NATIONAL LIBRARY OF MEDICINE Washington t? •TA T^ • iT®^ '?& ••iw,i. l ■■ v- C,« T '■" '-'"' LEXINGTON, K. PRINTED AND PUBLISH' T) BV JAMES W. PALMER. 18 23. ferfRobucTibN. FA.CTS accurately observed, and faithfully recorded, can a< lone improve the practice of medicine. Books of cases, there- fore, are infinitely preferable to books of theories. Merely to report what a person has observed, may be reckoned an easy mode of writing But is there no difficulty in divesting the mind of prejudice? no effort necessary in a man's 'shaking off the yoke of authority? in extricating himself from the trammels of routine practice? Too many physicians begin practice under the incalculable disadvantage of implicitly believing what they are taught, and of disbelieving every thing contrary- It is no uncommon thing for one to affirm, that he has observed particu- lar effects from a certain remedy or mode of treatment; while another makes the same experiment, with a very different result. The explanation is, the circumstances of the patients, and thfe conduct of the practitioners, though assumed to be parallel, may yet be very different. Besides, it is not every practitioner who withes to see an innovation verified, however important. A thorough knowledge of the powers and modes of operation of medicines, is absolutely necessary to successful practice. Whoever is but superficially acquainted with this branch of his profession, must prove but a lame and blundering practitioner, however splendid his talents and acquirements in other respects. Such knowledge is not to be acqu red by merely getting the list of officinal medicines, or formulae of the Pharmacopoeia by heart, so as to be able to answer a few questions at an examination foa a decree It is the result of long study, assiduous application, and power of discrimination. It is easy to judge from a physi- cian's prescrip ions, of the extent of his knowledge in tjierapeu- tics Whoever exhibits a number of remedies at the same time, whether of similar or opposite tendencies, is not destined great- ly to illuminate (tie medical horizon. By simplicity of practice alone can the powers of medicines be accurately ascertained. If a number of causes are put in op- eration together, and at random, to which are we to attribute the effect? Complex practice cannot but lead to erroneous con- clusions concerning the powers of medicines. This proposition, though almost self-evident, I shall illustrate by a most apposite instance. A considerable number of years ago, Dr Von Tribo- let, physician at Bern, published Remarkable Observations on the use of veri, large doses of Henbane in Inflammation. With this medicine he cured the severest cases of s-henical pneumonia, and other inflammatory complaints, without the aid of blood-let- ting, and his patients recovered sooner than those who were 4 treated in the usual method. Bat, unfortnrately for the credit of henbane, our author adds, / give nothing -with it but the an. timonial-wine* There can beno d«ubt ll>»' Dr. I nboltl a-cribed j to henbane what belonged chiefly to Emetic Tartar His prac- tice, therefore, is strongly corroborative of my own. The successful application of a single remedy to a number of different diseases, will be a sufficient pro )f to some, I m ..ware, that it is not or much use in any. But it must be recollected, that the leading features of all the diseases treated of in this Work are only two, inflammatory action, and irregular distribu- j tion of the blood. The bare mention of a preventive of consumption will 1 ikewise, lam convinced, make an unfavoiable impression on the minds of many with regard to this work. It should be read, however, and the facts duly weighed, before judgment is parsed. I ask no more. I have had my share of experience, and know accurately the practice of the leading men in this city, in consumption; and I am free to say, I never saw any remedy, or combination of rem- edies, produce effects at all comparable with those of Emetic Tartar in cases 41, 55, 56, &c of this work. As things are gen- erally more easily judged of by comparison, I shall state my practice in opposition to the common, in a single instance. Al- most all physical patients are more or less troubled with cough. Emetic Tartar allays the inflammatory irritation of the lungs, and expels the acrimony which occasions it, from the system; | other practitioners uniformly prescribe opiates, which merely coerce the cough, and, at the same time, increase the phlogistic diathesis. I leave it to common sense to decide which of the modes of cure is the most scientific—which is most likely to benefit the patient. ♦London Medical and Physical Journal, vol. xxxvii, page 164. ILLUSTRATIONS OF THE POWEn OF EMETIC TABTAB. ONE of the greatest bars to improvement in the prac- tice ot medicine is the supine belief, that nothing can be added to our knowledge of the qualities of those reme- dies which have been long in use. Hence it is, that the greater number of these who are stimulated by the noble ambition of distinguishing themselves as the benefactors of mankind, direct their efforts to the discovery of new remedies, instead of instituting experiments with those whose medicinal powers are demonstrated. But I be- lieve it trill be conceded by the liberal and well informed of the profession, that much may yet be discovered with regard to the powers of those medicines even which have been in use from time immemorial, and which are famil- iar to every practitioner. It is well known, that doses of medicines have been given by mistake, which no practi- tioner would have been justified inprescribing;and instead nf doing miichief, produced only the desired effect. Such occurrences are of themselves sufficient, one would think, 40 excite the most indolent to observation, and to con- vince the inquisitive, that his knowledge is imperfect. Despicable indeed must that practitioner be, who, from beginning to end of his career, is legulated entirely by the general directions of a dispensatory in his exhibition of medicines,—wlio will not take a single step unless he can quote an authority. It is well known, that an ordi- nary dose of medicine will at one time prove hyper-ca- thartic, and at another time quite inefficient, in the same individual. Is it not therefore a lair inference, that much remains to be discovered with regard to the powers of medicine in different diseases, and in different cir- cumstances of the system in the same disease? Is it not rendered more than probable, that trials of increased doses of medicine, consistently with perfect safety to the patient, in one case, or one disease, and diminished doses iu others, would, if conducted witkaccurate ob- a iervation, produce results with which we are altogether unacquainted? Medical practitioners, no doubt, imagin- ed they were sufficiently well acquainted with purgaiivc medicines, before Dr. Hamilton wrote on the subject. But he has given a different view of the matter; and there are few practitioners, 1 believe- who will not own their obligations to that distinguished author. Were such mode of investigation, as that I have hinted at, more generally practised, physicians would find them- selves under less necessity of hunting after new reme- dies; they would find the tenth ot what they already pos- sess mote than sufficient for all the purposes of practice; they would become like dextrous surgeons, who depend more on their own management and skill, than on num- ber of instruments. One thing must be admitted, for it is universally true, that the most skilful practitioners prescribe the fewest medicines. It is those who practise from mere authority, at random and by rote, who pour mixture upon mixture into tlieir patients, and ily from medicine to medicine, in order to accon.piish their pur- pose,—thereby rendering the. means of cure infinitely mere insupportable to their patients than the disease it- self. The scientific practitioner, on the contrary, when his prescriptions are not attended with the desired effect, suspects the accuracy of his own observation, or of the information he may have obtained as to the state of his ■ patient; and therefore inquires more minutely into th,e .circumstances of the case; varies the dose instead of changing the medicine, or omits medicine altogether; well knowing, that it can never be other than an auxiliaiy to nature, in the combats she has to sustain with disease. Emetic Tartar has been in use ever since the in- troduction of chemical medicines into practice, and ev- ery author has been loud in its praise. It is very ques- tionable, however, that its employment has been as uni- versalis the encomiums bestowed on it would indi- cate. This much I can assert, that 1 have been in the habit, for many years, of meeting with the most eminent practitioners in this city, who never once hinted at the employment of antimonials, in even the most acute in- flammatory diseases. I have, moreover, made inquiry of my professional friends,---gentlemen in extensive practice, what their experience was on this head? and, li to a man, they frankly acknowledge, that, though they knew Emetic Tartar to be an excellent medicine, in nauseating doses, as promoting perspiration without heat- ing the system, yet they never entertained the view that I have given of it;—that "the sedative and febrifuge powers of Emetic Tartar," is a phrase quite new to them;—and that they never trusted to it as calculated to save a single ounce of blood to any patient, in any circumstances. With Dr. Cullen, Emetic Tartar was a favorite rem- edy. This appears from his First Lines. I have been told, but I do not believe it, that he carried this medi- cine an unjustifiable length. The only subject of re- gret, however, is, his recommending it, wherever he speaks of it, in nauseating doses. Had not this been the case, the authority of so great a inm must infallibly have rendered the employment of it touch more general than it has yet been. Nausea is an unpleasant feeling'; nor is it easy to induce patients to swallow the medi- cine a second time, which is sure to produce it. Prac- titioners, too, who suffer themselves to be influenced chiefly by appearances, would naturally conclude against a remedy which, unless exhibited with judgment and caution, is violent in its operation, arid which, in the days of Dr. Cullen, was comparatively new. Hence, together with the aversion manifested to it by a great, living character, the almost total neglect Emetic Tartar has experienced in this country. Even at this dav, it is in nauseating doses only the remedy is recommended;, and in constitutional derangement alone; or where lo- cal affection is so considerable as to give reason to ap- prehend constitutional derangement. I trust, however, to be able to shew, that Emetic Tartar is eminently effi- cacious in chronic, as well as in acute disorders; in top- ical affections, as well as in general derangement; and that its efficacy, in either case, is not confined to nau- seating doses. Nay, more, 1 will demonstrate that, in many cases of local inflammation, accompanied with violent reaction, blood-letting to one-third the extent generally practised, is not necessary to the cure; that a speedy and perfect cure can be obtained with the loss &f so moderate a quantity of blood, as to warrant the conclusion, that it might be safely omitted altogether, 4 oven in circumstances in which it ii generally consuiei ed the only means of saving the patient. It is on all hands agreed, that blood taken from a large mifice, in other words quickly, so as t;> produce . syncope, has more decided effects in sthenic inflamma- tion, taan a large quantity taken slowly, or at different time*. Does not this suggest, that neither the quantity of blood in the system, nor the quality, is the cause of the disease? and, therefore, that excessive blood-letting is not necessary to the cure? Does it not point out, that if, by any other means than blood-letting, the same de- gree of relaxation of the system could be induced as takes' place in syncope, equally beneficial results might be ob- tained, as to lowering arterial action, and resolving con- gestion? I think it more than probable, that, even in the severest case of sthenic inflammation, Emetic Tar- tar may be so exhibited, as, after one or two bleedings, according to circumstances, to supersede the farther use of the lancet. And, would not this be a mighty object gained? If such a thing is possible, why should practi- tioners continue to abstract sixty, a hundred, two hun- dred ounces of blood from a person laboring under pneumonia? A recovery after such practice is in many instances, an escape, not a cure! Is it consistent with any principle, that life should be reduced to the last ebb, without regard to age, habit or constitution, on ac- s count of the recurrence of pain in the chest, and diffi- culty of breathing, when we possess the means of equal- izing the circulation, without producing corresponding debility? The Diathesis Phlogistica of authors, or tho preternaturally increased tone or contractility ot the arterial system—sometimes induced bvany considerable local inflammation, at others, the effect of general cau- ses, and always tending to congestion—is most readily and effectually taken off by the relaxing power of blood- letting; which ought, therefore, in pressing circumstan- ces, to be first employed. What I contend for is, There is no necessity, in even the most urgent case, (or car- rying the lancet the length of "giving the patient the chance;" that is, of nearlv bleeding him to death, in or- der to save his life. But blood-letting operates in two ways, in lowering the action ot the system in inflammatory affections. la 5 the first place, the distension of the arterial system is mechanically taken off. In the second place, the stim- ulus of the blood itself is diminished, and consequently the action of the heart, as depending on that stimulus. For, in proportion as the quantum of red particle is les- sened, the circulating mass mu>t lose its exciting pow- ers. Hence the debility consequent on excessive loss of blood To moderate vascular action, therefore, without inducing dangerous debility, must be the leading indi- cations in inflammatory complaints. And these indica- tions will be best fulfilled by keeping in view the prima- ry affection. That the nervous system is first affected, in the com- mencement of febrile complaints, we know, from the change ot feeling, and prostration of strength experien- ced. Afterwards, the vascular system becomes affected and the circle is completely formed; tne nervous and vascular systems now act reciprocally on each other. The timeous application, therefore, of means suited to remove the primary affection—of the warm-bath, friction and percussion—the latter to the spine in particular; and these succeeded by Emetic Tartar, in doses proportion- ed to the urgency of the case—would go far, in many casts, to prevent re-action altogether; and consequently the necessity of blood-letting. At all events, Emetic Tartar, from its natural and powerful tendency to equal- ize the nervous power, cannot fail, even where blood- letting is necessary in the first instance, to supersede the necessity of recurring to it so often, and carrying it to that degree, which are found necessary, when the lan- cet alone is trusted to, for the removal of,inflammatory complaints. Should it be said that if the nervous and arterial sys- tems act reciprocally on each other in supporting re-ac- tion, blood-letting must be beneficial in diminishing the morbid influence of the latter on the former; I admit the justness of the observation. For it must be recollected, I am not combating blood-letting in toto: I object only to its being carried beyond just bounds—to its being employed singly and alone in any important case—and to its being had recourse to on every frivolous occasion. It must be admitted, moreover, by the most strenuous advocate for blood-letting, that m a case of inflamma- A fl. G tion, where depletion has been practised on a liberal scale, the arterial must have ceased to influence the ner- vous system, in a morbid degree, long before it becomes necessary, in order to obtain more blood, to place the head lower than the trunk of the body, that the brain may receive from the heart that support, without which it cannot perform its functions. In reporting cases of inflammation, it is usual for practitioners to state the appearance of. the blood every time it is drawn. From this, one would be tempted to think they seek the justification of their practice in such appearance. The tendency to separation in the proxi- mate principles of the blood, however, is an effect,not w cause of inflammatory action; and rather indicates what bus already taken place, than what is actually going on in the system. This is evident, from the fact, that blood drawn in the commencement of inflammatory complaints, often exhibits not the slightest trace of a buffy coat; whereas a short time afterward, this appearance is man- ifest. The scientific practitioner, therefore, will never be induced, from such appearance, to take a single ounce more or less, in anv case, or in any circumstance;!. The authority for blood-letting is to be' sought for. in the ac- tion of the system, and in the state of the secretions and excretion?; not in the appearance of the blood after it is drawn. In proportion to the morbid excitement of the vital and suspension of the natural functions, is blood- letting, or any other remedies which produce similar ef- fects, indicated. Thus, if the heart and arteiies are in a state of high excitement, the respiration hunied, and the temperature of the body increased in proportion—-;f ihesc^-efcion'iif the saliva and gastric juice is suspended; if the .skin is dry, the bowels costive, the urine scanty and high colored;those remed:es..which restrain the action of the vital organs and which restore secretion and excretion are indicated, whatever appearance the blood mayexhihit. If these sympt-ns have existed for any len-rh "„f ti-oe," there can Le no doubt the whole mass of blood world exhibit the bully coat. It is impossible a fluid from which all the solids and fluids of the body are secreted— a fluid mvhich, during health, a perpetual process of i waste and repair is carried on—can continue to exhibit a healthy appearance, when the furctiuns of secretion and excretion are suspended or impaired. Independent- ly, therefore, of the absurdity of being regulated in the administration of a powerful remedy by ex post facto evidence; whoever pays any regard to the appearance of the blood, will often omit blood-letting when it will be ol the most essential service, and carry it too far when it ought to be suspended. I know a surgeon who was consulted by a man having very little appearance of ailment about him, but who wished to be bred. The surgeon objected, but being urged he proceeded to the operation; and observing in the first cup unequivocal appearances as he thought, of inflam- mation, he boasts of having bled the patient as long as he could stand, sit, hear or see. Twelve ordinary cups of blood were drawn! I do not know whether to ad- mire this practitioner's courage or consistency most. In- deed I have often been at a loss to know, whether it is on their courage or on their skill that such practitioners pique themselves:. One thing is certain, that in their hands, one of the best of remedies becomes much more dangerous than the disease they are called to cure. 1 accidentally saw a young woman lately, who had been bled ten times in the course of a month, for a ca- tarrhal affection, with stitch in the side. She still had an incessant dry cough, with, marked determination ot blood to the head, although she had lost from loO to 160 ounces of blood. These circumstances prove, that profuse and repeated blood-letting will not always equal- ize the circulation. The collapse, indeed, that must fol- low the abstraction of a great quantity ot the vital fluid, is extremely unfavorable to its equal diffusion; and also to excretion, either by the skin or the lungs. Hence may be explained the inefficacy of blood-letting in many cases ot inflammatory irritation of the lungs, and of ap- oplectic diathesis. From this view of the subject, 1 think I may affirm, without fear of being successfully contradicted, that there is neither safety nor science in carrying blood-letting to the extremes so much m voKue :n the present div. that the practice is in many instan- ces lit'le less dangerous than the disease it is intended tocu-e, will be conceded, I believe, by its most strenu- ous advocates; that it is, in many instances, really more «o, is confirmed by every day's experience. And, trom 3 many considerations, it may be demonstrated, a prion, that it cannot but be fatal. Nature will conquer many dreadful attacks of disease; but it her resources are ex- hausted, she must succumb. Suppose a person advanc- ed in life, and who had been accustomed to live fully, to be all at once, when in perfect good health, put upon water-gruel and purgatives, and to have twenty-five or thirty ounces of blood taken every day, for three, four, or five days successively—what