A MEDICAL DISCOURSE, ON SEVERAL NARCOTIC VEGETABLE SUBSTANCES^ READ BEFORE THE MASSACHUSETTS MEDICAL SOCIETY, AT THEIR ANNUAL MEETING, JUNE 4th, 1806. By JOSHUA FISHER, * Mon. Vice-Prejidcnt of the Society. ■........uaftftfcj^^S SALEM: PRINTED BY JOSHUA CUSHIN0. 1806. A MEDICAL DISCOURSE. THE narcotic plants conflitute a very important part of the materia medica. The life of the patient often depends on the accu- racy of the phyfician's knowledge of their me- dicinal effefts : it is therefore prefumed, that every attempt to extend our information, on this important fubjedl, will be received with candor. Inflead of attempting a regular eflay on any one of thefe medicines, permit me, on this oc- cafion, to offer fome mifcellaneous, practical remarks refpe&ing feveral of them, fubjoin- ing concife hiflories of a few cafes. Opium, the mofl important remedy which the vegetable kingdom affords, claims the firfl place. Much time has been fpent in debating, whether this medicine ought to be claffed among the flimulants or fedatives. A parti- cular difcuffion of this queflion would be fo- reign to my prefent purpofe : let it fuffice to obferve [ 4 3 obferve, that if we confult experience and ob- fervation, we fhall find that medicine, as well as difeafe, frequently affects the human body in a manner very different from that which is pointed out by the framers of fyflems :—that Opium may either increafe fenfibility and ac- tion, diminifh them, or produce the one effect in fucceffion to the other ; that it is capable of increafing action in one part of the body, while it diminifhes it in another—of remov- ing morbid actions, while it increafes fome of thofe that are natural—of exciting or increaf- ing morbid actions—and of deflroying action altogether, Opium appears naturally to produce, at firfl, an inereafe, in fome degree, of fenfibility and action ; and afterwards, in a ftill greater de- gre, a diminution of both. From the experi- ments of Dr. Crumpe, it appears, that given to a perfoq in health, it gradually accelerates the pulfe for about half an hour ; afterwards, for a longer or fliorter fpace of time, general- ly according to. the quantity given, the pulfe is retarded : but fiich is the variety of opera- tion, produced by the various combinations of natural temperament, flate of the fyftem, quantity taken, and other circumftances, that the one or the other of thefe effects is often fcarcely perceptible. In fmall dofes, it ap- pears C * ] pears fometimes to act as a fimple flimulant ; producing exhilaration, watchfulnefs, &c. while in large dofes, under different, or even the fame circumflances, it produces effects di- rectly the reverfe, without any perceptible previous excitement. In cafes of painful fpafms, we commonly find the difeafe increas- ed, in five or fix minutes, even under a dofe that will, in twice that time, produce an alle- viation. In cafes where the dofe is infuffi- cient, by one half, to remove the fpafms, the effect feems to be the fame, as under a full dofe, when the time is inefficient by one half; that is, the difeafe is ufually augmented ; but with this difference, that, in the one cafe, the augmentation is only for a very fhort time j in the other, it becomes, in fome meafure, per- manent. Hence it appears not improbable, that Opium may be exhibited in fuch dofes, and at fuch intervals, as to aggravate the dif- eafe in almofl any conceivable degree. How often this may have actually taken place, in * practice, cannot be determined : we have hiftories of fome cafes of fevere fpafms, in which phyficians have adventured to give a grain every hour : in fuch cafes, it is certain that much larger dofes may be given, without any effect, except that of increafing the com- plaint. In I « 3 In exhibiting Opium as an anodyne, it is of importance that the requifite dofe fhould be given at once, or in as fhort a fpace of time as poffible. In ten or twelve minutes, it may be afcertained whether the dofe given will prove fufficient to afford relief; if not, another ought to be given immediately, and the repe- tition continued, till a complete relaxation be obtained. Such dofes may always be given, at once, with perfect fafety, as that any quan- tity, which the cafe may require, may be ex- hibited in the fpace of an hour. To exemplify the practice here recommend- ed, I will mention the cafe of a young lady, aged feventeen, who was feized with excru- ciating fpafms, probably tetanus, the confe- quence of a rupture of the fartorius mufcle. Someflighter fymptoms, of a fimilar kind, had taken place on the preceding day, which had required twelve grains of Opium ; that dofe was therefore ordered to be given immediate- ly. In ten minutes, finding no abatement of the fpafms, twelve grains more were given ; and the dofe was repeated every ten minutes, till fhe had taken fix dofes, or feventy-two grains. This quantity removed the fpafms, produced a comatofe