeks. I have, however, never heard of any case in which the bark effected a cure; in the cases in which it appeared to do good, it was given in conjunc- tion with the free use of wine, to which latter, we may, I think, fairly attribute the benefit which may have been derived from such a combination. Of the use of bark in chorea, Dr. Cullen entertain- ed a very favourable opinion. I have seen one case effectually cured by the bark, together with a few purges. The patient was a very delicate girl, about twelve years old, very debilitated before the disease came on, and of a strumous habit. She took the bark in forty grain doses, four times a day, having previously evacuated the contents of the bowels by purgatives, and was cured in about three weeks. In general, however, I should not be inclined to use the bark in this disease except in the state of convalescence, at which time it is of unquestion- able service. I am fully satisfied from what I have seen, that the purgative plan of treatment recommended by 198 TONICS. Hamilton, with the occasional employment of gentle tonics or antispasmodics, will, in the majority of cases, be more effectual than any other plan of treatment with which we are at present acquainted. Pertussis is another of the spasmodic diseases in which the Peruvian bark has been particularly recom- mended. Dr. Morris appears to have been the first who employed the bark in this disease, and his report of its effects are very favourable. He gave it with castor.* Cullen observes, that in the advancement of the disease, when the cough is kept up by habit, and no pulmonary congestions are present, the bark may put an end to the disease. Many of the German writers speak par- ticularly in favour of the bark in this disease. In this country it is, I believe, very seldom, if ever, given; and except under the circumstances mentioned by Cul- len, it does not, I am inclined to believe, deserve much attention. Bark has been also much prescribed in asthma. In the paroxysm it can be of no service; but, where the disease is connected with a cachectic state of the system, attended with indigestion, this, in common with other tonics, may be employed with advantage. In pulmonary consumption, the bark has been recom- mended by some writers, as a useful remedy. Observing that this disease is marked by periodical paroxysms, with pretty regular cold fits, followed by heat, and at' last copious sweats, succeeded by a temporary abate- ment of all the symptoms, physicians were led to sup- pose, that as the bark is so valuable a remedy in intermit- tents, which are characterized by a similar train of symptoms, it might be employed with advantage in phthi- sis. Experience, however, has proved that it is not only of no value in this disease, but uniformly perni- cious in its operation. " I have seen the bark given," * Medical Observations and Inquiries, vol. iii. p. 281. tonics. 199 says Dr. Fothergill, " in almost every state of the phthi- sis puhnonalis, even in the first commencement., whilst the breast was in pain, the cough dry and harsh, the pulse quick and hard, and the heat considerable! What was the consequence? Frequently an haemoptysis, and all its worst attendants; ulcerated lungs, purulent spit- ting, colliquation, and death."* This writer states, that symptoms resembling those of genuine phthisis, are sometimes produced by delicate mothers suckling their children longer than is consist- ent with their ability. In cases of this kind, he observes, the bark given early and in moderate doses, often pro- duces very exellent effects; and adds, that he is satisfied that, by this remedy, he has " retrieved many from de- plorable situations," and that under such circumstances a prudent employment of the remedy may be made with safety and advantage. Where symptoms of consumption supervene, in con- sequence of copious discharges from abscesses, fluor albus, or other similar debilitating evacuations, the bark is a useful remedy, provided the lungs be not yet in- flamed. If, however, the breathing is oppressed, the cough dry, the pulse quick and hard, with shooting pains through the chest, the bark will inevitably increase the disease.! There is another variety of consumption, in which the bark may sometimes be beneficially employed. It is that species of the disease which has been lately de- scribed under the name of dyspeptic phthisis. In the early stages of this complaint, whilst the affection of the lungs is as yet sympathetic, the moderate employment of bark, with laxatives, is often followed by very bene- ficial results. It is, however, decidedly pernicious when- * London Medical Observations and Inquiries, vol. v. p. 347 t Dr. Fothergill. 200 TONICS. ever the pulmonary organs become the seat of inflam- mation, or organic alterations. Of the use of bark in dyspepsia, I have no very favour- able opinion, when the disease is once completely form- ed, and the lungs or liver are brought into a morbid con- dition. In mere weakness of the stomach, giving rise to flatulence and acidity, the bark, either by itself or in combination with iron, maybe used with advantage; but in that fixed form of the disease in which the mind and body are equally unfitted, both for the enjoyments and duties of life, the bark, and, indeed, all tonics, must be administered with the greatest circumspection. In scrophulous complaints the bark is a remedy of very considerable powers, and deserves to be placed among our most useful medicines in this disease. " In tumefied glands, where the habit happens to be feeble, and the circulation weak, from constitution or accident, bark is a most efficacious remedy ; and, what is re- markable, acts as a resolvent and discutient."* Dr. Fordyce observes also, that much may be done with this remedy in scrophulous ulcerations, or in "gleety phage- denic and semigangrenous sores." In debilitated per- sons of a strumous habit, the bark, with cold bathing and iron, is a very valuable remedy. Barks, in combina- tion with the mineral alkali, has been known to remove scrophulous swellings, when no other form of this medi- cine would have the least effect.! In a few cases of scrophulous ulcerations, I obtained much advantage from the bark given conjointly with cicuta and minute por- tions of corrosive sublimate. In this stage of the com- plaint, however, we can very seldom procure complete relief by any mode of treatment which has hitherto been devised. * An account of some Virtues of the Peruvian Bark, not gene- rally known nor described, particularly in Scrophulous Cases, by John Fordyce, in Med. Observ. and Inquir.vol. i. t M.S. Lectures of the late professor Barton. TONICS. 20\ The bark has also been recommended as very service- able in certain varieties of dropsy. Where, for instance, anasarcous swellings depend on mere debility, and no visceral obstructions exist, the bark, as a general robo- rant, is a remedy of excellent powers. In combination with cream of tartar, it is said to be peculiarly efficacious in the dropsies which succeed intermittents. I should doubt, however, its general applicability in cases of this kind, since dropsies from this cause are very commonly connected with visceral indurations; a circumstance which experience shows to be especially unfavourable to the salutary operation of this remedy. In hemicrania, when, like an intermittent, it returns at regular periods, the bark is the best remedy with which we are acquainted. I have usaally combined it with valerian, and administered it in large doses. It is always useful to evacuate the stomach and bowels previously to employing this remedy. The Peruvian bark is also very commonly prescribed in gangrene. When the gangrene depends on deficien- cy of action, this remedy is of unquestionable utility. Where it depends on increased action or inflammation the bark is always injurious if it be given before the gen- eral inflammatory excitement has subsided. To promote the separation and sloughing of dead parts, however, and support the sinking powers of the system during this process, after the general inflammatory action has disap- peared, the bark may be very advantageously resorted to. It is usually given in combination with opium, vola- tile alkali, or wine, and its powers are much assisted by these articles. Having now given an account of the therapeutic ap- plication of the bark, it remains for me to say something concerning its mode of exhibition. The best form for exhibiting the bark is, undoubt- edly, in substance. The stomach, however, will some- times reject it when taken in this way, and in this case vol. i.—c c 202 TONICS. it should be given in the form of an infusion, conjointly with the tincture. When thus administered, it will, in ge- neral, remain very easy on the stomach. By giving the in- fusion and tincture together, we obtain all the power of the bark residing both in its gummy*and resinous princi- ples; an advantage which cannot be so completely had by using these preparations separately. From the experi- ments of Pelletier and Caventou, it appears that the ex- tract of bark is a preparation of no great powers; being liable to all the objections that have already been men- tioned in the former part of this chapter, as lying against the decoction or infusion. If the bark disagrees with the stomach in whatever shape it be taken, it may be beneficially employed in the form of a clyster. Administered in this way it is particu- larly applicable to the diseases of children, where it may be necessary to employ this remedy. The bark may also be advantageously used as an external application, either in the form of powder quilted into a waistcoat, or of decoction, as a bath. Doctor Alexander states, that he cured intermittents by immersing the lower extremities in a decoction of bark, when the stomach rejected the medicine. ARISTOLOCHIA SERPENTARIA.—VIRGINIA SNAKEROOT. This plant is found exclusively in the United States, and was introduced to the notice of the profession as a remedy for the bites of venomous serpents. The root, which is the only part employed in medicine, is peren- nial, consisting of very numerous fibres, matted together, proceeding from a common head or caudex. The fibres are of a yellow ochre colour externally, and of a pale yellow within. The central or knotty part of the root TONICS. 203 is of a dark brown colour. It has an agreeable aromatic smell, resembling that of valerian; its taste is warm, pungent, and bitterish, not unlike that of camphor or of the pinus canadensis. Subjected to the action of- alco- hol, "it affords a bright green tincture, which is render- ed turbid by water; by filtration a small portion of a green matter is separated, but its transparency is not restored. It neither precipitates tannin or gelatine, nor affects the salts of iron or tincture of turnsole. When the diluted tincture is distilled, the spirits and tincture pass over milky, strongly impregnated with its pe- culiar odour." Lewis states that the spirituous extract is more powerful than the watery, " not so much from its having lost less in evaporation, as from its containing the active parts of the root concentrated into a smaller volume ; its quantity amounting only to about one half of that of the other." The snakeroot was first brought into notice as a re- medy for the bite of venomous serpents ; and although soon found to be destitute of antidotal powers, experience showed it ro be a remedy of very considerable value in a variety of circumstances. When taken into the stomach, it increases the force and frequency of the pulse, excites a glow of heat throughout the system, and produces pretty copious di- aphoresis. It is not, however, simply stimulant and diaphoretic in its effects, for along with these qualities it possesses very important tonic powers. Possessing, along with its tonic, pretty powerful stim- ulant properties, the snakeroot is peculiarly suited to fe- vers of a low grade of excitement ; on the other hand, however, it can never be employed without danger, wherever blood-letting is indicated. In every variety of fever, however, when the inflam- matory excitement has been reduced, or the system is sinking into a typhoid state, the snakeroot is a remedy of unquestionable utility. It is especially serviceable in 204 TONICS. the latter stages of febrile diseases, when the skin and tongue remain dry and hot, and the pulse is feeble, fre- quent, and corded. When given in this state, it com- monly excites a general diaphoresis; the tongue becomes moist, and the pulse and general [lowers of the system become invigorated. A good deal has been said in favour of the powers of the serpentaria in putrid fevers, and, from the general properties of this remedy, there can be little doubt of its applicability to the treatment of fevers of this kind. The snakeroot was formerly a good deal employed in intermittents. Of its efficacy, however, in the cure of this disease, when administered by itself, not a great deal can *be said. I have employed it in a considerable num- ber of instances, but always without success, and I am inclined to believe that it is not often capable of arrest- ing this disease. When united, however, with bark, or some of the bitter tonics, it seems to increase their effi- cacy, and it is in this way, that it is now commonly em- ployed in intermittent and remittent fevers. It is particu- larly useful with Peruvian bark, in those intermittents whose paroxysms terminate by an imperfect sweat, leav- ing the skin hot and dry during the intermission. During the prevalence of the late epidemic pneumo nia typhoides, in this country, the serpentaria was much prescribed by some physicians. Being at once stimu- lant, diaphoretic, and roborant, it was peculiarly calcu- lated to produce beneficial effects in this disease, by equalizing the circulation, and imparting vigour to the vital powers. Dr. Dyckman states, that he has prescrib- ed the snakeroot in combination with seneka, with mark- ed advantages, in this disease. It may also be employ- ed with advantage in the latter stages of pneumonia, and bronchial affections, being useful not only by its tonic operation, but chiefly, perhaps, by exciting the cutane- ous emunctories, and thereby relieving the pulmonic system. TONICS. 205 The late professor Barton used to dwell particularly, in his lectures, on the utility of this remedy in bilious pleurisy. This disease occurs in miasmatic districts, and is generally most prevalent in the winter and spring, after an autumn in which bilious diseases were common. The pulse is often full, strong and bounding, and would seem to require the lancet, but in general the loss of the smallest quantity of blood is productive of the greatest debility. In this complaint I am acquainted with nothing so valuable as the serpentaria.* In this disease the liver is uncommonly active, giving rise to an excessive quan- tity of bile, as is evinced by the bilious vomitings which frequently accompany the first slage of the complaint. Before exhibiting stimulants of any kind, therefore, the intestinal canal should be well evacuated by an emetic, followed by mercurial purges. When this is effected, we may employ the serpentaria freely, in conjunction with minute doses of calomel, in order to correct the functional disorder of the biliary organs. In some of the exanthematous fevers, of a low typhoid character, the infusion of serpentaria has been recom- mended as of much service, in keeping up the action of the cutaneous vessels, and preventing the retrocession of the eruption. The snakeroot has also been found highly useful in re- straining bilious vomiting; and in removing that irrita- bility of the stomach which is often so troublesome in bilious diseases. The snakeroot has often been recommended for its effects in dyspepsia. I do not doubt that it may often be useful in the last periods of this complaint, when the stomach it as yet the only organ particularly affected. After some of the neighbouring organs have, however, be- come involved in the disease, especially if the secondary affections are of an inflammatory character, I have rea- son, from experience, to regard it as injurious. * Barton's M.S. lectures on the Mat. Med, ^Ob IONICS. The infusion of snakeroot may be used with ad- vantage, as a gargle, in ill-conditioned ulcers of the throat. The dose, in powder, is from twenty to thirty grains. It is usually given in infusion, of which a wine-glassful may be taken every half hour or hour. By boiling, its powers are entirely destroyed. PRUNUS VIRGINIANA.—WILD-CHERRY. This is a large and handsome tree, indigenous to the United States, in many parts of which it is found in con- siderable abundance. The bark of the tree, which is the part employed in medicine, has a bitter astringent, and slightly aromatic taste. Its smell resembles that of those substances which contain prussic acid, particularly the peach kernel. This bark, indeed, contains a very con- siderable portion of the prussic acid, a circumstance upon which 1 am inclined to believe its remediate powers mainly depend. When taken into the system, it produces a slight in- crease of the action of the heart and arteries, and in- duces, in some individuals, considerable drowsiness. When continued for some time, and not in very large doses, it gives tone to the stomach, and, by this effect, vigour to the general system. When, however, it is taken > in large quantities, and frequently repeated, it weakens the digestive organs, and produces an effect upon the ac- tion of the heart and arteries, the very reverse of a stim- ulant. In my own person I have several times reduced my pulse from seventy-five to fifty strokes in a minute, by copious draughts of the cold infusion, taken several times during the day, and continued for twelve or four- teen days. This effect has not, I believe, been noticed before, but from much experience with it I am strongly TONICS. OQl inclined to believe that we may control the action of the heart and arteries to a considerable extent, by the use of this substance. The wild cherry bark has been highly recommended in the cure of intermittents. I have myself employed it a good deal, while residing in the country, and in the majority of cases, with success. It has appeared to me most useful in those cases in which the bark did not pro- duce its usual beneficial effects; and in one instance, where the bark, arsenic and mercury, had all been tried ineffectually, the patient was finally cured by the use of the wild-cherry bark infusion. In phthisis, also, this bark has been employed with de- cided benefit.. I have prescribed it often in hectic fever, and in some instances with unequivocal advantage. There is, indeed, no difficulty in perceiving how this bark may produce beneficial effects in cases of this kind. It is well known now, that the prussic acid, when judi- ciously administered, is capable of moderating, nay, even of removing, all the symptoms attending the early stage of pulmonary consumption. The testimony we have is too respectable and numerous to admit of any reasonable doubt as to its powers in this way. Now, the wild-cherry tree bark contains no inconsiderable portion of this acid, and it is obvious, therefore, by using the infusion of it, we employ a medicine which contains prussic acid, together with a bitter and an astringent principle, dissolved in a considerable portion of water. These ingredients would appear, 1 think, particularly calcu- lated to produce good effects in pulmonary consump- tion, by at once lessening the irritability of the system, which the prussic acid does in an eminent degree, supporting the strength of the patient by the tonic principles which it contains. I have already stated the power which this remedy possesses, when taken in very large doses, of diminishing the action of the heart and arteries, and it is, doubtless, by its controll- 208 TONICS. ing influence in this way, in consequence, perhaps, of the prussic acid which it contains, that its action has been found so useful in diseases attended with an irri- tated or hectic state of the circulation. Whether it be ever capable of giving perfect relief in phthisis, is ex- tremely doubtful, but of this I am satisfied from re- peated experience, that it is one of our most valuable palliatives, and well deserving of attention in the present disease. Its effects, indeed, upon phthisical patients, are very similar to those of the prussic acid. It lessens the frequency, tension, and irritated state of the pulse; mo- derates the cough, and profuse nocturnal perspirations; checks the diarrhoea, and sustains the general strength of the system. In chronic hysteria, I have, in several instances, pre- scribed this remedy, with great relief to the patients. I have found it equally useful in wandering rheumatic pains and swellings, attended with a small, corded, and frequent pulse, and general debility of the system. The wild-cherry bark has also been recommended as a very useful remedy in asthma. Of its power in this complaint I can say nothing from my own experience. It is to be given during the intervals of the fits, and in large doses. When given in moderate doses, it often produces ex- cellent effects in dyspepsia. I have, however, found that large #nd frequent doses of this remedy, have a tendency rather to weaken than to invigorate the digestive pow- ers of the stomach. This I have particularly observed in my own case. Very excellent effects are said to have been produced by washing irritable and fungous ulcers with a decoc- tion of this bark* The bark of the root is stronger than that of the trunk. To certain animals the leaves of the tree are * Thacher's Dispensatory. TONICS. 209 said to be poisonous. The cherries have been advan- tageously u^ed, as a domestic remedy, in scurvy and dysentery. The dose of the powdered bark is from 5ss. to 3n\ The decoction does not appear to possess much strength. The prussic acid, which appears to be its most import- ant part is driven off by boiling. The cold infusion, however, is an excellent preparation. An ounce of the bark is to be infused in a pint of cold water, for twenty- four hours. Dose, a wine-glass full every four hours. CORNUS FLORIDA.--DOGWOOD. This is a common and well known tree throughout the United States. It appears from the experiments of Dr. John M. Walker,* that the bark of this tree differs but very little in chemical composition from the Peruvian bark, and experience has fully demonstrated that, in their operation on the system, these two articles possess a very close resemblance. In its sensible qualities too, the dogwood bark is very much like the cinchona; it has a bitter, astringent, and slightly aromatic taste. Its as- tringency is, however, stronger than that of the Peru- vian bark. In the cure of intermittents, the dogwood bark has been a good deal used in some parts of this country, and from the concurrent testimony of those who have em- ployed it, as well as from my own experience, I am per- suaded that, of all our indigenous tonics, this bark is the most useful in the present disease. When employed in a recent state it is said to be apt to disagree with the stomach, and to produce pains in the bowels. To obviate this, it is only necessary to give * Inaugural Dissertation. Philadelphia, 1797. VOL. I.—D d 210 TONICS. it in conjunction with a few drops of laudanum; or to employ the bark after it has been collected for some time. Thirty-five grains of the dogwood bark, is about equal to thirty of cinchona. An infusion of the flowers has been used with advantage in flatulent colic. " A decoction of the small branches and buds agrees well with weak stomachs, and is, perhaps, the most eligible form of exhibiting this medicine/'* The cornus seiicea, or swamp dogwood, another American species of this genus, possesses powers in every respect equal to those of the c. florida. It forms a beautiful tincture with proof spirit. It is given in the same dose as the c. florida. Both these species of cornus may be advantageously- given with aromatics and other tonics. An excellent mode of prescribing them in intermittents, is in union with Virginia snakeroot. CHIRONIA ANGULARIS.--CENTAURY. This is a beautiful plant, and exceedingly adundant in some parts of the United States. The root, which is annual, consists of yellowish fibres; the stem is erect, from one to two feet high, herbaceous, smooth, and four-sided; the branches are opposite and axillary; the leaves opposite, ovate, amplexicaule, and three nerved. The flowers, which are numerous, grow at the extremi- ties of the branches, and are of a beautiful rose colour above, but pale, and in many specimens nearly white in the centre underneath. The calix is much shorter than the corolla; its segments are very acute. The centre of the corolla is marked by a pentangular star, of a yel- * Collections, 8cc. TONICS. 211 low colour, bordered with green. The petals are ob- ovate, and sometimes nearly lanceolate. This plant is one of the most useful and agreeable of our indigenous vegetable bitters; and is decidedly more valuable than the centaury (chironia centaurium) of Europe. It is a pure bitter, possessing a slight aroma- tic flavour, and by no means offensive to the stomach. Both alcohol and water extract its active principles. It does not appear to possess any astringency. In domes- tic practice it is much used as a stomachic, for weak- ness of the digestive organs; and I know of no bitter which is more grateful and effectual in cases of thjs kind, than this one. It has also been a good deal used in some parts of the country in intermittents. I have myself employed it in some instances, but I do not re- member any case in my practice which was cured by it. I knew a country practitioner, however, who was in the habit of giving this remedy conjointly with cala- mus aromaticus, in intermittents, and with very consi- derable success. It is commonly given in the form of strong infusion. Of this, from a half to a whole gill may be taken fre- quently during the day. The dose of the powder is from twenty to thirty grains. There is an excellent figure of this plant in Dr. Bar- ton's Vegetable Materia Medica of the United States, vol. ii. LIRIODENDRON TULIPIFERA. This is one of the largest and most beautiful of Ame- rican forest trees. It rises to the height of eighty, nine- ty, and even one hundred and forty feet, putting forth, about the middle of May, an abundance of superb flow- ers, marked with green, yellow, and red streaks, which, 212 TONICS. together with its beautiful foliage, give to the tree a very magnificent appearance. The bark, which is the part employed in medicine, is of a strongly bitter, and slightly aromatic taste. According to the analysis of Dr. Ro* gers,* it contains gum, resin, muriatic acid, iron, calca- reous salt, mucus, and fecula. This bark has been long employed, both in domestic and regular practice in the United States, and it appears from the testimony which has been published in favour of it, to be well entitled to the attention of the profession. This bark possesses considerable stimulant properties, but it is chiefly on account of its tonic effects that it de- serves notice. It acts also occasionally as a diuretic, and in general, it produces very conspicuous diaphoretic ef- fects when largely administered. The bark of the root appears, however, to be less stimulant and more purely tonic, than that of the trunk or smaller branches. Given in union with dogwood, and the prinos verticil- latus, it has been employed with much success in the cure of intermittents. The late Dr. Rush employed it, as he states, " with as much satisfaction as any of the common bitters of the shops/'! Dr. J. T. Young, in a letter to governor Clayton, of Delaware, says, " I have prescribed the poplar bark in a variety of cases of the intermittent fever; and can de- clare from experience that it is equally efficacious with the Peruvian bark, if properly administered."! As this bark is, however, considerably stimulant, it should never be given where the intermission is marked by symptoms denoting a phlogistic tendency in the system. Bleeding and purging are necessary preliminaries to the em- ployment of this remedy where the habit is inflamma- tory. * Inaugural Dissertation. Philad. 1802. t Transactions of the College of Physicians of Philad. 1793. t Carey's American Museum, vol. xii. TONICS. 