condition would this person be in at the end of such a process of privation and exhaustion? But if, in addition to these, he also labored under distress of body, and anxiety ot mind, the danger ot his situation would be much increased. Is it reasonable to expect that nature will triumph over such fearful odds? But the immediate consequences of exhaustion are not alone to be dreaded from, the unlimited use of the lancet. The blood is the source of all the fluids of the body. If, therefore, that is greatly deteriorated, so must these; and all the functions to which they are sub- servient, impaired. Hence the tendency to putridity in the fluids of those who have suffered great loss of blood. I once saw a lad, fifteen years of age, labouring under pneumonia, and from whom sixty-four ounces of blood were abstracted in the course of three days. He be- came extremely languid, and his whole skin of a death- j like appearance. In examining the trunk of the body, 1 I drew my finger lightly across his breast, when the cut- icle came off, and a watery fluid exuded from every pore. Contrary to the strict orders of the physician who preceded me, I gave him half a glass of port wine, and repeated it at short intervals, for several times. From that moment the boy did well. Many a patient, there is little doubt, whose constitution resists fur a time the shock of sudden exhaustion, ultimately falls a sacri- fice to its consequences. Thecjreof inflammatory complaints by blood-letting, -. without the aid of those remedies which more directly '< affect the nervous system, is certainly not the most sci- entitle mode of proceeding. It is, at best, but curing by anticipation, or by obviating the effects of the primary affection, leaving this to shift lor itself. It re-action has taken place before the physician is called in, blood let- 9 tiog, as already observed, may be necessary, becaus* increased arterial action, at first an effect, now acts as a cause. But certainly attention is even then due to the primary affection. And if due attention is paid to it, its effects will be more easily controlled. The advocates for the unlimited use of the lancet, however, follow a more summary method. They cure their patients in the same way the Romans gave peace to the countries they invaded; and that was, by making the blood of the in- habitants to flow, till they became perfectly passive. This is lowering the action of the system with a ven- geance! But it will be found, that as certainly as the action ot the arterial depends on that of the nervous system, so certainly will those remedies which tend to equalize the nervous power supersede the necessity of unlimited blood-letting. These observations being intended as introductoryonly to a more extended discussion of the subjects herein men- tioned, I proceed to a detail of facts, dlustrative of the efficacy of Emetic Tartar in the cure of Fever, Inflam- mation, and Asthma; and in the prevention of Phthisis and Apoplexy. CASE I. Mr. S. aged thirty, wa9 attacked on the 7th Decem- ber, 1817, with pneumonia, for which he was bled to six- ty ounces in three successive days; and on the 15th, again to twenty ounces. Having got out in about three weeks after this, he was again seized with pain in the breast and difficulty of breathing, accompanied with much higher fever than in the first attack. He was bled to twenty-six ounces, with relief at the time; but in twenty-four hours after, all the symptoms returned With increased violence. Afraid of the patient's strength failing, as his feet were now become cedematous, I was unwilling to carry blood-letting any farther. I therefore ordered an ounce of a solution of two grains of Emetic Tartar in six ounces of water, to be given every hour. The third dose produced sickness ; and with it relief from pain. In four days the patient was free from com- plaint in his chest. About the middle of February he had another attack of pneumonia, which again yielded to Emetic Tartar, without bloodletting being premised, 10 Had I, in this instance, continued to trust fo the lancei for subduing the inflammatory action that existed, tho- racic efi'usion would have been induced, and I would infallibly have killed my patient. CASE II. George Page, aged 36, a mason, had the outside of his right leg, from a little below the knee to the ankle, grazed by a plank in the falling of a scaffold, on the 25th November, 1817. Having, by compression with the hand, reduced the tumour formed at the outside by the violence of the squeeze, and applied a bandage to sup- port the parts, I ordered a poultice to the parts higher up, which were abraded, and whose.organization, I was convinced, was destroyed. On the fourth day the patient could walk through the house, and the parts abraded had assumed a black ap- pearance. 1 therefore expected they would have sepa- rated without occasioning any derangement of the sys- tem. On!xthfc fifth day, however, I found the patient in a career of fever which I have seldom witnessed. I hesitated a moment whether I should bleed him copious- ly; but preferred exhibiting an ounce every hour, till nausea should be produced, of a solution" of Emetic Tartar—half a grain to the ounce of water. The third dose occasioned sickness. His friends imagined hint dving, but he told them ha was prepared to expect such effects from the medicine He took no mo e of it. Next day he was as free from fever as if he had never had any. The gangrened part separated and the wound healed up kindly. CASE III. Mrs. B. aged fifty-five, a thin, delicate, complaining woman, was attacked in January, 1818, with pain in the chest, difficulty of breathing, and fever. She had strug- gled with her complaints some days before I was called. I found her extremely weak, pain in the breast fixed, se- vere and impending respiration to a distressing decree pulse 100. small and hard. Mie complained also of be- ing drenched in sweat every night; tut especially to. wards morning, and on the head and superior pa'rts of the body chiefly. I ordered her a solution of 4 grains $f Emetic Tartar in eight ounces of water. Of this she was to take a table-spoonful, four times in the twenty- four hours, unless such quantity sickened her; in which case the dose was to be diminished, so as not to occa- sion nausea. In five days the pain in the breast was removed, and she could make a full inspiration. Debil- ity and night-sweats were now her only complaints: For these I had recourse to nitrate of silver in the form of pill—a fourth of a grain a dose, three times a day. The power of this medicine in checking the sweating, was almost immediately felt; and the patient gained strength daily. In ten days from the time I was called in, I took leave of this lady—restored to a greater degree of health and strength than she had for a long time en- joyed. CASE IV. Mrs. P. contracted a bad cold in the course of the winter 1818, which continued for many weeks. Cough became at last incessant, accompanied with increased soreness in the chest, and difficulty of breathing. I was called on the 12th March, and found her pulse 58, op- pressed and interrupted. No voice. She declined be- ing bled. I therefore ordered as follows : R'Tart. antimon. et potass, gr. ii. Sulphat. magnes. oz. i. Aq font. oz. viii. Solve. Capiat cochlear, mag. omni hora, usque ad nauseam sci- endam. 13th.—Had not taken above three ounces cf the med- icine, for dread of sickness. All the symptoms much the same as yesterday. I now insisted on letting blood; but could procure no more than 14 ounces, on account of the patient fainting. Continue the medicine as for- merly dir cted. \4th.—Pulse still 58, and oppressed, but less inter- rupted. Some voice. Cough greatly abated. Some expectoration. Bowels regular. Continue the medi- cine. 15£ft.—Pulse 62, less oppressed, and quite regular. Cough almost gone. Voice restored, and breathing per- fectly free. Fine diaphoresis. Continue the medicine. I had now no fear of re-action taking place, though the 13 circulation was not so free as I could lave wished. From the moment, indeed, that the patient took her medicine as directed, every symptom gave wzy. and she never had the slightest degree of sickness. Within a week from the time I first 8aw the patient, she was perfectly free from complaint; and the pulse had risen to 70, with- out any increase of heat. CASE V. Mrs. M. aged twenty-six, was seized on the 27th March, 1818, with a violent pain in the left lumbar re- gion, reaching round to the pubes. She could neither rise up nor sit down without crying cut. Pulse 80, strong and hard. I ordered four grains of Emetic Tartar, and an ounce of Epsom salts, in eight ounces of water; of this, a table spoonful every hour for three times, and af- terwards every two hours. The three first doses opera- ted powerfully on both stomach and bowels. Of) the 28th the pulse was still at 80, but soft and full. Appli- ed compression and percussion to the pained parts; by which the patient was enabled to move with ease. In the evening I found my patient much worse, on account of having used freedom with herself in the course of the day. Had taken none of her medicine. Her pulse was increased in hardness, frequency, and force. A fixed pain in the chest, right side, affected respiration strongly. In one word, she was precisely in a state that, according to modern practice, demanded an imme- diate and free use of the lancet. 1 diluted the medi- cine, and represented the danger of not complying with directions. This had the desired effect. She took her medicine freely; and next day at noon, I found her free from complaint, her pulse 60, and pain in the chest gone entirely. ° _ In communicating to my friend, Dr. Anderson of New York, the observations I had made on the sedative and febrifuge powers of Emetic Tartar, he informed me that so far as he could learn, this medicine is much more generally employed in America than in this country. On coming to particulars, however, he admitted that my anguage concerning it was new to him; that he never heard it talked of as sedative and febrifuge; nor of its being capable of superseding blood-lefting in inflamma- 13' tion, to the degree 1 have observed it; an observation, however, which he has amply confirmed by the two fol- lowing excellent cases. I set the more value on these cases, that they were communicated by one wh-o was sceptical on the subject at the time they occurred, and who is well qualified to appreciate the power of medicine. They are, in one word, the tribute of an en- lightened, liberal,, unbiassed mind; and I shall present them to the reader in the author's own words. CASE VL "Buccleugh Place, Feb. 28, 1818. "Dear Sir, "I send you the following case of Cynanche Tonsil- laris, in consequence of our late conversation on the beneficial effects of Tart Antimon. when exhibited in inflammatory, and some other diseases. A young lady, aged twenty, of a thin habit of body, was attacked on the 16th February with difficult and painful deglutition. On the I7tkshe took some opening medicine; but finding herself considerably worse, she requested me to see her on the 18th. Upon examination, I found both tonsils much swelled and inflamed, the left considerably more so than the right, the velum pendulum palati elongated, and the uvula laying on the dorsum of the tongue, and the tongue considerably swelled, skin hot and dry, pulse 107. I desired her to take an ounce of the sulphate of magnesia, and to repeat it in three or four hours if ne- cessary—to apply the liniment, ammoniat. fort, diligent- ly to the neck, to bathe the feet in warm water, and to foment the throat with steam arising from a decoction of chamomile flowers and poppy heads. She felt a little relieved in the evening, but there was no sensible amend- ment in the throat.—19th, increased difficulty in swal- lowing, and pain extending to the left ear. The throat was of a darker colour, with several small whitish specks on the left tonsil. Skin hot and dry; pulse 120; order- ed a solution of gr. iv. tart, antimon- in eight ounces of water, a table spoonful every hour, till vomiting should be produced. This was effected after the third dose, when a small quantity of bilious matter was dis- charged. A copious perspiration followed, which was allowed to subside, and gentle diaphoresis was kept up H by a table spoonful every hour, of a solution of two grains tart, antimon. in eight ounces of water.— 20*/;, passed a good night; skin cool and moist; pulse 78, pain in the ear entirely gone, and swelling in the fauces very much abated. Nothiug further was required in this case, than an astringent gargle to restore tone to the parts.— 22c?, The patient was engaged in her usual avocations, with little or no diminution of strength. "It appears to me, that, according to the present fash- ionable mode of practice, if I may be allowed the ex- pression, this lady would have come cheaply off with the less cf from thirty to forty ounces of blood. Indeed, on the 19th, I doubted whether the urgency of the symp- toms did not require blood-letting. But the delicate habit of the patient, with the malignant appearance of the fauces, and my firm conviction, from several cases you related to me, of the efficacy of this important rem- edy in inflammatory diseases, induced me to rely upon it as the principal means of cure. (Signed) Andrew Anderson, M. D." It is not uncommon, certainly, to administer emetics in the beginning of this disease; and they are often at- tended with the happiest effects. The local inflamma- tion is thereby mechanically discussed. But whoever heard of cvnanche tonsillaris, where the local affection was so severe, and fever ran so high, being cured in one night, after having existed for four days? On the 19th, the pulse was 120; on the 20th, 78—with correspondent amendment of all the other symptoms. Blood letting, to any extent, could not have done more than was, in this instance effected by two or three grains of Emetic Tartar! CASE VII. "Bucchugh Place, April 9, 1818. "Dear Sin, "The following is a case of iriflammation in the lungs, in which tart, antimon. was liberally and successfully employed. A young man aged eighteen, of a spare ha- bit of body, sent for me on the evening of the 10th March. He complained of general uneasiness, pain in r it, I extracted only ten ounces of blood, merely to take off the pressure of" present symptoms, and to give time for the Tart. Antim. to produce its effect. Ordered pulv. jalap, comp. ^dr. Su!jn>uriat. hydrar. gr. vi. m ; and a table spoonful of the solution every half-hour.— 3 o'Clock P M The powder has operated four times; has taken six doses of the solution; does not feel sick; has less pain; coughs easier, and expectorates freely; skin moist; pulse 120; feels much relieved. Desired him to continue the solution every hour if awake. "March 12.—Slept tolerably well; has taken five doses of the solution since yesterday; perspired a great deal during the night; feels a very slight pain upon taking a full inspiration: no sickness; has had no farther evacua- tion from from the bowels; skin moist; tongue foul; pulse 98. Ordered sulphat. magnes. |oz.; and to continue the solution every hour.— 13th, Slept well; feels no pain; tongue much cleaner; skin moist and cool; bowels open: has some appetite: wishes to get out of bed: pulse ran- ges from 74 to 78. 14th. 15th, 16th. Has taken the solution occasionally: is perfectly well, and almost as strong as before his illness. "It must be evident to every unprejudiced person, that the small quantity of blood taken in this case could have very little effect in permanently reducing the in- flammatory action. It is unnecessary to make any far- 16 {her observations, as the facts above stated appear to ma to be quite conclusive. (Signed) Andrew Anderson, M. D." The sum of this case is, that pneumonia of uncommon severity was cured in two days by Emetic Tartar, aided ^ by the mission ot only ten ounces of biood, and a pur- gative Nor was there the slightest degree of nausea during the whole cure. If Emetic Tartar has not bten strangely neglected, and its powers under-rated, how comes it that blood- letting is resorted to on every emergency, and carried such lengths as are recommended from every chair, and inculcated by every author? If practitioners believed they were possessed of a remedy capable of curing such a case of pneumonia as that now detailed, they would i quickly perceive the absurdity of trusting to the lancet alone, in any the most urgent circumstances. That medicine which can of itself cure a case of pneumonia of uncommon severity, must be a powerful auxiliary to blood-letting in the worst possible case of inflammation. CASE VIII. Mr. W. was attacked on the 17th December, 1817, early in the morning, with pain in the great toe, at the instep, reaching through to the sole, and round the outer ankle of the right foot I was called to him in the course of the day, and found the parts swelled, excru- j ciatingly pained, and of a fiery red. Pulse 80. From my patient having had several attacks of gout before, there was no room to doubt that his present complain: was of the same nature. I proposed to bathe the parts with spirits and water of a temperature with that of the parts—a practice 1 followed before Dr. Scudamore pub- lished on gout. To this the patient objected, on the score of his having been treated in the same way once before, when he had a slow recovery. I applied compression with my hand, dipped in flour, for a lew minutes, which he bore very well, though friction would have made him mad. Ordered a solution of two grains of Emetic Tar- tar in six ounces of water, of which he was directed to take an ounce every two hours. Dec. 18.—Passed a very restless night. Pulse 96, and 17 hard, with stitch in the right side—increased by coughs ing or a full inspiration. Had taken very little of his medicine. I now informed him, that, if he did not take his medicine as prescribed, I would be under the necessity of bleeding him freely, by which he might lay his ac- count with being much longer confined than he other- wise would be. This had the desired effect, as he re- gretted absence from business much. This day he took his medicine steadily, with the addition of two drachms compound powder of jalap. In the evening 1 found his pulse much fuller and softer, with an agreeable diapho- resis all over the body; stitch in the side declining, and the purgative had operated briskly.—Dec. i9th. Passed the night very well; no uneasiness from the foot; redness and swelling declining; pulse 86, full and soft. Continue the antimonial mixture in quantity to maintain a softness of. the skin.—Dec. 20th. Pulse natural; stitch gone; bow- els regular. But the patient cannot point his foot to the ground. Applied percussion gently all over the sole, and then a bandage. In tie evening could walk a little. Repeated the operation and bandage. Next day, 21st, could walk pretty well. On the 22d, walked perfect- ly well. On the 25th, my patient sent for me to his counting room, when he told me his right foot was as bad as his his left had been, and that he could not point it to the ground, were he to be made proprietor of Edinburgh for so doing. Admitted he had got a fresh cold; pulse ri- sing and hard. Applied percussion to the sole of the foot for some minutes, when the patient was imme- diately enabled to walk. Gave him a slightly nause- ating dose of his antimonial medicine. He dined in his counting-room, and walked home at eight o'clock. Passed an uncomfortable night. Next day resumed his antimonial medicine, none of which he had taken during the night. This day he took six drachms sulphat. mag- nes. also.—t7th. Was free from complaint, with the ex- ception of being slightly lame. Two more doses, there- fore of percussion, exhibited on the morning and evening of this day, completed the cure, and the patient went abroad on the 28th in perfect good health, which he has enjoyed uninterruptedly ever since. is All the authors and practitioners without exception, whom I have had an opportunity ef consulting, recom- mend Emetic Tartar in nauseating doses—with the view of producing sensible effects on the skin. I am quite prepared, however, to shew, that its exhibition is not confined to cases of high re-action; and that its benefi- cial influence does not always depend on its producing nausea; that, on the contrary, it operates powerfully as a sedative, and equalizes the circulation in cases of lo- cal inflammation, where no re-action exists—without producing nausea, or any sensible effect whatever on the skin. In cases of high re-action, it is advisable and necessa* ry to induce, as quickly as possible, that temporary de- bility which is the consequence of nausea, and by which every considerable operation of the animal machine is lowered, but it is for want of observation that nau- sea is so generally made the criterion of an efficient dose of Emetic Tartar. Emetic Tartar, though a perfectly safe remedy, yet requires to be exhibited with caution. In some consti- tutions it produces nausea and vomiting, in even the minutest doses; to others it may be given with freedom, without being attended with any such consequences. Nor have I observed it less beneficial in the latter, than in the former cases. Some people are nauseated by the first or second, and not by succeeding doses of the same quantity: others are not sensibly affected till the medi- cine accumulates its powers, as it were, in the system; and in ali this variety of idiosyncracy, it still lowers the action of the system and of every considerable opera- tion in it. CASE IX. . A man aged thirty-six, id" a spare habit of body, was seized instantaneously on the 22d January, 1818, while from home, with lumbago. And so excruciating was the pain, that he was driven home, laid at full length in a cart. I visited him next day, and found he could not even tun himself in bed without extreme suffering. Pulse 60. and oppressed. He was averse to blood-let- ting, so I ordered him four grains Emetic Tartar in 8 ounces of water, of which he was to take an ounce ev- 19 pry hour till sickness or vomiting ensued.