infenfibility, flow, flerto- rous breathing, and a flow, full pulfe. In eight hours, the fpafms began to return, and the C 7 ] the Opium was given as before. A few of the firfl dofes increafed the fymptoms ; but, after fhe had taken the full quantity, they difappear- ed. In this manner, and with the fame effect, the Opium was repeated, at intervals of eight hours, for three days, when the fpafms ceas- ed, and fhe recovered. During this period of three days, fhe took nearly eleven drams of ex- cellent Opium, and not a grain more than was abfolutely necefTary. In the colica Pidtonum, or Devonfhire co- lic, Opium has fometimes been given, for the purpofe of obtaining temporary relief: but it does not appear to have been known, that, in a fufficient dofe, it is capable of effecting a fure, fafe and fpeedy cure. For many years pafl, I have not feen a fingle cafe of this diflreffing difeafe, which has not yielded in about an hour. No preparation is necefTary, except the evacuating of the flomach, which is gene- rally done by a fpontaneous puking, before we fee the patient. The quantity of Opium, which has been found necefTary to effect a cure, has varied, from fifteen to forty grains. I never have known the difeafe to return ; nor any difadvantage to arife, from this mode of practice ; nor have I ever found any difficul- ty in moving the bowels, in the courfe of twenty-four hours, after the removal of the pain. C 3 3 pain. Although Opium alone will fucceed, it is better to join with it a few grains of calo- mel, in divided dofes. The fame mode of practice has been purfu- ed in cholera, and with equal fuccefs. A gen- tleman, of about fixty-five years, was feized with this difeafe, in fo violent a manner, that, when I firfl faw him, a few hours after the at- tack, his countenance was cadaverous, his nofe and hands cold, the blood had become flagnant around his nails, the pulfe was hardly perceptible, and every fymptom indicated his fpeedy diflblution. The fevere naufea and puking rendered his flomach unable, for fome time, to retain the necefTary quantity of Opium ; as foon as was practicable, we got down fixty grains, ten of which were return- ed by vomiting. The quantity retained, foon removed every diflreffing fymptom : gra- dually, and with difficulty, he recovered his ftrength. The Stramonium is another valuable me- dicine, of the fame family. I fhall confine my obfervations, reipeaing it, to its ufe in cafes of epilepfy. This practice is not new : but it fecms not to have been attended to, at leafl in this country, as it deferves. Epileptic fits, in refpcct to the ufe of the Stramonium, may be C 9 3 be divided into three clafTes. Thofe of the firfl clafs occur daily, or very frequently. In thefe cafes, after removing worms, acids, and whatever may irritate, the patient is to be kept conflantly under the influence of the medicine } for this purpofe, he will require, every day, one or two dofes, according to the feverity of the fymptoms. The faturated tinaure is the mofl convenient form for children. The re- quifite dofe may be known by the dilation of the pupils. While the patient is kept in this flate, the fits will rarely take place, and the habit of recurring is gradually broken. In the cafe of a boy of five or fix years old, who had been attacked three or four times, daily, for fcveral months, his fenfes were fo far impaired, that he would devour the mofl filthy fubflances, with the fame avidity as the mofl palatable food ; after the firfl dofe of the Stramonium, the fits ceafed ; but the ten- dency to return made it necefTary to continue the medicine for fome weeks longer; in procefs of time, he recovered his reafon, A child, of about three years, was fubjeft to fits ; one generally took place every day ; they had not, however, been of fo long coh- ti nuance as in the preceding cafe : by miflake he took the Stramonium in too large a dole j B it C 10 3 it produced fevere vomiting, convulfions, flu- por, &c. which continued through the day : the parents were fo terrified, by the effea of the firfl dofe, that they could not be induced to give a fecond: the fits, however, never returned. Fits of the fecond clafs either recur at re- gular periods, frequently monthly, or the pa- tient is warned of their approach, by fome previous fymptoms. In either of thefe cafes, the Stramonium is to be given when we ap- prehend the accefs of a paroxyfm, and to be difcontinued when the danger is pafl. < All the cafes of thefe two clafTes, which have been under my care (and the number is not very fmall) have been cured by the Stramonium, affifled by chalybeates, or fuch other medicines as particular fymptoms ap- peared to require. Cafes of the third clafs do not obferve any regular period, nor do they give any warning of their approach. They are generally excit- ed by fome other difeafe ; or by fome irregu- larity of the patient. In cafes of this kind, the Stramonium cannot be ufed even occafionally, with a profpea of much benefit; and to give it, during a long period, leflens its antifpaf- modic C " 3 modic effeas, and debilitates the patient.