213 It has also been much recommended in chronic rheu- matism and in gout,* and from its manifest tendency to produce diaphoresis, together with its tonic operation, there can be little doubt of its occasional usefulness in affections of this kind. From these combined proper- ties it also often acts with great advantage in the advanc- ed stage of dysentery.! In this disease I have repeated- ly employed it in conjunction with the ulmus aspera, in the farm of decoction, and in general the effects were very satisfactory. Dr. J. T. Young, whom I have already quoted, speaks in very high terms of this remedy in the cure of hysteria. " I can assert from experience," says he, " there is not in all the materia medica a more certain, speedy, and effectual remedy in the hysteria, than the poplar bark, combined with a small quantity of laudanum." Dr. Young also states, that he has used this bark with much advantage as an anthelmintic. "I have never known it to fail," he observes, " in a single case of worms which has come under my observation." I have given it for this purpose in several instances, without deriving any good effects from it. In a debilitated state of the stomach, the powdered bark of this tree, in union with steel dust, has been pre- scribed with very great advantage-! The bark may be given in substance, tincture, infusion, or decoction. In substance, however, it acts with most power. The dose of the powdered bark, for an adult, is from thirty to one hundred and twenty grains. If it produces purging and griping, a few drops of laudanum should be added to it. * Barton's Collections. t Thacher's Dispensatory. t Ibid. 2U TONICS. BONPLANDIA TRIFOLIATA, (CUSPARIA FEBRIFUGA.)--AN GUSTURA BARK. It is not a great while since this bark has been known to the profession: but it would appear from the experi- ence of those who have given an account of its remedi- ate powers, to be entitled to very considerable attention. The Angustura bark is obtained from a large and beau- tiful forest tree, growing in abundance in the woods near Carouy and Alta Gracia. It is also found in the valley of Santa Fe, between Cumana and New Barce- lona,* and particularly in the woods near Carouy and Alta Gracia. The botanical character of this tree was not known until it was described by Humboldt and Bon- pland. Willdenow, to whom specimens were sent by Jhese enterprising and intelligent travellers, constituted it into a new genus, to which he gave the name Bon- plandia. It is said to approach very nearly in its botan- ical character to quassia, but to be nevertheless, suffi- ciently discrepant from this to require for its classifica- tion a separate genus. The bark of this tree comes to us in small, slightly convex, wrinkled, and externally whitish pieces, of about four or five inches in-length. It has a very bitter and slightly aromatic taste—Its odour is peculiar and nause- ous. When pulverized it becomes of a bright yellow colour. According to M. Vauquelin, this bark does not pre- cipitate animal gelatine, but it forms a copious precipi- tate with tartar emetic, iron, copper, lead, and tan. One of its principal chemical peculiarities, therefore, is, that it does not precipitate animal gelantine. M. Vauquelin thinks, too, that the principle which gives to this bark the power of precipitating metallic solutions, is not the same as that which gives a similar property to the Peru- * Alibert. TONICS. 215 vian bark* From the analysis of other chemists,how- ever, it appears that the Angustura bark contains cin- chonin, besides resin, extractive, carbonate of ammonia, and an essential oil. Its active principle is readily ex- tracted by cold and hot water, and it does not appear that long boiling injures its powers.! The Angustura bark is a stimulant tonic of very con- siderable powers ; and is much less apt to nauseate or oppress the stomach than the cinchona bark. When first introduced into notice it was highly extolled as a remedy in intermittent fevers ; and although it has now lost much of its former reputation, there are still some highly respectable physicians who regard it as a remedy of very great power in the cure of intermittents. It has also been recommended as particularly useful in chlorosis. I have lately prescribed it in a case of this complaint, in combination with iron, and the effect was very beneficial. In this case, however, the iron may have been the most efficacious of the two articles in combination. In dyspepsia, while the disease is yet entirely confin- ed to the digestive organs, the Angustura bark may be beneficially given. I have used it in my own case, and obtained considerable relief from it. It is also said to be a very effectual remedy in diarrhoea, depending on a weakness of the bowels, and in dysentery. In these af- fections I have never administered it, but I can readily believe, that in the former disease, and in the chronic form of the latter, it may be employed with advantage. In powder it is given in the dose of from six to thirty grains. The dose of the decoction or infusion is from §i. to §ii. When given in very large doses it has a ten- dency to produce nausea. The incompatible substances are : sulphate of iron, sulphate of copper, oxymuriate * Alibert, Mat. Med. torn. i. p. 78. t Paris's Pharmacologia. 2lb TONICS. of mercury, nitrate of silver, tartarized antimony, sub- acetate and acetate of lead, potass.* "There is found in the market," says Dr. Paris, "a particular bark, which has been called^/me Angii&tura, but which is of a different species, and is a very ener- getic poison. This bark is characterized by having its epidermis covered with a matter which has the appear- ance of rust of iron, and which, moreover, possesses cer- tain chemical properties of this metal, for if water acid- ulated with muriatic acid, be agitated in contact with its powder, it assumes a beautiful green colour, and affords, with an alkaline prussiate, a prussian blue precipitate. Late researches have detected the presence of an alka- line element in this bark, to which the name of Brucine has been bestowed. When this alkali is dissolved in boiling alkohol, and crystallized by spontaneous evapo- ration, it yields colourless and transparent crystals, in the form of oblique quadrangular prisms." COLUMBO. This is the root of the menispermum columbo, a native of Ceylon, and is brought to us from Columbo, the capital of this island. The botanical character of this plant was entirely unknown until Mr. Fortin, in 1805, discovered it near Mosambique, whence it was carried into Portugal, and ascertained to belong to the genus menispermum. The root, which alone is employed in medicine, is imported in transverse slices, from an eighth to a quarter of an inch in thickness. The bark of the root is rugous, thick, and of a greenish, verging to an obscure brown colour. The internal, or parenchyma- tous part of the root is yellowish. In general there are * Paiis's Pharmacologia. TONICS. 217 three distinct parts composing this root, the bark, the woody part, and medullary portion.* It has a faint aro- matic odour, and is intensely bitter and slightly acrid in taste. According to an elaborate anaJysis made of this root by M. Planche, it contains a kind of animal matter, which exists in it in very great proportion, and a yellow substance of an intensely bitter taste, which rea- dily dissolves in water and in alkohol. It also contains a very large portion of starch. By repeated distillation a volatile oil may be obtained from it; and it appears to contain malate of lime, and sulphate of lime.! It also contains cinchonin. About one-third of its weight is dissolved by boiling water; its best menstruum, however, is proof spirit, with which it forms a very beautiful and active tincture. This is one of the purest and least stimulating bitters we possess. It has been prescribed in intermittents, but it does not appear to be particularly efficacious in this disease. It has also been recommended in phthisis; but, from what I have seen, of its effects in this disease, I am not induced to believe that it is often useful, or even proper, in this hopeless malady. The columbo has also been recommended in dysen- tery and diarrhoea, but I suspect its powers in these com- plaints are of no great value, unless, indeed, as a tonic, in the declining stage, or state of convalescence from these diseases. In the cholera morbus of the East In- dies, this remedy is said to be of very considerable value. In the cholera infantum, when it assumes a chronic form, the columbo may be advantageously given. The disease, however, in which it seems most decid- edly beneficial, is indigestion. In this complaint it is one of the best tonics we can employ. The dose of the powder is from gr. xv. to 3ss.; that of * Alibert, Mat. Med. torn. i. p. 96. f Ibid. torn. i. p. 97. VOL. I.—e e 218 TONICS. the infusion from §iss. to 3ii. It may be given in com- bination with iron, rhubarb, or saline purgatives. The incompatible substances are, infusion of galls and yellow cinchona bark, subacetate and acetate of lead, corrosive sublimate and lime-water. The nitrate of silver, muri- ate of mercury or tart, antim. do not affect it. GENTIANA LUTEA.--GENTIAN. This is a perennial plant, indigenous to the mountain- ous parts of Germany, France, &c. The root, which is the only part employed in medicine, is long, slender, branched, externally of a brown colour, and of a yellow- ish colour within- Its taste is intensely bitter, but it has no particular smell. Chemical analysis shows it to con- tain resin, some oil, bitter extractive, a portion of tannin, and mucilage. Both water and alkohol extract its ac- tive principles, but proof spirit appears to be its best menstruum. Of all the tonic bitters the gentian is the most fre- quently employed as a remedy. It contains no astringen- cy, but is considerably more stimulant than the columbo. The gentian has been successfully employed in com- bination with astringents in the cure of intermittents. Cullen says, he never knew it to fail in curing intermit- tent fever, when given with galls or tormental. When given alone, however, its powers are much less certain and useful. Lind, also, commends it as an efficacious remedy in this disease. At present, however, it is very seldom used for this purpose, nor does it appear to be entitled to much credit for its virtues in this complaint. As a tonic, in general debility,or in a weak state of the stomach and bowels, the gentian is an excellent reme- dy. It is particularly beneficial as a stomachic ; and, in indigestion, it is, perhaps, the most useful of the bitter TONICS. 219 tonics. It has also been recommended in gout, particu- larly in the convalescent state, when much debility of the stomach is present. Gentian is an article in the composition of the famous Portland powder, which ap- pears to have been employed with great advantage in preventing the paroxysms of gout. The dose of the powdered root is from gr. x. to 3i. It is also given in the forms of an extract, infusion, or tincture, all of which are excellent preparations.* In a large dose it is apt to purge. QUASSIA EXCELSA.--QUASSIA. The quassia excelsa, is a large tree growing spon- taneously in Surinam, from which its wood was first brought into Europe in the year 1761. The wood of this tree, and more especially that of the root, is of a pure and intense bitter taste, which, accord- ing to Thomson, depends on a peculiar bitter principle to which the name of quassin has been given. Accord- ing to Crell and Tromsdorff, the quassia contains a greater proportion of gummy matter than of resinous, and hence they infer that the infusion of it in cold water is its best preparation. The quassia is a very excellent tonic and may be Ve- ry usefully employed in all cases where remedies of this kind are indicated. It possesses scarcely any stimulat- ing or heating properties, and is, therefore, peculiarly calculated to improve the digestive powers of the sto- * "Brodum's'Nervous Cordial consists of the tincture of gentian, columbo, cardamon, and bark, with the compound spirit of laven- der, and wine of iron. Staughton's Elixir is a tincture of gentian with the addition of serpentaria, orange peel, cardamus, and some other aromatics." —Paris's Pharmacologia. 220 TONICS. mach in weak and very irritable subjects. It was at one time a good deal employed in the cure of intermittents. It has, however, not sustained its reputation in this dis- ease, and is now but very seldom employed in its cure. It said to be very efficacious in suppressing bilious vomitings, attending bilious and putrid fevers. Alibert, states that he succeeded in curing a female, by this re- medy, of habitual vomiting, which had prevented her for a long time retaining any nourishment on her sto- mach. He also says, that he has used the quassia with much success in cases of dyspepsia. In the depraved ap- petite in chlorosis, particularly when there is a disposi- tion to eating dirt, chalk, &.c. the quassia is said to be a very efficacious remedy.* As a stomachic, it is, indeed, one of our best reme- dies; it is said to be especially useful in indigestion aris- ing from intoxication. When administered in combina- tion with some absorbent, it acts with much advantage in the weakness and languor attending chronic hys- teria.! In diarrhcea from a want of tone in the bowels and stomach, the quassia is an excellent remedy. It has also been recommended in leucorrhcea, gout, cachexy; and Alibert says that it ought to be employed as a pro- phylactic, by persons who are subject to intestinal worms. It is usually given in infusion. The infusion made in the proportion of three or four drachms of the wood to twelve ounces of water, may be taken in doses of one, two, or three, table-spoonfuls. QUASSIA SIMAROUBA.—SIMAROUBA. This species of quassia is brought from St. Domin- go, Jamaica, &c. and is also found growing spontane- * Barton's M.S. Lectures on Mat. Med. + Thacher's Dispensatory. TONICS. 221 ously in southern parts of the United States. The bark and not the wood of this species of quassia is used in medicine. It is inodorous, and exceedingly bitter, with- out any perceptible astringency. It is of a tough and fibrous texture, of a pale yellowish colour, and rough on the external surface. It furnishes a very abundant watery extract, but contains very little resin. It does not, like the quassia, strike a black colour with the sul- phate of iron.* The simarouba has been highly spoken of as a re- medy in dysentery and diarrhoea. It has been particu- larly recommended for its efficacy in the former of these complaints, by Priugle, Lind, Stoll, Zimmerman, Blane, Tissot, Bampfield, &c. The latter writer, in his work on scorbutic dysentery, observes: " The infusion of simarouba, or a decoction of it, has been recommended generally in the obstinate chronic stages of dysentery. (See Blane on Diseases of Seamen, fyc.) In my prac- tice it has shown great powers, but these were of un- certain benefit. It was too apt to produce constipation, and its painful and disordered consequences." I have myself employed it in this disease, after it had assumed a chronic form, and repeated evacuations had been pre- mised, and the effects have frequently been very bene- ficial. Alibert says that this remedy has been used with much advantage at the hospital St. Louis, in diarrhoeas, following scurvy and intermittent fevers. It has also been much recommended in dyspepsia and intermittent fevers; experience, however, has not estab- lished its efficacy in these diseases, and it is certainly inferior in this respect to several other articles of this class of remedies. In powder it is given in doses of half a drachm. The decoction, however, is the most con- venient form, and it possesses all the powers of the sub- stance. • Alibert, Mat. Med. 222 IONICS. CROTON ELEUTHERIA.—CASCARILLA. This is a small shrubby tree, indigenous to Jamaica. Eleuthera, Carolina, Florida, and various parts of South America. The bark of this shrub, which is the only part used as a medicine, comes to us in the shape of round tubes, the external surface of which is ash-colour- ed; internally it is of a brownish colour. Its taste is very bitter, and it has a strong aromatic odour, which becomes particularly manifest when burned. It contains a very large proportion of resin, and hence alkohol is its most appropriate menstruum. According to the ana- lysis of Tromsdorff, it contains also, besides resin, a small portion of mucilage, a bitter principle, and a very volatile essential oil. As a remediate article, this bark was first brought into notice in the year 1692, in a dissertation attribut- ed to a Spaniard of the name of Vincent Garcias Salat. It soon afterwards attracted the attention of many of the most celebrated physicians of Germany,* and was highly praised for its febrifuge powers; which, by some, were affirmed to be superior even to those of the Peruvian bark. Stahl and his followers contributed greatly to its reputation as a remedy in intermittent fevers; and Jun- ker and Alberti spoke in the highest terms of its powers in this disease. It has been particularly recommended for its usefulness in what have been called putrid or ma- lignant intermittents. The veYy strong and respectable testimony which we have in the writings of physicians in favour of the febrifuge virtues of the cascarilla bark, do not premit us to doubt of its usefulness in this way. Without pretending to say that it is equal to the bark, it is quite certain, I think, that it merits much * Alibert, Mat. Med. TONICS. 225 more attention than appears to be given to it at pre- sent. This bark is a very active and useful remedy in weakness of the stomach, giving rise to frequent vomit- ing and symptoms of indigestion. Cullen, however, speaks but lightly of this medicine, but 1 feel persuaded that his estimate of its powers falls considerably short of its real merits. I have given it in intermittents, and have taken it myself, for indigestion, and with decided advantage. It has also been employed in dysentery, diarrhoea, flatulent colic, and internal haemorrhages. From my own experience, however, I can say nothing of its powers in these complaints; but I do not presume, that in this repect it is entitled to much attention. It is given in powder, from twelve to thirty grains. Its tincture is an active preparation, but the decoction or infusion possesses no great powers. ANTHEMIS N0B1LIS. Chamomile is one of the most ancient articles of the materia medica. It was employed by the Egyptians as an external application, in the cure of fevers; and it ap- pears from the Greek writers, that it was held in very- great estimation by them* It does not appear that chamomile flowers have as yet been subjected to any particular analysis. They have been ascertained, however, to contain a consider- able portion of bitter extractive, and an essential oil of a beautiful sapphire blue, or of a greenish brown colour. By being exposed to the light and air, this oil is liable to undergo changes. * Alibert 224 TONICS. Chamomile flowers were at one time much prescrib- ed for the cure of intermittents, and much respectable testimony is extant in favour of their powers in this complaint. We are informed by Dr. Cullen that Dr. Pitcairn thought them quite equal in this respect to the Peruvian bark, and Hoffman considered them very effi- cacious. Cullen, also, employed them with success in this disease. He states, however, that their employ- ment is frequently attended with the inconvenience of readily running off by stool, to obviate which he usually gave them with an opiate or some astringent. As a stomachic bitter, chamomile flow ers are much employed, and their effects in this way are commonly decidedly beneficial. They are also an excellent re- medy in spasmodic and flatulent colics; in hysteria, at- tended with habitual weakness of the digestive organs, and in restraining violent bilious vomitings. When em- ployed for restraining vomiting, a weak infusion must be employed; a strong one having the property rather of exciting than allaying vomiting. The infusion is much employed to promote the operation of emetics, but for this purpose it ought to be used strong. Chamomile flowers are often employed in colds and catarrhs, as a gentle diaphoretic, and they, indeed, sel- dom faif in producing this effect. The essential oil is used as a carminative, and cordial diaphoretic. The leaves and flowers of chamomile have sometimes been used as an external discutient application; and the in- fusion of them is said to be very beneficial when used in the form of a clyster, in dysentery and colic. The incompatible substances are, the soluble preparations of iron, nitrate of silver, oxymuriate of mercury, acetate and subacetate of lead, solutions of isinglass, infusion of yellow Peruvian bark.* In substance these flowers may be given in the dose * Paris's Pharmacologia. TONICS. 225 of a drachm or more; but they are usually prescribed in the form of an infusion. They give out their virtues both to water and rectified spirit. uumulus i.uruLus. This is a native both of Europe and America, and has for a long time held its station among the articles of our materia medica, although its principal importance depends on its economical uses, and particularly on the use which is made of it in brewing malt liquors. Cold water extracts but little of the bitter principle of the hop. In boiling water, however, it is entirely solu- ble. Alkohol also, is a good menstruum of its bitter ex- tractive. The aqueous infusion becomes black on add- ing to it some solution of sulphat of iron. The hop is a very excellent stomachic, and has been for a long time valued for its usefulness in dyspepsia and other diseases depending on a loss of tone in the sto- mach. The summits of this plant, also, in which the bit- ter and aromatic principles are combined, are said to be exceedingly useful in weakness of the digestive organs. They have been particularly recommended in scrophu- lous diseases, and in rachitis* The use of the infusion of the hop, has been supposed to be capable, when long continued, of dissolving a urin- ary calculus while yet in the bladder. Its Jithontriptic powers are not only exceedingly questionable, but it is even asserted on very high authority, that its effects in this way are injurious. The late Dr. Barton found, in his own case, that the use of malt liquors subjected him to more frequent and severe nephritic attacks. The infusion is taken in doses of about two ounces * Alibert, Mat.Med. torn. i. p. 146-. VOL. I.—F f 226 TONICS. every two or three hours, to the extent of a pint in twen- ty-four hours. In another place I shall speak of its anodyne or narco- tic properties. Every one knows the effects of the hop pillow in procuring sleep. FERRUM.--IRON. Among the mineral tonics, iron, undoubtedly, holds the first rank, whether we consider the importance of its general tonic effects, or the extent and variety of its re- mediate applications. Cullen thought that iron is totally inactive in its me- tallic state, except it meet with an acid in the stomach, to corrode and render it soluble. This idea is, however, without foundation, as it is now sufficiently ascertained that the gastric juice readily dis- solves iron in its metallic state, " without the interven- tion or aid of the acetous, or any other acid present in the stomach."* The effects of iron on the system, are those of a slow but permanent tonic, increasing the fulness and frequen-' cy of the pulse, rendering the blood more florid, and im- parling permanent vigour and lone to the general system. It is, therefore, obvious from these effects, that this metal is peculiarly calculated to act beneficially in cases of debility attended with a weak and sluggish pulse, and a pale, cold, and relaxed state of the body. One of its earliest remediate applications was for the purpose of restraining haemorrhages; and in these cases it may be injurious or beneficial, according to the par- ticular state of the system attending the complaint. In what are called active haemorrhages, this remedy could * Dr. Barton, in a note to Cullen's Mat. Med. IONICS. 227 hardly fail to act perniciously, unless, indeed, some of its astringent preparations be employed. In those chronic haemorrhages, however, which depend on a laxity of the animal fibre, and are accompanied with a pale and ca- chectic state of the body, iron, either in its metallic form, or in that of its milder preparations, is a remedy of un- questionable benefit. It is peculiarly advantageous in those cases of chronic uterine haemorrhages which occur in females somewhat advanced in life, and of a relaxed and debilitated habit of the system. In cases of this kind I have done much good by exhibiting small doses of iron and Peruvian bark, and interposing occasionally some active astringent, when the discharge became alarming. M. Alibert says, that he has employed this remedy with much success in the haemorrhages which accompany scurvy.* In general, iron is a very important remedy in all dis- eases attended with a feeble and cachectic state of the system. In chlorosis, it is justly considered as one of our most useful remediate means. In this affection there is always a great want of tone and activity in eve- ry part of the system; every thing indicates languor and relaxation of the vital energies. The pale and leaden hue of the countenance, the flaccidity of the skin and muscles, the swellings of the feet, the anorexia or deprav- ed appetite, the indisposition to active exercises; all these symptoms point out the necessity of invigorating mea- sures, and none appears to be so generally useful as iron, aided by the gentle exercise of gestation. Iron is also much prescribed as an emmenagogue; and it is, in fact, often the most effectual remedy we can em- ploy. It must be observed, however, that it is only in those cases of amenorrhcea which depend on debility and relaxation, that it can be employed with advantage. Where the complaint is attended with an opposite state * Alibert, Elemens deTherapeiitique, torn. i. p. 180 228 TONICS. of the system, this remedy is not only useless, but abso- lutely pernicious. The emmenagogue effects of iron ap- peal", therefore, to depend on its powers as a general to- nic; and it is only in proportion as its general roboraut effects are produced, that it acts beneficially in restoring the suppressed menses in cases of this kind. Iron has been highly recommended in scrophulous af- fections. Alibert >ays, "there are few remedies more useful in scrophulous complaints than iron.''* Other practitioners have added their testimony in fa- vour of its remediate power in affections of this kind. Of late it has also been particularly recommended in the cure of cancerous ulcerations. Dr. Carmichael, of Dublin, has written a work! expressly on the use of iron in the cure of cancerous affections. Respectable as is the testimony of Dr. Carmichael, more extensive and diversified experience is still wanting, before we can pronounce on the real value of this practice. It is not, however, just to oppose speculative doubts to the facts of direct experiment, and we have, therefore, no right to invalidate the large body of evidence offered by Dr. Car- michael in favour of this remedy in cancer, until ample and diversified experience shall have shown it to be inef- ficacious. Dr. C. recommends the iron to be given in very large doses, and to be continued for a long time; the ulcers are to be sprinkled with the powdered carbonate of this metal, or touched with the muriated tincture. In atony of the stomach and bowels, chalybeates are often exceedingly useful, when given in combination with bitters. This remedy has also been commended for its effects in dropsy. Sydenham proposed its em- ployment in the commencement of this disease, on the supposition that it depends essentially on a weak and watery state of the blood. " Steel," he says, " is the * Elemens de Therapeutiques, 8cc. torn. i. p. 181. t An Essay on the effects of the Carbonate and other prepara- tions of Iron in Cancer. 1809. TONICS. 