—24£/t, Has taken all the medicine without any other sensible effect than that he can turn himself in bed, rise up and lie down with much greater ease. Pulse below 60, and op- pressed; bowels natural.- Repeat the mixture.—25r/j, Pain in the recumbent posture gone; can turn himself any way he pleases, and stoop almost to the ground with- out much uneasiness. Bowels regular; pulse above 60, and less oppressed. 26th, Has been out of bed most of yesterday: pulse natural Thinks there is a little mois- ture on his skin in the morning, but is certain the medi- cine keeps his bowels in order. As the patient com- plained of want of rest, he had an opiate at bed-time. He also continued his antimonial mixture, though les* frequently, through the day; and from this date he rap- idly recovered. Here, then, is a case, in which local congestion and pain effecting the circulation, and from which violent re-action was to be apprehended, was resol ved and subdued by Emetic Tartar, without producing nausea, or any decidedly sensi- ble effects on the skin. Nausea, and its effects on the skin, are therefore contingent consequences of the exhibition of Emetic Tartar: that is to say, they may happen in one case and not in another; they may occur at one time, and not at another, in the same individual, and yet the medicine produce the desired effects in ail. CASE X. Captain B. applied to me on the 12th December, 1817, for a rheumatic affection in his right shoulder and left elbow joint. He could neither put on nor off his coat without aid, and was deprived of sleep by the pain in the elbow attacking him in the night, in paroxysms of such severity as to make him cry out. In ten minutes I gave freedom of motion to the shoulder; aad the pain in the elbow was coerced in a considerable degree by a bandage, but not removed.—On the 13th he did not go abroad, and when I visited him at 3 P. M. found a slight degree of fever present. Two grains of Emetic Tartar in six ounces of water were ordered: of this the patient was directed to take a table spoonful every hour, till nau- sea supervened.—14th, Had taken most of his medicine without nausea or any sensible perspiration. Slept well, 20* having had but one attack of pain in the night, which was instantly checked by percussion.— \5th, 16th, Sleeps without interruption, and is free from complaint. CASE XT. About the middle of January, 1818, William Pater- son, a poor lad, aged nineteen, came to my hou9e at 9 o'clock at night, with one arm of a ragged coat on, and another off, complaining most grievously of pain in his elbow joint There was much swelling round the joint, and a considerable way both above and below it. 1 han- dled the parts as the patient could suffer me, but had no bandage to apply. In a few minutes he began crying like a child. I asked him if I had hurt him? He as- sured me not, but he was sure a snow shower was fall- ing, for the pain was always much exasperated by such an occurrence. 1 looked out and found his conjecture correct. 1 gave him three ounces of antimonial mix- ture, in which was a grain and a half of Emetic Tartar., directing the one half to be taken as soon as the patient got home, and the other half in an hour after. Next morning it was reported to me, he slept all night, a few minutes only excepted, when he experienced a slight par- oxysm, and I ordered the medicine to be continued. On the third day after his applying to me, 1 visited the pa- tient, as the physician whose care he was under before he came to me had not, he said, called on him for some time. I found him lying at ease, the swelling reduced two-thirds, the pain, even to the touch, entirely gone, ex- cept in a single point in the bend of the arm. Six grains of Emetic Tartar in twelve ounces of water, was the a- mount of the medicine taken. It produced not the slightest nausea, nor any observable increase of perspi- ration, fur thirty-six hours. It then began to operate powerfully on the skin But before this took place, pain was completely subdued. Indeed, he had but one return of pain, and for a few minutes only after he began the medicine. I applied compression to the pained point, first with my hand, and then with a bandage—including the whole of the parts that had been swelled. Two more operations gave complete motion to the joint, and the patient was at his work in a week. SI This and the preceding case afford one of the finest illustrations of the power of medicine, that perhaps ever occurred to any practitioner: and exhibit the sedative qualities of Emetic Tartar in a striking point of view. Nor is it possible to adduce more satisfactory instances of a constitutional remedy affecting parts in a state of morbid action, without producing correspondent or sen- sible effects on the system. In these cases the natural tendency of Emetic Tartar to affect the stomach and the skin seems to have been counteracted by a superior determination to the parts af- fected. Or they verify the observation, that where there is much local pain, the doses of medicines require to be greatly increased, to produce their effects upon the sys- tem. Here, too, I may remark, that if, as some thiiik, the proximate cause of rheumatism consists in a peculiar affection of the nervous system—particularly of the nerves of the parts affected: then the two immediately preceding cases prove, that Emetic Tartar exerts a di- rectly sedative power on the nervous system. Paterson remarked, sua sponte, that he felt the first doses of the medicine go directly to the pained part, producing the sensation of an agreeable motion all over it. Dr. Barlow of Rath, in an ingenious and able essay,* relates some cases of rheumatism, which he quickly cured by Emetic Tartar—exhibited in doses sufficient to stag- ger the resolution of even the boldest practitioner. The Doctor himself does not recommend the general adop- tion of the practice; and if the cases which I have de- tailed shall come to his knowledge, he will see, that it is not necessary to the cure of the most excruciating case of rheumatism;—he will see that Emetic Tartar effects as complete cures, when exhibited in doses insufficient to produce any sensible evacuation, as when accumulat- ed in the system to the amount of sixteen grains. The unavoidable consequence is, that Dr. Barlow proceeds on assumed data—that morbid secretion in the stomach and bowels are not the cause of rheumatic pains and stiffness of the joints. It will be denied by none, I presume, that morbid se- cretions in the stomach and bowels may, and do exist, * Edin. Med. & Surg, Journal, vol. x. SSL In a greater or less degree, in every constitutional de- j range merit—that such secretions may occasion sympa- thies in distant parts—that they may be both a cause and an effect of constitutional derangement--that gene- ral health is preserved and promoted by the frequent e« vacuation of the stomach and bowels; but to attribute to morbid secretions alone, in the stomach and bowel .<, ef- fects which are so much under the control of external circumstances— effects which may exist to-elay and not ' to-morrow, while the cause remains the same—is to refer to an uniform cause effects which are variable and in- constant, not only in degree, but as to their very exis- tence. Emetic Tartar, in doses of seven or eight times the me- dium quantity for an emetic, must produce, it may well be supposed, both copious and discolored evacuations from the stomach and bowels. The secretion into these cavities must be greatly increased, during violent purg- ing and vomiting: so that much more will ultimately be discharged, than really existed at the commencement of the process. The violent excitement of any organ will, by concen- trating the nervous energy, relieve, for a time, every oth- er part from pain. But violent vomiting and purging give a tremendous concussion to the whole frame, and powerfully excite the action of the absorbents. Vascular congestion, there- fore, cannot but be strongly affected by them. U is on the very same principle, then, with compression and per- cussion, that vomiting relieves congestion in rheumatism. The only difference is, that, in the one case, the remedy is applied through the system; in the other, mechanically and directly to the parts affected. In the one case, the efforts of the whole system are put in requisition for the relief of a part; in the other the part is relieved without the system being so much as aware of it. Compression and percussion, by simply unloading and exciting the ac- tion of the vessels, give as complete relief from pain and swelling in rheumatism, as the most excessive evacua- tions, of whatever kind, can accomplish. The effects of Emetic Tartar in the cure of rheumatism are, therefore, not to be attributed to the dislodgment of either morbid or morbific matter from the stomach and bowels. •I'o We have a fine illustration of the power of concussion in equalizing; the circulation, in sneezing. This is an effort of nature to prevent the determination of blood to the head, and to resolve congestion already formed in catarrhal affections. Every body knows the universal and forcible concussion the body receives, and the relief obtained, on these occasions. This effort of nature can be imitated by percussion applied to the shoul lers, and the whole length of the spine. 1 have done it a thousand times with perfect relief from violent headache, and ev- ery catarrhal symptom. We never attribute the effects of emetics in dropsy, or hernia humoralis, to the evacua- tions which are made from the stomach and bowels; but to the action excited in the system \nd I am convinc- ed, that Emetic Tartar owes more of its febrifi ge pow- ers, in the commencement of fever, to its equalizing the circulation, and therefore lowering the action of the sys- tem, than to the displacement of either morbid or mor- bific matter. Let any one contemplate Dr. Cullen's inimitable de- scription of the phenomena of fever, and say if the ner- vous system is not primarily affected? if to this cause are not referable all the succeeding phenomena of irreg- ular and oppressed action in the first place, and in the se- cond place, the re-action of the arterial system? Emet- ic Tartar, therefore, having a direct influence on the ner- vous system, prevents or moderates its re-action; and, consequently, that of the arterial system, independently of any evacuation it may occasion. The matter is evi- dent to the most superficial observation. It will not be denied, I presume, that the nervous power is equally li- able, with the blood, to irregular distribution. Neither will it be denied, that where the nervous energy is de- ficient or concentrated in any part, arterial action is di- minished or increased. And, when the nervous system is in a peculiar state of excitement, a diathesis phlogis- tica, or fever, is the consequence. CASE XH. On the 30th April, 1818, a servant girl, twenty-six years of age, of a very full habit of body, came under my care. She had complained for eight days previous to this, and now became unable to do her work. There v-as typhus in the family at the time, which induced the medical gentleman in attendance to send her to the Fe- ver-Hospital, bhe was therefore brought to Edinburgh in a cart, the distance of two miles; but instead of going directly to the hospital, she took up her quarters with her friends for the night. I saw her at 9 o'clock P. M. She complained of headache, pain in the back, and a sense of fatigue and uneasiness all over the body. Pulse 86. I prescribed a table spoonful every hour while awake, unless sickness should be produced, of a so- lution of two grains of Emetic Tartar, and an ounce of sulphate of magnesia, in six ounces of water.—1st May, 11 o'clock Ji. M. Did not rest well; symptoms Much as last night; has taken half the quantity of the medicine. Bowels costive. Take an ounce of Epsom salts, and continue the antimonial. 9 o'clock P. M. Salts operated once. Has taken all the antimonial. Ex- perienced an approach to nausea, at one time in the course of the day. Considers herself much better. Headache not near so oppressive. Pulse 80.—May 2d, 11 o'clock A. M. Slept well; very little or no headache; pain in the back, and sense of fatigue, entirely gone. Pulse also declining. Take an ounce and a half of Ep- som salts immediately, and continue the antimonial.— May Sd. Quite free from complaint. The patient re- turned to her service on the afternoon of this day. CASE XIII. On the 7th of May, 1818,1 was called to a young la- dy, who was taken ill the night before, without any known cause. She complained of headache and general uneasiness. Pulse 86. 1 began her with very small do- ses of Emetic Tartar dissolved in water, as I knew her constitution well. The second dose, containing not more than an eighth of a grain of the medicine, and ex- hibited at the distance of two hours from the .first, occa- sioned sickness, and vomiting a mouthful or two of pure bile, which gave temporary relief from headache. In the evening the patient fainted on being taken out of bed.—May 8th. Passed a very good night: pulse 80. Take an ounce of Epsom salts, and continue the anti- monial in small quantity.—May 9th. Headache quite gone. Pulse 72.—May 10th, 11th. Pulse down to 64* and the patient considers herself well. 25 Thu9 were these two cases of fever cut short in lim- ine, by the exhi oition of Emetic Tartar—continued in alterative doses as long as any re-action existed. The power of Euietic Tartar in lowering the action of any organ in a state of inflammation, is in no case more conspicuous than in hernia humoralis. But it is not by exciting vomiting that I have fvund it beneficial in such cases. I always prefer it in alterative doses, as sufficient for every purpose in view, and having this advantage, that the patient takes it without scruple; whereas, if once nausea or vomiting is produced, an insuperable aversion is, in most cases,-ever after manifested to the medicine. CASE XIV. A gentleman contracttd gonorrhoea, in which the in- flammation ran pretty high, and the discharge was co- pious. Circumstances rendering it necessary to keep up appearances, he could not confine himself. I advis- ed abstemiousness in diet, ea^e, cleanliness, and a saline aperient occasionally. In a few days he got hernia1 hu- moralis. The affection had reached the scrotum, which had become red, by the time the circumstance was communicated to me. I ordered suspension, and a so- lution of Emetic Tartar in water, of the strength of haU a grain to the ounce. Of this mixture he took an ounce every two or three hours; and the progress of the com- plaint was immediately arrested. The cure, indeed, of the hernia humoralis, was completed in one day. The medicine was continued in small quantity for some time, but not more than six grains of Emetic Tartar were taken, and there was no return of the complaint. CASE XV. A young gentleman having contracted gonorrhoea, was greatly alarmed lest the circumstance should come to the knowledge of his friends; and therefore insisted on having an injection, that the cure might be more spee- dy. Iu a few days the discharge had nearly ceased, when the patient was seized with pain and swelling in one of his testes. I prescribed Emetic Tartar in altera- tive doses, as tne patient could not be confined. I he pain soon abated, but was not altogether removed, on 26 account of the extreme caution observed in taking the medicine, lest sickness should be induced by it. I re- monstrated with him on account of his timidity, and he increased the dose, till slight nausea was oily once pro- duced. He abandoned the medicine, and I abandoned my patient. He then promised compliance, resumed the medicine for a few days, and the cure was complet- ed. CASE XVI. Mr. J R aged seventeen,#came under my eare on the 8th May, 1818. for hernia humoralis. Dad had gonorr- Iicea for two months, for which he used astringent injec- tions at his own discretion. Pulse 92, full and strong; headache; pain in the loins: tongue foul, and skin hot. Ordered three grain of Emetic '1 artar, and an ounce of sulphate of magnesia, in eight ounces of water. Of this, to take an ounce every half hour for three times, and then every hour, unless sickness should be produced. 8 o'Clock P. M—Has taken about tour ounce* of his ' medicine, which occasioned sickness of short continu-' ance, and vomiting a mouthful or two of pure bile. Pulse 86; pain of the testes not abated. Has had no motion of the bowels to-day. Take of sulphate of magnesia, an ounce; and continue the antimonial in quantity short of occasioning nausea. 9th, 10 o'Clock J. M.— Pain of the testes, head, and loins, gone. Had one copious motion of the bowels ; pnlse 80. Continue the antimonial so as not to occasion nausea. , May 10th.—Pulse 64; swelling of the testes and red-' ness of the scrotum scarcely perceptible; no pain any where. The patient, in short, is perfectly well. Con- tinue the antimonial in small quantity for some days. I think I may venture to affirm, that there is not ano- ther practitioner within the walls of this metropolis who would not have etr.ploved blood-letting, general or topi- cal, or both, in this case; and followed it up wiih fomen- tations. But would such mode ot proceeding have been attended with success, either more rapid or more com- plete? Two grains of Emetic Tartar, with an ounce or < two of sulphate of magnesia, effected a cure in two days, -\ 27 vvithout the slightest inconvenience to either the patient or his friends;—a circumstance this, that, had the prac- tice no other advantage, would go far in recommending it to patients of this description. 1 must remark, too, that the patient was but once nauseated by his medicine, and that only slightly;—an effect I intended at the be- ginning, in order the more speedily to check the febrile action. CASE XVII. A country gentleman having contracted a most viru- lent gonorrhoea,.applied to his surjjeon, who prescribed refrigerant medicines and astringent injections. The. whole penis became irritible and inflamed, with much effusion in the prepuce. The dischnr^e soon abated, but the other symptoms remained. , In these circumstan- ces the gentleman applied to me; desiring me above all thing9 to put a stop to the discharge. I told him f "Si£ would much rather see it return; and therefore prescrib- ed a vegetable diet; and small doses of Kpsom salts oc- casionally. In a f'.w days hernia humoralis supervened; when I ordered a suspensory bandage and Emetic Tar- tar in solution. The pain and inflammation were quick- ly arrested. The patient kept at home, and continued the medicine for a few days without experiencing nau- sea, increased perspiration, or any unpleasant symptom. And the cure was completed, in every respect, in ten days fiorr, his first application to me. Most authors affirm, that the testes, if once they swell, are never reduced to their original size. I Can freely state, however, that all the four preceding cases form exceptions to tjie general observation; and I can account for the facts on no other principle, than the increased ac- tion of the absorbents, of the gland, from the medicine being continued for some time. If it should be asked, How a medicine which lowers the action of the system, can increase the action of any particular set of vessels? I answer, that we know from, observation and experience, foxglove diminishes the irritability of the system, and in- creases the action of the absorbents. CAS$ XVIII. A young man applied to me for the cure of a gonorr 28 hcea of very moderate symptoms. The discharge was never copious, and soon disappeared under the use of \ small doses of a saline medicine internally, and an in- jection of a weak solution of acetate ef lead. But an unpleasant sen-ation of heat remained along the whole course of the uretha, accompanied with a sense of ful- ness where Cowper's glands are situated; and an unusu- al nisus wp.s required for the dischaige of the urine. Leeches were recommended, but the patient had no op- portunity of using them. 1 then prescribed the bLue pill till the mouth was slightly affected; but the complaint re- mained unaltered. Recourse was then had to Emetic Tartar, in the form of pill, each of which contained a fourth of a grain of the medicine. Of these, two were taken at bed-time, and one in the course of the day. The patient had not used a dozen, when he experienced con- siderable relief; and a dozen and a half more completed if the cure. CASE XIX. A woman about forty years of age tonsulted me in- , the course of last winter, with regard to a chronic affec- tion of the bladder. She had labored under the com- plaint for some time, and at last got the better of a false delicacy, which prevented her from asking medical aid. She had an incessant obtuse pain in the region of the bladder, which increased with the accumulation ot wa- ter; and evacuation was effected with difficulty and in- creased pain. I prescribed Emetic Tartar in the form • of pill—of a fourth of a grain each. Of these she was durected totaks two at bed-time, and one in the course of the day. unless sickness or vomiting should occur. When she had taken two dozen, she returned and told me she was perfectly cured; nor did she ever experience the slightest sickness, or inconvenience of any kind, from the medicine. 