—I have feen it afford fome relief, but never knew it perform a cure. It has been obferved, that a medicine, by being extolled beyond its merits, generally fails of fupporting even that degree of repu- tation to which it is juflly entitled. This ob- fervation may be applied to the Cicuta : but although it may be incapable of curing can- cers, yet it is a very valuable medicine. In ca- fes of a fcrofulous affeaion of the abdominal vifcera, it is, perhaps, the befl that is known. The ufe of it is generally followed by an eruption on the fkin ; which feems to indicate a tranflation of the difeafe. A flriking in- flance of this occurred in a boy, of five or fix years old. I found him feverifh and emaciat- ed : the fecretion of urine wasfmall; the ab- domen tumid and tenfe. A dofe of calomel operated as a cathartic, and removed the tenr fion. The whole furface of the abdomen then prefented to the feel a congeries of fmall tu- mours, refembling a clufler of grapes. The Cicuta was prefcribed. A cutaneous eruption foon appeared on various parts, which eventu- ally covered the whole furface of the body: it took off every inch of the cuticle, and even the nails from his fingers and toes. The in- ternal ufe of the hemlock was continued, and the C 12 3 the child lay, for a confiderable time, wrap- ped in a fheet, fpread over with an unguen- tum e cicuta. As foon as the fkin was fo far healed, that I could examine the abdomen, I found every appearance of internal difeafe re- moved : fome tumefied glands had appeared on the furface, particularly in the groins ; thefe would not yield to the hemlock, but gradually difappeared, after the patient had recovered his flrength. In cafes of phthifis pulmonalis, arifing from a fcrofulous affeaion of the glands of the lungs, the Cicuta demands our attention. It xnuft be acknowledged, that it has not, always, anfwered my wifhes ; particularly where the fymptoms of fcrofula were ambiguous ; but I xnuft fay that in feveral inflances I have feen it produce much better effeas, than it has been my lot ever to witnefs from the ufe of the fox-glove, It is hoped that the Cicuta will prove an effi% cacious remedy in cafes of jaundice, produced \>y biliary concretions. About twenty-five years ago, I had under my care a man, who, for feveral months, had laboured under a jaundice, which refifled the common methods of cure. Refleaingon the ufual C is 3 ufiial caufe of the obflruaion of the common biliary dua, it appeared to me improbable, that a biliary calculus, confidering the ufual form and fize, fhould of itfelf, and at once, be able to produce a complete obflruaion ; there mufl therefore be a fpafm or contraaidn of the dua. The acute fpafmodic pain, often felt when a calculus firfl lodges in the dua, appeared to favour the fuppofition. A fimple antifpafmodic mufl therefore be the befl reme- dy ; and the Cicuta prefented itfelf, as the mofl promifing. Whether the theory be jufl: or not, is fubmitted. The faas are, the man took the hemlock, every night, in increafed dofes. The morning after he had taken the firfl full dofe, the bile began to pafs, and the obflruaion was foon completely removed. Confidering the variety of caufes, which are capable of producing an obflruaion of the bi- liary duas, it is not fuppofable that hemlock, or indeed that any medicine, fhould, in every inflance, be able to remove it. Three cafes of this difeafe, combined with others, have happened within my knowledge, where nei- ther this, nor any other means, fucceeded : but, excepting thofe three, every patient, who has been under my care, for this difeafe, fince my firfl ufe of this remedy ; and every one, who, within my knowledge, has ufed it, has been C i* 3 been cured by it ; and, in one inflance, the cure was effeaed by a fingle dofe. I will add only the cafe of the late Prefi- dent Willard : as he refided in this vicini- ty, it is probable, that mofl of the circum- stances are known to fome of the gentlemen prefent. When I firfl faw him, he had labour- ed, for more than fix months, under a complete jaundice. During this period, he had punau- ally followed the advice and prescriptions of his phyficians. Among other means, a courfe of calomel had been purfued, as far as was judged prudent. The obflruaion remain- ed fixed. I gave him fome pills of the extraa of hemlock, defiring him to take one the firfl night, and to increafe the dofe by an addition- al pill, every night, till he felt the ufual fymp- toms of a full dofe. On the feventh night, for the firfl time, he felt a flight naufea and giddi- nefs. The next morning, he found that the bile had begun to pafs through the dua. He continued the medicine in full dofes, for fome time longer: the pafTage became free, and was never afterwards obftru&ed. W~z- Ft~351r^ t?tU