229 chief corroborative in the beginning of dropsy, for it heats and invigorates the blood." It is, however, well known now, that this disease is very generally connect- ed with a phlogistic condition of the system, and where this is the case the-use of iron must be obviously impro- per. In anasarcous swellings, from general debility, we can readily perceive that this remedy may produce ex- cellent effects. Alibert* mentions the case of a weak and delicate female, labouring under anasarca, who was constantly much relieved by the black Gxyde of iron; and Dr. Robert Archer has reported a case of general drop- sy, in a soldier, which was effectually cured by sulphuret of iron.! Mr. Halle describes a singular affection under the name of ancemia, (privation of blood,) which, in the year 1804, attacked all the workmen in a mine of anthra- cite, near Valenciennes, and which is represented as offering symptoms very analogous to those of chlorosis. In this malady he administered iron filings, in combina- tion with Peruvian bark, with the happiest effects. Other physicians employed iron with equal success in this disease. M. Leblen, physician of the hospital at Dunkirk, to which some of the sick were taken, admin- istered the red oxyde of iron with perfect success. J In another place I shall speak of the anthelmintic powers of this remedy. The filings of iron may be taken from twenty grains to a drachm. It is generally joined with some aromatic substance, and may be very conveniently given in the form of an electuary. Care should be taken that the fillings be well purified by a magnet, as they are apt, when procured from work shops, to be mixed with * Elemens de Therapeutique, torn. i. p. 180. t American Medical Recorder, vol. ii. \ Bibliotheque Medicale, torn. vi. p. 195 et 342, et torn. viii. p. 297. Vide Traite de Mat. Med. par C. J. A. Schwilgue, torn. i. p. 310. 230 lOMCS. the filings of other metals, particularly copper. " For pharmaceutical purposes, iron wire should be preferred, as being the most pure, since the softest irou only can be drawn ; and Mr. Philips has shown us, in experi- ments upon the 'ferrum tartarizatum/ that soft iron is more eastfy acted on by tartar."* The preparations of this metal are very various; of these I shall, however, mention only such as are consid- ered the most important, and fully capable of affording all the advantages which cau be derived from chalybeate remedies. Ferri sub-carbonas.—Carbonate of iron.—Rubigo fcrri.—This is a dark brown powder, destitute of odour, and has a slightly stiplic taste. It consists of a mixture of peroxide, protoxide, and subcarbonate of protoxide of iron, in proportions subject to variation, according to the temperature at which the preparation is made. Acids act upon it and dissolve it with effervescence; in water, however, it is wholly insoluble. This is, perhaps, the best preparation of iron, in the majority of cases for which martial remedies may be thought necessary. It is by no means unpleasant to take, and sits easily on the stomach. In certain cases, how- ever, where a costive habit of body exists, this prepara- tion is apt to increase the confined state of the bowels, and when this is the case, we ought to employ the filings instead of the rust. The carbonate of iron has lately been recommended as a very efficacious medicine in tic doloureux. Mr. B. Hutchinson has published a pamphlet in which he adduces many examples of the efficacy of this remedy in this disease. Mr. Richmond, also, has lately reported a case which was promptly relieved by the carbonate of iron, after a great variety of remedies had been ineffectu- ally tried. He prescribed it in drachm doses three times a day.! * Paris's Pharmacologia. t Med. and Phys. Journal, No. 271, p. 271, for Sept. 1821. TONICS. 23 [ It may be given in the form of pills, or powder, com- bined with aromatics, in doses of from gr. vi. to Ix. Ferri sulphas.—Green vitriol.—Copperas.—The sul- phate of iron consists of green coloured transparent, rhomboidal chrystals. Wheu exposed to the air they ef- floresce, and when subjected to a high temperature, they are deprived of their acid, leaving a peroxide of iron, which constitutes the colcothar of vitriol. The sulphate of iron dissolves in two parts of water at 60°, and in three fourths at 212°. In alkohol it is insoluble, unless the iron be further oxidized when it undergoes solution in this menstruum.* This preparation possesses all the powers of iron, and may be employed with advantage wherever a chalybeate is wanted. Its employment requires, however, much more caution than the preceding preparation; for, when given in large doses, it is apt to produce pains in the sto- mach and bowels, and may excite very alarming symp- toms; Besides its tonic properties, it is, also, powerfully as- tringent, and answers very well in solution as a wash for indolent and fungous ulcers. It is also a good applica- tion to herpetic eruptions. It is given in the dose of gr. i. to v. in combination with rhubarb, myrrh, &c. The incompatible substances are, " salts whose base forms an insoluble compound with sulphuric acid; the earths, the alkalies, and their carbonates; borate of so- da, nitrate of potass, muriate of ammonia, tartrate of potass and soda, acetate of ammonia, nitrate of silver, subacetate and acetate of lead, and soaps." Feny,m ammoniatum.—Flores martialis.—This salt is obtained in the form of small granular crystals, which deliquesce on being exposed to the air. It is of au orange yellow colour, of a styptic taste, and of an odour similar to that of saffron. The chemical composition of * Paris's Pharmacologia. 232 IONICS. this salt appears to vary considerably with regard to the proportion of the substances that enter into it, according " to the degree of heat and time employed for its prepar- ation." It would appear to consist of submuriate of am- monia and submuriate of iron, with the iron in a state of red oxide. Four drachms of this substance are dissolv- ed in one ounce of water. Alkohol dissolves it readily.* This preparation possesses the tonic virtues common to the other martial remedies. In some instances, how- ever, where we wish to avoid constipation, it is prefera- ble to the rust; for although it does not act sensibly as an aperient, it has, nevertheless, no constringing pow- ers, and, therefore, does not interfere with the regu- lar action of the bowels, as is sometimes the case with the rust. The dose is from two to ten or twelve grains, in the form of a bolus. Ferrum tartarizatum.—This preparation consists of brownish green coloured powder, having no odour, and a taste slightly styptic. It dissolves with great ease in water, the solution remaining a long time without under- going any changes-! This is an excellent preparation of iron. A watery solution of it is recommended by Dr. Bateman as a chalybeate peculiarly suited, from its tasteless quality, to the palates of children, and as being more efficacious than the vinum ferri. Its qualities have also been par- ticularly commended in a communication from Dr. Bir- beck, published in the London Medical Review.! The incompatible substances are, "a strong acid, lime-water, hydro-sulphuret of potass, astringent vegeta- bles. The fixed alkalies and their carbonates decom- pose the solution very slowly unless heated; but ammo- nia and its subcarbonate produce upon it no effect, whether it be hot or coid." Dose, from gr. x. to 3ss. * Paris's Pharmacologia. t Ibid. $ No. xix. July, 1819. TONICS. 233 Phosphasferri.—Phosphate of Iron.—The phosphate of iron is a preparation, which, like the preceding one, has been but lately introduced as a remediate article. It consists of a powder, either of a blue or yellow colour, according to the mode in which it is prepared. It has no odour, and little or no taste. The blue phosphate is considerably stronger than the yellow. The latter may be given in doses of from twenty to sixty grains, three or four times a day; but the former cannot be adminis- tered beyond eight or ten grains, without being apt to excite nausea and vomiting. The phosphate of iron is considered by those who have employed it an excellent chalybeate. It is said to be particularly serviceable in amenorrhcea attended with weak digestive powers. It has also been administered with very favourable results in obstinate cutaneous erup- tions, chronic rheumatism, and scrophula. This is the preparation chiefly recommended by Dr. Carmichael for the cure of cancer. Prussiate of Iron.—The prussiate of iron has been lately employed with much success in the treatment of intermittent fevers. Dr. Zollickoffer of Baltimore was the first who noticed its powers in this way. He relates a number of cases in which it was successfully used.* He gave it in doses of from four to six grains every four hours. During the present season, I have known this remedy to be employed with considerable success by several practitioners of this city. I have prescribed it in five or six cases, in three of which, it removed the dis- ease very promptly. In cases of children, it is a very convenient medicine, being destitute of taste or smell, and the dose forming but a very small bulk. It sets easily on the stomach, and may be administered in every stage of the disease. * American Medical Recorder, vol. v. p. 540. VOL. I.—G g TONICS. CUPRUM.—COPPER. Copper has a slightly styptic taste, and a peculiar faint, nauseous smell. It is said by some writers that this metal is perfectly inert when received into the sto- mach in its metallic state. Mr. Drouard convinced himself of its innocence by administering the filings to dogs; in no instance did it produce any injurious conse- quences. Indeed we often see children who have swal- lowed copper coins without any perceptible effects on the system. In cases where it has proved deleterious, an acid probably existed in the stomach, by which the metal was converted into a soluble salt, and.thus render- ed active. Others, however, assert that it is poisonous in its metallic state. It is said to be acted on by the gastric liquor, and rendered active. This may be the case; but it is extremely probable that the copper is not dissolved in its metallic slate, but in that of an oxide, to which it is previously converted by the fluids in the sto- mach.* In its metallic state copper was formerly employed as a remedy in rheumatism; and Cothenius recommends its filings in the cure of hydrophobia. At present it is, I believe, never prescribed in the metallic state. It is susceptible of a variety of chemical preparations, some of which are remedies of undoubted utility. Cupri sulphas.—Blue vitriol.—Having already notic- * Dr. Paris mentions a striking instance in proof of the inert- ness of copper when taken into the system in its metallic state. " A young woman," says he, " swallowed six copper penny pieces, with a view of destroying herself; she was attended by Dr. Maton and myself, in the Westminster hospital, for two years, for a disease which we considered visceral, but which was> evi- dently the effects of mechanical obstruction occasioned by the coin. After a lapse of five years she voided them, and then con- fessed the cause of her protracted disease, during the whole course of which no symptom arose which could in any way be attributed to the poisonous influence of copper. TONICS. 235 ed this article as an emetic, I shall here speak only of its remediate powers as a tonic and alterative. As such it has been particularly recommended in the cure of in- termittents, by Dr. Donald Monro, and others; and in several obstinate cases of this disease, I have myself em- ployed it with perfect success. It is to be given in doses just sufficient to excite slight nausea.* In the cure of epilepsy this remedy was, at one time, a good deal pre- scribed. Dr. Cullen, before he became acquainted with the cuprum ammoniacum, gave it in this disease and in hysteria, and he states that its effects were often highly beneficial. This salt has also been commended for its effects in resolving scrophulous swellings. Dr. Parsons speaks highly of it in this respect. Chalmers prescribed it with success in colica pictonum, and Adair gave it with advantage in other varieties of colic and in dysentery. As an external application to chancre, and other venereal ulcerations, it often produces excellent effects. For this purpose it is best employed in solution in the proportion of about five grains to one ounce of water. When we wish to use it for the purpose of de- stroying the surface of a chancre, it may be applied in substance, like caustic. It also forms an excellent'injec- tion for gleety and leucorrhceal discharges. Dr. J. Foot, of London, in his late works on the venereal dis- ease, recommends, in the strongest terms, the following injections in gonorrhoea, after the inflammation has been reduced. Dissolve blue vitriol in a sufficient quantity of water, precipitate the solution with lixivium of tartar. Suffer it to separate, then pour off the clear liquor; wash the precipitate until it becomes insipid; make a saturat- ed aqueous solution of sal. volat. amnion.; mix as much of this precipitate with the filtered solution of the vola- * Dr. Monro prescribed it in the following formula: R vitriol caerul. gr. iv. extract cort. peruv. gr. xxxii. syrup, q. s. divide in pil. xvi. One to be taken four times a day for two weeks. 236 TONICS. tile salt as it will dissolve, which reserve for use. Mix of this six drops to every ounce of water for an injec- tion. Cuprum ammoniacum.—Ammoniated copper.— This preparation consists of a triple salt, a subsulphate of oxide of copper and ammonia. It has a metalline and exceedingly styptic taste, and an ammoniacal odour. It is soluble in the proportion of Bi. to an ounce of water. This preparation has been much employed in nervous and convulsive diseases, and from the testimony which has been published in favour of it by Michaehs, Cullen, Gregory, Tissot, Odier, Duncan, Bland, and many other physicians of the first respectability, we have no grounds to doubt its usefulness in this respect. Dr Batt, a physician of celebrity, has more recently published an account of the extraordinary effects of this remedy in the cure epilepsy. He administered it in combination with valerian, to three persons, the father and two daughters, affected with this disease, and all were effectually cured by it. In hysteric affections, attended with great irritability, anxiety, cramps, and feebleness, the cuprum ammonia- cum is a remedy of very useful powers. In the cure of obstinate intermittents this remedy is highly spoken of by Brera; he thinks it quite equal to arsenic in this disease, especially where there is much irritability of the general system, and the intestinal canal is in a state of debility.* A solution of this preparation is an excellent appli- cation to old and ill-conditioned ulcers; and has also been applied with much advantage to the removal of opacity of the cornea. We may commence with it in the dose of half a grain twice a day, gradually increasing the quantity as far as the stomach will bear it. It is best given in the form *Burdach's Arzneymittellehre, B. ii. p. 184. TONICS. 237 of pills. It is sometimes given with sugar; but if it be true that this vegetable substance counteracts the oper- ation of copper, such a combination would appear to be improper. Thuessink, a German physician, has published some very interesting observations on the powers of this re- medy in hysteria. He considers it particularly useful in those chronic cases which depend, or at least are ac- companied with, debility and relaxation, and a very irri- table state of the system.* In my own practice I have made considerable use of this remedy both in epilepsy and in hysterical complaints. I have never been suc- cessful in a case of epilepsy, but in the chronic form of hysteria I have given it with the most decided benefit. This preparation has also been advantageously used in other spasmodic affections. B. Bell gave it with complete success in a case of spasmodic cough, attend- ed with great irritability of the nervous system; and Walker! states, that he cured many cases of chorea with this remedy. He observes that he found it particularly successful where the disease was accompanied with much relaxation and debility. Willan, also, cured a case of chorea with this medicine. OXYDUM ZINCI.—FLOWERS OF ZINC. This preparation of zinc has been much extolled for its antispasmodic and tonic powers. In small doses, it excites and invigorates the energies of the system, though by a very slow and imperceptible operation. When given in very large doses its action is more violent, producing vomiting, spasms of the stomach, constipation * In Samml. auerles. Abhandlungen fur practishe Aerzte. vol. xvii. p. 266. t A Treatise on Nervous Diseases. 238 TONICS. or diarrhoea, inflammation of the bowels, convulsions. and paralysis. These effects are, however, never ob- served unless it be taken in enormous quantities, and we have, therefore, nothing to apprehend from its regu- lar and proper administration. It was introduced into practice as a remedy in spasmodic diseases, by Gaubius, who reported strongly in favour of its powers in affec- tions of this kind. He gave it in chorea and epilepsy, and in some instances with perfect success. The occa- sional efficacy of this practice has since been abundant- ly verified by many very eminent physicians. Goodsir, Pcrcival, Beireis, Crell, Hufeland, and other physicians, have reported cases demonstrating the powers of this medicine in epilepsy. Hufeland gave it in combination with cuprum ammoniacum, extract of hyoscyamus, and valerian. It appears to be more particularly useful in this disease when it affects children. Burdach observes, that it probably does more good in children by neutral izing acid in the stomach and destroying worms. In a case of this disease in a child, I gave this re- medy in large and frequent doses, and in the course of two months succeeded in putting a permanent stop to the disease. Dr. Rush states that he cured a case of ten years standing with the flowers of zinc. It has also been employed against hooping-cough. Hager and Lceffler recommend it highly in this singular disease. The flowers of zinc is a remedy of considerable value in hysteric affections, connected with much relaxation and weakness. In cases of this kind I have sometimes employed it with Peruvian bark, and in several instances with very considerable advantage. This remedy has likewise been employed with very good effects in spasmodic diseases arising from suppres- sion of chronic cutaneous eruptions. Robcel used it in children affected with symptoms of chorea in conse- quence of the suppression of eruptions on the head, and TONICS 239 he states that the result was entirely favourable; the eruption returned after using the remedy for some days, and the disease disappeared.* In the form of an ointment the flowers of zinc admit of various useful applications. The ointment is recom- mended as an excellent application to herpetic ulcera- tions. It is also used in scrophulous inflammation of the eyes. For this purpose the ointment should be made by mixing two parts of the flowers of zinc with three of lard. It is given to children in doses of from one to six grains, three or four times a day. Adults may take from six to twenty grains.! Sulphas zinci.— White vitriol.—The sulphate of zinc, is a remedy of very considerable powers, and has been much employed in spasmodic and other diseases. Under the head of Emetics, I have already spoken of the re- mediate application of this substance, so far as its eme- tic properties are concerned, and it remains for me, therefore, in this place, only to notice its virtues as a tonic. In the cure of epilepsy, many practitioners have thought it preferable to the preceding preparation, and I am inclined to believe that this opinion is well found- ed. Cullen gave it in this disease with advantage, and JohnstonJ states that he cured several cases with it. In hysteria Dr. Lettsom employed this article in con- junction with quassia, and the result according to his account was favourable. Ideler, a German writer of * Burdach, Arzneymittellehre, vol. ii. p. 197. t " Dr. Roloff, of Magdeburgh, has lately discovered the casual presence of arsenic in the oxide of zinc ; by boiling the substance in distilled water and assaying the solution with ammoniaco-ni- trate of silver, its presence may be instantly recognized; chalk may be detected by sulphuric acid, exciting an effervescence; and white lead, by forming an insoluble sulphate of lead. It ought to be volatile."—Paris's Pharmacologia. J Medical Essays and Observations. 240 TONICS. considerable note, states that he gave the white vitriol in spasmodic asthma with the happiest effect. In an- other part of this work we have spoken of Moseley's vitriolic solution. Dr. Hewson, of this city, has lately informed me that he has been particularly successful in curing intermit- tents with this remedy. Dr. S. Ffirth, in a letter to Dr. S. Mitchell, dated Calcutta, 1805, speaks in very high terms of this practice. " The sulphate of zinc," says he, "is a remedy which I have been in the habit of prescribing in several diseases as a tonic, and am of opinion, that when combined with a narcotic anodyne, it may be substituted very advantageously for the cin- chona officinalis. I have often done this in practice, and was seldom disappointed in its good effects." " In remittent fevers it is a useful and valuable reme- dy, and can be given when the bark is inadmissible, especially if combined with the extract of hyoscyamus niger. In the remittent form of the malignant fever of Asia, I have given it to the extent of three grains of the hyoscyamus niger, and four of vitriolum album, every hour and a half. I formerly used this remedy with much success," he continues, tJ in a number of cases of inter- mittent fever, in Pennsylvania; when I resided at the Philadelphia Dispensary, I had frequently an opportu- nity of comparing its virtues in the cure of intermittent fevers, with bark and arsenic; the result of my experi- ence was, that in many cases it cured where the bark failed; but I found, also, that the bark succeeded in as many cases where the vit. alb. had disappointed me." The dose of this medicine, when employed as a tonic, is from one grain to two or three. It is most conveni- ently given in the form of pills. TONICS 241 OX1DUM BISMUTHI.--MAGISTERY OF BISMUTH. It is nofmore than twenty-eight years since this re- medy was introduced into practice by Dr. Odier,* of Geneva, and De la Roche, of Paris. Its remediate vir- tues had, however, been particularly noticed by Jacobi,! nearly a century before Dr. Odier published his obser- vations on its employment; but it does not appear that it had attracted the attention of the profession anterior to the publication of Dr. Odier's paper. The diseases in which it has been particularly recommended, are, gas- trodynia, spasms of the stomach, hysteric colics, pyrosis, and other dyspeptic complaints. The testimony of Dr. Marcet, Dr. Bardsley, and Clark, in England; of Hufeland, Reil, Krysig, Belsen, &c. in Germany, and of Dr. Hosack, and Moore, in this country, are strongly in favour of the remediate powers of this article, in the above disease. At present its employment is chiefly confined to the cure of gastrodynia, pyrosis, and cardialgia. In these affections it seems to be pretty generally admitted to be a medicine of considerable value. Dr. Marcet, whose testimony deserves great respect, in a paper read in 1801, before the London Medical Society, says, "I have since had frequent opportunities, at Guy's hospital, of trying the oxyde of bismuth in spasmodic affections of the stomach, and those trials have fully confirmed the opinion which I formerly gave of the utility of this medicine." Dr. Samuel W. Moore, of New-York, in his excellent dissertation on the medical virtues of the white oxide of bismuth, relates three cases of painful affections of the stomach, in which this re- medy was employed with much success. I have em- * Journal de Medicine, 1786, torn, lxviii. p. 49. t L. F. Jacobi de Bismutbo. Erford, 1697, 4 Burdach, VOL. I.—H ll 242 ionics. ployed it in several cases of spasmodic pain of llie stomach, and in two its effects were decidedly beneficial; though in the others, which appeared to me perfect cases of gastrodynia, it had not the slightest effect whatever. Upon the whole, however, the evidence we have in fa- vour of the powers of this remedy, in the diseases men- tioned, entitles it to much attention from the profes- sion. This medicine may be given in the dose of from three grains to ten, three or four times a day. Hufeland says, that its virtues arc increased by being given in combi- nation with the extract of hyoscyamus and ol. cajeput. Odier gave it a quarter of an hour before eating, and to the extent of twelve grains for a dose. NITRAS ARGENTI.—LUNAR CAUSTIC. The nitrate of silver, when fused and cast into small cylindrical pieces, forms the lunar caustic of the shops. These pieces are of a dark grey colour, and break with a shining crystalline fracture. The lunar caustic pos- sesses no odour, but it has an exceedingly austere bitter, and metalline taste. It is soluble in an equal weight of water at 60°: it also dissolves in alkohol. In another place I shall have occasion to speak of the employment of this substance as an escarotic; in the pre- sent place, therefore, I have only to notice its remedi- ate powers as a tonic. The internal employment of the nitrate of silver has been particularly recommended in the cure of epilepsy. Dr. Simms, of London, relates several cases in which this remedy was successfully employed. Dr. Cappe,* also, speaks well of the powers of this medicine in epi- * Duncan's Annals of Medicine, for 1798, p. 456. TONICS. 243 lepsy. Nord, a German writer, gives an account of a case of epilepsy complicated with mania, in which the nitrate of silver was employed with complete success.* It has also been successfully used in the disease by Dr. Gough,! Sir Henry Halford,J and Dr. Roget.§ Semen- tini, an Italian physician, says it is more efficacious in this disease than any other remedy we possess. It ought to be given in combination with a vegetable ex- tract. This writer states, also, that he found it suc- cessful in paralysis.|| He says that a cutaneous erup- tion, of a pustular kind, frequently appears in those who are taking this remedy; when this takes place we may be assured of the beneficial influence of the medicine. Other names might be added in testimony of the effica- cy of this medicine in epileptic complaints. Many prac- titioners, however, who have prescribed this remedy, in the present disease, have been entirely disappointed. I must confess that, in my own practice, it has not pro- duced any advantages, although I have given it largely and perseveringly in several instances. The nitrate of silver has, also, been used with advan- tage in other convulsive affections. Wollf speaks of it in the most exalted terms as a remedy for tremours of the heart.H And Dr. Povvel, of London, has published cases of its successful use in chorea. This remedy has likewise been employed with suc- cess in angina pectoris, dropsy, and leucon hcea. " In several instances of leucorrhcea/' says Dr. Thacher, (i the nitrate of silver has been employed in doses of one twelfth of a grain three times a day, with complete * Medicinishe National Zcitung, 1798. Sup. No. xiii. s, 206. t Medical Museum, by Dr. J. R. Coxe, vol. iii. p. 70. J Medico-Chirurgical Transactions, vol. ix. p. 236. § Ibid. vol. vii. || Giornale di Fisica, torn. xi. p. 355. if Burdach, Arzneymittellehre, B. ii. p.. 173. 244 TONICS. success." Bayle and Geoffroy speak favourably of its effects in dropsy. In combination with cicuta, I have, in a few instances, prescribed this remedy with excellent effect in scrophu- lous ulcerations. In old constitutional ulcers, the nitrate of silver, administered in doses of from gr. i. to vi. three times a day, has been known to prove highly beneficial. I once prescribed it with complete success in an alarm- ing case of ulceration of the gums and jaws, from the imprudent use of mercury. A part of the palate and upper jaw, with the two middle incisors, had already come away, and the ulceration was spreading rapidly. I administered four grains of the nitrate of silver, three times a day, and by this remedy alone, succeeded with- out difficulty in arresting the disease. This preparation is, indeed, highly recommended by Hahnemann, in the treatment of mercurial diseases. Dr. Roberts, an Eng- lish writer, employed it with much benefit in counter- acting the deleterious effects of lead. The nitrate of silver may be given from one-fourth of a grain to six grains; gradually increasing the dose. Nord began with half a grain and gradually augmented the dose to fifteen grains ;three times a day. I have frequently given it to the extent of six grains. It is now ascertained beyond a doubt, that the long continued use of nitrate of silver is capable of giving a permanent black colour to the skin. The late Dr. Albers, of Bremen, relates several cases of this kind.