1 never saw any person so grateful as was this woman, for the benefit she derived from my advice—a certain proof this, that her complaint had been severe. I mentioned my success in the above case, to a sur- geon in town, who had a lady under his care in similar ; circumstances. He immediately put his patient on the Emetic Tartar pills; and had the satisfaction of complet- I 29 ing a cure in the course of ten days from that date. CASE XX. . On the 2d of April, 1818, a young gentleman consult- ed mcfora constant uneasiness he felt about the region of the bladder, and which was increased bv the accumu- lation of water. He made water with difficulty and in- creased pain. Dated his complaint from exposure, some time before, to cold and wet. I was satisfied from the ni~ sus requisite in expelling the uriue, that the neck of the bladder was principally affected. I put him upon Emet- ic Tartar, with little or no effect for some days. At length the medicine began to operate; not, however, by any other sensible effect, than freedom from pain, and facility of making water. Two dozen of pills, each containing a fourth of a grain of Emetic Tartar, effect- ed a complete cure. CASE XXI. A young gentleman, by indulgence in a detestable practice, induced such a state of irritability in the semi- nal vessels, that he had an involuntary emission every sixth night. This habit of the parts became so inveter- ate as to set at defiance every mode of cure that had hitherto been found successful in such cases. Nitrate of silver promised fair, hut ultimately failed of a radical cure. I then had recourse to Emetic Tartar in the form of pill—a fourth of a grain at bed-time. He continued the medicine eighteen days, during ail which time he had not a single return of his complaint. He now gave over the former and the latter returned with a frequency and copiousness as if to make up for lost time. I advised the patient to allow the complaint to take its course for a short time. With this he complied, and it returned to the old habit of recurring every sixth night. On the 1st of \pril he again resumed the Emetic Tartar, with per- fect success for three weeks. I then substituted nitrate of silver, and the cure promises to be permanent. • May, 1819.—The complaint never returned, even in the slightest degree. CASE XXII. On the 24th February, 1818, Mrs. M. came under my C 2 30 care, afflicted with rheumatism in her ankles, knees, shoulders, and spine. She had been ill for some months, and could not walk a step. Pulse 112, and small. Is harassed with cough, especially in the night time. Can- not make a full inspiration. Has a child six months old which she suckles with the left breast. The right breast inflamed s< on after delivery, and suppurated in several places successively. It is still greatly enlarged, indu- rated, and inflamed at several points, and discharging at one or two openings. By compression and percussion, succeeded by bandages, the patient was enabled to walk betwixt her bed and the fire, at my first visit, and she never again lost the use of her legs. Before this she was always carried by two women. In about ten days her inferior extremities were free from pain. Not so with the back and shoulders. Percussion here was in- admissible, on account of the breast. 1 therefore put her, from the beginning, on a solution of Emetic Tartar, in alterative doses. In the course of three weeks, the patient could suffer percussion on the trunk of the body, in any force admissible in a state of health—the dispo- sition to inflammation in the mammary gland being com- pletely subdued. By this time its bulk was greatly lessened, it had become more soft and compressible, and, with the remaining rheumatic affection, was'soon com- pletely cured- 1 attribute this speedy removal of a dis- position to inflammation and suppuration in the mamma, to the Emetic Tartar alone. In morbid determination of blood to the head, wheth- er followed by inflammation, or merely occasioning con- gestion, I cannot conceive a more powerful auxiliary to blood-letting than Emetic Tartar. Powerfully relaxing the whole frame, and diffusing the blood to every part afke, it not only diminishes the force of the heart, and lowers the tone of the arteries, but must also diminish in proportion, the quantity of blood sent to the head. Ex- hibited, therefore, with judgment and perseverance, and in quantity short of occasioning vomiting, it bids fair to supersede the necessity of carrying depletion to the ex- tent generally practised, when blood-letting alone is trus- ted to in such complaints. I have been informed by Surgeons in the Army, that they have seen blood letting 31 carried to such a length, in Ophthalmia, as to induce de* bility, which terminated in typhus. Is it not likely that Emetic Tartar would have assisted powerfully in resol- ving congestion, and equalizing the circulation, in such cases? CASE XXIII. On the 18th May, 1818, Mrs. L. aged thirty-six, was seized with frequent rigors and oppressive headache, which continued for three or four days. Her right eye then became inflamed, extremely painful, and impatient of light. I saw her on the evening of the 25th. The Adnata of the eye affected exhibited a mass of turgid blood vessels, through which there was not a single white streak or speck to be seen. There was great pain, diffi- culty of motion of the eye lid, and a considerable fl »w of tears. Inflammation was. just beginning in the left eye also. I could not ascertain the state of the pulse, as the patient had walked two miles. I ordered a solution of two grains of Emetic Tartar in six ounces of water; of which she w.as to take a table spoonful every hour, or every two hours, as she found it affect her. Mau 26th___Has taken five doses of the medicine with- out experiencing any effects from it. Does not think her eye anv better. On examining it, however, I found she was not speaking the truth; and she acknowledged she was in a state of increased irritation, from having walked two miles under a burning sun, without any oth- er shade than a handkerchief held to her eye. Inflam- mation in the left eye had not advanced but rather reced- ed; in* the right eye it was sensibly decreased. Placing the patient's back, therefore, to the-lijght, and putting a shade over her eyes, she admitted she saw better, and could move her eyes with greater freedom. Continue the medicine in greater quantity. May 27th. evening.—Inflammation of the right eye considerably abated; left eye as before. Took her med- icine in the course of this day, so as to produce slight nausea. . . May 30th.—Inflammation of the right eye greatly a- bated Can suffer exposure to the light, and distinguish objects. Had a return of headache yesterday, with threats of the same sort of attack in the left eye as she 32 experienced in the right; when she had recourse to her medicine, which, she believes, checked the inflammation. At all events the inflammation is checked; and when we consider the course ophthalmia commonly runs; that it uniformly attacks both eyes in succession, if not simul- taneously, with equal severity; there cannot be a doubt, that the credit of the cure is* due to the Emetic Tartar employed As the Emetic Tartar kept her bowels in or- der, 1 purposely avoided giving this patient a single grain of any other medicine, a weak solution of acetate of lead excepted; that no doubt might be left of its pow- ers June 1st.—The patient thinks herself perfectly well; active inflammation is completely subdued; the ball of t.he eye is decreased in size; the motion of the eyedida is free; exposure to light gives no pain; the cure, in one word, is complete. Continue the medicine in alterative doses, for some days. A week after this I again saw this patient, when every trace of inflammation had dis- appeared. Here, then, is a case of violent ophthalmia membranarum, deep-seated, accompanied with pyrexia, cured in a week, and under very unfavorable circumstan- ces, by a few grains of Emetic Tartar! CASE XXIV. At three o'clock P. M. on the 17th of June, 1818, I was called to Mr. B. who had been complaining for some days of headache,-and general uneasiness. Unable lon- ger to maintain the contest, he came home an hour be- fore I was called, and went directly to bed. Pain in the forehead and at the occiput was insufferable. His face was flushed; skin hot; pulse 96, full and strong. He complained also of pains shooting through every part of his body, but particularly about his neck and chest. I proposed he should be bled immediately; which was pe- remptorily resisted by his mother. R iart. Antimon. et Potass gr. ii. Aq. font, oz.viii. solve. Capt cochlear, mag. omni hora usque ad nauseam ciend. 9 o'Clock P. M—No alteration of symptoms, lias not taken a third of the quantity ordered of his medi- cine. R Sulpha.t. magnes. oz. i. S3 Ap.. Bullient. oz. vi. solve.—Quamprimum sumend. Continue the antimonial solution. 12 o'Clock at night.—Headache rather increased; great restlessness; skin hot; pulse 96, full and strong; physic has not operated; not a drop more of the antimo- nial solution taken since last visit. I now informed the patient, that he must-either take his medicine or suffer me to bleed him; otherwise I would no longer be responsi- ble. He submitted to the first alternative; I therefore gave him a wine glass full of the antimonial solution with my own hand; and also a bolus, composed often grains of the mass of aloetic pill, and a fouithof a grain of Emetic Tartar, intimately combined. In less than an hour he became sick, vomited a very small quantity; and in a short time fell into a profound sleep, which lasted five hours. 18*/i, lo o'Clock Jl. M.—Headache greatly relieved? or rather entirely gone; skin moist and cool; pulse 74; bowels open. The patient got out of his bed before din- ner, took another bolus in the evening;and next day was free from complaint. This gentleman, though 23 years of age only, had lost, from epistaxis, and by the lancet, much more blood thaa ever was in his body at any one time. He observed the strictest temperance in his mode of living; but such was the determination of blood to the head, and 90 subject was he to inflammatory complaints, that he was"under the necessity of losing blood to a considerable amount, so frequently, that his friends became heartily sick and tired of a mode of cure, which produced no lasting ef- fect. These were their reasons for preventing me from letting blood at the beginning—reasons which certainly would have had no weight with me in circumstances so urgent, had my confidence in the sedative and febrifuge powers ot Emetic Tartar been less than it is. The fre- quent use of this medicine in alterative doses, will ope- rate, there is reason to believe, such a change in the dis- tribution of the blood in this patient, as to supersede the necessity of blood-letting in future. May. 1819.—Never was prognosis more completely and happily verified than the above. A determination of blood to the head continued to manifest itself for some time, by repeated attacks of the headache and bleed- Jng at the nose; but the Emetic Tartar being persisted in, J every symptom permanently disappeared at the end ot a fortnight. The patient now declared himself perfect- , | ly free from complaint; and felt an elasticity and buoy- ■., ancy of spirits, to which, from a perpetual sense of ful- . ntss and weight in the head, he had long been a stran- ger. CASE XXV. On the 6th June, I was called to an unmarried lady# aged thirty-six, whom I found laboring under Nephritis. , She had been iH for a week previous, but the symptoms . now became pressing, so that she was compelled to have recourse to medical aid, much against her inclination. She complained of colic pains, with a sense of coldness and fullness of the abdomen; of costiveness, coldness of the feet, sever- lancinating pain in the region of the kid- neys, shooting along the course of the ureters and inside of the thighs, particularly the left. Urine scanty, high- colored, and made with difficulty. Occasional sickness and vomiting. Pulse 100, aad small. Tongue foul. Could not lie in bed, nor sit long in any posture, on ac- count ot the lancinating pain in the back and ureters, Had taken castor oil and other aperient medicines, which moved the bowels without relieving pain. I advised that twenty ounces of blood should be taken from the arm immediately; but the patient could not be brought to con- sent. Although offended with her obstinacy, I was se- • cretly pleased at an opportunity, too precious to be let slip,"of trying what Emetic Tartar would do in such a case. I therefore ordered a solution of two grains of this medicine in four ounces of water, of which a table spoonful was directed to Le given every hour, till nausea should be produced This was at three o'Clock P.M. I visited my patient at seven in the evening, when t found her in bed, and that she had taken only an ounce and a half of her medicine, for fear of being sickened by it. No other alteration of symptoms, than that she can lie in bed. Continue the medicine with demulcent drink through the night, while awake, and avoid lying on the the back as much as possible. June 7th.—-Took several doses of her medicine early in the morning, which produced nausea and slight vomit- O 35 nig. These effects were succeeded by profuse perspira tion, which I found the patient encouraging by a lo;ul of bedclothes. Pulse 90, and softer. Feels the lancinat- ing pain very seldom and not so severly. Urme still scanty, high colored, and made with difficulty. Contin- ue the medicine. 7 o'Clock P. M.—Continued all day in bed Much the same in every respect as at last visit, the profuse perspiration excepted. Continue the medicine. June 8th.—Pul>e 86. Water is made with less diffi- culty, and in greater quantity, but very high-colored. In other respects, as before. Bowels costive. R Sulphat. magnes. oz.i quamprimum sumend. Con- tinue the antimonial solution. 7 o'Clock P. M Did not take the salts, as the solution operated sufficiently on the bowels, June 9th.—Lancinating pain in the back scarcely rett; coldness of the extremities and tern-ion of the abdomen entirely gone; bowels open. Febrile symptoms greatly declined. Makes water at times freely, at other times has calls when none can be made. Continue the medi- cine June 10th^-In every respect much as yesterday. June 11th.— Says she is quite well, can make water freely, has had no pain for the last twelve hours. Con- tinue the medicine for some days. This was the most refractory patient ever I had to deal with. To no entreaty would she yield—to no ad- vice would she submit unless it tallied with her own o- pinion Had she been bled as I advised, or had she even taken her medicine as directed, and as she might well have done without any inconvenience, the cure, rapid as it was, would have been accomplished much sooner. Four grains of Emetic Tartar, in little more than eight ounces of water, was the amount of all that was taken, and this with the utmost difficulty, in the course of five days But these very circumstances demonstrate the powerful controul Emetic Tartar exercises over the sys- tem, and every organ in it, in a state of inflammatory action. o CASE XXVI. ' A medical gentleman fiom England, Who has been iu practice for many years, consulted me in the latter end of April j concerning a hepatic affection of ten years' Standing. He als » complained of rheumatism on the right side of the spine, aud in the right arm. Had had two attacks of jaundice, and had undergone several courses of mercury. Being much engaged in practice, however, he could not pay that attention to himself that his complaints demanded. Had consulted Dr. Bai- ley, and some other eminent physiciars in London and elsewhere, who agreed there was an affection of the liver. Being desirous of having percussion applied to his back and arm, I began it with very gentle force, on account of a sensation of painful concussion which it oc- casioned in the region of the liver. 1 likewise recom- mended small doses of Emetic Tartar, to be continued as the patient could bear it. He began with an eighth of a grain at bed time, every other night. Kven this minute quantity produced sensible relaxation of j the whole frame. So much so, indeed, that the pa- tient was not much in love with the practice. Concur- ring in opinion with me, however, as to its mode of op- eration, and encouraged by its effects in those cases of obscure inflammation above detailed, he continued the ■ medicine. About a fortnight ago, (25th May, 1818,) he took a lourth ot a gram at bedtime, which occasioned sickness- in the night, but not vomiting. I promised him the happiest effects from this occurrence, and was not disappointed. The cough to which he had been subject for a great length of time, now lef him. His countenance j began to clear up. He can bear pressure on his right side ■with ease, and experiences much freer motion of the : trunk of his body He continues the medicine, and I , have no doubt it will operate a complete cure. ' It is worthy of remark, that this gentleman also expe- rienced a pleasant sensation in the parts affected, from the first doses of the medicine. He felt as it the disease ^ in bis back and arm were about to leave him. This sen- sation, however, became gradually less observable. ; These two facts (cases 11 and 26) cannot but be regard- ed as strongly corroborative of what 1 have already«ad- ': »anced, that Emetic Tartar has a direct influence on the 37 nervous system: that it is sedative and febrifuge, indepen- dently of exciting the action of the, stomach, the bow- els, and the skin. It is impossible, indeed, to explain its operation on any other principle, in the majority of the cases here recorded. CASE xxvir. Mrs. S. was seized, on the 6th July, 1818, with head- ache, and chilliness all over the body; which, however, did not amount to rigor. These symptoms continued for two days, when the left eye began to inflame. She con- suited me on the 10th, when the tunica conjunctiva ex- hibited a mass of vessels gorged with blood, There was much pain inthe eye. and great sensibility to light; and it discharged, at intervals, gushes of hot water, which produced a scalding sensation. As the patient had come from a considerable distance, I cannot speak as to the state of her pulse. I ordered a solution of four grains of Emetic Tartar in eight ounces of water; and,ol this, a table spoonful every two hours till nausea should be in- duced;—the medicine to be continued afterwards, in quantity short of occasioning nausea. July 13th, evening.—Has taken all her medicine. In- flammation of the eye is not at all diminished in appear- ance. When I made this remaik, the patient told me, that, though the eye looked as bad as ever, the pain was almost gone; and that unless she exposed it freely; to the light, she had little or no uneasiness from it. She inform- ed me. moreover, that shs had had two attacks of head- ache since last visit; both of which were instantly repel- led by a nauseating dose of the solution. Continue the medicine. July 14th.—The quantity of blood in the vessels ot the tunica conjunctiva considerably diminished. Has seldom any uneasiness except from exposure to clear 5>ht. No discharge of hot tears. Bowels costive. Has had none of the antimonial medicine for the last twen- ty-four hours. Take an ounce of Epsom salts immediate- ly; and continue the antimonial. July \8th.—The eye is more inflamed than ever. Yes- terday the patient considered herself nearly well—the pain being entirely gone, and the appearanct also, ot the eye, much improved. Could assign no cau&e for the 33 sudden change to the worse; but, upon being questioned', said that, having kept the house all day for fenr of the sun hurting her eye, and because she perspired copiously, she went out in the evening for the benefit of the air, and sat at the door, till she felt herself become very chill; that she went to bed perfectly well, but awoke in the wight time with violent rheumatic pains in the left side of her head and under jaw, and next day found her eye mucn worse. This relapse is therefore to be placed to the account of the patient's imprudence; not to the in- fcfficaey of the Emetic Tartar. The cure, indeed, was, hy her own admission, very near complete. Bowels o- jpen Continue the antimonial solution. July i2d.— Inflammation almost entirely gone. Can look steadily at any object. The inflammation has been subsiding ever since last visit, so that the relapse was of very short duration. The patient remarked, without my putting any question to her, that she was quite sen- sible of the beneficial influence of the medicine, in re- lieving the sense of heat and fulness in her eye, and in removing every thing like headache. Continue the me- dicine, in alterative doses, for some days. CASE XXVIII. Margaret Peebles, aged twenty, having overheated herself by a lung walk on the 15th July, 1818, and not taken pivper care of herself afterwards, was seized in the night with a violent stitch in her right side, imme- diately under the short rib3. I was called to her at six o'clock in the morning of the 16th, and found her in great pain. Skin cool; pulse slow and oppressed, but regular I could, not count it, as the patient was una- ble to remain in one posture for a moment. Bled her in the arm to the amount of twenty four ounce?. 10 o'clock. A. Jl.—The pain was relieved for a short time after the bleeding, butir soon returned,is increasing, and shooting up to the chest. Cannot make any thing , like a full inspiiation. Pulse J5. and oppressed, but reg- ular. Ordeivd four grains of Emetic Tartar in twelve ounces of water—a wine glass full to be tfcken immedi- ately, and half that quantity at the end of every hour, till nausea is induced. 1 o'clock, P. M.—Has taken only two doses of her 3U medicine, which produced nausea and slight vomiting; is quite free from pain; pulse 70. The patient informed me, that after my visit at ten o'clock, the pain continued to increase, till it became as severe as before bleeding. A short time, however, after taking the second dose of the medicine, it went entirely off. I inquired, it the pain subsided when sickness came on? and was told, that the pain went off a considerable time before sick ness was produced:—another instance this, and a mark- ed one too, of the sedative power of Emetic Tartar. The cessation of pain preceded nausea a considerable time: and, therefore, could not be the effect of it. Can make a full inspiration. 8 o'clvdc, P. M.—Has had no return of pain, and has continued the medicine without being again nauseated, or experiencing any sensible increase of perspiration. Skin cool; pulse 60. There has been no motion of the bowels to-day—notwithsranding which, the patient thinks herself perfectly well. Ordered two drachms compound powder of jalap to be taken immediately. Ju'.v, 17th.—it mains free from fever and pain, and thinks herself perfectly well Ordered a drachm of the mass of aloetic pills, and a grain and a half of Emetic Tartar to be made into twelve pills:—tv, o to betaken immediately, and to be repeated every two hours till the bowels are moved. In this case, I purposely delayed exhibiting the Emet- ic Tartar till my second visit, that I might have it in my power to estimate precisely the effect- of the bleeding. This proved quite inadequate to the removal ot the com- plaint; but the Emetic Tartar subdued it instantly I do not say that Emetic Tartar would have produced such effects so rapidly without b'ood-letting being premised; but I contend that it rendered farther evacuation by the lancet unnecessary—that less than a grain of this medi- cine saved thirty or forty ounces of blood to the patient; and if this is not an object of consideration to any pa- tient, I do not know what is. I have not the slightest hesitation in asserting, that the mission of any quantity of blood could not have been more effectual in restoring the balance of the circulation, than was the inconsider- able portion of Emetic Tartar employed on this occasion: As soon as this medicine produced sufficient relaxation 40 of the system, a shew ? f re-action was manifested—the pulse rose from 55 to 70. By continuing the medicine, however, the pulse was reduced.in a few hours to the natural standard. If blood-letting had been practised, till pain was completely and permanently subdued, the pulse would have risen in frequency in the same' manner. But it would have remained frequent, from the debility that must have ensued Emetic Tartar has no such ef- fect; at least, not in the thousandth degree. In cases of inflammation, it has all the effects of blood-letting, ex- cept debility. This it has in a certain degree, because relaxation is debility for the time; but the powers of life are no way diminished by it. • The quantum of blood is not lessened; its qualities are not deteriorated.. - There is another circumstance in this case which de- serves very particular attention. Accumulation in the bowels is a i-nost distressing source of irritation in every febrile affection. Purgatives, therefore, rank next to blood-letting, in the scale of antiphlogistic remedies; very serious inflammatory complaints, iudeed, may be prevented or removed by the timeous and thorough evao- uation alone of the primas vias. Emetic Tartar, there- fore, being capable, as evinced in the case under consid- eration, of subduing inflammation, where a full bleeding proved of but very temporary advantage, and where e- vacuation of the bowels had not been effected, must be considered as possessed of sedatiye powers in a much ,'"i higher degree than has hitherto been apprehended. CASE XXIX. On the 25d August, 181S, I experienced a sense of fulness in my head, particularly in the left side, which I was disposed to attribute to cold. Next day the same sensation occurred in an increased degree, when I was going from house to house visiting my patients; innumer- able objects began to float before my eyes, and a degree of insensibility was creeping upon me. I slackened my handkerchief, but was not relieved. I took it off alto- j gether, but reaped no advantage from so doing. I was convinced I saw well enough with my right eye, but im- agined I saw with only half of my left. I made the ex- periment of covering the right eye with my hand, when \ I found the sensation of semivision an illusion, i walk» l 41 ed home'slowly,and tpok a slightly nauseatingdose of an- timonial wine in a glass of water. I kept walking about, and standing alternately. In a short time a gentle glow came over my face, and remained for a little. I then experienced a more equal fulness in the head, accompan- ied with slight headache. These sensations gradually wore off; and I sat down to dinner an hour after taking the medicine, not only free from complaint, but with highly pleasurable feelings. I doubled the dose at bed- time, and continued the medicine for two days. I had no return of the complaint. Let it never be said, after this, that blood letting is tne sine qua non in cases of threatening apoplexy. CASE XXX. James Watson, aged twenty-six, in consequence of fatigue and subsequent exposure to cold on the 10th September, was taken ill on the 12th. I was called up- on at one o'clock, P. M. Complained of violent pain in the.loins, slight headache, and pain in the breast. A full inspiration wa3 succeeded by violent coughing. Could not lie but on his back, and could not move with- out great pain. Skin hot; bowels costive; pulse 104, full and strong; tongue white. I ordered forty drops of antimoni.il wine, four grains to the ounce, to be given immediately in a glass of water; and in three hours, other twenty drops in the same way. He had also twcr pill*, composed of Emetic Tartar and aloetic mass, ad- ministered. 'j o'Clock T. M.— The pills had operated rather strong- ly. Vomited the first dose of the antimonial, but re- tained the second. Pulse 90. Take twenty drops of the antimonial at bed-time. September' 15th.—Skin quite cool; Pulse still 90, buf, had been dressing himself immediately before, as I found him sitting at the fireside. Pain in the back gone. Continue the. medicine in doses of twenty drops three times a-day. Septembir 14th___Pulse 76; and the patient feels himself perfectly well in every respect. Les3 than a grain and a half, inclusive of what the two pills contained (a fourth >f a grain,) was the a- axount of the Emetic Tartar administered in thi& casej D & -42 and with all the good, without any of the bad, effects of blood-letting. CASE XXXI. A gentleman, aged fifty, was attacked with purging and vomiting on the 22d July, in consequence, as he supposed, of exposure to cold. On the 24th, when I was called, these symptoms had considerably abated; or rather, had disappeared. Headache, with violent throh- bing of the temples, and tinnitus aurium had succeeded. Tongue very white; pulse 110. Being well acquainted with the constitution and habits of my patient, I had no doubt that this complaint was an attack of gout. To takeoff the determination of blood to the head, and to moderate the action of the system, were the obvious in- dications. Time was, when I would instantly have abstracted at least.thirty ounces of blood from the jugular vein; and I would have considered the man fit for bedlam who would have proposed Emetic Tartar, where the stomach and bowels were so irritable. Such, however, was my confidence in the febrifuge powers of this medicine- such my conviction of its unrivalled efficacy in preserving and restoring the balance of the circulation, that I hes- itated not a moment in trusting to it the cure of this urgent and important case. Accordingly, an eighth of a grain in solution was ordered every two hours, or as the patient could bear it. The second dose produced nausea and slight vomiting, which soon subsided, and were followed by an amelioration of all the symptoms. This took place at five o'clock P. M. of the 24th. On the 25th, the patient was so much better, that he propo- sed going abroad, to which I would not consent. On the 27th, however, he went out without asking leave. It is not surprising that, for a day or two, he was menaced at times with the return of headache; but in every in- stance a dose of the medicine instantly checked its pro- gress. Nor were the slightest unpleasant effects produ- ced on the stomach and bowels. CASE XXXII. Mr. S. aged thirty-six, of a full habit, short neck, flo- rid countenance, and not of the most regular and ab« 43 Gtemioua habits, consulted me on the 3lst of August, 1818, for an affection in his head. He had complained for some time of stupor and giddiness, which gradually increased, and now unfitted him for managing his affairs. He could not stoop, or turn his head quickly round, without the risk of dropping down. I prescribed twen- ty-five or thirty drops, as he found it affect him, of my antimonial wine, in a glass of water three times a-day. I did not hear of him again till the 24th September, when I was called to his house. He informed me he had fol- lowed my directions, and having got quite well in a few •days, gave over the medicine, and returned to his or- 'dinary way of living. He was suddenly taken ill in the same way, when he consulted another practitioner, who gave him a purgative mixture, which had little or no effect on the complaint in the head. A third practi- tioner was now applied to, who ordered him to be cup- ped in the neck; and fourteen ounces of blood were ab- stracted", with great relief at the time, but of very short duration. The giddiness, upon the slightest motion, re- curred in an increased degree. He could not turn him- self in bed but in the slowest manner, without the risk of inducing insensibility. He described himself as feel- ing the motion of a fluid m the posterior part of the brain, directly opposite the ridge of the occiput. His neck was also stiff and paired. Pulse 92. Take thirty drops of antimonial wine in a glass of water three times a-dav. September 25th.—Pulse 80. Neck still stiff, and the sensation in the head undiminished. I handled the neck, convinced it was rheumatism which occasioned the stiffness and pain, and gave freedom of motion in less . than five minutes. This operation had no effect, how- ever, on the giddiness and sense of fulness, and of mo- tion in the interior of the cranium. Continue the vin. antimonial. and take two of the compound aloes and tart, antimon. pills. September 26th.—Pulse below 80. Skin soft and pli- ant. Can turn any way he pleases with the utmost fa- cility. Sensation of fulness and of motion in the head entirely gone. The patient's spirits are quite buoyant. Continue the vin. antimonial. according to circumstan- ces. 44 Havingbeeu called into the country at this time, I did not see the patient for ten days; but found on com- inghome he had had no return of his complaint. CASE XXXIIF. But it is not in increased, or inflammatory action of the blood vessels alone, or in morbid determinations of the blood to particular organs, that the power of Emetic Tartar is manifested. It is equally efficient in those nervou3 disorders which are denominated spasms. And this is an additional and conclusive proof, that it is through the medium of the nervous, that the action of the sanguiferous system is influenced by it. A young woman, aged seventeen, of a plethoric hab- it, and whose mather and a number of other relations had died of consumption, came into my service at Whitsun- dayj 1818. She had not been many days in the family when she was seized with a fit of asthma. She.inform- ed me, she had been subject for some time to such pa- roxysms; and that the catamenia had ever since almost entirely disappeared The girl wished much to be bled; but this I declined—first, because, though I have carried blood-letting to every warrantable length, I never saw it of any benefit in asthma, properly so called—and, se« condly, because I did not wish to lay the foundation of a bad habit. I therefore gave her a dose of Emetic Tartar.. in solution, which produced slight nausea, and perfecb, relief from all difficulty of respiration. I ordered her J to give me information at any time when threatened with a paroxysm, or with difficulty of breathing in the slight- est degree. This she had occasion to do frequently through the. summer; and she was on every occasion perfectly and immediately relieved by the same means. Emetic Tartar never failed to prevent the paroxysm al- together, or to cut it short if formed; for the girl some- times did not complain till she found herself almost at suffocation. Sometimes the medicine produced nausea, sometimes not. Four months passed on in this way; the paroxysms gradually becoming less frequent and less severe. By this time the catamenia had returned in perfect order and in natural quantity. During Septem-, ber and October I heard no complaint, and she left my family at Martinmas. 45 A few days after this, she returned one evening with a very severe sore throat, With much swelling and in-' flammatien. Pulse 100, full and strong. I gave her three doses of antimonial wine; one to be taken at bed- time, the other in the morning, and the third in the course of the day,—desiring her to return and inform me in the evening, if able, how she found herself. She returned the second day, and told me she found herself almost well next morning after calling on me, and did get perfectly well in the course of that day. There is little doubt that this young woman will ultimately fall a. sacrifice to the disease she inherits from her mother, and to which she manifests so strong a predisposition; but I have as little doubt, that, did her situation in life admit of avoiding the occasional causes, the practice I followed would not only postpone tjie consummation so much to -be feared, but would prevent it altogether. CASE XXXIV. ,--------Manson, aged fourteen, fell from a window, a height of sixteen feet, on the 20th August, 1818. I saw him very soon after he was carried home, when he had so severe a rigor on him that the chattering of bis * teeth was heard at a considerable distance. Pulse 84, full and strong. Having satisfied myself there was no fracture, dislocation, nor displacement of any viscus, I exhibited thirty drops of antimonial wine. This was at one o'clock P. M 3 o'Clock.—Pulse still 84, with considerable heat of skin. Let him have twenty drops of antimonial wine iii a glass of water, immediately. 6 o'Clock.—Is in a profound sleep, with a fine diapho- resis all over the body. Pulse 100, but softer. 9 o'Clock.—Feels quite comfortable. Pulse 92, but soft. Habeat hora somni, Sulphat. magnes. oz. i. August 21, 10 o'Clock, A. M.—-Pulse 80. Salts op- erated only once. Let them be repeated to an ounce and a half. Continue the antimonial occasionally. J 9 o'Clock, P. JlL-rPulse natural; and the patient feel* quite well. •its It is worthy of observation, that the iimetic Tartar produced no sickness in this instance; and had sensible effects on the skin only once, after the second dose. The boy's father was taking this medicine at the same time for lumbago, very liberally; and it had no sensible ef- fects on him, other than his getting well in three or four days under its administration, combined with two dose9 of percussion. CASE XXXV. This case was communicated to me by James Moir, Esq. surgeon, Royal Navy, and is as follows:—* I was requested to visit a girl about thirteen years of age; and, upon making inquiry into the particulars of her case, was informed, that she was rather subject to headache, and that, on the 21st November, she was seized with se- vere pain in the head, accompanied with heat of skin, great thirst, and constipation of the bowels. Her moth: er gave her a dose of alts in the morning of the 22d, which operated t'reely; and she had water acidulaied with cream of tartar, for common drink, fcshe passed a restless night; and, on the evening of the 23d, I was sent for. I found her complaining of severe pain in her head, her skin very hot and dry. the tongue parched, and pulse ' i 140, strong and full, tier breathing was free, but she ', j complained of general uneasiness and pain over her whole body. "Having lately perused Dr Balfour's publication on Tartar Emetic, I thought this was a case in which it would have a fair trial. I therefore ordered four grains in four ounces of water, of which half a table spoonful was to be taken every hour; but if sickness or vomiting was induced, this dose was to be exhibited every two1 hours only. After the fourth half spoonful, slight vom- iting was excited; and the medicine was continued eve- ry two hours afterwards without occasioning any sick- ness. J "November 24th.—Rested pietty well during the night; head much relieved; skin moist; bowels open; pulse 120. Complains of pain in her throat. Upon ex- amination, I found the left amygdala considerably swel- I led and inflamed. Ordered a gargle of vinegar. Con- Maue the antimonial medicine. £benin*.—Little or no 4/' headache; pulse 110. Ordered the remainder of the antimonial solution to be taken in divided doses before going to bed. November 25th.— I found my patient occupied in sew- ing this morning, with a natural pulse, and free from eve- ry complaint. In this case, violent headache, inflamma- tion of the throat, and every inflammatory symptom was removed; and the pulse, which, when 1 was called in, beat 140 strokes in a minute, was reduced to its natural standard,—all in the space of thirty-six hours, and by four grains of Tartar Emetic; for 1 prescribed no other internal remedy." (Signed) "JAMES MOIR, Surgeon, R. N." "Edinburgh, l&th Dec. 1812." CASE XXXVI. On the 6th of January I was called to a young wo- man, twenty-one years of age, whom I found complain- in^ of a violent stitch in her tight side, affecting respira- tion considerably. Pulse 55, irregular and oppressed— the sure harbinger of violent re-action. The patient at- tributed her illness to cold, to which she had been re- cently exposed; and was under great alarm for herself, as she felt her complaints increasing rapidly. I pre- scribed a solution of four grains of Emetic lartar m eight ounces of water; and directed about an ounce and a half to be taken every hour till nausea should be in- duced. She commenced taking her medicine at hal.-past seven in'the evening, and continued it, according to di- rections, till about the half was taken. She then sick- ened, and vomited repeatedly, till three o'clock next morning. _, .. . January 7th. 10 o'clock, A. M—Found my patient walking through the house, busied in her usual occupa- tions, and free from all complaint, except a slight de- cree of remaining nausea. Pulse 65, regular arid tree. Respiration perfectly free, and the stitch entirely gone. She informed me that the pain in her side, which was the original and principal complaint, left her at nine o clock the preceding evening; that is, an hour and a halt alter beginning; her medicine, and before any sickness or vom- iting occurred! These are the simple unvarnished facts «f The case; and 1 leave it to the judgment of every 48 cardid practitioner, if they do not exhibit the sedative and febrifuge powers of Emetic Tartar in an entirely new light? CASE XXXVII. Miss Janet Baird, aged twenty-six, after complaining several days of weakness, listlessness, and pains shoot- ing through her body, was confined to bed on the 5th of December last. 1 was called to her in the evening, and found her extremely restless; her pulse 120; face much flushed, and skin hot and dry. I ordered a wine glass full, every two hours, of a solution of four grains of. Emetic Tartar in twelve ounces of water. The first dose occasioned violent pain in the. bowels, which was followed by slight purging. She, notwithstanding, con- tinued the medicine; and, after an additional dose or two, fell into a profound sleep of three hours continu- ance. December 6th — Pulse 110; heat of skin and flushing of the face much abated. The first dose only of the medicine produced violent effects on the bov/els; but it never occasioned nausea, or sensible increase of perspi- ration. Continue the medicine. December 7th.