* A case, also, is reported by Dr. F. Harrold, of Eng- land, in which the skin became nearly black in con- sequence of the internal use of this remedy;! and Sir H. Halford gives an account of a person who took it for a year and a half, and whose skin, at last, assumed a permanent dark hue. J * Vide Eclectic Repertory, April, 1816. t London Med. Repository, vol. v. May, 1817. t Medico-Chirnrg. Transact, vol. ix. p. 237. TONICS. 245 The incompatible substances are, " fixed alkalies and alkaline earths, the muriatic, sulphuric, and tartaric acids, and all the salts which contain them; soaps, arsenic, hydro-sulphurets, astringent vegetable infusions, undistilled waters." It does not deliquesce when free from copper. AURUAI.—GOLD. During the ages of alchemy, gold enjoyed consider- able reputation as a medicine. It had, however, sunk into entire neglect, when Dr. Chrestien,* in 1811, pub- lished his observations concerning its remediate powers, and again brought it to the attention of the profession. This writer adduces a number of facts illustrative of its efficacy in syphilitic and scrophulous cases; and asserts that the employment of gold is not liable to the same in- convenience which occasionally attends the use of mer- cury. It cures the disease without exciting ptyalism; and unless given in too large doses, produces no sensi- ble disturbance in the system. No particuliar care as to regimen is required during its employment, and the patient, we are told, may go about his ordinary business; nay it is even stated, that the remediate employment, of gold admits of a generous diet and the moderate enjoy- ment of wine. The preparations which he used are: metallic gold, in the state of minute division; oxide of gold, precipitated by potash; the oxide precipitated by tin; and the triple muriate of gold and soda. Of these preparations the muriates are vastly more powerful than the oxides and divided gold. The latter is the weakest of them all. Orfila ranks the muriate of gold among * Observations surun Nouveau Remede dans le Traitment des Maladies Veneriennes et Lymphatices, par A. Chrestien, a Paris, 1811. 246 TONIC?. the poisonous substances; and Chrestien asserts that il is incomparably stronger than corrosive sublimate. He administered it in doses, at first no larger than one- fifteenth of a grain, and if pushed beyond one-tenth of a grain, it never failed to excite fever and inflammatory symptoms. The oxide he gave in doses of from half a grain to two grains, and the metallic gold, to the extent of three grains daily. Duportal, who, in conjunction with Pelletier, publish- ed a very interesting memoir on the preparations of gold, adds his testimony in favour of the efficacy of this remedy in syphilitic complaints. He relates a remark- able instance of the good effects of these preparations in a cancerous ulcer, " that had destroyed tho upper lip,, attacked the soft parts of the nose and left cheek, de- stroyed the square bones, and rendered the maxillary bone carious." Notwithstanding the very high terms in which the auriferous preparations have been spoken of by Drs. Chrestien, Duportal, Plenciz, and others, it does not appear that they are much attended to at pre- sent in the treatment of any diseases. Pontin, however, and several other Swedish physicians, who have tried this remedy, state that they never obtained any real ad- vantages from its use. In this country the reports of several eminent prac- titioners have not been very favourable in relation to the power of this remedy in scrophulous and syphilitic diseases. Dr. Hosack and Dr. Francis saw several cases in which the syphilitic symptoms returned after they had disappeared under the use of the gold. It onght to be observed, however, that this is not unfre- quently the case even with the acknowledged specific, mercury, when too soon discontinued or improperly used. It would appear, also, from the experience of these and other physicians, that the muriate of gold is of doubtful efficacy in the secondary symptoms of this IONICS. 247 disease.* To this, however, we may oppose the evidence of Dr. Saml. L. Mitchill, who, in a communication to Dr. Dyckman, says, CkThe efficacy of this medicine has been tried year after year in the New-York hospital. My practice with it there Jias been witnessed by all the attendants of the wards. It possesses admirable virtues against syphilis. Without presuming to affirm that it is capable of eradicating the distemper in every instance, my opinion, upon the whole, is, that the muriate of gold will effect all that is achieved by muriate of quicksilver, with incomparably less inconvenience to the patient. He gels well under the operation of the former without the hazard of a sore mouth or a salivation, and with very little wear and tear of constitution. I consider the introduction of this preparation into common use as one of the greatest improvements in modern medicine; and I wish it were already as universal as the malady it is intended to remove. The muriate of gold is found to increase the quantity of urine, in many instances, to such a degree, that it ought to be ranked among the diuretics of the materia medica."! I have employed the gold in two cases of secondary syphilitic ulcers of long standing; in one of these there was an evident amendment in the appearance of. the ulcers, but I could not succeed in curing them by this remedy; the other case yielded to its powers, and the patient has since remained perfectly well. In both these cases I had previously employed mercury for a long time, but without any good effects whatever. I have also ad- ministered it in a case of scrophulous ulcerations, and succeeded very soon in healing up the sores. The cure was not, however, permanent. In a recent memoir on the remediate properties of gold, by Dr. J. C. Niel, a French physician, it is asserted, " that the aurific pre- * Dyckman's Dispensatory, p. 201. t Ibid. 248 TONICS. parations are exceedingly efficacious in tinea, elephan- tiasis, and scrophula." This writer states, that the pre- parations of gold sometimes excite salivation; which, however, is not attended by the unpleasant effects that arise from a mercurial salivation. It seldom produces much inflammation of the mouth, and does not affect the teeth, nor is it attended with a foetid breath.* From what has already been published in relation to this remedy, it is sufficiently evident that it possesses very important powers. We, however, want much more ample experience upon this subject, before we can de- cide upon its real merits, and the particular cases to which it may be especially adapted. Dr. Chrestien administered the different preparations of this metal by friction on the gums. It may, how- ever, be more efficaciously used internally, either en- veloped in some mucilaginous liquid, or in the form of pills. The pure muriate cannot be well given in this latter way, as it is much too caustic and deliquescent. For this purpose the triple muriate of gold and soda, must be employed. This may be given from one- fifteenth to one-eighth of a grain, gradually increasing the dose. According to M. Figuer, the pure muriate may be conveniently given in the following mode: dis- solve sixteen grains of the salt in one ounce of water; preserve this solution in a vial, well closed and seclude it from the light. A half a drachm of this may be made into pills, with starch or the crumbs of bread, or by being mixed with a sufficient quantity of some mucila- ginous fluid to obtund its acrimony, it may be taken in a liquid form. The oxide is given in much larger doses. Dr. Chrestien gave it from a half a grain to two grains. Other practitioners have, however, given it to a much greater extent. Van Mons administered from twenty to twenty-five grains. The report of this physician is much * London Med. and Phys. Jour. vol. xMi. p. 248. TONICS. 249 in favour of the efficacy of this preparation. He found it particularly efficacious in curing chancre.* ARSENICUM.--ARSENIC. Arsenic is a hard grey-coloured metaj, of a granu- lar texture, and great brittleness. In its metallic state it does not affect the animal economy. Combined, how- ever, with a certain portion of oxygen, it forms the white oxide of arsenic of the shops—the most active mineral poison with which we are acquainted. The oxide of arsenic is generally found in the form of white semivi- treous lumps, exhibiting, when pulverized, the appear- ance of white sugar. When exposed to a heat of about 383° of Fahrenheit, it rapidly volatilizes in white in- odorous fumes. The alliaceous or garlic-like smell does not belong to the oxide of arsenic in a state of vapour, but is wholly confined to the fumes of metallic arsenic. When the oxide of this metal, or the common arsenic of the shops, is thrown upon hot charcoal, the garlic smell of the fumes is quite perceptible. But in this in- stance, the oxide is decomposed, the oxygen uniting to the charcoal, and the metal escaping in the form of fumes, having a garlic odour. " It is stated by Orfila and other chemists," says Dr. Paris, " that if it be projected upon heated copper the alliaceous odour is evolved. This, however, takes place only when the copper is in a state of ignition, at which temperature its affinity for oxygen enables it to reduce the arsenious acid; for I find, by experiment, that if a few grains of this substance be heated on a plate of cop- per, by means of a spirit-lamp or blow-pipe, no odour is perceptible, for the whole of the acid is dissipated before t Burdach, Arzneymitte\lehre, vol. ii. p. 20$. VOL. I.—I i 250 TONICS. the copper can acquire a sufficiently exalted temperature to deoxidize it. If the arsenious acid be heated on a plate of zinc, the smell is not evolved until the metal is in a state of fusion; if, instead of these metals, we em- ploy, in our experiments those of gold, silver, and pla- tina, no alliaceous smell whatever is produced at any temperature." The knowledge of this fact is of con- siderable importance in employing this experiment as a test for arsenic; for it is evident, that if the substance suspected to contain the white arsenic be subjected to heat, without being in contact with any substance capable of depriving it of its oxygen, no alliaceous odour will be evolved. The oxide of arsenic combines with potash, soda, and liquid ammonia to saturation, forming soluble arseniles, and possessing, therefoure, some of the essential proper- ties of acids. According to the accurate experiments of Klaproth, it takes four hundered parts of water at 60°, to dissolve one part of the oxide of arsenic, and only thirty parts at 212°. If it be boiled in water, and the solution be suffered to cool, it will retain thirty parts of it to one thou- sand of water, and deposit the superfluous part in the form of tetrahedral crystals. " This fact," observes Dr. Paris, " shows the importance of employing boiling water in every chemical examination of substances sup- posed to contain arsenious acid." The oxide of arsenic is also soluble in alkohol and oils. The oxide of arsenic acts with great violence when taken internally, and commonly destroys life in a very short time. When taken in too large a dose, as for in- stance, one-fourth of a grain, it excites nausea and slight chills By continuing it in such doses, it destroys the appetite, excites vomiting, pains in the stomach and bowels, painful diarrhoea, great anxiety, and oppression in the breast, debility and emaciation, numbness of the hands and feet, dropsical swellings, tremors, and para- TONICS. 251 lysis. In doses above a grain, it destroys life, with symp- toms denoting inflammation of the alimentary canal. It is generally believed to produce its deleterious effects, by acting directly on the villous coats of the stomach and bowels, producing inflammation and ulceration of these parts. This idea is certainly countenanced both by the appearances on dissection, and by the corrosive quality of this substance. Mr. Brodie, however, rejects this explanation of its modus operandi, and thinks him- self warranted to conclude, from several experiments which he performed on this subject, that arsenic enters into the circulation, and that it produces its effects by acting at once upon the nervous system, the organs of the circulation, and the alimentary canal; and that death depends immediately on a suspension of the functions of the brain and heart.* This opinion is also entertained by Orfila. Dr. George F. Jaeger, of Stutgard, in a very elaborate and interesting dissertation on the effects of arsenic on various organized bodies, adduces a number of strong arguments to prove that arsenic does not pn> duce its deleterious effects by a local action on the sto- mach and bowels, " nor in the manner of the acrid poisons, nor upon the nervous system; but is analogous to the poison of the viper and ticunas, which act prima- rily upon the blood."! It appears from the experiments of Jaeger, that arsenic is entirely inert when applied di- rectly to a nerve. That death from arsenic does not depend on the inflammation or local lesion which it pro- duces in the part to which it is applied, is rendered cer- tain by the fact, that it has been known to destroy ani- mals in a short time on being applied to wounds. Sprae- gel states that he sprinkled a drachm of arsenious acid into a recent wound on a dog's back, and that the death * Philosophical Transactions for the year 1812. t Edinburgh Med. and Surgical Journal, January, 1811. Dis.- sertado InauRuralisde Eilectibus Arsenici in Varios Organismos, &c. Auctor. (i. F. Jaeger. 1808, Tubings. 252 TONICS. of the animal took place at the end of five hours.* It is a remarkable fact, also, that when arsenic destroys life on being applied to a wound, it often produces nearly the same organic effects on the membranes of the ali- mentary canal, as when taken internally. In the experi- ment just mentioned from Spraegel, " the stomach and intestines were greatly inflamed, both on their exterior and interior surface; coagulated blood was effused into their cavities, and had insinuated itself between their coats. The pleura, pericardium, and lungs appeared very inflamed." Flunter, Home, and Brodie have made the same observations. Arsenic has even been known to destroy life, when taken internally, without leaving any very manifest traces of inflammation on the stomach and bowels. There can be no doubt, however, that the extensive disorganization which this mineral com- monly produces in the coats of the alimentary canal is sufficient, independent of any other effects, to destroy life; and it is, probably, in this way that it is most fre- quently fatal when received into the stomach. Arsenic is not only destructive of animal, but also of vegetable life. From M. Jaeger's observations, it appears that the death of vegetables is induced by arsenic by the gradual absorption and distribution of the poison by the vessels and cellular membrane, so that the parts die in succession as the particles of the arsenic reach them." Paris states that'the influence of arsenical vapours near the copper smelting works of Cornwall and Wales, " is very apparent in the condition both of the animals and vegetables in the vicinity." Arsenic, like most other powerful substances may be applied to very important remediate purposes. It was employed as an external remedy, both by the Greek and Arabian physicians. Dioscorides recommends its use in . * Orfila's Toxicology, vol. i. p. 114. Spraegel ExperimeQta circa vnria Vcnena. Disp. Med. Goet. 1753. tonics. $53 this way; and Athenaeus speaks of some arsenical pre- paration as very beneficial in the form of a clyster in dysentery. It is only in modern times, however, that the medicinal powers of arsenic have been particularly no- ticed as an internal remedy. Nearly a century ago it was recommended in the cure of intermittent fevers by Jacobi:* and the observations of Brera and Fowler have since brought it into general notice as a remedy in this disease. By many physicians it has, indeed, been very highly extolled, and its reputation as an efficacious me- dicine, is now well established. It is not, however, to be employed with equal advantage, or even with safety, in all cases of this disease: In patients of debilitated and cachectic habits of body, especially where a scorbutic tendency, or a disposition to passive haemorrhage exists, this remedy is apt to produce dropsical swellings, great debility, and symptoms of general depravation. It is, also, said to act perniciously in phthisical persons, or where there exists a strong inflammatory diathesis. Examples of this kind, I have occasionally observed in my own practice, and I feel entirely satisfied, that, although a very powerful remedy in the majority of cases, it cannot be indiscriminately employed without running the risk of doing injury. The state of the sys- tem in which arsenic appears to be peculiarly calculate ed to do good in'this disease, is the very opposite of that which I have just mentioned as inimical to its remedi- ate powers. In cases attended with considerable fulness of habit, not very irritable or debilitated, with a mode- rately full, soft, and regular pulse during the intermis- sion, and unaccompanied by any local congestions, or organic affections of internal parts, the arsenic will, in general, act as a very efficacious and safe remedy.f * Burdach, Arzneymittellehre, vol. ii. p. 475. Jacobi de Ar- senici Sale alcalico domiti usu interno salutari, (Acta Academ. Elect. Mogunt. torn. i. p. 116.) t " It is a very extraordinary fact." says Dr. Paris," that pre-" 254 TONICS. Dr. Thomas D. Mitchell, a very intelligent physician of this city, states, that while practicing at Norristown, in 1820, where he had an opportunity of seeing many cases of intermittent fever, he found the bark ineffectu- al in the majority of instances, whilst arsenic, in the form of Fowler's solution, given from fifteen to twenty drops, almost uniformly proved successful. He never observed any injurious effects to follow its exhibition. Before giving such large doses, he had tried the ordi- nary ones, as from eight to ten drops, but his patients de- rived no advantage from the medicine when given in this way. It appears, therefore, from the statement of this physician, that where arsenic is indicated, it ought to be given in as large doses as the stomach will bear, it being much more promptly efficacious; and not more detrimental to the general habit, when thus administer- ed, than when given in smaller doses. To children from two to five years old, he gave from one to six drops of the solution three times a day. M. Gasc, a French physician of eminence, has lately published the result of his experience with this remedy, in the cure of intermittents. His observations were made at the hospitals of Dantzick. "The number of patients, with this fever, was so great in the hospital," says the physician, " and the disease had been so re- bellious to the ordinary modes of treatment, that I de- termined to have recourse to the use of arsenic. My first trials with it were so satisfactory, and the success- ful results so numerous, that I did not hesitate to ex- tend the use of it to almost all the cases of fever of that species, in the hospital, without regard to particular complications of disease, provided they were not of a vious to the establishment of the copper works in Cornwall, the marsjies in their vicinity were continually exciting intermittent fever, whereas, since that period, a case of ague has not occured in the neighbourhood.—Pharmacologia, p. 282. TONICS. 255 nature to contraindicate it in a positive manner." The result, he states, was highly satisfactory." I have myself been a good deal in the habit of employ- ing arsenic in the cure of this disease; and have occa- sionally found it successful where I could do nothing with the cinchona. These two remedies are, indeed, adapted to very different states of the system. The cin- chona is most efficacious in a relaxed and exhausted state of the system, and will often disappoint our expectations in persons of a full and robust habit of body. In inter- mittents, attended with a phlogistic habit, the bark is al- ways more effectual after the general powers of the sys- tem have been somewhat reduced by evacuants. On the contrary, however, the arsenic, as has already been stated, would seem to be best suited to the cure of this disease in persons of a firm and healthy constitution, and often to act injuriously when given in a debilitated, cachectic, and irritable state of the system. I have hardly ever employed arsenic in this disease without giving it in conjunction with opium. I have usually given the laudanum and arsenic separately; the former in the dose of from ten to fifteen drops, about half an hour after a dose of the latter. By this plan we avojd the disagreeable sickness which effectual doses of the arsenic are apt to create, and it does not appear that its powers are lessened by this mode of exhibition. This remedy has, also, been prescribed in combination with bark. These two substances are, however, chemically incompatible, the arsenical solutions forming precipitates with the bark,—a circumstance which renders this com- bination of doubtful propriety. Dr. Ferriar speaks very favourably of the use of arsen- ic in the last stage of typhus, when the tongue is covered with a thick black crust, and the ordinary tonics and stimulants do not produce any beneficial effects. By the * London Med, and Phys. Jour. Feb. 1817. 256 TONICS. use of arsenic, he says, the tongue very generally be- comes clean.* Arsenic has, also, been recommended as a useful re- medy in rheumatism. In the chronic variety of this com- plaint, I have, in a few instances, employed it with re- markable advantage. But the powers of this remedy are more decidedly evinced in syphilitic rheumatism, and in that variety which is sometimes the consequence of the imprudent use of mercury. In rheumatic pains from this latter cause, I know, indeed, no remedy which is so effectual as the present one. Among the writers who speak more particularly in favour of the remediate pow- ers of arsenic in chronic rheumatism, may be mentioned Kellie, Hardman, and Jenkinson. Favourable reports have, also, been published of the effects of arsenic in epilepsy. Drs. Duncan and Alex- ander give examples of its successful employment in this disease. Dr. Ferriar speaks well of the powers of arsenic in hooping-cough, after the inflammatory symptoms have been subdued by antiphlogistic remedies. " In the be- ginning of this disease," says he, " when it is accom- panied by symptoms of fever and inflammation, bleeding is sometimes necessary. Blisters are more frequently necessary, and Dr. Armstrong's plan of exhibiting tar- tarized antimony, in doses which prove gently emetic, is undoubtedly, very useful; chiefly, perhaps, by supplying the means of expectoration to very young children. But, after these preliminary steps are taken; I believe that the only remedy which promises to shorten the disorder effectually, is the solution of white arsenic." He gave it, at first, in the dose of one drop, for an infant; and to children under seven years, he gave two drops, daily. Dr. Klapp, of this city, has informed me, that he has found the arsenic decidedly beneficial in the present * Medical Histories, vol. i. p. 84. TONICS. 251 disease. I have given it in seme cases, in a few of which its good effects were conspicuous. Arsenic has also been prescribed with success in spasmodic asthma. Dr. Alexander mentions its suc- cessful employment in this way. Of its powers in this disease I know nothing from my own experience. Some accounts have, also, been published of the suc- cessful employment of this remedy in tic doloureux. Dr. MKechnie, surgeon at Paisly, relates a case which was cured by arsenic, after various modes of practice had been tried ineffectually.* Hardman and Jenkin- son, also, commend its powers in this painful affection. Arsenic has recently been employed with much suc- cess in chorea. In the fourth volume of the Medico- Chirurgical Transactions, a case of this disease is related, which yielded without difficulty to this remedy. Mr. Salter, also, has given an account of four cases of cho- rea successfully treated with this medicine.! Mr. Hill, in an excellent paper published in the Edinburgh Medical Journal, recommends arsenic ae Cosme. * Medical and Surgical Observations, p. 47. t This ointment is composed of arsenic, sulphur, the powder- ed flowers of the ranunculus flammula, and the cotula foetida, made into a paste with the white of eggs. TONICS. 261 ed. " Wine, regarded by many persons as proper to restore action, is, in this case, a new poison, which acts precisely as that, the effects of which we have combated. It is only after three or four days that solid food is to be taken, in small quantities, and such as is of easy diges- tion.'* * Orfila CHAPTER VII. //. Medicines calculated to correct certain morbid states of the System, by acting on the Contractility of the Muscular Fibre. ASTRINGENTS. Astringents are such substances as produce constric- tion or condensation in the living animal fibre. Of the modus operandi of these remedies we know exceedingly little. It is certain, at least, that it cannot be explained, as Cullen supposed, on the principle of their action in the process of tanning. It is by producing a pecu- liar excitement jn the living system, directed upon the contractile and irritable fibre, that these substances pro- duce their effects. Further than this general and vague fact, I fear, we shall never be able to go in our inquiries upon this point. Various opinions have been entertained relative to the particular principle which gives to substances their as- tringency. By some it has been supposed to be the gallic acid; others have considered it as constituted by an union of this acid with an earthy base; and others again have regarded tannin as the astringent principle. That none of these hypotheses are entitled to any cre- dit, is evident from the fact, that some of the most as- tringent substances known, contain neither tannin nor gallic acid. The truth is. that the proximate principle of remedies is just as inscrutable as the essential cha- ASTRINGENTS. 263 racter of the impressions which they produce on the living system. These are objects which the human mind cannot reach, and about which all our most inge- nious speculations are worth nothing. Astringent substances are applicable to a great variety of remediate purposes. In the treatment of excessive evacuations, especially of haemorrhages, they have been recommended in all ages. In hasmorrhagy from the nose, lungs, stomach, bowels, and uterus, these remedies are, indeed, often of decided utility. They are not, however, to be employed without reference to the state of the general circulation. In what is called active haemorrhage, where there is tension and force in the pulse, astringents, except, perhaps, the sugar of lead, should never be employed without previous depletion. In the treatment of dysentery, astringents were for- merly much employed. At present, however, their use in the early stages of this disease is very justly considered as highly pernicious. Cullen was one of the first who spoke decidedly against their employment in this com- plaint. Although his objections to their use are unques- tionably correct, they were not predicated upon just views concerning the nature of dysentery. He suppos- ed that this disease depends on an " increased constric- tion of a considerable portion of the intestinal canal," and concluded, therefore, that astringents must do harm by increasing still more this constricted state of the bowels. The pathology of this complaint is, however, better understood at present, it being well established that it is essentially connected with a phlogistic state of the intestinal canal, as well as of the general system. It is on this account that astringents act perniciously in the early stages of this disease. They not only tend to in- crease the general inflammatory excitement of the sys- . tem, but their direct action upon the tender and irritated surface of the bowels, is calculated to do much mis- chief, by increasing the local intestinal inflammation. 