—Pulse 96. Complains of pain in her back and knees. Continue the medicine as the bowels can bear it. , I was called from home on the 8th December, without ■\ seeing my patient again. I left directions, however, to call in one of my professional friends, if the fever and pain did not soon subside. She continued the antimonial for two or three days longer, when every symptom of disease disappeared. In this case of acute rheumatism, in which the symptoms ran pretty high, all the medicine -exhibited consisted of from eight to ten grains of Emetic Tartar. CASE XXXVIII. James Russell, about forty years of age, came under my care in September, 1818. The man seemed to be,* dying purely for want of air He had laboured underg asthma for twelve years; and had devoured a great deal'' of medicine,Without experiencing any benefit. 1 pre- scribed a watery solution Ot Emetic Tartar; of which 49 he was directed Co take a dose, short of occasioning nau- sea, three times a-day. He, however, repeatedly took an Himetic dose of his own accord; and always experi- enced increased benefit from it. When he had used th« medicine about a fortnight, he began to think it might be of some service to him; for he was quite scep- tical at first, owing to his having formerly used so much medicine in vain. At the end of a month, he declared himself much better. His test was. "1 can come up the brae now without stopping." He could now make a lull inspiration; and his countenance had assumed a more healthy appearance;—a circumstance this, suffi- ciently demonstrative of the change produced in the function of respiration. I accidentally -.aw this man, on the 13th of May last, in perfect good health, and at his work. CASE XXXIX. In September last, I was consulted in the case of a man about forty years of age, in the last stage of pul- monary consumption; his flesh and strength were greatly reduced, the expectoration was copious and foetid, the nocturnal sweats profuse; his pulse was permanently 120, his respiration laborious, and he was harassed with a hoarse and hollow cough to a most distressing degree. Notwithstanding the emaciation and prostration of strength in this case, I did not think the difficulty of breathing, which occurred in paroxysms, proceeded alto- gether from debility. It appeared to be owing, in a great measure, to inflammatory action in the lungs, from fresh accessions of cold. This was also the opinion of Ar- chibald Hamilton, Esq. late surgeon of the 92d regiment, by whom I was called in, and who knew his. patient in the Peninsular war. With a view, therefore, of redu- cing inflammatory action, we prescribed Emetic Tartar, in doses that excited the slightest degree of nausea im- a«-inab'e; and. in order to diminish the quantum, and correct the foetor of the sputum,—and also to moderate the colliquative sweats, nitrate of silver was, at the same time, exhibited. I am well aware, that this practice may appea- unscientific,—that a medicine which pow- erfully increases evacuation by the skin may appear e- qually inadmissible where hectic sweatings prevail, as a E 5c tonic remedy where inflammatory .iction exists. Tbft (acts- of llie case, however, set all such reasoning at de- fiance. Almost immediately f>om the ^commencement of this treatment, a sense of tightness in the chest, of which the patient always complained, and the occasion- al proxysms of dyspnoea disappeared in a great degree; in a short time the sputum was diminished in quantify,• and greatly meliorated in smell and appearance; in a- week, the pulse was reduced to 90; the sweatings were considerably moderated, and his cough soon became much softer and less frequent In short, had this man po■ sessed the means of subsistence and accommodation suited to a patient in his circumstances, we would have rlared to entertain a faint hope o; accomplishing a cure. Of these, however, he was entirely destitute, and fell the victim of want and disease combined. This case, though of fatal termination, is fraught with the most important instruction. 'That Emetic 'Tartar which, in this instance, manifested such curative, must possess piophylartic powers in an eminent degree, in phthisis pulmonalis, is an inference, the fairness of which cannot be t\t nied. Had this medicine, therefore, been timeously employed, and its exhibition persisted in, it is more than probable that ulceration of the lungs would have been prevented. A remedy which subdues inflam- matory action in the lungs when in a btate of ulceration, cannot but be supposed capable of subduing the infiam- , ; matory action which always precedes ulceration, amH theieby, ot preventing the farther progress of the dis- ease. CASE XL. Mrs. Forest, who completed her eightieth year on the last day of 1818, was seized on theTth December with dyspnoea in so distressing a degree, that she was neces- j j sitated to preserve the erect posture, night and day. There was no pain in the chest, but she had a consider- able degree of fever—the pulse being 100, full and strong, and t'ip bowels costive. This lady, having enjoyed al- most unii-terrupted good health dunng her long life, was decidedly aveisv t:> much medical interference. She would not submit to be bled. 1 had, therefore, an oppor- tunity, without subjecting myself to the charge of making 51 unwarrantable experiments, of trying thepower of Emetic Tartar in a very urgent and interesting case. 1 pre- scribed small doses at first, lest 1 should give umbrage to my patient. \n emetic dose, however, being admin- istered by mistake, she found herself immediately and greatly relieved She now piqued herself upon her readiness to comply with whatever advice I Blight give. I therefore, continued the medicine, and occa- sionally in nauseating, and even emetic doses,— interpo- sing a purgative, as circumstances required. Eight grains only of Emetic Tartar were used in the course of ten days, when I had the satisfaction of seeing this venera- ble matron restored to perfect health—which she still (June, 1319) continues to enjoy. CASE XLI. Mr II. M. aged twenty-one. of a very* fair complex- ion, began to feei a sense of tightness in his chest, ear- ly in the spring of 1818, accompanied with obtuse pain, particularly at the top and left side oftlie sternum, and slight cough—both which were increased by a full in- spiration. Could not lie on his left side, on account of the pain at the top of the thorax. He did not perceive Ijis strength much impaired, out was sensible of respira- tion being much easier hurried, ongoing up a stair, ov anv ascent. \t length, he began to spit blood occasion- ally. Alarmed at this, he consulted me on the llth.of November. At this time, the pain in the chest was be- come more pe. ceptible, and, of course, respiration less free. Pulse 70 Expectorated occasionally a small quantity of pui iforro matter. I prescribed Emetic Tartar in small doses, as I in- tended it should be continued a considerable length of tim . An eighth of a grain in solution was taken at bed-time, and about a sixteenth in the worning. The evening dose was increased when any blood appeared in the sputum. He continued this course, attending to his business at the same time, for some weeks, when the pain in the chest left him entirely. He could now lie on his left side, and make a full inspiration, without any impediment. The spitting of Hood also, which never was frequent, became gradually less so; and, in about two months from the commencement of the medicine, 52 disappeared altogether. I now directed my patient to take his medicine at night only, and to proportion the dose according to circumstances,—omitting it altogether when free from complaint, and doubling the dose, both as to quantum and frequency, when the slightest ca- tarrhal, or any of his former symptoms, appeared. June, 1819.—He is at this date quite free from com- plaint, but continues his antimonial medicine occasion- ally. CASE XL1I. John Pettigrew, aged fortv-two, consulted me on the 8th of January on account of an asthmatic affection, under which he had laboured for many months About ten months previous to his applying to me, ht had fallen into a state of bad health, of which asthma and symp- toms of general dropsy were the principal features. The dropsical affection yielded to medicine, but the asthma remained .unmitigated by all he could take—and he had been under the direction of various private prac- titioners. I prescribed a solution of four grains of Emetic Tar- tar in an ounce and a half of water, of which he was directed to take a tea spoonful three times a-day. The first dose proved smartly emetic, but none of the suc- ceeding produced even nausea. He took precisely four . grains of the medicine in a week; and when it ran short, or he omitted to take it, the next dose uniformly occa- sioned vomiting; but even the same quantity never had this effect when taken regularly at set intervals. This patient always felt great relief after full vomiting, so that he intentionally omitted his medicine, now and then, for a short time, that the next dose might pro- duce it. By the time this man had taken six ounces of the so- lution, or twenty-four grains of Emetic 'Tartar, he fejfe a himself quite another man He could now make a full inspiration, and retain his breath a considerable time, without coughing or experiencing any inconvenience; j he could mount up a stair of any length (I saw him mount up eighty steps) without being more hurried in his breathing than a person free from complaint,—he admit- ted a great improvement in his strength,—any one look- 53 ing at him could have perceived a change in the position of his head and shoulders; whereas, when he applied to me, he could not go up a few steps of a stair without being exhausted,—his thorax, or lungs, or both, refused to dilate for the purpose of a full inspiration,—and even an attempt at this produced exhaustion and cough. CASE XLIII. Mr. G. aged forty-five, of a fine florid complexion, was seized about the end of harvest with an obscure paia in his breast, which affected respiration considerably. Knew no cause for the complaint, and therefore paid little or no attention to it for some weeks. About Mar- tinmas it began to increase, attended with cough. The patient's friends now became alarmed and resolved on taking advice. He therefore embraced, the first oppor- tunity of his being in Edinburgh, to consult me. I pre- scribed antimonial wine, in doses short of occasioning nausea, twice a day—directing a larger dose in the eve- ning than what could be well taken in the course of the day, by a gentleman engaged in business from morning to night,.and more or less on horseback every day. Al- most from his commencing this course, he felt benefit from the medicine; and was quite free from complaint in less than a month. I saw my patient in the end of February, when he informed me, he was convinced I had saved his lite. This gentleman is so much pleased with a practice from which he derived so much benefit, through means so simple, that he speaks of it with enthusiasm wherev- er he goes. A poor man in his neighbourhood, eighty years of age, was confined to bed with difficulty of breathing and obscure pain in the chest, for many days; and never expected to be able to leave it again. Mr. Gr, hearing of the case, sent a little of his medicine, with directions; and the poor man was at his work the third day. There is not a sore throat, or cattarhal affection of any degree that occurs in the village or neighborhood in which this gentleman resides, but he is applied to for a little of his medicine; and he distributes it with a phi- lanthropy and success that gives no small umbrage to the surgeon of the place. My friend is more alive, however, to the calls of distress, than to the remon- E 2 54 strancts of any interested, illiberal practitioner what- ever. CA>E XL1V. Mrs. S. aged fifty, of a very florid complexion and full habit of body, was seized with dyspnoea, in the course of November, last year, to which she paid little attention for some weeks. Symptoms becoming urgent, however", she at last took advice, and was forthwith put upon anti- monial wine, in small doses, twice or thrice a-day. The minutest quantity of the medicine nauseated this pa- tient, and often proved emetic, but always with great re- lief of symptoms. It was continued, therefore, for some weeks, when every symptom of disease disappeared. None but those who know this lady's constitution can appreciate the unspeakable advantage and relief she ob- tained, on this occasion, from less than three grains of Emetic Tartar, the exhibition of which was extended to three weeks. From her appearance, the symptoms of her complaint, her history the fate of her children, all of whom had scrofulous affections; I apprehended the worst from the moment I was informed of her situation.. My satisfaction was therefore proportionally great on being enabled to rescue her from impsnding destruction. CASE XLV. A girl, fifteen years of age, and exhibiting unequivo- cal signs of a scrofulous constitution, applied to me in . April, 1818, for advice with regard to an enlargement of one of the submaxillary glands, which I had no doubt was scrofulous. The swelling occurred without any known cause, and wa« considerable when I first saw it. My young patient, apprehending nothing less than a de- formity in her countenance, which often seals the fate of many a deserving young woman, wa9 quite inconsolable. I put her upon Emetic Tartar in small doses orce or twice a-day. She took her medicine for weeks without my being able to say I perceived any difference. At length the gland became softer, and the swelling evi- dently less, in June, the patient had an attack of' fe- ver, in which inflammatory symptoms ran pretty hi»h. I exhibited the Emetic Tartar more freely; which not only subdued the increased action of the system, but the swelling cf the gland disappeared almost entirely. As 55 the patient recovered, the swelling recurred in a slight degree; but the Emetic Tartar being resumed for a short time, it was so far reduced as to be invisible. That scrofulous inflammation and ulceration of the lymph a tie glands of this girl's neck were prevented, by the exhi- bition of Emetic Tartar in alterative doses, for a consid- erable time, there cannot, I think, be a doubt* CASE XLVI. A young lady, aged fifteen, was put under ray care in the course of September, 1818, in a most deplorable situation. A continuous scrofulous ulcer extended from ear to ear, down the front of the neck, and half way down the breast bone,—on the latter place, several inch- es in diameter; there were likewise two extensive and deep ulcers in one of her le^s. She inherited the dis- ease from her mother; and had been in the situation in which I found her, two years and a half, without receiv- ing the least benefit from the treatment followed by an eminent surgeon who had advised her all this while. In- dependent of the pain attending ulcers so extensive, the copious discharge which issued from them, and in which her clothes were daily soaked, rendered the situation of this girl doubly uncomfortable. This was an evil that could be instantly remedied; and it is surprising any man of common sense should have continued, for two years and a half, to apply ointments to surfaces, whose vessels were necessarily in a preturr.aturally relaxed state. JVa ointments ought to come in contact ivith a scrofulous ul- cer. The first thing I ordered was, that the surface of the sores should be washed clean, and dried. They were then covered with fine, soft, dry lint, cut in small pieces, and applied so, that each successive piece partially cov- ered the preceding. In this way, a thick spongy mass was formed, sufficient to absorb all the matter produced in twenty four hours. A pledget of lint and simple ce- rate was laid over the whole, to prevent evaporation, and thereby, to preserve the surfaces of the wounds and dressing in a soft and pliant state. The comfort which the patient experienced from this very simple and obvious- ly proper mode of proceeding, quite delighted her. The lint next the surface of the wounds came off at next 56 dressing, in a mass, impregnated with matter; not a drop of which had escaped to pollute her clothes, and occa- sion, as formerly, a disagreeable smell. This circum- stance was of immense consideration to the patient and all around her; and disposed her to submit to whatever might be further advised. I now prescribed a vinous solution of Emetic Tartar in alterative doses, twice a-day for a short time, and af- terwards in the evening only; and infusion of galls for washing the wounds daily. This occasioned a consid- erable degree of smarting at first; but the application was continued unremittingly. The Emetic Tartar was ex- hibited with the view of preventing any derangement of the system, or inflammatory action of the vessels of the sores, that might be induced by checking the accus- tomed discharge from surfaces so extensive. Steadily pursuing this plan, my young patient's very countenance was visibly improved in a short time; and at the end of a few weeks, the sores in the neck and breast were not only filled up to a level with the sur- rounding skin; but I had the satisfaction of seeing a cir- cle of new skin formed completely round them, and projecting considerably inwards at different points. Iso- lated spots in the middle of the sores soon came to be covered with new skin also, and to approximate each other, till large patches were formed, which, in their turn, extended themselves in every direction. In this manner did the cure proceed; and at the moment I write (27th February) the whole of the neck is completely , healed up, and the wound in the breast reduced to a ve- " ry small compass. The ulcers in the leg threatened to | be more refractory; but they also are now filled up, and ™ very nearly closed. Whether the astringent infusion or the Emetic Tar- tar had the greatest share in this cure, I shall not decide; but this I know, that I should not have ventured on the external application, without exhibiting the internal rem- edy at the same time. As it was, the muscles of the front of the neck became partially swelled, rigid, and painful, on two or three different occasions, during the cure. The only difference of treatment, however, ob- served on such emergencies, was that of increasing the 57 dose of Emetic Tartar; when every inflammatory symp- tom disappeared. CASE XLVII. While I was attending the preceding case, an elder' sister of my patient was seized in the very same way she had been, at the beginning of her complaints, with swelling and slightly lancinating pain in one of the glands under her chin. When 1 first examined it, the swelling was considerable, and the surface ot the gland irregular, exhibiting the appearance of a pointed instru- ment pressing outwards against the skin. This young lady and all her family were in great tribulation, appre- hending nothing less than deformity, and distress equal to what her sister had suffered. I immediately put her on a course of Emetic Tartar in alterative doses, night and morning. She continued thus for several weeks, without peceivihg any sensible effects from the • medicine, or alteration in the appearance of the gland: however, it did not increase in size, and she never felt pain in it after commencing the medicine. In about six weeks from the time I first examined the swelling, it had declined so far as not to be perceptible to the eye, and the point which elevated, the skin had subsided.' Trust- ing that nature Would complete the cure I consented that the patient should intermit the medicine; but cau- tioned her to have recourse to it, in nauseating doses, upon the slightest increase in size, or sensation of pain in the gland. Happily no such thing has occurred, and it is now (March, 1819) reduced to half its original size. CASE XLVIII. The power of Emetic Tartar in moderating fever and inflammatory action, is conspicuous in no disease more than in measles; and I am convinced, if it were more liberally employed, that it would not only diminish the danger, but render the pneumonic and scrofulous seque- lae of this disease infinitely less frequent. These re- marks I shall illustrate by what occurred in a single family.—On the 10th of February,! was called to a boy, eight years of age, dying of croup—which had been preceded, first, by scarlet fever, and then by measles. The physician with whom I was called to consult, had? i»8 in my opinion, treated the case in the most scientific manner. The only alteration I proposed wa9, to in- crease the dose of antimonial solution, which I found had been exhibited for some time, but not in quantity to Occasion nau-ca. My suggestion was complied with; and next day the pulse had fallen thirty beats in a minute. The patient expectorated a considerable portion of mem- brane, as he had likewise done before I saw him; so that we entertaii ed some hopes of a recovery*—the more especially, as the calomel, which was exhibited at the same time, had produced s-ome green stools. We were disappointed. It was, however, of a second at- tack of croup that this boy died. The first supervened Upon scarlet fever, and was expected to have proved fatai; but wis cured, bis physician is decidedly of opin- ion, by the Emetic Tartar emplo-ed on that occasion. Measlt-s. as already stated, immediately succeeded; so that the patient fell a victim to-attacks of disease, the nu'iiber, rapidity, and violence of which, no constitution, , however aided by medicine, culd resist. Three other children of the family were soon after Seized with tiie measles T;ie eldest, twin brother 'o him immediately deceased, was aff cted from the begin- ning vuth a dry, inc ssant, hoarse, ringing cough, pre-' cisely similar, Viis father and mother said, to 'that of the deceased. Pulse 120, and hard. They were, therefore, in great tribulation In absence of the other physician, I ordered a watery solution of Emetic Tartar, in nau- seating doses, of which he approved. Next day, the pulse was 110, the cough almost gone; when it did occur, it was softer, and the patient expectorated freely. All this happened before the eruption appeared. In the se- cond stage of the disease, the cough again became croupyj When, notwithstanding the bowels were affected with purging and tenesmus, we administered the Emetic Tar- tar, with the same happy effect as before. The youngest of our three patients, a very plurtip boy, contracted a very croupy cough, about the height of the eruption. It also yh-lded immediately to the Emetic Tartar. On the 9th day, Irom the commence- ment of the disease, all three were free from eom*. plaint. 09 CASE XLIX. Ort the 2d of March, 1 was called to James Baird, aged eleven, whom I found labouring under pneumonia. He had severe, fixed pain, at the top of the right breast, a dry,hard cough, a burning hot skin, a hard pulse, beating 134 in a minute, and oppressive head acb-. It was at five o'clock in the afternoon of the third day of his distress I first saw him; and I gave him a fourth of a grain of Emetic Tartar, dissolved in water, before I left his bed- side,—ordering the medicine to. be repeated every two hours, in doses of an eighth of a grain.—9 o'clock, P. M.—Vomited ?.n hour after taking the first dose of his medicine, but. retained the second. Pulse 126, skin moist, but the pain in the breast and head unmitigated, I took from six to seven ounces of blood from the arm; during which operation, the boy became sick, and vomit- ed. The bowels also were affected. I desired the pa- tient might not be disturbed through the night, if he re- mained quiet and cool; but that be should get his medi- cine as formerly directed, if he became hot and test- less.—March 3d, A. M.—Remained quiet and cool till five in the morning, when he became hot and restless. The medicine was then exhibited, but in trifling quanti- ties; the fact is, I do not believe he got any of it. Pulse, at the present 140, skin hot, and pain in the breast and head severe, tongue white, bowels sufficiently open. With my own hand, I administered a double dose (quar- ter of a grain) of his medicine, and ordered half the quantity to be exhibited in two hours.—3 o'clock, P. M.— The patient vomited, without being previously sick, the moment he got his second dose. Has had considerable pain in his bowels from the medicine; skin much cooler, soft and pliant; does not complain so much of his breast and head; pulse 120.—9 o'clock, P. M Fell asleep immediately after last visit, and remained so till now. Skin moist; pulse 106; coughs and inspires fully, with- out pain in the breast. 1 pronounced the cure as cer- tain, and nearly complete. Continue the medicine in small doses.— March 4th.—Has no complaint, rested well; pulse 96. but soft. Continue the medicine in doses short of occasioning vomiting.—March 5th—Con- tinues well, pulse 80, and soft. Another ii stance this, of the absurdity of imagining, that blood-letting alone bO can cure pneumonia—can subdue inflammatory action— of imagining, that oceans of blood must be made to -How. |n. order to restore the balance ot the circulation in inflammatory complaints. It will not be denied, that, in this case, the symptoms were urgent; yet the cure was certain in 22 hours, and complete in less than 36, from the exhibition of only three grains of Emetic Tartar. Seven ounces of blood were taken, I admit; but can those gentlemen whose practice I am combating, con- 6istant!y attribute much to the mission of seven ounces of blood? besides, re-action became higher, and pain in the chest more severe, after blood-letting was em- ployed* ' CASE L. About the end of winter, a gentleman on the borders of seventy, consulted me for a giddiness and swimming in his head. He was of a very full habit of body, and bad enjoyed good health all his" life. This affection had manifested itself in the night previous to his applying to me, and was greatly increased on attempting to turn himself in bed. Considering his stomach alone to he in fault, he went abroad, and had some medicine in & druggist's shop, but without any relief. As soon as he told me his case, I exhibited a dose of antimonial wine, some of which I .chanced to have by me; and gave him a phial of it, with directions to take a small dose repeatedly, till an ap- proach to nausea should be felt; but. above all things, to avoid vomiting. I advised him, moreover, to live spar- ingly, to take some purgative medicine, to avoid stoop- ing and every kind of exertion, to sleep with his head high, and not to turn in bed, but in a slow and cautious manner. I did not see my patient next day; but, on the follow- ing, I met him on the street, perfectly well, and resolv- ed to continue his medicine. That night, however or the following, having forgot my directions, or consider- ing himself out of all danger, he turned suddenly in bed, and was immediately seized with a severe fit of giddi- ness. His surgeon was sent for; and to v*hat he did, the genthman's countenance bears ample testimony, and will do so for life. J' 61 Had I been consulted on the second occasion, I cer- tainly would have advised blood-letting; but to the ex- tent only of relieving urgent symptoms. Authorized by former experience in the same subject, I would have trusted to Emetic Tartar for completing the cure. From the time he was first seized, the giddiness never left him, or abated in the least, till 1 administered the medi- cine as alieady stated, when it went off* entirely; and he remained free from it for some days—indeed, till, by the sudden exertion of turning in bed, the blood was ac- cumulated in the head. Had my directions been impli- citly followed, there would have been no occasion for blood letting. So much couvinced, indeed, is the patient himself, ot the prophylactic powers of Emetic Tartar in apoplexy, that, after copious and repeated depletion, he again applied to me for more of the medicine. CASE LI. About the end of March, a young lady was seized with a rheumatic affection if one side of her face, ac- companied with a strong determination of blood to the head. , There was exquisite pain in several teeth of the upper jaw, shooting up the side of Vie nose, and along the cheek bone. She had taken an opiate, with a view of relieving pain, which it did; but, at the same time, in- creased the impetus of the blood to the head. When I was consulted, the pain was beginning to return, and the patient, every how and then, expected the blood to gash from her nose. I instantly administered a lose of a«>ti- monial wine in water, which had the most happy and soothing effects. The pain in the gums, and sense oftui- ness and throbbing at the side of the nose, entirely left her in less than a quarter of an hour. I enjoined the erect posture, a dose «»f Rpsom saits at bed-rime, togeth- er with thirty drops of Antimonial wine of double the usual strength. She passed the night in profound s;eep. Next day she site dared not attempt the day before. \ sense of tender- ness remained in the parts originally affected. - m pa- tient con mued her ant oonial wine; and, in two or three days at most, was free from complaint. 63 CASE LII. About the beginning of March, I was called to a lady upwards of seventy, of a thin habit of body, and a pale and wrinkled countenance. She had complained for some days of headache, and called me in on account of a bleeding at the nhse that had occurred. I found her pulse 90, and hard. The bleeding had recurred repeat- edly, but to a trifling extent I immediately prescribed Emetic Tartar, so as to occasion very slight nausea;1 with the strictest orders to avoid vomiting. 'The second or third dose produced the very state to which 1 wished to bring the patient. In this state, however, her daughter* gave her another dose, which was instautly followed by slight vomiting. In the act of vomiting, the bleeding at the nose recurred, but soon subsided after the foi mer ceased. From this mistake, the nurse learned to man- age matters better, and the bleeding never returned. Two days after, I visited my patient, and found her pulse soft and less frequent, and the headache entirely gone. When the advocates for profuse blood-letting, in actual or threatened apoplexy, shall convince me they have made a fair trial of Emetic Tartar, or of moderate blood-letting followed by Emetic Tartar, without suc- cess, I shall then, but not till then, adopt their practice. CASE LIII. On the 22d of March, I was consulted by a gentle- man, about twenty-one years of age, for a pleuradynia in the right side. Pulse about 50, irregular and oppres- sed. I proposed bleeding him immediately, to which he was quite averse. I therefore prescribed Emetic Tar- tar, with injunctions to keep the house, and consider himself ill. Being twenty-four miles from home, and on business, he only took the medical part of my advice, and went to the theatre in the evening with some ladies. I did not see him again till the morning of the 24th, when I was sent for. He had taken his medicine the preceding evening, so as to occasion vomiting in the night; after which he had several hours of sound sleep. I found his pulse below 50, irregular and oppressed. I attempted to bleed him, but could procure only about six ounces. He was so fat, and his veins were so small and deep seated, that it required no small pains to pro* 63 cure even this quantity. My disappointment, however^. did not create in me any great uneasiness. I pushed the Emetic Tartar in the course of the day. At nine o'clock in the evening 1 found him sitting close by a large fire, enjoying the company-of several ladies and gentlemen, greatly better, he said, and possessing free motion of the trunk of his body, which he had not in the morning. I ordered him to bed, but he sat up till eleven transacting business. Next day, I was sent for before breakfast, and found him worse than ever. The pain under the cartilages of the true ribs was acute, and affected respiration in a distressing degree. I succeed- ed in drawing eighteen ounces of blood from his arm, and now exhibited Emetic Tartar more frequently, and in larger doses than before. The patient expressed g-eat satisfaction with this medicine; he felt relief, for a considerable time, from every dose. In the course of the day his pulse rose from 50 to 80, and became per- fectly regular. The cure, I may say, commenced in the morning of the 25th, and I had no occasion to visit him after the evening of the 26th, although, at his own desire, he continued the antimonial medicine for two days long- er. No other remedy was used, except a dose or two of Epsom salts. The hypnotic, or sleep-inducing power of Emetic Tartar, was most conspicuous in this case. Du- ring the night of the 25th, the patient, though he could not yet make a full inspiration without pain, enjoyed as sound and placid sleep as if he had been entirely free from complaint. CASE LIV. On the 24th March, I was called to a young girl, aged six, in scarlet fever. She was under the care of her brother, a surgeon, who requested my aid on account of a violent affection of the lungs, which refused to yield to any thing he could devise. Pulse 140, cough inces- sant, hard, and without the slightest expectoration. I proposed bleeding the child at the arm immediately, as I conceived nothing else could save her. She would not ' submit. I ^hen prescribed a solution of one grain of Emetic Tartar to an ounce of water, of which a tea spoonful was directed to be given every hour. 64 4 o'Clock, P. M.—Has got three or four doses of the medicir.e, which occasioned nausea and vomiting two or three several times. Pulse 130, skin moist, cough still incessant and dry. Coidinue the medicine, in doses of two thirds the quantify formerly administered. 9 o'Clock, P. M —Pulse 120, cough still very fre- quent, hut evidently not so dry. Continue the medici .', with infusion of senna, as the child refuses saline medi- cines. March 25, A. M.—Pulse 120, but soft; cough giving way: slept a good deal in the night; bowels open. Con- tinue the antimonial medicine. From this time forward the fever gradually abated, and the pneumonic symptoms had entirely disappeared by the fourth day from the time the antimonial medicine was administered. No other remedy was used, except a dose, or two of calomel and jalap; but even this was not exhibited till after the fever and cough had greatly abated. Any practitioner that had witnessed this case would not be disposed to conclude that I have overrated the*povvers of Emetic Tartar in any instance, CASE LV. On the 7th of May, 1 was called to a young lady, aged sixteen, who had been "in an indifferent state of health for some time." I found her much emaciated, harassed with incessant coughing, and her sputum copiously j streaked, or rather altogether coloured, with blood.— Prise 114. Astonished at the apathy of her friends, who seemed not to apprehend any danger, though moving in a circle in which more intelligence might have been expected, I frankly told them I feared the worst, and t!i,' intended to cure. This must be the case, a fortiori, in patients predisposed to consumption, in whom debility is so easily induced, and with so much difficulty over- come. The instances I have adduced in the preceding reports, ; of Emetic Tartar subduing pneumonic inflammation in particular, with little or no aid from blood-letting, suffi- 71 ciently prove its importance in the treatment of the dis- ease occurring in phthisical constitutions. We are not obliged, In order to subdue inflammation, to carry de- pletion the length of greatly reducing the strength of the patient. It blood-letting is necessary in the first instance, Emetic Tartar presents itself as an auxiliary little less powerful than, if not equivalent to, the prin- cipal. Indeed, I contend I have redeemed my pledge of "'demonstrating that, in many cases of local inflam- mation, accompanied with violent re action, blood-let- ting, to one third the extent generally practised, is not necessary to the cure; that a speedy and perfect cure caw Oe obtained with the loss of so moderate a quantity of blood, as to warrant the conclusion, that it might be safely omitted altogether, even in circumstan- ces in which it is generally considered the only means of saving the patient." Catarrh, though in sound constitutions, generally a mild disease, may, by frequent recurrence, long contin- uance, mismanagement, or neglect, be productive of phthisis in those predisposed to it in various ways. It may be exasperated by fresh and repeated accessions of cold, so as to produce pneumonic inflammation—by the afflux of fluids to the bronchiae, it may occasion haemop- tysis—by long continued irritation of the lungs, it may produce tubercles, or occasion the inflammation of tu- bercles already formed. If, therefore, catarrh consists in an afflux of fluids to the mucous membrane of the nose, fauces, and bronchios, accompanied with inflammatory action of these parts—if this afflux and this action are occasioned by diminished perspiration, and increased by fresh accessions of cold, repelling the fluids from the surface—if Emetic Tartar is powerful in equalizing the circulation, in determining to the surface, and in subdu- ing inflammatory irritation; then it must alsote consid- ered a powerful preventive of phthisis from catarrh. Asthma is cured or relieved by Emetic Tartar, on the same principles on which it subdues inflammation This is evident from the history of Asthma, which, though considered a nervous disorder, yet has some things in common with the phlegmasise. 72 « The disease is often hereditary; and depends on a pe- culiar mobility of the moving fibres of the lungs. The proximate cause seems to consist in a spasmodic con- traction of the muscular fibres of the bronchiae; but an asthmatic fit depends on fulness of the vessels of the lungs. This fulness or congestion may be, and often is, occasioned by a cold and humid atmosphere, checking the perspuation,and repelling the blood from the surface to the internal parts Catarrhal affection?, accordingly, often accompany the disease; and a frequent pulse, with othe^ symptoms of fever, are not unfrequent attendants of a paroxysm of asthma;—so far Dr. Cullen. Now, as the immediate effect of Emetic Tartar, in inflammatory complaints; is the equalization of the nervous power, and, consequently, of the circulation of the blood; so is it in asthma If, therefore, congestion of blood in the lungs is the exciting caus* of a paroxysm of asthma; no pa- roxysm can occur while the balance of the circulation is maintained In this wayj .would explain what 1 have often observed, that emetic doses of Emetic Tartar gives most complete and permanent relief to asthmatic patients. Such doses most powerfully relax the whole frame—most forcibly, propel the blood to the surface, and distant parts of the body—and thereby most effectually relieve the lungs. Thus, by curing asthma, Emetic Tar- tar becomes a preventive of the consequences that might tw from it, particularly to those predisposed to con- nptinn. These observations, it roust be evident, apply exclu- sively to asthma properly so called. No such eff'ecti can be expected from any remedy, in those disorders which only simulate this disease, and are symptomatic ot a morbid state of the heart and aorta. I refer the reader to cases 33, 38, 42. I think it prop- er also to mention, that, in the course of the last six months, I have received many verbal testimonies, both from medical practitioners, and from patients themselves, of the power of Emetic Tartar in curing and relieving asthma, dyspnoea, and chronic irritation of the lungs. Tubercles are the most frequent of all the occasional eau-es of consumption, and produce a disease mucb more fatal than all the other causes combined. Their formation, therefore, should be prevented, or their reso- lution procured, without delay, and by all possible means. But these Objects are not so easily attained as clearly indicated. Accordingly, physicians have been hitherto compelled to satisfy themselves with merely en- deavoring to prevent inflammation and consequent sup- puration of tubercles. Dr. Cullen, however, does not despair of a remedy being yet found for their cure, al- though he candidly acknowledges his ignorance of any such. Warranted, then, by such high authority, to con- tinue our researches, let us review the various causes of, and circumstances attending, the formation of tubercles, together with the known powers of Emetic 'Tartar, and see, whether the data will authorise conclusions in favotic of this remedy, as possessing in any degree the qualities we are in quest of. When a nerson, born of phthisical parents, of a phthis- ical constitution, at the phthisical period of life, and in the enjoyment of almost an excess of health, contracts a short dry cough, which becomes habitual, and is exas- perated by fresh accessions of cold, with which he be- comes more and more easily affected, there is cause for the most serious alarm. In some cases things continue in much the same state for a considerable time; general- ly, however, new symptoms and causes of alarm gradu- ally develope themselves. A sense of straitness, if not of local pain, is felt in the chest. The breathing is ea- sily hunied Langour and debility begin to be experi enced, and emaciation to be perceptible. During the developement of these symptoms, tubercles are supposed to be forming in the lungs. In such cases, then, the re- mote causes of tubercles are to be sought for in a here- ditary taint or predisposition to phthisis, and in a cer- tain time of life. These conspire to render the body peculiarly susceptible of being affected by the causes of inflammation. Accordingly, phthisis, even in the pre- disposed, can often be dated from exposure to cold, from excess, or from some cause or other of inflammatory action Independently of observation and exptrieice, it may well be supposed, that suppressed perspiration must be the principal occasional cause of a disease, which it exasperates in every stage of its progieas. Suppressed perspiration, to which the excitability ot 74 phthisical patientsTender them so very liable, must crfe* ate and increase an inflammatory diathesis—must occa- sion an afflux of humours, and an irritation in the lungs, which are to be regaided as the immediate causes of the formation of those"substances in them, denominated tu- bercles. These observations apply equally to tubercles, which are occasioned by asthma, catarrh, and haemoptysis An afflux of humours, and long continued irritation in the i lungs, are the last links in the chain of causes producing j tubercles, in every case where they occur; whether preceded by other diseases, or occurring in appearance j spontaneously. Where there is long-continued afflux j of blood, or congestion in the Iung», as in the disposed to haemoptysis, a proportionate quantity of excren.enti- fious matter falls to be carried off by this en unctory. 