264 ASTRINGENTS. They are further injurious by confining the vitiated and irritating contents of the bowels. After the inflamma- tory symptoms have been subdued, and proper evacua- tions made from the bowels, ihe employment of mild astringents may sometimes be resorted to with benefit. As a general rule, however, they are to be regarded as improper, especially in the dysenteries of this climate. In tropical dysentery, as it has been called, astringents are more frequently useful. But even here they require a cautious employment. In the treatment of diarrhoea, astringents are more generally useful. They are not, however, to be em- ployed even in this complaint without some risk of doing harm, when febrile symptoms accompany the dis- charge, or when administered without having previously unloaded the bowels of their vitiated contents, by pro- per purgatives. When given without these precautions, they are apt to give rise to colic, headach, and other un- favourable symptoms. When the disease is protracted, and no signs of a phlogistic tendency be present, we may, in general, use astringents with advantage. In cases of this kind I have found very minute doses of calomel, given in union with some vegetable astringent, exceedingly useful. Astringents are, also, much employed in leucorrhcea. In that form of the disease which Dr. Darwin calls the fluor albus frigidus, these remedies are commpnly very beneficial. When there is much febrile action connect- ed with the complaint, they are, however, universally injurious. The usual and best way of employing as- tringents in this disease, is in the form of injection. They are not unfrequently, also, given internally; but it does not appear that they are capable of doing much good when thus employed. In using astringent injec- tions in this complaint, we should take care that we adapt the strength of the injection to the degree of sen- sibility and irritation in the affected parts. Where there ASTRINGENTS. 265 is considerable ardor urince, with other marks of a phlo- gistic state of the internal surface of the vagina, the astringency of the injections should be very weak, and employed for the purpose rather of washing away the irritating secretions, than with a view to arrest the dis- charge by an impression made on the parts affected. The employment of astringent injections in gonor- rhoea, is exceedingly common. Many writers, however, reprobate their indiscriminate use in this complaint, and there can be little doubt that much mischief is often done by their employment. During the early or more inflammatory stage of the complaint, they can never be useful, and will seldom fail to do harm. The conse- quences which result from their imprudent use are, chordee, hernia humoralis, stricture, violent inflamma- tion in the urethra and neck of the bladder, phymosis, &c. After the discharge has continued for some time, and the general as well as local inflammatory action has been reduced by antiphlogistic measures, mild astringent or stimulating injections are of unquestionable utility. Too little attention is, however, commonly paid to gene- ral remedies in this affection. Bleeding, saline purga- tives, and a low diet, are of essential service in the early stage of the majority of cases of this kind. By these measures, and the liberal employment of balsam copaiva, we may, for the most part, cure the disease speedily and safely. Astringents are, also, much used as external applica- tions to inflamed parts. In ophthalmia they may often be employed with great advantage. In this, however, as in the former complaint, they may, also, produce much mischief by being applied during the early or active stage of the inflammation. When the local and general in- flammatory action has been reduced by proper antiphlo- gistic means, moderately astringent collyria are gene- rally very serviceable. In aphthous ulcerations of the mouth and throat, or in inflammation or relaxation of vol. i.—l 1 266 ASTRINGENTS. the palate and tonsils, astringent gargles are much em- ployed. In prolapsed parts, as of the uterus and anus, astringent injections are, also, often of great service. Some writers have supposed that astringents possess the property of relieving the symptoms of urinary cal- culi. This opinion is certainly countenanced by the be- neficial effects which uva ursi produces in affections of this kind. But it would appear that the antilithic pow- ers of this substance do not reside in its astringency, since we know of no other astringent that possesses any obvious powers in this way. The class of astringent substances is very numerous. The property of astringency is especially common in the barks and roots of vegetables. The mineral astringents are, generally, much more powerful than those which are obtained from the vegetable kingdom. The majo- rity of the latter are connected with other active proper- ties; the former are, for the most part, purely astringent. or astringent and tonic. CORTEX QUERCI. The genus quercus is a very extensive one, and the barks of all its different species possess more or less as- tringency. That which is employed in medicine is chiefly obtained from the black oak, (quercus tinctoria, Mich.) although some of the other species of this family furnish us with barks, equally, if not more astringent. The late professor Barton was of opinion that the ches- nut and Spanish oak barks (q. monticola, q. falcata,) are preferable, in most cases, to the black oak bark; he as- serted that they possess all the useful properties of the tinctorice in a superior degree, without partaking of the purgative quality of the latter.* * M.S. Lectures on Mat. Med ASTRINGENTS. 261 Oak bark contains a very large proportion of tannin, which is readily extracted by infusion. It appears from the experiments of Mr. Davy, that the proportion of tan- nin varies according to the age of the tree from which the bark is taken; the younger containing more of this principle than the older bark. The oak bark was very early employed in medicine. Galen recommended a decoction of the leaves and outer bark of the oak in dysentery, uterine and pulmonary haemorrhages, and in fluxus cceliacus.* It is undoubt- edly one of the most powerful vegetable astringents we possess; and capable, as such, of being applied to very useful purposes in medicine. In the treatment of inter- mittent fevers it has been recommended as a remedy of very considerable efficacy.f I have known it to be given in this disease with prompt success; it is, however, ex- ceedingly disgusting to the taste, and few patients can be induced to take it. In the intermittents of very young children, I have, in a few instances, used the oak bark decoction as a bath with benefit. But there are other indigenous barks of superior efficacy in this respect, and they do not, like this one, give so disagreeable a dye to the skin. In chronic diarrhoea this bark has been found very serviceable. Its employment in dysentery is, however, very objectionable, except, perhaps, in the last stage of very protracted cases. As an injection in leu- corrhcea, the infusion of oak bark has been much recom- mended by some writers, and I have myself employed it in this way with very good effects. It is, also, a useful application in inflammation and swelling of the fauces, prolapsus uvulae, and cynanche tonsillaris. " In many cases," says Dr. Cullen, " this decoction, early applied, has appeared useful in preventing those disorders. I have, indeed, almost constantly joined a portion of alum to these decoctions; but I have frequently found * Alibert, Nouv. Elem. de Therap. vol. i. p. 93. t Dr. Rousseau, Philad. Med. Museum, vol.ii. 268 ASTRINGENTS. that a solution of alum alone, of the strength it could be conveniently employed in, did not prove so effectual." Bathing in a decoction of black oak bark has, also, been recommended as an efficacious remedy in tabes mesenterica. Dr. J Fletcher, of Virginia, has reported four cases of this disease which yielded readily to pur- gatives together with bathing twice a day in a strong de- coction of this bark.* The inhalation of the finely powdered oak bark has been known to produce very ex- cellent effects in pulmonary consumption. An instance of this kind was communicated to me some years ago by Mr. William Webb, of Lancaster county. He informed me that a man who had laboured under the usual symp- toms of confirmed phthisis, was advised to employ him- self in grinding bark for a tanner in his neighbourhood. He was extremely weak and emaciated when he went into the bark mill; in a short time, however, the cough, night sweats, and other hectic symptoms began to abate sensibly, and in less than three months he was perfectly restored to health. The powdered oak bark, in the form of a poultice, is an excellent application to mortified or gangrenous parts. Dr. Barton employed it both internally and externally with great success, in a case of gangrene of the foot.f Mr. Lizars has recently published some observations on the efficacy of oak bark in the cure of reducible her- nia, in which he declares that he has used it with " won- derful success."| He directs it to be used in the follow- ing manner: a strong decoction is to be made by boil- ing a few pounds of the bark over a gentle fire for two or three days, adding a little boiling water from time to time so that the bark may be always covered. This de- coction is to be strained and evaporated to the consist- * Am. Med. Recorder, vol. iii. p. 363. t Collections towards a Mat. Med. of the U. States, p. 11. t Edinburgh Medical Journal, No. 72. ASTRINGENTS. 269 ence nearly of an inspissated juice. Previously to using this inspissated decoction, it should be warmed in order to suspend the astringent matter. The hernia having been reduced, the groin is to be bathed with the decoc- tion three or four times a day, and the truss applied. Mr. Lizars states, that he has cured hernia of many years standing in the course of a few weeks. It may be observed that the use of oak bark for the cure of hernia is by no means a new practice. Desessarts employed the powdered bark for this purpose more than fifty years ago.* He put it into small muslin bags which he moistened with wine, and laid on the groin under the pad of the truss, having previously returned the hernia. He affirms that it seldom required more than a few weeks to perform a perfect cure in children. In the 35th number of the Gazette Salutaire, the efficacy of a strong decoction of this bark in hernia is strongly insist- ed on;f and Kaempf, a writer of great respectability, says, that the good effects of the oak bark in the cure of her- nia cannot be too highly praised.| For internal use an ounce of the powdered bark is to be boiled in two pints of water down to one pint. The dose of this is from one to two ounces. The leaves and .cups of the acorns differ very little in astringency from the bark. The acorns possess more of the bitter principle, and on being roasted, evolve a considerable portion of an empyreumatic oil. These have been highly recommended in tabes mesenterica.§ They are, also, said to be very serviceable in spasmodic cough, asthma, chronic hysteria, amenorrhoea,|| diarrhoea, * Gardane, Gazette de Sante, 1775. t Richter's Chirurgische Biblioth. B. 4. p. 25. | Von einer neuen methode die hartnoeckigsten krankheiten zu heilen, &c. p. 382. § Kaiser von dem Nutzen der Eicheln in der dorrsucht der kin der. Frankfurt, 1784, 8. || Marx, Geschichte der Eicheln, &c. Burdach's Arzneymit • ellehre, torn. iii. p. 564. 270 ASTRINGENTS. and rheumatism. They are given to the extent of from one to two ounces daily. They are used, by some, as a beverage instead of coffee. GALL&. The gall-nuts of commerce are obtained from the quercus cerris, a species of oak indigenous to Asia Minor, " from the Bosphorus to Syria, and from the shore of the Archipelago to the frontiers of Persia." It is also found growing in the southern countries of Europe. The galls are excrescences from the young shoots of this tree, and are produced by the puncture of an insect (diplolepis gallae tinctoriae) to deposit an egg. They are nearly round, and studded with a number of rough wart-like tuberosities. They are hard, and when broke exhibit a smooth or flinty fracture. They have no odour, but are extremely astringent, and bitter to the taste. Both water and alcohol extract their active'principles. According to Neumann's experiments, water extracts seven-eighths of their substance, alcohol a little more than seven-eighths.* The chemical composition of galls does not appear to be as yet perfectly ascertained. Sir H. Davy obtained from five hundred grains of Aleppo galls, one hundred and thirty grains of tannin, twelve of mu- cilage and matter rendered insoluble by evaporation, thirty-one of gallic acid, and a little extractive matter, and twelve of calcareous earth and saline matter. Besides these component parts, it appears, from the experiments of M. Braconnot, that the gall-nut contains a peculiar acid, distinct from the gallic acid, and to which he has given the name of eltagic acid.-f The in- fusion and tincture of galls strike a black precipitate * Chemia Medica, vol. ii. p. 2. t Annales de Chimie, vol. ix. p. 187, new series. ASTRINGENTS. 271 with iron. The precipitate formed by the acetate and subacetate of lead is greyish; that by tartarized anti- mony, yellowish; by sulphate of copper, brown; sulphate of zinc, reddish-black; nitrate of silver, deep olive; and nitrate of mercury, bright yellow.* Concentrated sul- phuric acid produces a copious milk-white curdy preci- pitate, which soon becomes brown, and assumes the appearance of a resimms substance. This precipitate is soluble in alcohol and boiling water. It consists of tan- nin and extractive matter, and is powerfully astringent. Nitric acid destroys the astringency of the infusion, but does not produce any precipitate; muriatic acid forms a white flaky precipitate. The carbonate of potass pro- duces a similar white precipitate, which consists of tan- nin, lime, and potass, and is destitute of astringency. It is but very sparingly soluble in water and alcohol. Lime- water occasions a precipitate of a dark green colour. Animal jellies and starch precipitate the tannin from the infusion. Galls are a very powerful astringent, and may be use- fully employed in cases where such remedies are indi- cated. They were at one time a good deal prescribed in the cure of intermittents, but it does not appear that they possess sufficient febrifuge power to entitle them to much attention in this respect. M. Poupart has made a favourable report on this subject in the memoirs of the French accademy for the year 1702; but, according to Bergius, galls are very pernicious when employed in this disease. Cullen, however, states that they produce no bad consequences when given with gentian or other bit- ters, f The infusion of galls has been recommended as a very useful injection in leucorrhcea and in gleet. In chronic diarrhoea, also, we may often derive much advantage * Paris's Pharmacologia. + Mat. Med. vol. ii. p. 34 212 ASTRINGENTS. from this remedy when prudently administered. In ul- cers, or inflammation of the palate, tonsils, or gums, and in relaxation of the uvula, the infusion forms an excel- lent astringent gargle. An ointment made of one part of finely powdered galls to eight of lard, forms a very useful application in hae- morrhoidal affections. In internal piles the decoction has been injected into the rectum. Such a practice is, however, not to be rashly imitated. The sudden sup- pression of haemorrhoidal discharges, by applications of this kind, has been often productive of very serious con- sequences; epilepsy, apoplexy, phthisis, and other dan- gerous affections have been induced in this way. Where the discharge has not as yet become habitual, and is ve- ry profuse, the employment of astringent injections may often be resorted to with advantage. As a general rule, however, the practice is not to be recommended. In prolapsus ani and uteri, injections of the infusion of galls are generally very useful. GERANIUM MACULATUM. The geranium maculatum, or spotted cranesbill, grows abundantly in almost every section of the United States. The root, which is the only part used for me- dicinal purposes, is thick, rough, and knobby. Exter- nally the dried root is of a dark brown, and internally of a pale flesh colour. It is one of the most powerful and pure vegetable astringents with which we are acquaint- ed. According to professor Bigelow's experiments, it contains a considerable proportion of tannin, and some gallic acid. " The gallic acid is indicated by the dark precipitate remaining in solution. It differs, however, from the acid of oak galls in not reddening vegetable ASTRINGENTS. 273 blues, and not passing over in distillation."* Its active principles are readily extracted both by alcohol and proof spirits. The tincture is strongly astringent. This root is the most agreeable astringent we possess. Its astringency is not associated with.bitterness or any other unpleasant taste. In the diseases of children, where astringents are indicated, a decoction of it in milk, is a very convenient and efficacious remedy. In this form it has been a good deal used in cholera infantum, and I have myself repeatedly prescribed it, in pro- tracted cases, with great benefit. I have, also, admin- istered the powdered root in union with calomel, in the proportion of gr. vi. of the former to one-sixth of a grain of the latter, with much advantage in this affec- tion. In the advanced stages of diarrhoea and dysen- tery, after proper evacuations have been made, it has proved very beneficial. In my own practice I have oc- casionally given it in cases of this kind with very good effects. I have, also, used the watery infusion as an in- jection in gonorrhoea, but not with any decided benefit. In aphthous affections of the mouth this remedy is fre- quently very useful. In a chronic and very obstinate case of ulceration of the mouth the patient was perfect- ly relieved by the use of gargles made of this root, after a great variety of other substances had been tried un- successfully by myself and others. Dr. Mease recom- mends it as very efficacious in restraining internal hae- morrhages; and Dr. Thacher says, that he has known the infusion to restrain haemorrhage from the lungs in a very prompt manner. It is said that the western Indians consider the geranium as the most effectual remedy they have for the venereal disease. From considerable experience with this medicine, as well as from the testimony of many other physicians, I am entirely satisfied that it is one of the most useful ve- * Bigelow's American Medical Botanv, vol. i. p. 89 VOL. I.—m m 274 ASTRINGENTS. getable astringents we possess. The saturated tincture may be given in doses of from one to two drachms. In substance it may be given to the extent of thirty or forty grains. OROBANCHE VIRGINIANA. The orobanche virginiana, or beech drop, is a para- sitic plant, growing almost exclusively on the roots of the beech tree. It is herbaceous, from six inches to a foot in height, and commonly of a pale yellow colour. The root is tuberous, clay-coloured, and covered on its lower part with a number of small fibres. The stem is erect and furnished " with short ovate scales instead of leaves, of which it is entirely destitute." The root of this plant is powerfully astringent, and has been frequently employed as such in the practice of some of our physicians. It entered as an ingredient into the famous cancer powder of Dr. Martin; and Dr. Barton observes, that " it has been of great service, ex- ternally applied, to obstinate ulcers, some of which had resisted the applications that are commonly made use of in such cases." In aphthous ulcerations of the mouth I have known it to be highly beneficial. I have, also, used a strong decoction of this root as a wash in an ob- stinate cutaneous affection of the herpetic kind, with complete success. Internally I have never employed it; I do not doubt, however, of its applicability to all the purposes for which vegetable astringents may be useful. In some parts of this country it is a common remedy for diarrhoea and dysentery. ASTRINGENTS. 275 QUASSIA SIMAROUBA. This tree grows abundantly in St. Domingo and Ja- maica, and is found, also, in the southern parts of the United States. The bark of the root is the only part of the tree employed in medicine. It is brought to us in pieces of some feet in length, and folded together length- wise. It is generally of a very fibrous and tenacious texture, of a pale yellowish colour on the inside, and beset with a number of little rough points on its exter- nal surface. It has a very bitter taste, but little or no sensible astringency. It furnishes a large portion of watery extract, but contains very little resin. The bark was introduced into practice as a remedy in dysentery and diarrhoea, above a hundred years ago; and it was much commended for its efficacy in affections of this kind by some of the most celebrated physicians of the last century. Priugle, Lind, Werlhoff, Stoll, Zim- mermann, Tissot, Pinel, &c. have spoken very favourably of its virtues in this respect. If we are to pay any de- ference to the authority of these names, we can hardly doubt of its usefulness in these diseases, when cautious- ly and judiciously administered.* It must, however, al- ways be kept in mind, that, in recommending astringent remedies in dysenteric complaints, reference is made to the advanced periods of the disease, in which stage alone can they ever be employed with any prospect of doing good. Blane speaks highly of the infusum sima- roubae in obstinate chronic cases of this kind. Bamp- field, however, reports less favourably of its powers. " In my practice," says he, " it has shown great powers of action, but these were of uncertain benefit. It was apt to produce constipation and its painful and disordered consequences. Its constipating effects appeared to be * Alibert. Elem. de Therap. 276 ASTRINGENTS. more disadvantageous to the patient, than its astringent powers on the morbidly secreting vessels were benefi- cial. I attempted to avail myself of its powers by mak- - ing it weaker or stronger, according to circumstances, but found that if too weak it had no effect; and, if strong, it always occasioned constipation."* This remedy has, also, been recommended in dys- pepsia and intermittent fevers; but it does not appear to be entitled to any particular attention for its powers in this respect. The dose of the powdered bark is from a half to a whole drachm. It is, however, usually given in infusion or decoction. The cold infusion is stronger to the taste than the decoction. The latter becomes turbid and reddish brown on cooling. hjematoxylon campechianum. This tree, which furnishes the logwood of commerce, is a native of South America, and is particularly abun- dant in the province of Honduras, whence it was brought into Jamaica, where it now grows very plentifully. The wood is compact and heavy, and of a deep red colour internally. When split open it has a peculiar sweetish odour. Its taste is sweet, followed by a slightly bitter astringency. The colouring matter of logwood may be obtained in a separate state, in the form of small brilliant crystals of a reddish white colour, and of a sub-astrin- gent, bitter and acrid flavour. This crystalline substance has recently received the name of hematin. The infu- sion of logwood is of a deep blood red colour. By adding to it the sulphate of iron it becomes black; the solution of sulphate of alumine changes it to a purple colour, which by the admixture of some potass assumes * Bampfield on Tropical Dysentery, p. 197. ASTRINGENTS. 277 a fine violet hue.* The oxydulated sulphate and nitrate of iron change the blood red decoction to a very beauti- ful dark blue. Carbonate of iron strikes a dull black precipitate, leaving a brown supernatent fluid. Mu- riate of tin forms a light and loose red precipitate with both the decoction and infusion, leaving the fluid as clear and colourless as water. Phosphate of lime ren- ders the colour somewhat more light, and forms, after some time, a dark brown precipitate. The alcoholic tincture is of a dark yellowish red colour, possessing the same chemical habitudes as the watery infusion. Wa- ter distilled from logwood remains perfectly clear, but acquires the peculiar odour of the wood. When the decoction is taken internally it very soon gives a deep red colour to the urine. By some practi- tioners it has been recommended as *i very efficacious remedy in dysentery and diarrhoea. Dr. John Hunter asserts that he found the extract of logwood very ser- viceable in cases of dysentery where the discharges were frequent and copious, and not attended with much tor- mina.! It has, also, been used with advantage in the chronic form of cholera infantum,! and I have known it to be given with excellent effects in a case of diabetes. The best form for exhibiting this remedy is an infu- sion. A cup full of this may be taken every three or four hours. The extract is, also, frequently employed. RUBUS VILLOSUS. The bark of the blackberry root is a pure and pow- erful astringent, and is now a good deal employed as such both in popular and in domestic practice. The sulphate * Dissertatio de Haematoxylo Campechino. Vide Pfaffs' Sys- tem der Mat. Med. T. ii. p. 213. t Treatise on the Diseases of Jamaica, p. 186. \ Dr. Chapman's Therapeutics and Mat. Med. vol. ii. p. 270. 278 ASTRINGENTS. of iron changes the colour of both the infusion and de- coction into a beautiful dark purple, and occasions a copious precipitate. Gelatin, also, produces a copi- ous white and opake precipitate. The alcoholic solution undergoes a partial decomposition on adding water to it. The precipitate thus formed is of a floccu- lent appearance, and when dry " exhibits the common resinous properties on exposure to heat."* This root has been much extolled by some late Ame- rican writers for its efficacy in the cure of chronic dys- entery, diarrhoea, and cholera infantum. I have myself employed it with advantage in the latter complaint. I prefer, however, using the geranium maculatum, as be- ing much more pleasant to the taste. I have seen an in- fusion of the blackberry root used in a case of haemate- mesis with apparent advantage. I have, also, known it to be used with very good effects as an application in the form of a cold poultice, in haemorrhoidal tumours. As an astringent, this article may, no doubt, be usefully employed, wherever such remedies are indicated. The berries of this bramble have also been used in medicine. Dr. Mease says, "a jelly made of blackber- ries when on the turn from red to black, is much used in the United States for gravel." It has been said that a decoction of the root of this plant is very useful in gravelly complaints. I am not aware, however, that there is any foundation for this opinion. kino. This is an inspissated vegetable juice, possessing very great astringency. The natural history of the trees from which it is obtained is, as yet, but imperfectly known. The kino of commerce consists of three distinct kinds- ' Bigelow's American Medical Botany, vol. ii. p. 163, ASTRINGENTS. 279 "The first is in very small jet-black fragments, perfectly opaque, without smell, crackling under the teeth when chewed, not colouring the saliva, after some time impart- ing only a slight astringent taste, not fusible, and diffi- cultly reduced to powder." There is another kind which consists of large pieces, of a very dark brown colour, resinous appearance, and interspersed with little air cells; very thin pieces of it are translucent, and of a ruby red colour; when chewed it crackles under the teeth; its taste is at first slightly acid, which soon changes to a very bitter and astringent one, "succeeded by a peculiar sweetness. It is infusible, and forms a reddish brown powder." This variety of kino is obtained from the juice of the coccoloba uvifera. There is a third variety of this substance which consists of dark brown pieces of different sizes. It is generally covered with a reddish brown powder, has a resinous and unequal fracture, and * is often mixed with bits of leaves, twigs, &c. Very thin pieces are transparent; it crackles but slightly un- der the teeth, and its taste is astringent, followed by sweetness. This variety is obtained from the eucalyptus resinifera, a tree indigenous to New South Wales.* " The London college," says Dr. Duncan, " have indi- cated the butea frondosa as the source of kino, but cer- tainly erroneously. It, however, produces, in large quantities, a red juice very analogous to kino, and which may unquestionably be used as a substitute for it. The production of these substances from so many different trees in Africa, America, Asia, and New Holland, show that kino is to be considered as a genus of which these are species. Kino contains a very large proportion of tannin, and does not possess any of the characteristic habitudes of the resins or gum-resins. According to Vauquelin's Analysis, one hundred parts of kino consist of seventy- * Dr. Duncan's Dispensatory 280 ASTRINGENTS five of tannin, twenty-four of red mucilage, and one of fibrous matter.1* Cold water dissolves about four-fifths of its substance; but in hot water it is much more solu- ble; and hence the decoction, on cooling, lets fall a copi- ous reddish brown sediment, and becomes turbid. Al- cohol dissolves the whole of this substance except its im- purities. " It is remarkable," says Dr. Duncan, " that alcohol dissolves kino entirely, but does not dissolve the residuum of the decoction." The solutions of kino form a greyish yellow precipitate with acetate of lead,— a reddish yellow one with nitrate of silver, a yellowish white one with tart, antimon.—and a green one with sulphate of iron. Gelatine, also, precipitates the solu- tions of kino.f By exposure to heat kino becomes soft, and if the heat is very considerable, it slowly enters into fusion. This substance was first introduced to the notice of the profession as a useful remediate article, by Dr. John Fothergill, about eighty years ago.J It has been recom- mended as an efficacious remedy in intermittent fevers, given either by itself or in conjunction with some of the bitter tonics. In the advanced stages of diarrhoea, and in chronic dysentery, it is very frequently employed; and I do not doubt that it will generally answer all the useful purposes in these complaints, that can be obtained from astringents. In the bowel complaints of children, espe- cially, it may often be very advantageously given in union with chalk and small portions of laudanum. The aque- ous solution of kino has been highly recommended as an injection in the cure of fluor albus and gonorrhoea. In the former of these complaints a solution of this substance in lime-water, is said to be particularly useful. Its use in * Ann. de Chimie. torn. xlvi. p. 321-332. t PfafF's Mat. Med. tom.ii. p. 200. \ A letter from Dr. John Fothergill to the Medical Society, concerning an astringent gum brought from Africa. See Med. Observ. and Inquir. vol. i. p. 358. ASTRINGENTS. 281 this way is objectionable, however, on acconnt of its staining every thing with which it comes in contact, of a blood-red colour. It has, also, been employed with good effects in diabetes; and Pemberton speaks very fa- vourably of its virtues in pyrosis. Some practitioners have found it to produce excellent effects in certain va- rieties of haemorrhage, more especially in protracted menorrhagia from laxity of the solids. Gillespi re- commends a solution of kino in red French wine, as an excellent application to foul scorbutic ulcers.* Kino is given in substance, in doses of from ten to thirty grains. It is, also, very frequently given in the form of tincture; from twenty to forty drops of which may be administered for a dose. « CATECHU EXTRACTUM. The tree, mimosa catechu, which furnishes this ex- tract, is a native of Hindostan, and is said to be particular- ly abundant on the uncultivated mountains of Rotas and Pallamou, in the province of Bahar, westward of Ben- gal. | Catechu is, however, also obtained from other species of mimosa; and at Bombay it is principally pre- pared from the nuts of the areca catechu. The cate- chu obtained from the mimosae, is prepared from the internal part of the wood by decoction, and evaporation in the sun. This substance comes to us in compact, hard, brittle, flat pieces, of a dark brown colour; and, when broken, exhibiting light and dark brown streaks. It possesses a * Lond. Med. Jour. vol. iv. p. 373. t For a good account of the tree producing the catechu, and of the mode of preparing this substance, see Med. Obs. and Inquir. vol. v. p. 148. VOL. I.—N n 282 ASTRINGENTS. powerfully astringent taste, succeeded by a slight sensa- tion of sweetness in the mouth, It has no odour. Its specific gravity varies from 1.28 to 1.39. Formerly it was thought to be a mineral product, and was, therefore, described under the improper name of terra japonica. Hagedorn and Boulduc,* were among the first who op- posed this error, and who established the fact of its ve- getable origin. According to Mr. Davy's analysis two hundred grains of Bombay catechu contains one hun- dred and nine grains of tannin, sixty-eight of a peculiar extractive matter, thirteen of mucilage, and ten of resi- dual matter. Bostock found traces of gallic acid in catechu. That which is brought from Bengal contains less tannin. It is almost wholly dissolved both by water and proof spirits. The oxysulphate of iron produces a beautiful green precipitate with the aqueous solution of this substance, which changes to an olive green, with a faint shade of brown by the further addition of some muriate or nitrate of iron. Lime, barytes, and stron- tian produce copious light brown, and the preparations of copper dark brown precipitates. It also forms a co- pious precipitate with gelatine. The concentrated muriatic and sulphuric acids produce pale precipitates, and the fuming nitrous acid destroys its property of pre- cipitating the solutions of lime and iron. The catechu was formerly much employed by phy- sicians, and it is unquestionably an article of strong and useful astringent powers. In diarrhoea and the advanc- ed periods of dysentery, it is equal if not superior to any of the vegetable astringents we possess. It is also said to be a very valuable remedy in fluor albus, when em- ployed in the form of an injection. Combined with gen- tian it has been used with success in obstinateintermit- tents.f In relaxation of the uvula, and ulcers of the * Mem. de l'Acad. des Sciences de Paris, A. 1709. p. 228. t Dr. Barton, in a note to Cullen's Mat. Med. vol. ii. p. 31 ASTRINGENTS. 2$3 mouth and fauces, it has been known to produce very excellent effects. It has, also, been prescribed with much advantage in general relaxation of the system with de- bility of the digestive organs. Clysters of a solution of catechu have been recom- mended as highly useful in restoring tone and energy to the bowels in cases of colica pictonum.* Mr. James Kerr states, that this substance forms a principal ingre- dient in an ointment of great repute among the Hindoos, composed of sulphate of copper 3iv. catechu §iv. alum ix. white resin ^iv. reduced to powder and mixed with olive oil and water sufficient to bring the mass to the consistence of an ointment. This ointment they use in all kinds of ulcers. " A gentleman," says Mr. Kerr, " of great practice, told me he used this ointment with success beyond expectation."! The catechu is administered both in the form of a powder and of tincture. The former is given in doses of from grs. x. to 9i. The latter from thirty to sixty drops. It is, also, occasionally prescribed in the form of an electuary and in lozenges. The latter by gradu- ally dissolving in the mouth, may be very conveniently and beneficially used in relaxation of the palate and fauces. SUPERACETAS PLUMBI. The acetate or sugar of lead consists of irregular masses resembling lumps- of white sugar, " being an aggregation of acicular four-sided prisms, terminated by dihedral summits." Its taste is sweet and styptic. When exposed to the air it slightly effloresces; and it is decom- posed by heat and light. It is soluble in twenty-five * Chirurg. Arzneymittellehre, Von C. L. Romer, B. i. s. 119. r Medical Obs. and Inq. vol. v. p. 158. 284 ASTRINGENTS. parts of water, and also in alcohol. The aqueous solu- tion is turbid and of a milky colour, but becomes trans- parent on adding a small portion of acetic acid to it. It is decomposed by the " alkalies, alkaline earths and their carbonates, most of the acids, alum, borax, the sulphates and muriates, soaps, all sulphurets, ammoniated and tar- tarized iron, tartarized antimony, undistilled water.'' When taken internally the sugar of lead produces a sensation of constriction on the fauces and along the whole course of the oesophagus. It accelerates the fre- quency of the pulse, but does not augment its strength or volume.* The effects of the continued influence of lead on the animal body, are of a nature so distressing and danger- ous, that it was long before physicians would venture on the internal employment of the saturnine preparations. We find, however, that the sugar of lead was occasion- ally used as an internal remedy as early as the days of Paracelsus. This eccentric genius extolled it as a reme- dy of great powers in diseases of the thoracic viscera, all of which he included under the general name of asthma.j Its internal use was, also, strongly recom- mended in all species of dropsies, by Goulard; and Wuerz and Gramannus, of the sixteenth, and Libavius, Raumer, and others, of the seventeenth centures, em- ployed it freely as an internal medicine. The use of lead in this way, was, however, strongly opposed by Stahl, Hoffmann, Boerhaave, and subsequently by Sir G. Baker j and the authority of these names proscribed almost wholly, for a time, its internal employment. But the apprehensions of the profession, in this respect, gradually gave place to the accumulating testimony of * Semmes' Inaugural Thesis, on the effects of lead, &c Philad. 1801. t Paracelsi Opera Omia, vol. ii. j Medical Transactions of the London College of physicians, vols. i. and ii. 1772. ASTRINGENTS. 285 experience in favour of its general inoffensiveness; and it is now pretty commonly admitted, that, although not destitute of deleterious properties, the sugar of lead may be exhibited internally in a variety of affections with great benefit and without the least injury, if ma- naged with prudence and judgment. It must be con- fessed, however, that this remedy has been known to produce injurious effects even under the most judicious administration; and we are, therefore, not to resort to it with an entire assurance of its being uniformly innox- ious. Like all our heroic remedies, it is capable of doing a great deal of good, and, also, under unfavourable circumstances of administration and constitutional pre- disposition, much harm. The sugar of lead was very early recommended as a useful medicine in phthisis pulmonalis. The Phar- macopoeia Bateana contains the formula of a tinctura anti-phthisica,* into which sugar of lead enters as a principal ingredient, and which is stated to be " truly a -good medicament in those consumptions which proceed from ulcers of the lungs."f Ettmuller, also, employed the sugar of lead internally in this disease. More re- cently this remedy has been particularly recommended in this affection by Horn,J Amelang,§ Remer, Kopp,|| Hildenbrand,H Jahn,** and others. I have myself, in a few instances, given it in this disease, and its. effects *§, Sacch. saturn. ... gii. Sal. martis - gi. Inf. spir. vin. - - - Ibi. Dose, from twenty to forty drops. f Pharmacopoeia Bateana, or Bates' Dispensatory, fourth edi- tion, by William Salmon, M. D. 1693. \ Horn's Archiv fur Medicinische Erfahrung. 1812, torn. i. §Hufeland's Journal of Pracktischen Heilkunde, torn. xxii. p. 3. ||Ibid. torn. xi. p. 62. ^[ Ibid. torn. viii. No. 4, p. 3. ** Materia Medica, p. 2. 286 ASTRINGENTS. were always manifestly beneficial. It generally lessens both the night sweats and expectoration, and often very considerably relieves the cough. It is especially useful as a palliative in the advanced stage of the complaint, when the patient is harassed by frequent colliquative discharges from the bowels. To check internal haemorrhages the sugar of lead is, undoubtedly, the most efficacious remedy we possess. It was occasionally resorted to in cases of this kind by the older physicians, but its virtues in this respect have only become duly appreciated during the last twenty or thirty years. The efficacy and safety of the sugar of lead in haemorrhages, rests now upon the evidence of a very extensive experience Monro, Hill, Reynolds, Barton, Amelang, Williamson, Jahn, Richter, Heberden, and many others have written in favour of its employment in such affections. It appears to be equally applicable to the treatment both of active and passive haemorrhages. When, however, the pulse is full and hard, bleeding is obviously an essential preliminary to the use of the lead. The late Dr. Barton was in the habit of prescribing this remedy in combination with small portions of opium or ipecacuanha. " Seldom," says he, " have I been disappointed in my expectations of benefit from this medicine, which, of all the articles of the materia me- dica, seems to me to possess the greatest command over the movements of the arterial system."* From my own experience with this remedy, in haemorrhagy, I am in- duced to entertain a very high opinion of its powers. In a single instance only have I known its use to be fol- lowed by symptoms of colic, and these readily yielded to a few doses of castor oil and opium. The sugar of lead has also been recommended in the cure of dysentery and diarrhoea. To this purpose it appears to have been very early applied, as we find it * Cullen's Mat. Med. vol. ii. p. 21, in a note. ASTRINGENTS. 287 mentioned by several of the older writers,—particularly by Ettmuller and Adair, who speak highly of its reme- diate powers in dysentery. Drs. Moseley and Jackson have also added their testimony in favour of its useful- ness, under certain circumstances, in this disease. "In chronic dysentery," says Dr. Jackson, " a solution of sugar of lead, viz. ten grains of the acetate to one drachm of the chrystals of tartar and two parts of boiling water, given every three or four hours, to the quantity of two ounces for a dose, gives evident relief on many occa- sions, and in no instance within my knowledge has any inconvenience arisen from the supposed deleterious effects of the lead."* Moseley employed this substance in the form of enemata, where the tenesmus was inve- terate and harassing, attended with frequent discharges of bloody mucus, or purulent matter, and great sore- ness about the anus.f Dr. Bampfield, another late writer on tropical diseases, states that Dr. Ainslie, at the artillery hospital at the mount of Madras, showed him cases " where this medicine was said to be strikingly use- ful." He does not, however, add much in favour of this remedy from his own experience. He says, that during its exhibition animal food should be abstained from.J Quite recently, Dr. Harlan, of this city, has published cases illustrative of the efficacy of this medicine in dy- sentery,§ and he seems to entertain a very high opinion of its powers as well as an entire conviction of its safety. My own limited experience with this article, in dysen- tery, has by no means been satisfactory. I have found it in a few instances to produce constipation with a dis- tressing pressing down of the bowels, without affording any relief to the tormina. I have no doubt, however, * Jackson on Febrile Diseases, vol. ii. p. 61. t Moseley on Tropical Diseases, p. 404, fourth edition. j Practical Treatise on Tropical Dysentery, p. 198. London, 1818. § American Medical Recorder, vol. v. 288 ASTRINGENTS. that cases may occasionally occur in which the sugar of lead will be found advantageous. But, as a general prac- tice, I am not disposed to think favourably of the re- medy. Of the employment of sugar of lead in intermittents I know nothing from my own experience. Some writers of the last century have spoken well of it in this dis- ease, but I suspect that its powers in this respect are not entitled to much attention. In some of the neuroses this article has been found decidedly beneficial. Sax- torph,* Richter,f Ossan,| and others employed it with success in epilepsy and hysteria. Dr. Rush,§ also, cured a case of epilepsy with this remedy; and in the New- York Medical Repository, || I have reported a remarka- ble case of this disease, in which the sugar of lead prov- ed completely successful. In this case the fits returned regularly about the periods of full moon. I prescribed three grains of the sugar of lead to be taken morn- ings and evenings, commencing three or four days before the expected return of the paroxysms, and continued it for five days at each period. The medicine was thus taken at five successive periods of full moon, and the patient, who had been affected with the disease upwards of eight years, was permanently cured thereby. The sugar of lead has also been prescribed in other spasmodic diseases. Kramp, a German writer, cured a case of spasmodic dysphagia by it, and Ettmuller em- ployed it in melancholia, in which he says " it is esteem- ed a specific."If It is said, also, to have been given with *Act. Reg. Soc. Med. Hafniensis, vol. Hi. 1792. t Specielle Therapie, vol. vii. p. 266. JOsann. Dissertatio de saturni usu Medico, maxime interno, 1809. § Philadelphia Medical Museum, vol. i. No. 1. || Vol. ii. No. 1. New Series. 1813. T Allen's Synopsis Medicinae, vol. i. s. 437. ASTREMGENTS. £89 advantage in tetanus.* Lately this remedy has been highly spoken of in the cure of hooping-cough. I have used it in five or six cases of this disease, and in a few instances it appeared to do some good. Its efficacy in this respect is, however, not sufficiently great to entitle it to much attention, and more especially as its employ- ment can certainly not be said to be without some risk of unpleasant consequences. The sugar of lead is one of the most useful remedies we possess for the reduction of external phlegmonous inflammation. In ophthalmia it has long been an exceed- ingly common remedy; and, although applications of this kind are by far too indiscriminately made, it may often be resorted to with great benefit. When the inflamma- tion does not depend on a constitutional cause, and is unaccompained by much excitement of the general cir- culation, saturnine collyria will, in general, prove very serviceable. Under opposite circumstances, however, such applications will not only do no good, but almost invariably produce mischief. The use of this remedy has been no less common, as an injection, in gonorrhoea, than in ophthalmia; and it certainly is very often ade- quate to the removal of the disease. The solution of sugar of lead, made into a cold poul- tice with the crumbs of bread, is also an excellent ap- plication in phymosis, hernia humoralis, and swelled in- guinal glands. Applied in the same way, it frequently affords great relief in inflamed haemorrhoidal tumours. This remedy has also been much praised by some writers for its effects in erysipelatous inflammation arising from external causes. By others, however, its use in this affection has been condemned; and my own experience has furnished me with no evidence of its usefulness in this respect. The sugar of lead may be given in doses of from half * Burdach, Arzneymittellehre, vol. ii. p. 241. VOL. I.—0 O 290 ASTRINGENTS. a grain to six grains, according to the nature and ur- gency of the symptoms for which it is administered. It is frequently given in the form of pills, in combination with opium. In administering this preparation of lead. care must be taken that the patient do not at the same time receive other substances into the stomach which have the power of decomposing it. The sulphates of magnesia and alum, for instance, would decompose the acetate and produce a sulphate of lead, which is entirely insoluble, and consequently inert.* Dr. Paris advises, that in taking the sugar of lead the patient should ab- stain " from all potation except cold water or draughts composed of diluted acetic acid, for at least an hour af- ter the ingestion of the medicine." The immediate effects of an enormous dose of sugar of lead are, a sweet astringent taste, with a sense of constriction in the throat, pains in the stomach, with retching, or vomiting of bloody mucus, bowels consti- pated or relaxed, with bloody evacuations, foetid eruc- tations, hiccup, a sense of constriction in the thorax, with difficulty of respiration, great thirst, painful mic- turition, cramps of the extremities, cold sweats, convul- sions, general sinking of the vital powers, and death. To counteract these effects, experience proves that much advantage may be derived from the early use of solutions of Glauber's salts, Epsom salts, and hard water. Orfila says that the liver of sulphur, which has been recommended by some, is pernicious. If the symptoms be not early subdued by these measures, and signs of gastric inflammation come on, the warm bath, fomentations and leeches to the abdomen, with copious draughts of infusions of linseed or mallows, or of water sweetened with sugar, should be resorted to.f * Paris's Pharmacologia. t Orfila's System of Toxicology, vol. i. p. 484 ASTRINGENTS. 29i SULPHAS ZINCI. The emetic and tonic properties of this article have already been noticed; and to complete its remediate his tory, it remains, therefore, only to speak of its virtues as an astringent. In chronic ophthalmia, a weak solution of the sulphate of zinc often produces excellent effects. It is certainly preferable, in such cases, to the acetate of lead, as hav^ ing besides its constringing, a greater roborant effect upon the dilated and debilitated capillaries of the inflam- ed part. As an astringent injection in gonorrhoea, its employment is very common. Its indiscriminate and unguarded use in this disease is, however, by no means to be approbated. It is much too harsh and irritating, and frequently gives rise to injurious consequences, when employed in the acute stage of the affection. When the discharge has assumed the character of gleet, it may generally be used with advantage. In injections for this complaint it is usually united with sugar of lead, to which some mucilage and a small portion of lau- danum is commonly added. Used in this way, it also forms an excellent application in fluor albus. The sulphate of zinc has been employed with much benefit against opacities of the cornea, and in ptery- gium or thickening of the conjunctiva. Himly used it with success in tumours of the sclerotica and cornea, applied in the form of powder mixed with sugar. It has also been successfully used as an escharotic in poly- pus of the nose; and in fungous tumours in the external meatus of the ear. A solution of it forms a very ex- cellent gargle in aphthous affections of the mouth, for which purpose it is highly recommended by Selle, Arm- strong, Hertz, and others. The sulphate of zinc is a remedy of very considerable powers in chronic cutane- ous eruptions. The famous ointment of Jasser con- 292 ASTRINGENTS. sists principally of this article. I have frequently employed it in the form of a lotion in scabies with perfect success. Of its use in bowel complaints I have already spoken under the head of Emetics. sulphas alumina. Alum is an earthy salt, consisting of sulphuric acid and alumina, with a portion of potass, or ammonia, or sometimes of both. " It crystallizes in regular octo- hedrons, whose sides are equilateral triangles." Its taste is sweetish, rough, and exceedingly astringent. It dissolves in fifteen times its weight of water at 60°, and in three-Zourths of its weight at 212°. It is also solu- ble in alcohol. When exposed to the air it slightly effloresces. " By the action of heat it first undergoes the watery fusion, then loses its water of crystallization, and lastly a great part of its acid," assuming a white, spongy appearance, friable and very light. It is decom- posed by the alkalies and alkaline salt, carbonate and muriate of ammonia, carbonate of magnesia, tartrate of potass, lime-water, superacetate of lead, the mercurial salts, " as well as by many vegetable and animal sub- stances, especially galls and kino."* Hence, as Dr. Paris observes, the addition of alum to vegetable astrin- gents is very injudicious. Alum was well known to the ancients, but it does not appear to have been used by them as an internal remedy. Dioscorides and Hippocrates praised its effects as a lo- tion, in various kinds of ulcers, and particularly in sores of the mouth, and in spongy, swelled gumfc Van- Helmont, Helvetius, Mead, and Thompson, were among the first who brought its internal use into particular notice. * Paris's Pharmacologia. ASTRINGENTS. 293 Lind speaks very highly of the powers of alum given with nutmeg in intermittent fever. He declares that, except the Peruvian bark, it proved more successful in his practice than any other remedy he ever used. Cul- len speaks less favourably of it. During the present season, I have prescribed it in four cases combined with nutmeg and serpentaria. One of the patients was cured after using the remedy four or five days. According to Dr. Darwin, alum is particularly suited to the cure /)f fevers attended with disease of the bowels. Alum is said to be one of the most effectual reme- dies we possess in colica pictohum. Grashues was the first who used it in this disease. Richter speaks in the most exalted terms of its effects in this painful and often intractable complaint. The testimony of a great many others eminent writers might be adduced in favour of its virtues in this respect.* Fifteen grains of the powder- ed alum is to be given every two or three hours, either by itself or in combination with opium.f In chronic discharges from the bowels, alum, either alone or in combination with other articles, has been fre- quently employed with considerable advantage. The alum whey forms an excellent remedy in such cases. I have known the use of powders composed of ten grains of alum, fifteen of calamus aromaticus, and one fourth of a grain of opium, to arrest a chronic diarrhoea of long standing very promptly, without any disagreeable consequences. Alum has also been successfully employ- ed in internal haemorrhage. Van-Helmont gave it with much success in uterine haemorrhages; and Cullen states that he found it serviceable in bleedings from the uterus, but not in those from the lungs. This, he thinks, * Sommer, in Hufeland's Journal d. pract. Heilk. B. vii. st. 1, p. 73. Gebel, ibid. B. viii. st. 2, p. 195. Percival, Observ. and Experiments on the Poison of Lead, p. 71. Lentin Memoral. area aerem, vitae genus, sanitat, et morbos clausthaliens, p. 115. t Richter's Specielle Therapie, B. iv. p. 201. 294 ASTRINGENTS^ was owing to the latter variety of haemorrhage being almost invariably of the active kind. In protracted san- guineous discharges from the uterus, connected with great relaxation of the solids, alum is undoubtedly a very valuable remedy. In cases of this kind it is very advantageously administered in combination with Peru- vian bark. Where the pulse is active it ought not to be given without previous depletion. Leake used a solu- tion of this substance in the form of an injection in this variety of haemorrhage. Alum has also been much ex- tolled for its remediate powers in leucorrhoea; and, em- ployed as an injection in this disease, it is certainly capable of doing considerable good. I have prescribed it occasionally in this way, though never with any decid- ed advantage. Where this disease is attended with great relaxation of the general system, or with that habit of body which has been denominated leucophlegmatic, alum combined with the rust of iron, is said to be pecu- liarly beneficial. Diabetes is another disease in which alum has been successfully used. Its employment in this complaint was particularly recommended by the celebrated Dr. Mead, and by Dover. Selle, also, states that he cured an obstinate case by giving the patient thirty grains of alum three times daily* The majority, however, of those who have tried the alum in this disease, do not speak favourably of its powers; and it does not, at pre- sent, enjoy any particular reputation in this respect. Used as an auxiliary to other measures, the alum whey may, no doubt, often be serviceable. As a principal remedy, however, it is certainly not to be relied on. The alum has also been recommended in flatulent colic, gastric debility, and in colliquative sweats, &c. As an external application, alum may be advantage- ously employed in a variety of complaints. In, relax- * Beitraege zur Natur and Arznei. &c. B. i. ASTRINGENTS. 295 ations of the uvula and cynanche tonsillaris much benefit may often be derived from the use of gargles containing alum. "In many persons," says Dr. Cul- len, " who are liable to be affected with swellings of the tonsils, we have known the disease prevented, or soon removed by a decoction of oak bark, to a pound of which a half a drachm of alum and two ounces of brandy were added."