'This is the case, a fortiori, in catarrhal affections, and in asthma so often accompanied by catarrh. No won- der, then, that the causes of inflammation, concurring with predisposition, should so often produce disease in the lungs. The wonder is, not that so many, butthat so few of mankind die of pulmonary complaints. The skin, the lungs, the intestines and kidneys, ex- crete substances of very dissimilar qualities. The matter, therefore, which ought to be carried off by the skin, being accumulated in the system,and in the course of circulation applied to the lungs, must affect them in a peculiar manner. Hence, in all cases of suppressed perspiration, they are mote or less affected; but in phthis- ical constitutions peculiarly so. When this cause is often applied, and long continued, depositions are form- ed, which, in their turn, increase the irritation to which j they owe their origin This irritation is soon communi- cated to the system; for irritation cannot remain long isolated in any important organ; much less in an organ so important to tlu system as are the lungs. The same effects must follow, though tubercles con- sist of indurated lymphatic glands. Thus, it is manifest, that phthisis is an inflammatory disease. It is produced by the causes of inflammation— .. j inflammatory symptoms accompany it from the first cough, to the last expiration of the patient. ' , Some physicians, rightly considering phthisis an inflarri- i 75 tnatory disease, have practised blood-letting in it to as incredible extent,—with the view, no doubt, of ultimate- ly subduing inflammatory action; but with no other ef- fect than accelerating, by the debility produced, a fatal termination. Even at this day, individual practitioners of no mean name are disposed to follow the same prac- tice. It will not be contended, 1 presume, that such physicians have much faith in the power of Emetic Tar- tar in subduing inflammatory action, irritability, and ir- ritation. On the assumption, that phthisis is, in its nature, in- flammatory, may be explained, we think, some of the most important, if not all, the phenomena of the disease. Of these I shall mention onlv two, debility and emacia- tion In speaking of the tendency to separation in the proximate principles of the blood, as an effect of inflam- matory diathesis, we rema-ked, that this effect is the re- sult of suspended or diminished secretion. Wherever fever exist*, secretion or the apposition of new matter is proportionably suspended; while the action of the ab- sorbents continue unimpaired. Hence the debility and emaciation, even in the early stages of consumption. Langour, debility, and falling oft' of the flesh never pre- cede, but are always consequent to febrile action. Of this there cannot be a doubt, as, with the developement of these symptoms, frequency of pulse is always com- bined. Now, whoever has read the preceding reports with that confidence to which truth is entitled, must coincide with me in toe conclusion, that Emetic Tartar possesses, in a degree superior to any other medicine yet known, the very qualities requued, both for the prevention and cure of consumption. It subdues inflammation, wheth- er general or local, acute or obscure. It is paregoric and hypnotic, without being narcotic. That is to say, it assuages pain, sooth s irritation, and induces sleep, without stupilyuig the patient. 1 have before observed, that, in the disposed to consumption, there is an acrimo- ny or taint which facilitates the operation of the occa- sional causes of the disease. This acrimony is increas- ed by the irregularity with which the excretory func- tions are performed, paiticularly of the skin. Emetic Tartar promotes all the excretions, especially those by 76 the skin and lungs; and, moreover, prevents congestion in the latter In one word, there is not a cause of phthis- is to which an antidote is not to be found in Emetic Tar- tar: wfich, combined with other remedies, and with a bland but generous diet, will be found capable, I trust, of restraining, in an important degree, the ravages of that fatal disease. On this sulject it would be easy to enlarge. But I am not writing a treatise on phthisis. I only give an outline of a practice which I have begun with success, and which I shall prosecute, till farther experience es- tablishes it, or proves my present views on the subject inro1 rert. For illustrations of the power of Emetic Tartar, in the cure and prevention of phthisis and phthisical com- plaints, see cases 33, 39, 41,43, 44,45,46, 47, 55, 56. In apoplexy, when its attacks are sudden, and without any premonitory symptoms, blood letting is necessary certainly, in the first place. But this powerful remedy may be, and very often is, carried too far. Where the disease depends on venous congestion, blood-letting most readily relieves the brain from pressure; when, on in- creased impetus of blood in the arteries, the same reme- dy will diminish it for a time. Blood-letting, however, will not always take off the disposition to apoplexy; and a perpetual recurrence to it can produce no other effect than dangprous debility. Apoplexy, doubtless, is often occasioned by plethora, and always by an irregular dis- tribution of the blood; but an apoplectic diathesis often exists where there is great debility, and in people far advanced in life. In such circumstances, copious and repeated blood-letting can neither be safe nor scientific practice. It is astonishing, indeed, to hear practition- ers boastirg of the quantity of blood they take from old and wrinkled patients, not only whci actually la- bouring under, but when merely threatened with an at- tack of this disease The question then occurs, can the disease be prevented by anv other mode of treatment? I answer. Yes. Nay. I affirm that, except where a se- rious attack has actually taken place, or is immediately threatened,blood letting is notnecessary in the treatment of apoplexy. At all events, there is no necessity for carrying it the length it is generally practised, or for trusting to it as the only remedy. The whole of the facts recorded in this essay bear testimony to the power of Emetic Tartar in restraining vascular action, and in equalizing the circulation; and, therefore, that it is a mor-? sufe and effectual preventive of apoplexy than blood-letting. If an apoplectic diathesis exist in some old, wrinkled, and pale-faced people,and in others that are by mi means plethoric; revulsive remedies which do not weaken the system, or but inconsiderably, and remedies which powerfully determine to the surface, are clearly indicated; not those which give sudden but temporary relief, and which cannot fail to induce debility. Nervous diseases, or diseases of debility, often mani- fest a tendency to, and sometimes terminate spontane- ously, or from improper treatment, in apoplexy. This must be owing to deficiency of general excitement. Who, in his senses, would think of abstracting blood in such cases? " There are few instances, one should imagine, in which a person whose understanding has not been de- bauched by superannuated prejudice or practice, been enslaved by the trammels of a professional and heredi- tary routinp, would think of removing debility by ab- stracting blood, or of restoring an enfeebled and exhaust- ed frame, by evacuating any pa> t of that fluid which conduces most essentially and immediately to its vigour and support. "The fatal result of apoplexy, perhaps, too frequently arises from the manner in which it is treated. Some- times, even after the paroxysm has subsided, bleeding is had recourse to, from a vague and empirical notion of its indiscriminate utility in this disease*." See cases 23, 24, 27. 29,31,32, 50,51, 52. Such are the effects 1 nave observed from Emetic Tar- tar, in general and loc.il, acute and chronic inflamma- tion, and iii irrgular distribution of the blood and ner- vous energy; effects, to say the least of them, sufficient to draw the attention of the profession to thi-- important remedy. And if the observations and lacts I have rela- ted shall have this effect, my object will be accomplished. * Report of Diseases, Monthly Magazine, vol. xx. 1805. See tdso Dr. Wnyttou Nervous Diseases. 7 8 The fact of Emetic Tartar having particularly arrest- ed the attention of such men as Cullen, Fordyce. and other eminent physicians, is a strong presumption that it possesses qualities which have escaped the observation of others. When by one individual only, properties are ascribed to a particular remedy, which have eluded the research of all others, th ugh sufficient pains may have been taken to detect them; there is room for scepticism. and caution. But when the 9ame observations are made by a succession of individuals, to whose judgment and opinion the profession shew deference in other matters; there is good reason to conclude, that such observations are not without f mndation; and that it is owing to preju- dice, or supineness, or both, they are not confirmed by others. That a strong prejudice against Emetic Tartar has existed in this country,—that it has been falling into disuse for the last twenty years,—and that the ideas entertained of its powers are general, vague, and unde- fined, are truths which cannot be successfully contro- verted, whatever may be pretended to the contrary. Ten d:iys have not elapsed (21st May, 1818) since one of the most eminent physicians of this city, and to whom the medical profession, and mankind in general, are under great obligations, frankly acknowledged to me, he had not, of late years, used it at all in inflam- matory complaints. This I knew to be the fact, but was better pleased to have it from his own mouth. About the same time, another physician, whom posterity will associate with the benefactors of the human race, told me, when I informed him what I was about, "that Cul- hm nauseated with Emetic Tartar many a poor patient cut of existence." Is it to be expected, then, that a medicine is in general use, which is held in little estima- tion by one physician, and abhorred by another,— io both" of whom, the younger part, and those of the |.u*rb!er walk, of the profession, are accustomed to look up? Emetic Tartar is said to be inadmissible where there is great debility; and in advanced stages of typhoid fe- ver. But upon what principle? Certainly on account of its lowering; the action of the system, already too low. This proves, then, that it must be highly beneficial in the inflammatory stage of fevers, when the action of the 79 system is too high. This proves, that Dr. CuTlen's prac- tice of exhibiting liberally, when the system is in a state of morbid tone, a remedy so powerfully relaxing* and sedative as Emetic Tartar ma nfestly is, must be con- sidered the result of profound knowledge in pathology. From the facts narrated, it may be fairly inferred, I think, that Emetic Tartar must be highly beneficial in every genus and species of inflammation, whether chro- nic or acute; not excepting those affections even (Cases Sf, 37, 48.) in which it has been supposed the medicine could not be retained in sufficient quantity to have much effect on the circulation. We have seen its, effects in symptomatic fever, induced by local injury,—in several severe cases of pneumonia,—in inflammatory gout,—in rheumatism, chronic and acute,— in cynanche tonsilla- ris,—in idiopathic fever,—in hernia humoralis,—in chro- nic inflammation of the bladder,—in inflammation of the mamma,—in ophthalmia,—in chronic hepatitis,—in ne- phritis,—in croup,—in measles,—in dyspucea,—in asth- ma,—in hasmoptysis—in consumption,—in apoplexy. It certainly is not carrying analogy too far, to anticipate similar beneficial effects from it in other kinds of in- flammation, and in inflammatory affections of other or- gans. Medical practitioners have observed, and so have peo* pie in general, that a vomit of Emetic Tartar, exhibited in the commencement of fever, is attended with benefi- cial effects. It generally puts an end to that oppression of the brain, lar.gour and listlessness, yawning and stretching, which constitute the primary phenomena of fever. But these effects it produces by restoring the functions of the brain and equilibrium of the nervous power, and, through these, the balance of the circula- tion; not, as physicians have vainly imagined, by merely evacuating the stomach. Yawning, and stretching, and sneezing, are evidently efforts of nature to preserve the balance of the circulation; and the forcible concussion given to the whole body by the action of vomiting must contribute powerfully to the same end. But the bene- ficial effects of Emetic Tartar are not merely mechani- cal: for if it is continued, after full vomiting is produced, in doses short of occasioning nausea even, it will be found to moderate re-action, and to drive it away alto- so gether. Its tendency is to preserve the balance of the circujation. and to restore it when lost Increased arte- rial. 01 inflammatory action, is incompatible ivith the presence oj Emetic Tartar in the system. From these observations it is evident, that, if Emetic Tartar dues not altogether supersede the. necessity of blood letting in fever, it at least renders copious deple- tion unnecessary The former acts primarily on the ner- vous, the latter on the sanguiferous system. Combined, therefore, less of each is necessary; and they are more efficient and safe in every case of febrile action than. blood-letting alone. From the power manifested by Emetic Tartar in equal- izing the circulation, particularly in obviating a deter- .mination of blood to the head, it should prove an excel- lent remedy in those cases of insanity which depend on increased tension and fulness of the vessels of the brain. Vomiting, except as powerfully determining to the sur- face, must be extremely preposterous in a paroxysm of high nervous excitement, whether occasioned by, or oc- casioning. incieasjd impetus of blood to the head; but I cannot conceive any thing more powerful in allaying nervous irritation, and in obviating or resolving vascular congestion, than nauseating doses of Emetic Tartar. Had vaccination remained undiscovered, and small- pox still continued its ravages, I would have said, that a liberal use of Emetic Tartar, by moderating the vio- lence of the eruptive fever, would greatly lessen the' danger ol this disease. From analogy, it may be fairly concluded, that much of the mortality among Europeans visiting tropical cli- mates may be p-evented, by the timeous and judicious use of Emetic Tartar. \s the diseases of those climates are the diseases of increased action of the system, this medicine, by moderating the action, which runs to so great a height in Europeans, cannot fail to render the seasoning-fever much less fatal. I am aware, that this reasoning will be resisted by most, if not all who have practis «l in the West Indies, where th< stomach is so quicidy and powerfully affected in all febrile oinplaints But it is not to be inferred, that a remedy cannot be h-ghly beneficial in the com- mencement of fever, because prejudicial in the advan- 81 ced stage, when the stomach is in a state of high irrita- tion. It does not follow, therefore, that Emetic Tartar is not admissible at all in the fevers of tropical, because it cannot be exhibited so liberally as in those of cold and temperate climates; nor that, it cannot act as a pow- erful preparative, in rendering the change which Eu- ropean constitutions undergo in hot climates, less vio- lent. Experience alone can determine the matter; and certainly it is a subject which merits the fullest inves- tigation. THE EXTERNAL APPLICATION OF EMETIC TARTAR. In 1822, the celebrated Dr. Jenner published the re- sult of his experience in the external use of this medi- cine. It appears that his attention was directed to this suoject in the year 1794; and that his own observation, and the testimony of his friends and correspondents, have enabled him to speak of this remedy in terms of very high commemlation. In imnia, in many forms of pneumonic inflammation, in hepatic complaints, in dyspepsia, asthma, in opthal- inia, in inflammation of the brain, in rheumatic affec- tions in various parts of the body, in paralytic disor- ^ ders, iri chorea St. Viti, in hysteria, in hypochondriasis, in epilepsy, Dr. Jenner recommends the external use of. *$ this article with great confidence, and has given in de- | tail the effects it produced in each of the above forms' -«■ of disease—Dr. Jenner quotes a paper written on this 1 subject in 1773, by Dc. Bradley, who usually rubbed it J on parts which were the seats of pain or below, in the \J course of absorption, and in every instance, it appeared ' to be a remedy of great efficacy; but he remarks, that the disagreeable symptoms caused by it made many de-* sert its use altogether or use it unfaithfully. >i In many cases. Dr. Bradley says, complaints were j removed by the first or second application; but in other ■■ instances it was necessary to persevere in the frictions lor three or four weeks.— The pustules produced by it were uniformly compared to those iri small pox, but they were much smaller, not so red at the base, nor so tense and white when fully suppurated. The decided 1*3 relief which i9 commonly experienced from this applica- tion during the first week, encourages patients to perse- vere pretty firmly for the first seven or eight days; at the end of which time the pustules become so numerous # , and distressing, that the remedy must be unavoidably intermitted—When the first, or any subsequent erup- f tion, is entirely healed, a renewal of the frictions pro- duces another in the same degree as before. t Dr. Robinson, in a paper published last year on chin- cough, speaks in the following emphatic manner of the general effects of Tartar Emetic in that disease. '•Frictions on the stomach with the tarta-ized antimo- I Vial ointment have been the most remarkably and most I undeviatingly useful. In cases where the pitient is of I a full habit, and the inflammatory diathesis runs high, moderate bleeding should be directed previous to the application of the ointment But I have used it with advantage, even in cases where the fever was attended xvilh delirium at night. The application of this omt- j ment is in many respects different trim blistering—It [ never produces gangrene, and always gives relief when j' it produces au eruption: whereas, blisters do not appear i to be of the smallest service in whooping cough when symptoms of inflammation exist, and even do hurt." * By the Tartai Emetic we can not only create vesi- i cles, but, says Dr. Jenner, we can do more. We have * t. at our command an application which will at the same ' p' time vesicate and produce diseased action on the akin itself by deeply deranging its structure beneath the sur- [ jf- face—Thi9 is probably one cause why the sympathetic \ I affections excited by the use of cantharides and those I £ changes produced by Tartar Emetic, are so very dif ] ferent. i . Dr. Farriar long since remarked, that in general there 11 was no safer conversion of diseases than that to the fcf skin; the distance of this part from those necessary to t' life, the varieties in the state of circulation to which it 1 is habituated, and the easy application of external reme- [ dies which it admits, combine for the security of the patient; whenever a disease is fully translated to the 1 skin, sudden conversions/rom the skin to internal parts, ; are, I believe, universally dangerous." [See Medical flistories.J 84 Dr. Jenner mixed one drachm of Tartar Emetic with one ounce of simple ointment or hog's lard. A small quantity of this rubbed upon the skin two or three times a-day, seldom fails of producing the papular eruption desired—Sometimes two drachms were mixed in an ounce of simple cerate. fCJ* See a very interesting paper on this subject by Dr. Edward Jenner. published in the 20th number of the Medical Recokber, edited by Dr. Eberle,xtt Phil- adelphia. amKeamBmmm^^&'Mmnmimr-