* In ophthalmia, after the inflammation has been some- what subdued by local and general depletory measures, or in the chronic form of the complaint, the alum curd,f as it is called, will, in general, prove very serviceable. Cullen states, that he has found the solution of alum, in the proportion of five grains to the ounce of water, still more effectual than the coagulum aluminosum. In the beginning of acute ophthalmia, these applications will very generally prove hurtful. Alum has also been used as an injection in gonorrhoea. In gleet it may be use- ful, but in recent gonorrhoea it is much too harsh and irritating, and ought never to be employed. CALX. As a mild astringent, lime-water is a remedy of very considerable utility. In the advanced periods of dysen- tery, in diarrhoea, and in cholera infantum, it often pro- duces excellent effects. In the chronic form of the latter disease I have been in the habit of prescribing it in union with a weak infusion of cinchona, and it has very generally appeared to me to be of service. Where * Mat. Med. vol. ii. p. 12. f This is made by rubbing a piece of alum with the white of eggs in a plate until a coagulum is formed. It is applied to the eye between two pieces of line linen. 296 ASTRINGENTS. there is acidity in the primae viae, attended with vomit- ing or diarrhoea, the lime-water is doubly indicated. In such cases it at once corrects the vitiated contents, and allays the morbid irritability of the stomach and bowels. It is, indeed, one of our most useful remedies to check inordinate vomiting. For this purpose it is usually ad- ministered with milk, given in doses of a table-spoonful of each every twenty or thirty minutes. Under the head of Antacids I have already noticed its utility in dyspeptic cases attended with acidity of the primae viae. Hoffman asserts that lime-water is the most effectual remedy we possess in scurvy arising from the continued "use of salted provisions. This, however, is not confirm- ed by the experience of others.* As an external remedy, lime-water may often be ad- vantageously used in old fungous ulcers, attended with inordinate discharges of a serous matter. It has also been recommended as affording great relief from the pain and fetor of malignant ulcers. It is even asserted to have been used with success in genuine cancer. Baumbach, a German writer, relates two cases of can- cerous ulcerations of the lips and breast, which, he says, were effectually cured by the internal and external use of lime-water.f In the cure of porrigo larvalis, or crusta lactea, lime-water, used both externally and internally, is recommended by Barlow, Dreiszig, and Wichmann j as an efficacious remedy. Hufeland re- commends a liniment made of equal parts of lime-water and sweet oil, as one of the most effectual applications in herpes.§ This liniment, with the addition of a por- tion of laudanum, is also a very excellent application in * Burdach, Arzneymittellehre, B. iii. 500. f Vogel, resp. Baumbach. Diss de curatione cancri occulti et aperti per aquam calcis vivae potam praestita. t Ideen Von Diagnostick, B. i. p. 50. $ Journal der Practischen Heilkunde, B. xxiii. st. 3, p. 209. ASTRINGENTS. 297 burns and scalds. I have repeatedly seen its virtues in this respect exemplified. Much was said a few ysars ago of the efficacy of the muriate of lime in scrophulous complaints. Fourcroy, Beddoes, and Hufeland have published very favourable accounts of its effects in this disease. I have known it to be employed in several instances of external scro- phulous ulcerations, but, although it was given in large doses, and continued for a considerable time, it did not evince any beneficial operation. It is certain that it has not answered the expectations that were at first excited by the accounts given of its effects by Beddoes and Hufe- land. The mode of giving it is, to dissolve one drachm of it in two ounces of water, of which thirty or forty drops are to be given every three or four hours. BAR1TES, The only preparation of barytes employed in medi- cine is the muriate. This salt has a bitter and pungent saline taste. Given in a moderate dose, it does not ma- nifest any sensible operation. An inordinate dose, how- ever, excites nausea, vomiting, and sometimes anxiety, palpitation and vertigo. Hufeland states, that he has known this medicine to produce a continued feeling of distressful anxiety for several days without any other obvious effect. It often occasions, when first used, and especially in patients who have worms, slight griping pains, with diarrhoea. It generally keeps the bowels somewhat relaxed. It has no perceptible effect upon the pulse. Hufeland says, that it appeared to him rather to retard than accelerate it. The excretory organs are more obviously influenced by this remedy. It generally augments the urine and cutaneous exhalation. Applied vol. i.—p p 298 ASTRINGENTS. to the skin, it produces a smarting, burning pain, and when concentrated it proves escarotic* The muriate of barytes, or, as it was formerly called, terra ponderosa, was first introduced to the notice of the profession by Dr. Crawford,! of England, as a re- medy of great powers in scrophulous affections. This writer assures us that he has found it successful in many of the most confirmed cases of scrophula. Mr. Pearson and Drs. Clark and Hamilton, have published observa- tions confirming Dr. Crawford's statements upon this subject. In Germany and France this remedy has found a number of able advocates. Goerling, Fourcroy, J. A. Schmidt, Petermanu, and especially Hufeland, have published statements illustrative of its beneficial effects in affections of this kind. It can, indeed, not be doubted that it has been found useful in this disease; but later experiments with it in this country as well as in Europe, do not justify the high praises that have been bestowed on it. Ferriar, Kretschmar, Fleiseh, Henke, Richter, &c. employed it in large and continued doses, without deriving the least advantage from it.| Some writers, amongst which are Girtanner and Arnemann, have represented it as frequently productive of highly injurious and even poisonous effects. In a single instance of violent and obstinate scrophu- lous ophthalmia in a child, I prescribed the solution of this substance, and had the satisfaction to see my pa- tient get well under its use. In employing this medi- cine, it is necessary to continue its use for a long time. In very tedious cases, Hufeland observes, its use should be interrupted every eight or fourteen days, and a pur- gative interposed. This remedy is said to be most use- * Hufeland, Dartstellung der Medicinishen Krafte der Salz- sauren Schwererde, p. 15. t Duncan's Medical Commentaries, vol. iv. Dec. 2, p. 433. _ t Richter's Specielle Therapie, vol. v. p. 623. ASTRINGENTS. 299 ful when there is an inflammatory and very irritated condition of the lymphatic system present, or where the bowels are loaded with irritating and bilious matters. It is especially efficacious when the disease appears in the form of cutaneous eruptions. In cases attended with great relaxation and weakness, or where symptoms of hectic are present, it seldom does any good, and often harm. Nor can it be used with benefit in cases com- plicated with scorbutic affections.* The muriate of barytes has also been used with ad- vantage in herpetic eruptions, scabies, porrigo, scirrhus, amenorrhoea, and mania; successful examples of all of which are mentioned by Hufeland and others. The dose of this remedy is from ten to fifty drops every three hours, of a solution of one drachm in an ounce of distilled water. It should always be commenc- ed with in a small dose, and gradually augmented. The sulphuric and nitric acids, the alkalies, magne- sia, tartarized antimony, burned sponge, and flowers of sulphur decompose it. Antimonial wine renders it slightly turbid, but does not entirely decompose it. It may be given with vegetable extracts and syrups, and decoctions, alcohol, corrosive sublimate, arsenic, with- out having its composition affected. AOIDUM NITRICUM. The nitric acid has, within the last twenty or thirty years, become an article of very considerable import- ance in therapeutics. M. Alyon, a French physician, introduced it to the notice of the profession as an ex- ceedingly valuable remedy in syphilis. He published a * Hufeland, op. citat. 300 ASTRINGENTS. number of cases illustrative of its efficacy in this dis- ease; and it was soon afterwards tried by several emi- nent English physicians, whose reports on its effects were very favourable. Cruickshank, Scott, Sandford, and Hammick, published observations tending to confirm its character as an efficacious antisyphilitic remedy. But no one was more extravagant in its praise than Bed- does* As is usual, however, with new remedies, it did not long sustain the reputation it at first acquired. The result of the experience of the profession on this sub- ject is,—that in old cases of syphilis, connected with a cachectic condition of the system, the nitric acid is ca- pable of mitigating the disease, but is inadequate to a perfect cure. In cases of this kind, and especially when symptoms of scurvy are complicated with it, much bene- fit may commonly be derived from the alternate employ- ment of the acid, and mercurial remedies. Where mercury fails to remove the symptoms entirely, and rheumatic pains, nodes, ulcers, &c. remain, the acid will sometimes prove highly serviceable. It is seldom sufficient to prevent the occurrence of secondary symp- toms; though it will often remove them after they have made their appearance. The nitric acid has been recommended as a very useful medicine in chronic hepatitis, as well as in scro- phulous ulcerations. I have used it in some cases of the former disease with advantage; but I have not known it to perform a perfect cure. This acid has also been recommended in dysentery and diarrhoea, but its use in this way does not appear to merit much consideration. This acid may also be beneficially used as an external application to syphilitic ulcers,f and in certain chronic * On the effects of Nitrous Acid, 8cc. 1797. t This is said to be an excellent ointment for purposes of this kind. R Acid nitric, concentr. 5i- pingued. vacc. 5i. misce int. sub leni igne et adde, opii. puriss 51. fiat unguentum. ASTRINGENTS. 301 cutaneous eruptions* Plenk recommends an ointment made of nitric acid and ung. althaea, of each half an ounce, and two drachms of ung. juniperi, applied twice a day, as highly efficacious in tinea capitis. The nitric acid may be taken from one to two drachms daily, dilut- ed in a quart of water, to which six or seven ounces of syrup is added. Its use increases the appetite, accele- rates the pulse, augments the secretion of urine and sali- va, and when long continued, produces a tenderness of the gums.f The nitro-muriatic acid has lately attracted very con- siderable attention, both as an external and an internal remedy. Dr. N. Scott was the first who noticed the superior remediate powers of this mixed acid.f It ap- pears to have a very particular tendency to act upon the glandular system, and especially to excite the secre- tory action of the liver and cutaneous exhalants. " As a very general rule for its employment," says Dr. Scott, " it may be observed, that whenever the mercurial pre- parations are indicated, the nitro-muriatic acid will be found useful, with this difference, that in cases where mercury is highly injurious from delicacy or peculiarity of constitution, or from other causes, the nitro-muriatic acid may be employed with safety and advantage." It is inadmissible in acute diseases. It is especially recom- mended in chronic hepatitis and in functional disorders of the liver. In these diseases Dr. Scott considers it as the most effectual and the safest remedy. It is said, likewise, to be very efficacious in syphilitic and pseudo-syphiltic af- fections. Dr. James Johnson, who appears to place con- siderable reliance on the nitro-muriatic bath, in the treat- ment of chronic hepatitis, gives the following directions for preparing and using it: " Into a glass vessel capable of * Alyon, Essai sur les proprietes medicinales d'oxygene, 1791. t Richter's Specielle Therapie, vol. v. p. 321. t Beddoes' Contributions. 302 ASTRINGENTS holding a pint or more of fluid, put eight ounces of water. and then pour in four ounces of the nitric acid of the London Pharmacopoeia, and four ounces of muriatic acid. One ounce of this mixture to a gallon of warm water, will form a bath of medium strength, and such as Mr. Astley Cooper commonly prescribes. The pro- portion may be increased to one ounce and a half, or diminished to half an ounce of the solution to the gallon of water, according to the age, strength, delicacy, or other peculiarity of the patient. The feet and legs of the patient ought to be immersed in this bath at a com- fortable warm temperature, say 96°, and kept there twenty minutes or half an hour, just before going to bed. This may be done every night, or every second night, and the same bath will remain good for five or six nights."* It is proper to observe, however, that several very respectable physicians, who have published the result of their experience with the nitro-muriatic acid bath, have not found it to answer the expectations which were excited by the publications of Dr. Scott and others. Mr. Guthrie, deputy inspector of military hospitals, states, as the result of his experience with this remedy, that it is of very uncertain operation, and that no depend- ence can be placed on it He does not, however, con- tend that the remedy is entirely destitute of useful pow- ers. " It seems often," he says, " not to produce any effects whatever, however extensive its application; and yet the complaint for which it has been used shall slowly subside or disappear, whilst in other instances it remains stationary or gets worse."f From my own experience I know very little of this remedy. I have employed it in a few instances of functional derangement of the liver; but as it was alternated with mercurial remedies, I am * On the Influence of Tropical Climates. t Medico-Chirurgical Transactions, vol. viii. for 1817 ASTRINGENTS. 303 not able to say how much of the beneficial result is to be ascribed to its operation. It appears to be beyond a doubt, however, that it is possessed of very useful re- mediate powers. But no one will now pretend to say that it approaches mercury in any of the diseases in which it has been recommended. It may, nevertheless, be sometimes usefully substituted for mercury, where this article cannot be given on account of idiosyncrasy, debility, or other causes. It may even occasionally hap- pen to prove effectual where mercury has done no good, or has been hurtful. This has been observed of a variety of articles whose remediate powers are in no respect equal to this metal. ACIDUM SULPHURICUM. The sulphuric acid is a medicinal agent of very con- siderable importance. By the German physicians this acid is very frequently prescribed in haemorrhagies;and some of the older English writers recommend it very highly for its powers in such cases. Sydenham espe- cially considered it as a remedy of great use in haemorr- hagy. At present it is only prescribed as an auxiliary, after the immediate violence of discharge has been re- strained by more active measures. In spitting of blood, and in slight but protracted bleedings from the uterus, it often answers very good purposes. As a tonic this acid is very frequently administered. It seems to be particu- larly adapted to invigorate the digestive organs during convalescence from febrile diseases. Sometimes, how- ever, it will produce unpleasent affections of the stomach, such as pains and nausea. When this occurs it must^ of course, be at once discontinued. The sulphuric acid is a very efficacious remedy in certain chronic eruptive diseases. The use of it in 304 ASTRINGENTS. this way originated, I believe, in Germany. Dr. Cothe- nius, principal physician of the Prussian army, employed it for the cure of the itch, in 1756. It has, since that time, been employed and commended by many of the most eminent physicians of Europe. Crollius, Tissot, Baldinger, Hafenreffer, Gahn, Richter, and a number of other writers have mentioned its virtues in this respect. Richter observes, that the external application of this acid, diluted with water, is, perhaps, the most useful of all our remedies in itch complicated with a scorbutic habit of body* Dr. Kinglake, also, has found this acid very effectual in cases of this kind.f Dr. Fos- broke, of Berkeley, in England, has recently published a paper on the use of dilute sulphuric acid in cutaneous affections, in which he relates several very striking ex- amples of its efficacy. He prescribed it in an obstinate case of lichen agrius, with prompt success. It was taken in a decoction of elm bark and of the wood of solanum dulcamara, " using, at the same time, as a wash, a decoc- tion of the deadly nightshade.J It should be taken in as large doses as the stomach will bear; from one to four drachms, properly diluted, may be taken in twenty- four hours. It is usually employed in the form of the acidum sulphuricum aromaticum, or elixir of vitriol. Made into an ointment with lard, it forms a very effica- cious application in diseases of this kind. In this way I have repeatedly employed it with prompt success in the itch. I have also cured a distressing case of prurigo formicans, by the external and internal use of this reme- dy alone. The ointment is made by simply incorporat- ing the acid with lard, in the proportion of about thirty drops to an ounce of the latter. Quite recently I have been informed by Dr. J. R. * Specielle Therapie, torn. vi. p. 179. t London Med. and Phys. Jour. 1801, p. 614. t London Medical and physical Journal, for July, 1822, vol. xlvii. p. 483. ASTRINGENTS. 305 Lucas, of Brunswick, Virginia, that the sulphuric acid, properly diluted, forms an exceedingly efficacious injec- tion in gonorrhoea.* I have tried it in one instance with success. About eight drops of the acid should be mixed with eight ounces of water, when used for this purpose. * American Medical Recorder, for October, i822. vol. i.—Qq CHAPTER VIII. MEDICINES WHOSE ACTION IS PRINCIPALLY DIRECTED TO THE UTERINE SYSTEM. /. Medicines that promote the Menstrual Discharge EMMENAGOGUES. Under this class are arranged such remedies as are supposed to be capable of promoting the menstrual dis- charge. It is very doubtful, however, whether any of the articles which have hitherto been employed for this purpose, possess any direct influence over the uterine secretions. We know, at least, that their emmenagogue effects are very uncertain; and that remedies of the most opposite character do occasionally, under peculiar circumstances, produce such effects. That the menstrual discharge is a secretion, and not a mere effusion of blood from the extremities of the uterine vessels, is an opinion now pretty generally enter- tained. This opinion is distinctly expressed by Allen, in a quotation from an author whom he does not men- tion. " I dare assert," says he, " that the menses pro- ceed entirely from the superfluous chyle concocted into a viscid humour, which by degrees mixes with the mass of blood, and, as is well known of all the several other secretions, is separated by the glands situated there for that very purpose, as manifestly appears on the dissection EMMENAGOGUES. 307 of those parts. The menses are considerably more viscid aiiO thick than the rest of the blood, and have ge- nerally an ungrateful and unusual smell, very different from what is drawn off by bleeding, or flows from an haemorrhage."* Bordeu, too, in his invaluable Treatise on the Glandsf advances the same opinion. Whatever opinion we may adopt in relation to the nature of this evacuation, certain it is, that whenever it becomes irregular or suppressed, the health always suf- fers more or less disturbance. Even the peculiar destiny of the sex,—the noble prerogative of becoming mothers, is destroyed, and with it, often, the teuderest hope, of the female. I have already said that it does not appear probable that any of our emmenagogues exert any direct action upon the uterus. If this were the case, we might, I think, calculate with much more certainty, on the ope- ration of these remedies, than experience teaches us to do. If we attend particularly to the effects of these articles, we discover that many of them have a decided tendency to increase the flow of blood to the pelvic vis- cera generally. This is also the case with some other means occasionally resorted to for the restoration of ob- structed catamenia, and which cannot be properly placed under the head of emmenagogues. Thus ligatures on the thighs, the semicupium, and fomentations to the ex- ternal parts of generation, can only act by creating a local plethora in the vessels of the pelvic viscera, and consequently of the uterus. I have known the extirpa- tion of large haemorrhoidal tumours to restore suppress- ed catamenia, by which the local drain of blood from these parts was removed, and the ordinary fulness of the uterine vessels re-established. It is not necessary that we should regard the menstrual discharge as a mere ef- * Synopsis Medicinae, vol. ii. p. 232. t Traite des.Gtandes. 308 EMMENAGOGUES. fusion of blood, arising from local uterine plethora, in order to admit this explanation of the modus operandi of emmenagogues. The phenomena are perfectly compa- tible with our notions of the secreted nature of the men- strual discharge. There is an intimate relation between the degree of exaltation in the vital properties of a part, and the quantity of blood circulating through it. We find, accordingly, that whatever increases the flow of blood to a gland, increases also its secretion. It is in this way, perhaps, that all irritations increase the pecu- liar secretions of the organs to which they are applied. They produce an immediate flow of blood to the organs irritated, the vital properties of which are thereby ele- vated, and a larger secretion of their peculiar fluid takes place. We can, therefore, readily understand how an in- creased determination of blood to the pelvic viscera may very often remove torpor in the uterine vessels, and thus restore the suppressed catamenia. Although emmena- gogues are a class of remedies expressly set apart as means for removing catamenial obstruction, they yet, in reality, constitute but a small portion of our remediate resources in such cases. In a very great number of in- stances we find it necessary to have recourse to general remedies, to the exclusion of such articles as are techni- cally denominated emmenagogues. If, for example, the catamenia cease to flow in consequence of a general re- laxation or debility of the system, our best curative means, of course, are such as invigorate the vital powers. Hence, tonics, exercise, the cold bath, an invigorating diet, &c. do occasionally produce the best effects in cases of obstructed menstruation. A suppression of the menses is also frequently attended by a state of the sys- tem directly the reverse of that of debility and relaxa- tion. There is a rigidity of fibre unfavourable to the regular performance of some of the organic functions; the habit is full and inflammatory, and though apparent- EMMENAGOGUES. 309 !y vigorous, easily snbdued by any unusual exertion. In cases of this kind, all the stimulating emmenagogues would, without the use of previous depletory measures, not only be ineffectual, but injurious. Bleeding, a tem- perate diet, tepid bath, &c. are here the proper reme- dies; and they often restore the regular evacuation of the catamenia, in a prompt and effectual manner. In prescribing, therefore, for suppression of the men- ses, it is of the utmost consequence that we attend to the general state of the system. Without such attention, indeed, our success must not only be extremely precari- ous, but our remedies very often increase the mischief we are called upon to remedy. Alibert justly observes, that there are few disorders which depend on such a variety of causes, or are con- nected with such different conditions of the general sys- tem, as obstructed catamenia. Hence, its remedies are so various, and often of such contrary character; and hence, too, the great uncertainty of all our remediate measures in such cases. radix hellebori nigri. The plant which furnishes this article is indigenous to the Austrian Alps, the Appenines, and the Pyrenees. The root, which is the only part employed in medicine, consists af numerous black fibres, springing from knotty branches, which issue out of a central radical tuber. Its taste is acrid, bitter, and nauseous, and, when chewed, it imparts a benumbed feeling to the tongue.* * The root of black hellebore is not unfrequently adulterated by other roots, some of which are powerfully poisonous. The roots of the adonis vernalis, trollius europaeus, actaea spicata, astrantia major, helleborus foetidus, veratrum alcum, and aconi- tum neomontanum, are occasionally mixed with or entirely sub- 310 EMMENAGOGtfBS. Water and alcohol draw from it a bitter and acrid extract. According to the analysis of Vauquelin, its constituent principles are, a very acrid essential oil, a small portion of extractive matter, faecula, a vegeto- animal substance, and salts. Geise considered the acrid oleo-aetherial fluid as a peculiar principle, to which he gave the name of heUe- borinum. According to Pfaff, however, this substance approaches more to the character of a resin than to an essential oil. It is best extracted by alcohol, and is dis- tinguished by its leaving an exceedingly acrid taste in the back part of the mouth and fauces, when chewed.* The root loses its active properties by age. Its fibrous are much more powerful than its knotty or tuberous parts. This is one of the most ancient articles of the materia medica. Ctesias, who lived in the time of Plato, and anterior to Hippocrates, speaks of it as a medicine of important virtues. It was particularly celebrated with the Greek and Roman physicians as a remedy in mania. The extraordinary cures performed at the island of An- ticyrus, famous for its hellebore, are celebrated by the poets and historians of antiquity. The doses which the ancients employed were, however, much larger than we would venture upon at the present day, and its effects stituted for it. The root of the adonis vernalis maybe distinguish- ed from that of the black hellebore by the fibres not issuing from branches, but immediately springing from a central tuber: they are also more numerous and more fleshy, externally darker and internally whiter, than those of the hellebore. The principal root of helleborus foetidus is thin, not knotty, nearly straight, with fewer fibres, which are short, very black, and much more acrid than those of helleborus niger. The root of actaea spicata is spin- dle-shaped, jointed, yellow within, with woody fibres. Trollius europaeus has a very short radical tuber with branched fibres, which have neither taste nor smell when dry. The root of as- trantia major is articulated, spindle-formed, and slightly acrid. That of aconitum napellus is roundish, spindle-shaped. * Pfaff's Mat. Med. torn. iii. p. 253. EMMENAGOGUES. 311 accordingly were often excessively violent. It appears, indeed, by the accounts which have reached us of the employment of this article among the ancients, that they never expected to cure, without producing with it symp- toms of a very violent character. Hence Oribasius, in his treatise on the use of hellebore, has two chapters, en- titled " Quae faciendum sit quum strangulatio occupat eos qui Elleborum sumpserunt," and "Qnae faciendum sit ubi vox et sensus ammittitur."* When given to animals in large doses, hellebore pro- duces the following effects: slow and difficult respiration; slowness and sometimes irregularity of pulse; vomiting of mucous and bilious matter; an increased flow of saliva; trembling and unsteadiness; vertigo; convulsions followed by tetanus, and diminution of heat. The animal finally becomes cold, respires after long intervals, and dies.f From a variety of experiments performed by M. Orfila on dogs, he concludes, 1. That powdered hellebore, ap- plied to the cellular texture, is rapidly absorbed into the circulation; 2. That its local effects are confined to the production of slight inflammation; 3. That "the part which is soluble in water is that in which the poisonous property of the hellebore resides;" 4. That the alkaline extract of black hellebore, which forms part of Bacher's tonic pills, is also extremely active. J When taken into the human stomach it manifestly increases the force and rapidity of the circulation, and excites a sensation of warmth throughout the whole body. When taken in large and repeated doses, its effects are often, as I have already stated, very violent. Indepen- dent of the powerful vomiting and purging which this * M«dical Sketches, by G. Kerr, p. 22. t A Memoir upon the effects of Helleborus Niger and Albus, by M. Schabel, of Weissenburg, read in Sept. 1818, to the So- ciety of Emulation, of Paris. \ System of Toxicology, by M. P. Orfila, M. D. translated by J. G. Nancrede, p. 208. 312 EMMENAGOGUES. article is known sometimes to produce, its long use occa- sions a singular feeling of coldness in the abdomen, mus- cular debility, anxiety about the heart, slow and small pulse, headach, stiffness of the muscles of the neck, pain in the glands about the throat, slimy whitish mucous discharges from the bowels, spasms, delirium, haemor- rhages, &c* The emmenagogue virtues of this article remained unnoticed until the celebrated Mead announced them to the public. As is usual with those who introduce new remedies, he lavished the most extravagant encomiums on the emmenagogue powers of this substance. On the continent of Europe, especially with the Germans, this remedy stands in no small repute. But in England, as well as in this country, the authority of Cullen, who re- garded it as nearly inert in this way, has thrown it into unmerited neglect. It seems to me quite certain, however, that both Mead and Cullen were wrong in their estimates of the powers of this medicine, and that it is entitled neither to the ex- travagant praises of the one, nor the unqualified condem- nation of the other. Indeed, within a few years past, its reputation as an article of the materia medica seems to be again advancing. Hellebore appears to possess a very considerable ten- dency to determine the circulation to the hypogastric and pelvic viscera. This is evinced by the sense of weight and pain which patients generally experience after having taken it for some days; I have known this determination to be so great as to produce a profuse haemorrhagy from the uterus. From its stimulant properties, one would be led to re- gard it as inapplicable to cases where there is a fulness * Buchner de salutarii et noxio Ellebori Nigri usu. Halae, 1748. Burdach's System der Arzneymittellehre, vol. Hi. p. 124. Hartman de virtute Hellebori Nigri. EMMENAGOGUES. 313 of habit, or in a sanguine constitution. Yet Mead, Lewis, and other eminent writers say, that it is precisely in such cases that its emmenagogue virtues are most conspicuous. Burdach, however, in his excellent work on the materia medica, asserts that it is particularly valuable in cases of torpor, where the face is pale and leucophlegmatic, and the pulse soft. To this latter opinion I am inclined myself; at least, my own expe- rience goes directly in favour of it, independently of the theoretical considerations which point that way. In a recent work on the materia medica* it is stated that it is especially useful as an emmenagogue when it purges, in cases attended with torpor and constipation of the bowels, and " perhaps with a degree of insensibi- lity of the uterus." My own experience, however, leads me to a contrary conclusion. It does not appear to me that its cathartic effects are, under any circumstances, necessary, or even accessory to the attainment of its em- menagogue results. I have been much in the habit of employing this article in amenorrhoea, and it has always appeared to me, that, whenever it purged freely, as it generally does when it purges at all, it was less apt to evince the desired effects. If, indeed, its emmenagogue powers depend upon its tendency to produce a local plethora in the uterine system, we can easily imagine how an active catharsis should lessen these effects. It may be exhibited in substance, or in the form of extract, infusion, or tincture. The extract is given in the dose of from six to ten grains. The tincture is most commonly employed; its dose is from twenty to forty drops, two or three times a day, in a cup of some aro- matic tea, such as rosemary, pennyroyal, &c. Bacher's pills answer extremely well. They are composed of equal * Elements of Therapeutics, 8cc. by Dr. N. Chapman. VOL. I.—r r 314 EMMENAGOGUES. parts of the extract of hellebore, myrrh, with a small portion of carduus benedictus.* Given as an hydragogue, these pills have been taken to the extent of thirty a day, in three doses often each, at the distance of an hour between every dose. Taken in this way they produce very copious evacuations by stool and urine. "Durii.g their use the patients must be en- joined to drink plentifully of mild liquids. Upon a due attention to this circumstance, viz. dilution, the success of the remedy as a hydragogue in a great measure de- pends."! JUNIPERUS SABINA. Savin is a small evergreen tree, of the cedar species, indigenous to Italy, Portugal, and Switzerland, where it • grows in elevated situations in considerable abundance. It is cultivated, with us, in gardens, and is perhaps, of all other articles of this class, the most commonly known for its emmenagogue virtues. Its leaves contain a large portion of a very pungent es- sential oil, to which the medicinal virtues of the plant may be fairly ascribed.J When taken internally it powerfully excites the vas- cular system. It produces a manifest flow of blood to the uterine system; and, when taken in large doses, oc- casions great heat, agitation, haemorrhage, and inflam- mation of the bowels. The testimony of Dr. Home, of Edinburgh, is strong * B Extracti ellebori. nigr. Extr. myrrh aquos. aa 5i. Pulv. card, bened. ... 3111. M. ft. In pilulas divid. aa gr. i. pondere. t Thesaurus Medicaminum, p. 62. \ Cullen. EMMENAGOGUES. 315 ui favour of the emmenagogue powers of this plant; and until the time of Cullen, it was very generally regarded as one of the most potent articles of this class of reme- dies. By this writer, however, whose authority, though great on all subjects, has, perhaps, often been too im- plicitly received, the reputed emmenagogue virtues of this substance were considered as unimportant. It there- fore soon fell into general disrepute both in England and in this country. When amenorrhoea depends on a relaxed state of the general system, or on an inactive and torpid condition of the uterine system, the savin may be often very advan- tageously employed.* It need hardly be observed, that its great stimulant properties render it inapplicable in cases attended with a high degree of phlogistic diathesis. Wedekind,f a German writer of great respectability, says, that this article may be applied with very great ad- vantage in the treatment of that atonic, or relaxed state of the uterus, attended with an unnatural secretion and soft swelling of this organ, Which is sometimes met with in women of advanced age, who have suffered much from repeated child-bearing or abortions, gnd which is gene- rally attended with a train of hysteric disturbances. 1 have occasionally employed this article in cases of amenorrhoea, in females of a relaxed habit of body; and, though sometimes without success, 1 have had sufficient evidence of its powers in this way to establish, in my opinion, its just claims to our attention. Savin has been employed in various other affections, in some of which its remediate powers seem to be very considerable. Rave, a German writer of respectability, speaks in the highest terms of its use in chronic rheu- * Bayler iiber die heilkraft der sabina. Burdach's Arzney- mittellehre, vol. iii. p. 300. t Wedekind iiber die anwendung der sabinae by frauenzimer- krankheiten. In Hufeland's Journal, vi. Bd. 1st. nr. 3. 316 EMMENAGOGUES. matism.* I have employed this remedy for more than ten years past, in this disease, and I can truly say that its good effects have, in my practice, often been surpris- ingly prompt and decisive. Savin, according to some writers, possesses active an- thelmintic powers.j From my own experience I can say nothing of its virtues in this respect. Werlhof speaks well of this article in caries of the bones. It has also been much extolled by some Ger- man writers for its remediate powers when applied to old and obstinate ulcers, either in the form of decoction or of poultice. As an escharotic application to venereal warts and other fungous excrescences, the powdered savin is not unfrequently employed. And an ointment made of it is one of the most excellent applications we possess for keeping up a discharge from a blistered sur- face. It is given in substance in the dose of from one to two scruples three or four times a day. It is almost impos- sible to pulverize it without previously drying it in a high degree of heat; and, as the active part is an essential oil, very readily volatilized by heat, the powder is always an improper form for exhibiting it. The best way is to beat it up with honey or with any kind of syrup, into the consistence of a conserve. A decoction of one ounce of the leaves to one pint of water, boiled down to half a pint, with the addition of two ounces of syrup, may be conveniently given in the dose of a large wine-glass full every two or three hours. The oil is given in doses of from one to six drops. Hartman gives the following prescription, into which savin enters as a most powerful emmenagogue: I$> Pulv. hellebor. nig. tyv. Pulv. G. myrrh. • Uber die anwendung der Sabina by der gicht, Sec. 1794. t Alibert. Burdach. EMMENAGOGUES. 317 Ferr. ammoniat. Extract sabinae. aa 5ss. Syrup, croc. q. s. ut, fiant pilulae ponder, aa gran. unse. Three to be taken three or four times a day.* The compound tinct. of savin, L. Ph. is given in the dose of a drachm twice a day. MENTHA PULEGIUM.—PENNYROYAL. The plant which goes by the name of pennyroyal in this country, is the cunila pulegoides, and not the men- tha pulegium, as is commonly thought by those who are not acquainted with botanical distinctions. These two plants are, however, so nearly allied to each other, both in botanical character and in their sensible properties, that we would be led, a priori, to expect, which in fact appears to be the case, an entire similarity in their me- dicinal powers. As a popular remedy for suppressed menstruation there is, perhaps, no other article so generally employed. Its emmenagogue virtues are, however, extremely pro- blematical. Cullen considered it as perfectly useless in this respect, although he thinks it of service in "the dyspeptic and spasmodic symptoms of the stomach," which some females experience about the period of men- struation. From my own experience I can say nothing in favour of this article, although I have prescribed it very frequently. As a vehicle for the exhibition of other emmenagogue remedies, an infusion of the pennyroyal is much in use in some parts of Europe, and in the interior of our own country. • Thesaurus Medicaminum, p. 145. 318 KMMENAG0GUES. ROSMARINUS OFFICINALIS. The rosemary is a plant well known in this country as a common garden shrub. It is indigenous to Spain, Italy, and the south of France. Water draws from it a bitter extractive matter. A very odorous, resinous prin- ciple is extracted from it by alcohol. It also yields a very pungent essential oil by distillation. Proust has dis- covered a sixteenth part of camphor in this oil. M. Margueron has found that oil of rosemary decomposes the nitrate of mercury, the oxymuriate of mercury, the yellow sulphate of mercury, and the caustic muriate of antimony* It is much in use as a domestic remedy for obstructed catamenia, and it would appear from the tes- timony of several respectable writers, that its powers as an emmenagogue are not inconsiderable. Cullen, how- ever, attributes to it no virtues in this way. Dr. Chap- man, on the contrary, gives it a better character, and alleges that he has used it in several cases " with un- equivocal success." Murray does not mention it as an emmenagogue. I have employed it in but a very few cases, and can therefore say but very little of it from my own experience. As a warm, aromatic stimulant, it may often be given with much advantage in nervous disorders, such as ver- tigo, palsy, and spasmodic pains of the stomach. It has also been extolled in the treatment of glandular swell- ings in infants.f But its usefulness, says M. Alibert.J is particularly conspicuous in chlorosis, a disease which is very generally complicated with a weakness of the abdo- minal viscera, or an aberration of their sensibility. The * Alibert, Matiere Med. vol. ii. p. 127. t J. C. Speis, Rosmarini Historia Medica. Helm, 1818. t Nouveaux Elemens de Therapeutxque et de Matiere Medi- cale, vol. ii. p. 128. EMMENAGOGUES. 319 same author states, that a vinous infusion of this plant is an excellent remedy in chronic diarrhoea. It is generally used in the form of an aqueous or vinous infusion. The essential oil is given from two to ten drops, on sugar. Rosemary is a principal ingredient of the preparation known under the name of Hungary water. RUBIA TINCTORUM.—MADDER. This is a perennial plant, and cultivated as an article of commerce in different parts of Europe. The root, which is the only part of the plant employed, is long, slender, of a red colour, and succulent, with a white lig- neous pith in the centre. Its taste is slightly bitter and somewhat austere, and imparts both its taste and colour- ing principle to water. When given to animals with their food it soon gives a red tinge to the bones and the urine. Mr. Gibson,* of Manchester, has experimented largely with this article, in relation to its effects upon the bones and secretions of animals, and he has established the fact, that its co- louring principle is manifested only where it meets with phosphate of lime, which acts as a mordant in fixing and evolving it. It is chiefly upon the evidence of Dr. Home in favour of its emmenagogue virtues, that its claims to notice are founded. By this eminent physician it was regarded as the safest and most powerful emmenagogue known. He asserts, that out of nineteen cases treated with this re- medy fourteen were cured. By the late Dr. Barton also, it was thought to possess no inconsiderable powers in * Transactions of the Manchester Literary and Philosophical Society. 320 EMMENAGOGUES. this way. Respectable as these testimonies are, it is still very doubtful whether this article possesses any such powers. Very few physicians employ it at the present day; and whatever may be its virtues, it does not possess the confidence of the profession as a remediate article. I have employed it frequently, but never derived the slightest advantage from it. It appears, indeed, to have very little influence of any kind upon the functions of the animal economy; nor has Cullen's suspicion with regard to its supposed deleterious qualities ever been confirmed. It is given in substance, in the dose of from 9i. to 3ii.* POLYGALA SENEGA. This plant, indigenous to the United States, is enti- tled to very great attention for its various and important medicinal virtues, whatever we may think of its powers as an emmenagogue. Dr. Hartshorne, of this city, appears to have been the first who noticed the emmenagogue virtues of this arti- cle. Dr. Chapman speaks of it in the highest terms of praise. " Of all the emmenagogues which I have tried," says he, *' this is the most efficacious, and will be found useful in all forms of amenorrhoea." And again: "I have used it with sufficient success to warrant me in recommending it as one of the most active, certain, and valuable of the emmenagogues." From my own expe- rience, however, as well as from that of some of the most respectable physicians of this city, I am led to a * Dr. Colhoun informs me that he saw a case of amenorrhoea, in the Pennsylvania Hospital, in which 5ss. was given, by mistake, instead of 3ss. It produced a slight discharge of blood from the uterus. The medicine may, therefore, be usually given in too small a dose. EMMENAGOGUES. <$% J very different estimate of the powers of this remedy as a promoter of the menstrual discharge. I have tried it repeatedly, but hitherto uniformly without success. I am not, however, disposed to regard it as wholly inert in this respect. The testimony in favour of it is too respectable to allow me to doubt its occasionally mani- festing such powers. I am nevertheless entirely con- vinced that Dr. Chapman has expressed an opinion much too favourable of its efficacy as an emmenagogue. It is best given in the form of decoction. An ounce of the bruised root to a pint of boiling water, and boiled down one-third, will make it sufficiently strong. Three or four ounces of this decoction must be given during the day. It should be commenced six or eight days pre- vious to the regular period of menstruation, and gradual- ly increased to as much as the stomach will bear.* cantharides. Agreeably to the ideas given in the commencement of this chapter, concerning the modus operandi of em- menagogues, we should be led, a priori, to expect such virtues in cantharides: for they have undoubtedly a very considerable tendency to determine the circulation to the pelvic viscera. The emmenagogue properties of cantharides have been noticed by Allen,f Adair,J and Burdach.§ The latter writer says: " In obstructions of the catamenia, arising from debility and torpor of the uterine system, fly plasters laid on the lower part of the abdomen, or on * Chapman's Therapeutics and Materia M dica. f Synopsis Medicinae, vol. ii. p. 235. | Essays on Fashionable Diseases, Sec. § System der Arzneymittellehre, B. iii. s. 107. VOL. I. S S 322 EMMENAGOGUES the sacrum, have been known to do good; or the tinc- ture of cantharides may be given internally, in combina- tion with tincture of aloes." Adair recommends this latter combination as very useful in amenorrhoea. Allen, in enumerating a variety of emmenagogues, mentions cantharides in union with camphor, but makes no fur- ther observations as to the powers of this mixture. Within a few years past Dr. Joseph Klapp, of this city, has directed his attention particularly to the emmena- gogue virtues of this article, and has published the result of his experience upon this subject, furnishing thereby much interesting evidence in favour of the existence of such properties in cantharides.* In my own practice I have found this article to display very decided emmenagogue virtues in several instances. In the majority of cases, however, I have found it to fail in common with other articles of this class.f In exhibit- ing this remedy, it is necessary to attend to the state of the general system. When the habit of body is full and inflammatory, venesection ought always to be premised to the exhibition of this medicine. In cold and phleg- matic temperaments, its action in this way would seem to be most conspicuous. It seems to be peculiarly adapt- ed to those cases of amenorrhoea which are attended with fluor albus. In this affection it appears to do good by exciting the mucous membrane of the uterus and vagina to a new train of actions, independently of its powers to increase the determination of blood to these parts. Twenty drops of the tincture is to be given three times a day, and gradually increased until symptoms of strangury supervene. * American Medical Recorder. 11 was directed to the employment of cantharides, as an em- menagogue, by Dr. Klapp's publication, prior to which I was not aware that this article had ever been used for such purposes. EMMENAGOGUES. 323 ALOES EXTRACTUM. The natural history of this article has already been given under the head of Cathartics. Agreeably to the opinion expressed in the beginning of this chapter, rela- tive to the modus operandi of emmenagogues, there is no difficulty in perceiving how aloes should prove em- menagogue independent of any specific virtue in this way. When speaking of this article before, its peculiar tendency to act upon and stimulate the rectum was particularly pointed out. The effect of such an irrita- tion, by a well-known law of the animal economy—ubi iritatio ibifluxus—is, an afflux of blood to the rectum and neighbouring organs. Hence the pernicious con- sequences of aloetic purges in persons labouring under haemorrhoidal affections. In cases of this kind it is ex- ceedingly apt to bring on bleeding from the tumours in the rectum, or, at least, to render them turgid and in- flamed. In males a long course of aloetic medicines seldom fails to bring on piles. In females, on the con- trary, where there is no strong tendency to haemorrhoides, it more commonly brings on copious discharges of blood from the uterus, or in amenorrhoea, re-establishes the regular flow of the catamenia. In patients of a delicate and relaxed habit of body, with a constipated condition of the bowels, we may often derive very great advantage from a combination of aloes, steel, and myrrh.* Where amenorrhoea is connected with haemorrhois, which is not unfrequently the case, aloes is an improper remedy. Instead of re-establishing the menstrual discharge, it is apt to increase still further the haemorrhoidal affection; and by thus establishing a more copious discharge from * ft Pil. aloes cum myrrh. Pil. ferri comp. a& 31- Sodae sub-carbonatis. ^i. M. Divide massam in pilulas xxx. Dose, two, twice a day. 324 EMMENAGOGUES. the vessels of the rectum, a derivation from the uterine vessels, and with it a diminution of the menstrual effort takes place. In chlorotic females small doses of aloes and iron will sometimes produce very happy effects. I have known it to be prescribed with prompt success in a case of amenorrhoea, in combination with pulv. ipeca- cuanhae, in the proportion of ten grains of aloes to one grain of ipecacuanha, every morning, noon, and evening. > The semicupium is an excellent auxiliary to this, as, in- deed, it is to all the other articles of this class. It does not appear that the emmenagogue effects of aloes is pro- portionate to its cathartic operation. Small doses, just sufficient to unload the bowels, will, in general, do better than such as are large and more active in their purgative effects. //. Medicines that increase the Parturient Action of the Uterus. ABORTIVA. As yet we know of but one article which has any de- cided tendency to excite the propulsive efforts of the gravid uterus, and this is the secale cornutum, or ergot. This article is a parasitic fungus, occupying the glumes of the rye, (triticum secale,) of the genus sclerotium, and natural order fungi. For an interesting account of its natural history, the reader is referred to a paper by Dr. William Tully, published in Silliman's Journal of Science and the Arts, vol. ii. p. 48. There is no article of the materia medica more emi- nently calculated to excite our admiration of that won- derful and mysterious connexion of the various organs of the animal economy, by which a slight impression upon EMMENACOGUES. 325 one part is instantly propagated to another, and there manifested often by the most vehement actions. Taken internally in a large dose, it excites nausea and vomiting, attended sometimes with vertigo, pain in the head, and increased excitement of the vascular system. Its power, however, of increasing the parturient efforts of the womb, is by far its most prominent and important character. As a partus accelerator, it stands alone in the materia medica, and is capable, by its prompt and certain operation, of affording the most happy results, in the hands of a cautious and judicious practitioner. When labour is protracted in consequence of feeble or irregular contractions of the uterus, this medicine, administered under due precautions, hardly ever fails to excite vigourous and effectual contractions. In a large majority of cases the ergot may, indeed, by regarded as a very fit substitute for the forceps and vectis. When once the uterus is under its influence, the parturient ef- forts generally continue uninterruptedly; the contractions of the womb never totally cease, but keep up a constant propulsive effort. It commonly manifests its operation in twenty or thirty minutes after its exhibition. Sometimes, however, the effects do not show themselves until a much longer time has elapsed. The force of the contractions are often surprisingly vehement; and it is, therefore, obvious that this medicine cannot be given indiscrimi- nately, or without a proper regard to circumstances. Should it be improperly given, before the os uteri is soft and in a state to dilate, or has already considerably di- lated, rupture of the wound might ensue. If the mouth of the uterus is considerably dilated, and no particular rigidity of the external parts present, it may be given with perfect safety and with almost a certainty of success. By some physicians it is supposed that this article ex- erts a deleterious influence on the foetus: the life of which, they assert, it not unfrequently destroys. If this 326' EMMENAGOGUES. be true, it forms, indeed, a very serious objection to its employment. My own experience with this article has not been sufficient to enable me to speak with confidence upon this point; I suspect, however, from what I have myself seen, and from the detailed experience of others, that there is no.good foundation for this opinion, and that the cases which have been recorded by some prac- titioners, as demonstrative of its injurious effects,* are to be considered in the light of accidental coincidences, rather than the positive results of the medicine .f The cases to which it seems particularly applicable are: 1. Where abortion becomes inevitable in the early part of pregnancy, and the contractions are feeble with considerable haemorrhage. In such cases the exhibition of this article will not only shorten the sufferings of the patient, but in a great degree remove the danger. 2. In cases of alarming haemorrhage near the close of utero-gestation, not occasioned by attachment of the pla- centa over the os uteri, and not accompanied by efficient contractions. 3. In puerperal convulsions in which a speedy deli- very becomes necessary. 4. In lingering labour, the os uteri being sufficiently dilated, and the parts properly relaxed. 5. In retention of the placenta from a want of contrac- tion of the uterus. * Vide Dr. Chatart's paper in the Med, Repos. for 1820. t Dr. Hosack, speaking of this article, says: " The ergot ha3 been called, in some of the books, from its effects in hastening la- bour, the pulvis ad partum; as it regards the child, it may, with almost equal truth, be denominated the pulvis ad mortem—'for I be- lieve its operation, when sufficient to expel the child, in cases where nature is alone unequal to the task, is to produce so violent a con- traction of the womb, and consequent convolution and compres- sion of the uterine vessels as very much to impede, if not total to interrupt the circulation between the mother and child." New-York Med. & Phys. Jour. Vol. i. p. 206 EMMENAGOGUES. 327 6. " In subjects liable to haemorrhage after delivery from laxity and deficiency of contraction."* In such cases the haemorrhagy may be entirely prevented by the exhibition of a proper dose of ergot fifteen or thirty minutes previous to the time when labour would other- wise be expected to terminate. 7. To restrain haemorrhagy after delivery. Ergot has been recommended as an emmenagogue, but I believe upon a very slender foundation. I have prescribed it in four cases, with a view to its emmena- gogue effects, but without the least advantage. It seems, indeed, to exert very little influence on the vascular sys- tem; and when we consider, that as an uteri contractor, it must tend rather to diminish than to increase the quantity of blood in the vessels of the womb, its emme- nagogue powers will at once appear very doubtful. This article was used, out of the profession, as a pro- moter of parturition, more than a century ago. In re- gular practice, however, it was not known until Dr. Stearns, of Albany, brought its virtues before the pub- lic; and to him, therefore, belongs the merit of having first directed the attention of medical men to the extra- ordinary powers of this article. In Europe it was at one time regarded as a powerful and extensive cause of disease. Epidemics of a very fatal character were ascribed to the effects of the ergot, mixed with the rye which was ground up for bread stuff. What foundation there is for this opinion I can- not undertake to say. It appears to me unphilosophi- cal, however, to account for epidemics by ascribing them to a cause which must be always, in a degree, present. *Dr. E. A. Atlee. Vide American Med. Recorder, vol iv p. 141. END OF VOL. I.